More People Now Survive Brain Injury - But We Need the Long-Term View for Their Care

Thankfully, steady and on-going medical advances means that the prognosis for people who suffer a serious brain injury - for example from a traffic or sports accident - is significantly better now than 20 years ago.

Thankfully, steady and on-going medical advances means that the prognosis for people who suffer a serious brain injury - for example from a traffic or sports accident - is significantly better now than 20 years ago.

As we learn that Michael Schumacher is making "small signs of progress" after his head hit a rock in a skiing accident in December last year, the reality is that more people are surviving serious brain injury with little reduction in life expectancy.

But the result is that there is a subsequent need that such people require specialised rehabilitation. Unfortunately, however, this is a service that the UK is not as a whole delivering to a sufficient quality.

A BBC News night film in November last year highlighted poor care for people with brain injuries. Indeed, historically, we have as a country failed to provide appropriate - sometimes even acceptable - care for what the Sue Ryder charity estimates to be 1m people disabled by neurological conditions, including brain injury. It's a postcode lottery for good services.

Recently a unit manager from the neurological care provider I head, PJ Care, assessed a young man - I shall call him Richard - whose attempted suicide had left him with massive brain injuries. We were shocked to hear he had been written off by health professionals. He was, to be frank, doomed to months, perhaps years, in a generic care home.

Yet, with appropriate evidence-based care and treatment Richard and people in similar predicaments can improve and go on eventually to a life in the community.

For sure, specialist rehabilitation in a properly-resourced neurological centre is, in the short-term, more costly. But what does the available evidence tell us about longer-term outcomes?

The Brain Injury journal published peer-reviewed research in December last year which found that "quality rehabilitation" in residential neurobehavioural centres saves between £200,000 and £1.13 million per patient in lifetime care costs such as GP appointments, hospital admissions and social services support. The study was based on 274 individuals.

This is why experts such as Professor Michael Barnes, chair of the UK Acquired Brain Injury Forum, are calling for more investment in brain injury rehabilitation. Prof Barnes told the BBC: "There is good evidence that although rehabilitation costs more money clearly than someone going home, or going to a nursing home, that money is recouped over two to three years by that person requiring less support from the state, getting back to work and earning money."

Like all specialist providers to the NHS we are eagerly awaiting the new commissioning landscape to settle, so we can put our case to NHS England's teams of specialist commissioners.

In the meantime, we will continue to push the message that specialised longer-term neurological care and treatment is, as the evidence shows, the way forward, clinically and by cost. There is every reason that NHS England's five-year strategy for specialised commissioning, due to be published in July, will reflect this.

Just last month, another one of our residents, a 22-year-old who spent three months in a coma after a car accident and had suffered serious brain injury, moved to supported living in the community.

When he was referred to one of our centres, Eagle Wood in Peterborough, he was unable to lift his head off his pillow. One year later he could run with physiotherapist support.

Yes, his care will again have cost more than either staying at home, or being in a non-specialist environment. But his rehabilitation outcomes have been significant.

After our founder, Jan Flawn, had 20 years ago seen first hand atrocious care for young people with neurological conditions she sat down at her kitchen table and wrote on an envelope her plan for a neurological care centre in Milton Keynes.

As a nurse, she wanted to try and put things right, and deliver better services for people with all neurological conditions, including brain injury.

I hope the NHS will not only share this aspiration, but help ensure it is reflected in all care and rehabilitation for people with neurological conditions.


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