Professor Michael Barnes, UKABIF Chair welcomed over 200 delegates to the United Kingdom Acquired Brain Injury Forum’s (UKABIF) 7th Annual Conference at the headquarters of the Royal College of General Practitioners in London’s Euston Square. Delegates from all fields of brain injury attended from the interdisciplinary rehabilitation team, commissioners, case managers, personal injury lawyers, social care workers, voluntary organisations, care providers and also individuals living with a brain injury.
In her introduction to current and future commissioning Professor Lynne Turner-Stokes said: “Specialist rehabilitation is a critical component of the acute care pathway and without it the benefits of early acute care can’t be realised”. Professor Turner-Stokes addressed delegates wearing several ‘hats’ including Chair of NHS England (NHSE) Clinical Reference Group for commissioning specialised rehabilitation services for patients with highly complex needs, and the Clinical Reference Panel for development of case mix and tariffs for rehabilitation, and Director of the UK Rehabilitation Outcomes Collaborative (UKROC). The diversity of rehabilitation makes planning and service provision challenging and complex. Professor Turner-Stokes discussed the tariff which is based on a 5-tier weighted bed day payment model using rehabilitation complexity scores. From 2015/16 the tariff will be related to Category A patients for a maximum of 180 days, unless an extension is agreed. Professor Turner-Stokes also presented new data from UKROC which provides compelling evidence to justify rehabilitation services. Analysis of UKROC data collected over four years from 52 specialist (Level 1 and Level 2) rehabilitation services in England was used to calculate the life-time savings. For the 3592 patients reviewed, the life-time saving was £2.74 billion, of which £1.95 billion were in the highly dependent group. “These are real savings to NHS Continuing Care and few interventions can claim this level of cost saving in this group of patients” concluded Professor Turner-Stokes.
In February this year, ten local authorities and 12 clinical commissioning groups (CCGs) for Greater Manchester (GM) and NHSE announced an agreement to devolve responsibility for the new health and social care budget to a new GM partnership which will oversee a budget of £6 billion. Kate O’Sullivan, Lead Comissioner Complex Care, Citywide Commissioning and Quality Team, Manchester North, Central and South CCGs Manchester Vanguard discussed how plans are progressing but emphasised: “It’s early days and there’s a lot of work to do to ensure health and social services can interact successfully, but progress is good”.
The treatments and outcome tools available for neurobehavioural rehabilitation were reviewed in the afternoon.
Professor Nick Alderman, Director of Clinical Services, Brain Injury Services, Partnerships in Care and Dr Sara da Silvo Ramos, Research Fellow, The Brain Injury Rehabilitation Trust (BIRT) concluded that no single outcome measure is suitable for all brain injury rehabilitation services and that a ‘basket’ of measures is required. The Independent Neurorehabilitation Providers Association (INPA) is looking currently at what measures should be in the ‘basket’. Dr Michael Dilley, Consultant Neuropsychiatrist at The Wolfson Neurorehabilitation Centre, St Georges Hospital, London gave an excellent review of the wide range of drugs used for treating many aspects of neurobehavioural brain injury including memory and cognitive impairment, executive function, disorders of attention, apathy and aggression.
UKABIF launched its third Manifesto ‘Life After Brain Injury: Children, Young People and Offending Behaviour’ to raise awareness and improve services for those with ABI. “We need to identify young people who are ‘at-risk’ of offending and keep them out of the Youth Justice System” said Professor Michael Barnes. Long-term brain injury in childhood and young adulthood is associated with an increased tendency of offending behaviour and, relative to the general population, there is a high prevalence of brain injury amongst young offenders in custody. All professionals involved with young people need to work together to recognise, understand and manage this problem as the evidence-base suggests that the incidence of brain injuries amongst young offenders in custody is significant. Offending behaviour and ABI is a European problem said Dr Éric Durand from the Fondation Hospitalière Sainte Marie in Paris. In France 61% of prisoners re-offend within five years and this is now a top priority for the French Ministry of Justice. The prevalence of TBI amongst prisoners in France is between 41% and 60%. Dr Durand presented the results of two studies; in the first study a self-reported questionnaire was completed by offenders (juveniles, males and females) on admission to Fleury-Mérogis prison in Paris, over a three months period. A total of 1148 questionnaires were completed and 30.6% reported a history of TBI; males were the highest with 32%, and 86% had sustained their first TBI before their first imprisonment. The second study, which is ongoing, is looking at 40 children (36 boys and four girls) who were treated in a rehabilitation department following a significant ABI, and who subsequently became offenders. “We know TBI is linked to criminal behaviour so it is important to screen for ABI when individuals arrive in prison” concluded Dr Durand.
UKABIF presented three Awards at the conference. Two winners were selected for the UKABIF Lawyer of the Year; Ann Allister from Carpenters Solicitors and Deirdre Healy from Irwin Mitchell. Dr Miles Rogish, Consultant Clinical Psychologist at York House, the Brain Injury Rehabilitation Trust’s independent hospital in York, was named UKABIF Clinician of the Year and the UKABIF 2014 Award for Inspiration was presented to Nick Verron, who despite a devastating brain injury, raised an amazing £3000 for UKABIF in August this year.
ACNR 2015;16(2):27. Published online 14/6/16