Neurorehabilitation – where next?

Ruth Smith, COO of Christchurch Group – the UK’s leading provider of award-winning outcomes-led neurological rehabilitation – considers 2019’s impact on the sector.

There have been many important developments in the neurorehabilitation sector this year, which will impact the lives of people with neurological conditions and Acquired Brain Injuries (ABI), as well as their families and those who work in the field.

We’ve seen the publication of the new Rehabilitation Prescription (RP) – a tool to document the rehabilitation needs and care pathway for individuals with ABI – which has addressed some of the key concerns of healthcare professionals working within the sector. Considering the fact that recent Headway figures estimate 1,000,000 people attend A&E following a head injury (with plenty more going unreported), it’s refreshing to see that policy makers are realising the importance of prioritising the needs of ABI patients and optimising their access to services along the care pathway. An initial rehabilitation assessment will now take place within 48-72 hours of admission, with all patients passing through Major Trauma Centres requiring an evaluation of their future rehabilitation needs.

However, as with many new policies, more work needs to be done around RPs, as people who have sustained ABIs don’t always enter Major Trauma Centres and therefore are not provided with a care plan. This can result in patients slipping under the radar and missing out on critical steps in their recovery plan – neurorehabilitation being one of them. Even within Major Trauma Centres, a quarter of these fail to provide a specialist neurorehabilitation consultant. To compound the issue further, RPs are not mandatory and although recent initiatives have been announced to incentivise centres to implement them, patients around the country often leave hospital without a plan in place.

I’m immensely proud of Christchurch Group’s bespoke Neurological Rehabilitation Programme, which provides assessment and rehabilitation for a variety of neurological conditions (such as Parkinson’s, Huntingdon’s or MS), as well as ABI and stroke. Developed collaboratively by our interdisciplinary therapy teams comprised of nurses, psychiatrists, psychologists, physiotherapists, speech and language therapists, occupational therapists, complementary therapists and spinal injury rehabilitation experts; our programme maximises recovery and independence as well as minimising the effects these conditions can have on an individual’s cognitive, social, emotional, physical and psychological wellbeing. It’s this highly focussed, tailored approach that means 86% of our clients are able to return to their homes, families and communities following a period of rehabilitation.

It’s also been brilliant to see the work of the All-Party Parliamentary Group (APPG) on Acquired Brain Injury in capturing public attention to address national gaps in funding and provision for neurorehabilitation service users. Led by Chris Bryant MP, the group played an instrumental role in leading the campaign for a new Rehabilitation Prescription, and Bryant’s contributions to debates at the House of Commons have been both moving and raised awareness of the pervasive stigma around brain injury.

As the Time to Get it Right report conducted by Sue Ryder in March this year showed, significantly more progress is required in the provision of long-term care for individuals with brain injuries and neurological issues. Over 15,000 people with complex neurological conditions in the UK are living in general old-age care homes, where they’re unable to receive the appropriate, specialist care they so desperately need. The individuals in these homes are victims of the UK’s “postcode lottery” – put simply; their access to adequate care provision has been dictated by their address. It’s ethically wrong to place people in age-inappropriate settings without peers of their own age and doubly wrong to do so when they are not receiving comprehensive care plans or any form of rehab.

The psychological impact of these neurological conditions (such as anxiety, depression and suicidal thoughts) is immense, and compounded by the failure to receive proper care. This is why clinically-measured, outcomes-led care is so vital to help people achieve their goals. We make it our priority to improve functional independence, motivation, cognitive/executive functioning and confidence. We help clients with their ability to undertake daily living activities such as washing, dressing, cooking and shopping, as the aim of discharging them to their home environments is at the forefront of our care provision. We ensure that clients are properly supported through every stage of the rehabilitation process – from acute rehabilitation through to community outreach in their own homes.

Working alongside clients and families is crucial to deliver therapy and care that is properly individualised to their needs and preferences. The Sue Ryder report also found that over 500 people nationwide were in ‘out of area’ placements in non-neighbouring local authorities – which meant living away from their homes, families, friends and social networks. We firmly believe that maintaining these social connections is vital for the mental wellbeing of clients, which is why we facilitate contact between them and their spouses, partners, parents and extended family by subsidising travel costs. We recognise that funding services such as these is a crucial emotional investment in our clients and their recovery process.

The discrepancies in the provision of neurorehabilitation across the country highlight the urgent need for joined-up thinking between the health and social care sectors, as well as the NHS and independent healthcare providers. The transition from acute primary care to living at home can be a long and challenging one, and often people find themselves with limited options if they are not in urgent need of hospital care and a bed. Neurorehabilitation is one of the most cost-effective clinical interventions. Despite this, there is so much more to be done in terms of cohesive, integrated thinking across a wide range of sectors. I would echo the comments made by The House of Commons Health and Social Care Committee in June 2019 who argued we must be “clearer about the roles local government, the voluntary and community sector and independent providers should play in the future of the NHS.” In order to make the best possible savings to the public purse, as well as realise better patient outcomes, it’s important that the NHS works collaboratively with private specialist providers who have proven track records in their field.

Standing up for some of the country’s most vulnerable patients and making their voices heard is the most rewarding part of my job. As we move into the final months of 2019, I hope the physical and emotional wellbeing of neurorehabilitation patients continues to become an increasing priority in this country. I look forward to seeing more integration, collaboration and improved healthcare outcomes in 2020.


About the author:

Christchurch Group is the UK’s leading provider of award-winning clinically-led neurorehabilitation services designed to improve the function, reduce symptoms, and enhance the well-being of patients with acquired brain injury (ABI), spinal injury and other neurological conditions.

Winner of Health Investor’s Best Complex Care Award 2018, the Group receives clients directly from acute facilities and provides a care pathway that maximises their rehabilitation potential with the aim of discharging them to their home environment.

Christchurch Group is a Headway Approved Provider with services reflecting the specific needs of people with Acquired Brain Injury (ABI). It is also a Member of the Independent Neurorehabilitation Providers Alliance committed to ensuring excellence in neurorehabilitation. It operates from 10 centres located across the UK – 90% of which are rated ‘Good’ or ‘Outstanding’ by the Care Quality Commission.