The first All Party Parliamentary Group for Acquired Brain Injury Launch Meeting took place on the 28th November and was well attended by MPs, peers and the brain injury community.
After a warm welcome from the APPG Chair Chris Bryant MP important discussions took place on topics including an overview of Acquired Brain Injury and rehabilitation services (Presentation from Professor Diane Playford), rehabilitation for economic growth (Presentation from Colonel John Etherington), and the global impact of TBI (Presentation from Professor David Menon)
Full details on each talk can be found below.
There will be four roundtables to discuss issues vital to improving the care of individuals with acquired brain injury. These are:
- Causes of ABI, trauma and neurorehabilitation service provision
- Crime and offending behaviour
- Concussion in sport
A report with recommendations will be produced after each meeting. Dates of the meetings will be confirmed.
The Chair, Chris Bryant, MP, also agreed to table relevant parliamentary questions
Presentation from Professor Diane Playford, President of the British Society for Rehabilitation Medicine
Overview of Acquired Brain Injury and rehabilitation services
Professor Playford gave an overview of acquired brain injuries and the multiple and varied effects acquired brain injury has on each individual. Brain Injury is the leading cause of death and disability worldwide. In the UK almost 1.5 million people attend A&E with head injuries each year and of these around 200,000 are admitted to hospital. Many thousands more suffer from strokes or brain injuries caused by infection and disease.
Specialist rehabilitation services are a critical component of the acute care pathway. Rehabilitation reduces the burden on acute and frontline services if patients are immediately accepted after their medical and surgical needs are met. A substantial body of evidence shows that specialised rehabilitation is effective, and is offset by savings in the cost of community care, making this a highly cost-efficient intervention.
Currently rehabilitation needs are not being met. The Major Trauma Plan (2010) did not take rehabilitation into consideration. Bed provision is insufficient and services are neither streamlined nor easily accessible. Furthermore, the Rehabilitation Prescription is largely not implemented and does not follow each patient along the care pathway as it should. Awareness is very low in primary care so people with acquired brain injury who are discharged into the community receive very little support.
Education is required to raise awareness of ABI. It warrants a category of its own due to the size of the problem, and should not be simply under the umbrella of ‘long-term conditions.’ Increased awareness of the magnitude of the problem should encourage extra funding for rehabilitation in this area.
Presentation from Colonel John Etherington
Director of Defence Rehabilitation, Consultant in Rheumatology and Rehabilitation Medicine at Defence Medical Rehabilitation Centre, Headley Court:
Rehabilitation for Economic Growth
Colonel Etherington gave a detailed presentation to show how rehabilitation can be a net contributor to the NHS and Society.
In the short-term, rehabilitation is costly, but it is far less expensive than poor clinical outcomes. Ongoing costs fall on the health services, individuals and carers, and society as a whole. The continuous requirement on health services due to lack of proper treatment places an avoidable and continuous cost burden. Disability due to poor care might prevent an individual returning to work, and more individuals requiring disability benefits places a greater cost burden on the taxpayer. The total cost of traumatic brain injury has been estimated at £15 billion, and figures are set to increase if changes are not made.
The dramatic long-term benefits of improved, immediate rehabilitation need to be emphasised in order change the current narrative that ‘rehabilitation doesn’t work,’ or that ‘it is nice, but we cannot afford it.’
Studies on war veterans who receive intensive, good quality rehabilitation following traumatic brain injury showed that the majority were able to live independently (87%) and return to work (92%). There could also be true for society at large.
Delayed transfer of care is currently a big concern, and ‘referral to treatment’ times are on the rise. Furthermore, 5% of cases treated in Major Trauma Centres subsequently receive specialist rehabilitation. This means that patients with brain injuries are not receiving rehabilitation as quickly as they should, and the aforementioned negative consequences are only becoming a bigger economic problem.
Dr Etherington also reinforced the lack of rehabilitation beds available in the UK. There are 994 specialist rehabilitation beds in England.
Initiatives such as the Injury Cost Recovery Scheme where insurers provide compensation for rehabilitation are largely underused. Awareness needs to be raised of these alternative-funding streams.
Ultimately, a new dialogue must begin incorporating a cross-governmental / society initiative and joint funding. The NHS needs to embrace broader societal outcomes: work, wellness, injury and illness prevention. Improving outcomes will generate national financial savings.
Better resourced and planned rehabilitation will result in:
Reduced welfare costs, reduced demand on the criminal justice and education systems, improved life expectancy, work and recovery.
Presentation from Professor David Menon,Professor and Head of the Division of Anaesthesia, Principal Investigator in the Wolfson Brain Imaging Centre, and Co-Chair of the Acute Brain Injury Programme at the University of Cambridge.
Professor Menon’s presentation focused on the recently published issue of The Lancet Neurology which explored traumatic brain injury. Studies found traumatic brain injury to be the leading cause of death globally.
Globally there are 50 million new traumatic brain injuries, and 1 million deaths caused by TBI each year. Furthermore, there are 50 million TBI survivors living with a disability, and many of these are young individuals. This is a huge burden since their life expectancy is normal.
Neurotrauma is the most important cause of neurodisability, and one in every two people will experience a TBI at some stage in their life. These facts are of vital importance yet largely unknown.
Outcomes tend to be worse in older patients, and knowledge of this can sometimes translate as inadequate care for older individuals.
Lack of a streamlined care pathway is a huge problem in treatment and rehabilitation of ABI patients. There is a fracture between initial response, acute care, and post-acute care. This jeopardises the chance of what could be a good recovery for any given ABI patient.
Whilst ABI is understood to be a long-term condition there is lack of understanding that ABI is a progressive disease among a significant proportion of ABI survivors. Short-term rehabilitation is therefore inadequate.
Greater work needs to be done on educating society on the prevention of brain injury.
An increasing amount of research is being done on traumatic brain injury, and hopefully this will help remediate what is a growing problem. The NIHR Global Health Research Group in Neurotrauma has numerous partners around the world, and there is a global, growing, consortium of funding agencies and studies; over 350 centres and ~50,000 patients (all TBI severities).
Key messages: Apply existing knowledge to improve prevention and clinical care; develop a common language for epidemiology and benchmarking care; advance knowledge, clinical care and outcomes through research.