interviews

Towards a national strategy for brain injury

Professor Philip Sugarman, CEO of St Andrew’s Healthcare, the largest charity sector provider of NHS care, discusses the opportunity to create and commission a national strategy for brain injury.

Brain injury as a specialism has often been overlooked in the past, with a distinct lack of clarity over which services to commission, despite industry consensus on both the need for a national strategy and on what that care pathway should look like.

At the 2012 National Brain Injury Centre Conference, delegates discussed how to drive awareness, understanding and clear direction for commissioners in the new NHS.

NHE spoke to Professor Philip Sugarman, CEO of St Andrew’s Healthcare, which ran the conference, about using the opportunity of the new commissioning arrangements to achieve standardisation in care.

Disorganisation and frustration

This year’s conference was the biggest ever, he said, with “lots of good quality presentations, people talking about the detail of the work they do with the service users and all the different facilities they have”.

However, a lack of strategic planning means best practice is not rolled out across the board. He explained: “The common frustration is the way the Government and the NHS commission care for people with brain injury: it’s disorganised.”

For other long-term conditions which affect people’s mental functioning, the Government has worked to develop a national strategy and “start to pull things together”.

This has been the case with conditions such as autism and dementia, resulting in a surge of awareness, understanding and responsibility for NHS commissioners to ensure people receive the best services.

“People’s recognition and understanding has been transformed hugely by having a very clear Government strategy,” he said. 

There are currently over a million people in the UK living with the consequences of brain injury, and more than 80,000 patients go through casualty with brain injuries each year. In other words: “It’s quite a big phenomenon, but there is no Government strategy.”

At the conference, the UK Acquired Brain Injury Forum (UKABIF) highlighted a health select committee report published 10 years ago which made a series of “very sensible” recommendations about how care for brain industry should be commissioned and how it should be organised – yet still no action had been taken in response.

Choosing specialisms

Now the NHS Commissioning Board is considering which specialisms to concentrate on, this could be the ideal opportunity to push brain injury into the spotlight. A national strategy would ensure commissioners understand how to commission for brain injury all across the country, offer a standard model of care, and ensure joined-up care is available.

Professor Sugarman said: “It’s a fantastic time to act on it because the NCB has brain injury on its list and is looking at neurological conditions, disabilities and long-term conditions.

“There’s been some fantastic developments in the UK. You’ve got great practice, lots of wonderful examples, but it’s very patchy geographically. You can describe the ideal care someone should get from the moment they have their brain injury through the different stages of acute care and earlier and later rehabilitation.

“The difficulty is, that care pathway is not the standard model for any particular commissioner.”

On the fringes

Prof Sugarman said that one of the challenges was to ensure brain injury does not simply get “lumped in” with everything else. He described the situation under the old system of the NHS, with brain injury considered on the fringes of mental health, medical rehabilitation, and chronic long-term conditions, rather than deserving of specialist national attention in its own right.

There had been progress on the provider and professional side, but not for public health or commissioning, he said. However, this is slowly beginning to change, with more awareness in the media, with celebrity examples.

He said: “It’s so important to society that we have very good services for brain injury, because the consequences are very expensive for society.”

St Andrew’s Healthcare and UKABIF were preparing to present their case to the NCB for a national strategy when NHE went to press.

The basic elements of this are “fairly uncontentious”, Prof Sugarman said, and the same message as in that select committee report 10 years ago. He admitted there was concern about resources but said: “A lot of the things that can be done can be done within existing resources.”

Speaking of finance, he highlighted the cost of the current approach, which demonstrates the need for change.

“If you line up the right elements of the care pathway for someone with brain injury then you can see really amazing recoveries: people can reach very high levels of independence.

“If they don’t get the right intervention at the right time, they tend to have quite high levels of disability and spend many years at a certain stage on the care pathway. It’s very expensive if people don’t get the most effective treatment.”

He concluded: “It’s simply rolling out what we already have many examples of to replace the less effective models that we were otherwise using.”