Everyone with a brain injury has the right to rehabilitation tailored to their needs, says Sara Hazzard. She is the Assistant Director of Strategic Communications at the Chartered Society of Physiotherapy (CSP) and co-chair of the Community Rehabilitation Alliance. Sara explains why rehabilitation must work for each individual and how community care plays a vital role in someone’s recovery.
“If two people suffer the same brain injury, should they automatically receive the same rehabilitation?
The short is answer is no. People with brain injuries will have different needs, depending on –the impact of the injuries themselves, other health issues, and their personal circumstances.
Someone may suffer a similar trauma but with important differences that need to be taken into account. People with brain injuries may have other health issues – physical and mental. For example, depression, chronic pain and musculoskeletal conditions are all common when someone has survived a brain injury. The impact and lived experience of each individual is important and relevant and will not be the same. All of these issues need to be factored into each person’s recovery and rehab. An individual’s goals from rehabilitation are individual to them.
What this boils down to is personalised care. By putting the person with a brain injury and their specific individual needs at the centre, we can understand how rehabilitation must differ by person, not diagnosis. The CSP is working as part of the Community Rehabilitation Alliance, a coalition of 60 health and social care charities alongside professional bodies. We’re working with them to drive a long term and more sustainable approach, which flexes to meet the needs of individuals. For an individual to reach their potential, the rehabilitation road is never straight and often takes many different turns. We must ensure the system can support their journey.
Providing the support that’s needed
When a person is denied the rehab they need it, also doesn’t make financial sense. People with traumatic brain injuries who receive rehabilitation once they have left an acute hospital ward cost the NHS and social care £27,800 less a year than those who don’t. Yet of the 1.3 million people living with traumatic brain injury, only 40% receive neurorehabilitation. For many, their rehab journey will start with intense, targeted and specialist rehab.
Further down the line, these needs may change. This is why an improved offer of community-based ‘core’ rehab, easily accessible for people with a range of long-term conditions, may be what is needed.
Fair access to support for everyone
What we must not do is confuse personalised rehab plans with inconsistency. It’s consistent access that is the gateway to equity. Historically, rehabilitation has been under resourced and this in turn drives systematic health inequity. People who can afford to pay for rehab to fill the gaps in provision, do, and those who can’t are left behind. This makes no economic sense as it pushes people into the highest cost parts of health and social care and out of the workplace.
There is much that we don’t know because the data isn’t collected or reported. In fact this is what has always made community rehabilitation the poor relation to other forms of treatment. After all, you don’t count what you don’t see, and you don’t see what you don’t count. You don’t fund what isn’t seen and counted.
Facing up to the challenges
We also need to look anew at the known challenges. Take hospital discharge, for example. Imagine if we accepted that we don’t have a problem with the process of hospital discharge problem = but an onward referral issue. Might that change where we look to find a solution? People should be getting the care they need at home; the challenge is keeping people out of hospital.
Ultimately, everyone with a brain injury will need – and has a right to – rehabilitation that is needs-led, person-centred and funded across the whole pathway. It makes so much sense. This problem isn’t too hard to solve, and it is too important to ignore.”