Dr Barbara ChandlerNHS Highland

Scottish ABI NMCNNo national standards or targets

agreed for management of ABISIGN guidelines for strokeSign guidelines for acute TBIQIS neurology agenda

Where is ABI? (Within the National Service Framework for long

term conditions (2005) England and Wales)

BSRM Standards for Rehabilitation Services Mapped on to the National Service Framework for Long-Term Conditions 2009, “inter-disciplinary team”

“Following discharge either from an inpatient rehabilitation unit or from an acute ward, care should be coordinated by a specialist brain injury team, although this resource is not available in all areas.” BSRM/RCP 2010

MAP OF HIGHLAND AND PICTURE OF LOVELY SCENERY

Population of Highland approx 300,000 Northumberland population = 300,000

Prevalence of severe TBI 150/100,000 Prevalence with persisting disabilities

at least 100/100,000

The challenge is that often the “disabilities” are hidden

Started in 1992 and “evolved”To provide a service across the

geographical area of Northumberland for TBI

Community based teamReferrals from

neurosciences; Centre for Rehabilitation GP’s, Social Work, Primary Care team Self referral (always contact GP)

Care Managers 1 Team Lead

Band 8a 2 F/T Band 6 1.5 Level 1

Admin 1 F/T Band 4 1 P/T admin

assistant

1 Neuro-psychol 8a 0.1 Rehab

Medicine 0.1SALT 0.8 OT Band 7 0.6 OT Band 5 0.6 PT Band 7 0.6 PT Band 6 1 Rehabilitation

assistant

Budget £400k staff; £35k non staff costs

Case load 130 +/- 10 Structured discharge plan Re-referrals (TBI a long term condition)

New referrals: 40 / yearMild head injuries – phone call advice

Team has grown and evolved over 18 years

Research into Carer needsResearch into sustained employmentEuropean Educational project –

community rehabilitationExploring employment groups

In each locality

Care Manager based there one day per week

Rehabilitation team members attend for specific patient interventions

Group encouraged to become independent

Headway link / support

Working age adults often with dependent family

Economic argumentNational targets for ABIHighland: ABI pathway – courage to

establish this with existing resourcesFurther resources, but not huge

resources