I was a member of the Warwick University Team which evaluated the National Traumatic Brain Injury Study, and which reported to the Department of Health in October 1997. I was also a member of the Social Services Inspectorate team which produced the report on personal social services for people with head injury, entitled A Hidden Disability (DoH 1996).

  Three main points are made in this memorandum:

(a)  The absence of suitable outcome measures for evaluating the success of community-based rehabilitation services.

(b)  The importance of assessing cross-sector benefits when evaluating community based rehabilitation services.

(c)  Concern about the absence of a specific user group to include people with head injury, in the Supporting People proposals.

COMMUNITY BASED REHABILITATION SERVICES FOR ADULTS WITH HEAD INJURY

  1.  Factors influencing outcomes of traumatic brain injury are extremely complex, and the characteristics and social circumstances of those undergoing rehabilitation are extremely diverse. It is not possible to identify a single method of rehabilitation which could be held up as a model for all teams.

  2.  The Warwick Team identified a dearth of suitable outcome measures to assess the benefits of rehabilitation following community re-entry, and developed their own measure based on the patient's assessment of the resolution of "problems" following interventions by community based teams. Many of these problems were not directly within the remit of the rehabilitation teams, but nevertheless had a huge impact on recovery: a fact which is now acknowledged in the move towards "Joined up thinking" between organisations. Many of the teams evaluated proved themselves to be highly responsive to the problems of individuals, and were prepared to negotiate with Education and Housing departments, and with employers, in order to facilitate community re-entry for their patients.

  3.  Given the impact of head injury on the life of an individual, it is important to acknowledge the cross-sector benefits provided by community based rehabilitation: without help, patients and families often become extremely isolated and the accident is often followed by family breakdown. Children may suffer inordinately. Professional intervention, though not necessarily able to prevent family breakdown, can offer support through the process. It is likely that, without help, many people become involved with the courts or the probation or prison services following head injury. Therefore it is unrealistic to assess the benefits of head injury rehabilitation solely in terms of benefits to the health services, and as far as possible outcome measures should take account of these cross sector benefits.

Supporting People

  4.  I am currently working in Local Government, and have been doing some work on implementing the Government's initiative Supporting People. Under this initiative, support services will no longer be paid for through Housing Benefit, but via a separate pot of money, currently being calculated by scrutiny of the current arrangements for tenancy and other support. The services included are to a great extent the sort of early intervention and preventative services—befriending, advocacy, tenancy support—of particular benefit to people with head injury, and the move is greatly to be welcomed as these services will no longer be tied to housing tenure.

  5.  For this reason, it is of great concern that the user groups outlined in the Supporting People proposals largely follow the old Social Services user groups—services for Older People, People with Mental Ill Health, and People with Physical Disability, with the addition of other vulnerable groups such as drug users and people suffering domestic violence. As part of the Warwick Team, and also as a member of the Social Services Inspectorate team responsible for the report "A Hidden Disability" (DoH 1996) I am aware that people with head injury are often excluded from accessing personal social services because they do not fit the main eligibility criteria. Some authorities, such as Worcestershire, have developed a separate user group of People with Complex Care Needs: this includes people with cognitive problems but no obvious physical disability or mental illness, and also people with degenerative disease which progresses erratically. I think it is very important that such a user group should be defined within the Supporting People initiative, because without that head injured people may again find themselves unable to access suitable services.

February 2001