Dr Barbara Chandler NHS Highland

 Scottish ABI NMCN  No national standards or targets agreed for management of ABI  SIGN guidelines for stroke  Sign guidelines for acute TBI  QIS 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 team  Referrals 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/TBand 6  1.5 Level 1  Admin  1 F/TBand 4  1 P/T admin assistant  1 Neuro-psychol 8a  0.1 Rehab Medicine  0.1SALT  0.8 OTBand 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 / year  Mild head injuries – phone call advice

 Team has grown and evolved over 18 years  Research into Carer needs  Research into sustained employment  European Educational project – community rehabilitation  Exploring 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 argument  National targets for ABI  Highland: ABI pathway – courage to establish this with existing resources  Further resources, but not huge resources