NHS brain injury budget cuts ruining lives of thousands afflicted or caring for someone with brain injury

guardian.co.uk/society/2013...

Stuart Noad likens having a brain injury to being a tiger that has lost its teeth. "You may still look like a tiger on the outside and you are sent back out into the wild to carry on with your life – but you can't actually survive," he says. The 49-year-old stonemason was seriously injured last May after coming off his bicycle on his way home from work. Airlifted to hospital, he later spent three weeks in the specialist neurological rehabilitation unit at Bath's Royal National hospital for rheumatic diseases (RNHRD), known locally as the Mineral hospital or Min. It is a period he credits with putting his life back on track. "You have to manage your life totally differently after a brain injury – and they understood that, even though I didn't at the time," he says. "They all had such insight and they were incredibly and totally patient."

But the neurological rehabilitation unit that made such a difference to Noad's life is closing this weekend, a victim of financial pressures at the hospital which, critics fear, are seeing highly specialised NHS services sacrificed for the sake of short-term cost savings.

According to Kirsty Matthews, chief executive of RNHRD, the number of more specialised cases to the unit has remained constant at around 50 a year, but a reduction in referrals overall over the last two years has seen income fall by 50%.

"This has had a very sharp impact on what is a relatively small service within one of the smallest specialist foundation trusts in the country," says Matthews in a statement. "With financial losses running at £430,000 a year, the service was not covering its direct costs or making a contribution towards the wider hospital infrastructure costs that support it. To recover this position, the service would need to be making a surplus of approximately £590,000 per annum. In response, the trust has reviewed all options and made great efforts to adapt but has not been able to resolve the fundamental position where the business model for the neurological rehabilitation unit is now no longer financially viable."

The decision to close the unit came after the health regulator, Monitor, stepped in over the trust's worsening financial position in May 2012. The trust has agreed to merge with the larger Royal United hospital in Bath later this year.

National resource at risk

But the RNHRD's own governors have been worried about the alternatives for patients needing neurological rehabilitation. In January, they warned in a public statement that "the closure of the Bath service will deprive the whole south-west of a specialist high-intensity neuro-rehabilitation facility, and will significantly reduce the national resource for training new doctors and therapists, both to deliver the next generation of experts to provide this service, and to give experience and advice to clinicians receiving these patients when they return to their home community".

Matthews says discussions have been ongoing to find alternatives for those who would have been seen in the Bath unit. Bath and North East Somerset council has been keeping an eye on the situation. In a paper last week to its wellbeing scrutiny panel, the south west specialist commissioning group, which is currently responsible for purchasing specialist NHS services in the region, said extra beds would be provided for the most serious cases at facilities in Oxford and Bristol, and less serious cases would be referred to a range of other centres with spare capacity.

But with radical changes to the NHS coming into force on 1 April set to transform the way services are commissioned, there are fears that an already stretched resource will not be given the priority it deserves.

Brain injury charity Headway says cost-cutting of acute and post-acute services for people affected by brain injury is not limited to the south-west of England. Across the UK, it says cuts to services are leading to those needing support being abandoned by the system.

The closures "will severely impact on the lives of local people who require highly complex specialist acute care in order to make the best possible recovery from brain injury," says Headway spokesman Luke Griggs.

At RNHRD, which looked after patients with brain injury caused by accidents or illnesses such as stroke, multiple sclerosis and brain tumours, around half of the 67 staff, often with many years of experience, are facing redundancy. Andy Ballard, senior negotiating officer for the Chartered Society of Physiotherapy (CSP), says: "It's always hard when jobs are lost, but this is more than that. People who work there are really grieving for the loss of a service that's made a difference to people's lives. What the Min does is so highly prized, offering something very special to people with those particular needs to make a crucial difference to their recovery. They provide a quite exceptional service and they are heartbroken that it's going to disappear."

A report last month on specialist rehabilitation by the Office of Health Economics for the law firm Irwin Mitchell found that rehabilitation services were already a "Cinderella service". With the NHS expected to find £20bn in savings by 2015, the authors warned that even more expertise is at risk. Yet, according to the report, early intensive rehabilitation after a brain injury can save as much as £1.6m over a patient's lifetime in reduced long-term support costs. As Colin Ettinger, partner in Irwin Mitchell's personal injury team, puts it: "If you have decent rehab services in place, they more than pay for themselves. It really does make a difference – very often people can go back to work, even if it's not what they did before. They are less of a burden on their family, the state or social services."

Professor Mike Barnes, a specialist in neurological rehabilitation and chair of the UK Acquired Brain Injury Forum, says 3,000 beds for acute brain injury rehabilitation across the NHS and private providers is already "grossly inadequate".

New commissioning arrangements will only make that worse, he says, with local commissioners not seeing the issue as a priority and "considerable confusion" about what will be commissioned nationally. "It's frankly a bit chaotic at the moment. We can't get a clear answer from anyone on who is going to be commissioning what and when," says Barnes. "We are starting from a low baseline and when you add in that chaos and, even worse, shutting a unit like Bath, we have real concerns. There is no doubt it will lead to further gaps in provision and further very patchy provision."

Rebekah Middleton, professional adviser at CSP, agrees. "There is real concern that people who need those services increasingly over time are not going to have access to them and are going to have to manage with lower levels of expertise, specialism and intensity," she says.

The NHS Commissioning Board was not available for comment.

For Noad, getting used to his new life after leaving the Min has been a tough process. Although he received some specialist outpatient support, contact with a psychologist who had no experience of brain injuries reinforced his view that it is expert support that really makes a difference. "I was appalled and angered to hear that the one place that I knew understood my condition was being closed down," he says. "At any time, let alone when you've had a brain injury, it would be almost cruel to be given access to something that you didn't know existed and that was so special, and then to see it thrown away."

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disgraceful coalition government.