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Services for Patients with ABI in Remote and Rural areas

Dr Barbara Chandler NHS Highland. Services for Patients with ABI in Remote and Rural areas. Context. 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?

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Services for Patients with ABI in Remote and Rural areas

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  1. Dr Barbara Chandler NHS Highland Services for Patients with ABI in Remote and Rural areas

  2. Context • 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)

  3. Context • 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

  4. MAP OF HIGHLAND AND PICTURE OF LOVELY SCENERY

  5. Facts and figures • 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

  6. Northumberland Head Injury Service • 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)

  7. Northumberland Head Injury Service • 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

  8. Facts and Figures • 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

  9. Northumberland Head Injury Service • Team has grown and evolved over 18 years • Research into Carer needs • Research into sustained employment • European Educational project – community rehabilitation • Exploring employment groups

  10. Patient and Carer Support 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

  11. Challenge • 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

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