Pre-budget Submission Joint Committee on Finance, Public Expenditure and Reform

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1 Pre-budget Submission 2016 Joint Committee on Finance, Public Expenditure and Reform July 2015

2 SUMMARY POINTS Acquired Brain Injury Ireland (ABI Ireland) is asking the Government to support people living with acquired brain injury (ABI) in Ireland in the 2016 Budget by providing funding to commence the implementation of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland, This requires investment in community based neuro-rehabilitation services as a priority to include: Roll out of multi-disciplinary community-based neuro-rehabilitation teams in each of the nine Community Health Organisation (CHO) areas. Development of a national ABI specific case management service leading to significant savings for the Health Service Executive (HSE). Investment in community-based ABI specific transitional living services to provide intensive, post-acute rehabilitation to address the issue of delayed discharges. 1. Community-based Neuro-Rehabilitation Teams (CRTs) The cornerstone of effective community neuro-rehabilitation is the multi-disciplinary 2 community-based neuro-rehabilitation team. CRTs are made up a range of disciplines and provide moderate to high-intensity neuro-rehabilitation inputs to enable activity and participation in community settings across home, educational, work and social environments. According to the National Policy on Strategy for the Provision of Neuro-Rehabilitation Services in Ireland , the CRTs will provide specialised neuro-rehabilitation therapy services in association with a cluster of primary care teams within a specific geographical region for a defined population. The CRTs will play a critical role in facilitating early discharge and continuity of therapy from acute and regional in-patient neuro-rehabilitation facilities. They will provide high-intensity neuro-rehabilitation services in the community as well as assess and make recommendations in options such as returning to work, education or occupational activities. Therefore, these new CRTs will be an essential component of community-based neurorehabilitation and central the lives of people with ABI who are the largest users of neurorehabilitation services. They now require an investment and leadership to ensure that they are part of the architecture of the nine emerging Community Health Organisations in the HSE. 2. Cost Effective ABI Specific Case Management There is compelling evidence that case management is a key way to enable service integration across the range of specialists and service providers. Research from the UK indicates that case management for complex cases that require interdisciplinary working is both person centred 1 Department of Health and Health Service Executive (2011) National Policy on Strategy for the Provision of Neuro- Rehabilitation Services in Ireland ABI Ireland Policy Briefing Paper providing a summary on the Strategy can be accessed here 2 CRTs typically comprise the disciplines of occupational therapy, physiotherapy, speech and language therapy, psychology or neuropsychology and social work IBID, p.86 1

3 and serves to maximise the person s independence and quality of life. It also leads to significant benefits to society including the reduction in the burden of care with avoidable, expensive and long or frequent hospital admissions being sigificantly reduced. 3 A geographically based ABI-specific case manager acts as a single point of contact and provides a clear pathway to support the person s transition from acute settings through post-acute and into community rehabilitation services. The case manager is the link person and helps to reduce the number of people with an ABI who fall through the net and provides on-going support to ensure that the person receives the necessary services. Research carried out in 2009 in the North East HSE region on ABI-specific case management services proved that they were cost effective. The study showed that case management facilitated discharge from nursing homes and hospitals, prevented admission to nursing homes and hospitals and lead to a reduced level of support (post case management intervention). In the year in question, the research showed that a net savings of 3.5m occurred. The following graph (Fig 1) represents the savings in monetary terms across the whole of the North East HSE area 4. Therefore, a comprehensive ABI case management service with national coverage and linkages to the CRTs is needed. Fig 1: 3. ABI-specific Transitional Services ABI Ireland s transitional living service provides intensive neuro-rehabilitation and support in a residential setting (for up to 6 months). It enables the person with an ABI to make the transition and return to live in their own community. A team of experienced inter-disciplinary clinicians develop a neuro-rehabilitation programme by assessing the individual needs of the person with an ABI. A tailored Individual Rehabilitation Plan (IRP) specific to their individual needs is developed and implemented. Currently, ABI Ireland, in partnership with the HSE, operates two transitional services in Sligo and Offaly. However, these services are limited in terms of numbers 3 Department of Health (UK) (2005) Supporting People with Long Term Conditions: An NHS and Social Care Model to support local innovation and integration, London, Department of Health 4 Whelan, D. (2010) An evaluation of the cost effectiveness of acquired brain Injury Ireland case management in the North East Area (Meath, Cavan/Monaghan and Louth). Unpublished MA thesis, Institute for Public Administration 2

4 of people that can be catered for and their locations. The provision of comprehensive transitional living services across the country is an essential part of the pathway in supporting the person with an ABI to move from hospital to home. It is equally critical in terms of addressing and being part of the solution to the delayed discharges issue that is a continual challenge in our healthcare system. Policy Context: Implementing the Neuro-Rehabilitation Strategy In 2011 the Department of Health and the HSE jointly published the National Policy on Strategy for the Provision of Neuro-Rehabilitation Services in Ireland The Strategy recognises the importance of neuro-rehabilitation and sets out a national model of service delivery. It also proposes a framework for the provision of neuro-rehabilitation services for Ireland in the future. The latter is largely based on a continuum of individualised supports and services that are accessed at different stages of the person s journey. This report is still awaiting the development of an implementation plan by the Department of Health and the HSE. There is an urgent need for the Government to prioritise and accelerate the development of this implementation plan given the timeframe for the Strategy and the vast levels of unmet need. Brain Injury in Ireland There is a dearth in brain injury-specific services in Ireland. There is a lack of recognition of this sub-group of our population as having a unique set of needs requiring ABI specialist services and supports. Many people with an ABI require access to the full suite of neuro-rehabilitation services to maximise their independence and abilities. More and more people are surviving brain injury because of advances in medicine and technology. However, due to the lack of suitable services, life after a brain injury is largely one of existing, not living. People with an ABI and their families are forced to live on the margins of our society. Due to the lack of suitable services some people with an ABI, including many young people, are consigned to live in highly inappropriate settings such as nursing homes and community hospitals. Others are living at home where families are not coping. There is a need to recongise and grow ABI specialist services across the secptrum of acute care, specialist, primary and community care. The cumulative effect of under-investment and lack of recognition of this group has resulted in a very significant build up of unmet needs. This is further compounded by the lack of epidemiological data on this cohort of our population. An investment in neuro-rehabilitation services in Ireland is essential so all people with ABI can access the services they need at different stages in their recovery. The current ad-hoc basis of service delivery is ineffective and inefficient. ABI Ireland s specific focus is to seek investment in community based neurorehabilitation 5 services where the person is helped to recover with the support of a personcentred inter-disciplinary team in community settings at the post-acute stage. 5 Neuro-rehabilitation is defined as a problem-solving process in which the person who experiences a neurological impairment or loss of function acquires the knowledge, skills and supports needed for their optimal physical, psychological, 3

5 Supporting Information About ABI Ireland ABI Ireland is a dedicated provider of community-based neuro-rehabilitation services for people with an acquired brain injury (ABI) and their families. As a brain injury can affect a person s ability to manage their own life, ABI Ireland works in communities across Ireland to support and empower people to rebuild their lives. ABI Ireland also campaigns, educates and advocates for the rights and needs of this hidden group in society. ABI Ireland was founded in 2000, originally known as the Peter Bradley Foundation. Following a road accident Peter acquired a brain injury. His family set up the organisation to address the complete lack of neuro-rehabilitation services for Peter and others with an ABI. ABI Ireland Services ABI Ireland provides a diverse range of accredited neuro-rehabilitation services. The core services include: Clinical neuro-rehabilitation team Residential rehabilitation Transitional living Day resource/clubhouse Home and community rehabilitation Case management Additional support services are also provided and include: ABI information Psychology (Cognitive Behaviour Therapy/family therapy) Social work (family support services) Carer supports Neuro-rehabilitation services What is an ABI? There are many ways in which a person can acquire a brain injury. These include, among others, a fall, assault, accident, infection, stroke or tumour. People s lives can change suddenly and significantly following an ABI. Having a serious brain injury is totally life altering for both the person and their family due the effects of brain injury. The brain is a complex organ. Depending on what part of the brain is injured, and the extent of the injury, the person will have to live with different consequences. Many of these consequences may be hidden, others not. They range from physical and sensory to cognitive and psychological. Effects of an ABI social and economic functioning. Department of Health (2011) National Policy and Strategy for the Provision of Neuro- Rehabilitation Services in Ireland, ) 4

6 Brain injury can affect how a person feels, thinks, acts and relates to others. ABI can cause a wide range of changes that affects: Thinking (memory and reasoning) Sensation (touch, taste and smell) Language (communication, expression and understanding) Emotions (personality changes, anxiety, acting out and coping skills) These impairments have consequences for the individual with the brain injury and their family and they may experience: Loss of income and unemployment Social and economic isolation Changes in relationships family dynamics What is neuro-rehabilitation? Neuro-rehabilitation is a clinical and social process to aid recovery after a brain injury. It is about relearning, compensating and regrowth so the person lives a life of their own choosing. It supports the person to live a meaningful everyday life. Each individual is assessed and a plan is put in place. The person is gradually supported by the (neuro-rehabilitation) team to regain skills, adapt to the environment and learn new ways to cope with day-to-day life. Key Facts and Figures on ABI in Ireland Each year it is estimated that 13,000 people in Ireland acquire a brain injury There are approximately 130,000 people with an ABI in Ireland today living with ABI ABI is one of the leading causes of disability and can have life-long consequences for people with the condition, their carers and families. Contact Details ABI Ireland welcomes the opportunity to give an oral presentation to the Joint Committee on Finance, Public Expenditure and Reform. Further information from Grainne McGettrick, Policy and Research Manager, ABI Ireland National Office, 42 Northumberland Ave., Dun Laoghaire, Co. Dublin. T: E: 5

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