Is it possible to go back to work too soon?

Transcription

1 Returning to work after a brain injury Section 5 Is it possible to go back to work too soon? It is quite natural to want to go back to work as soon as possible. However, people often make the mistake of thinking because they are feeling physically able to return to work, that they will be able to cope with the wider demands of the job. Many jobs are lost because the person returns to work too soon. Typically, they will overestimate their abilities and underestimate the effects of fatigue on performance. is therefore an essential part of the task of any rehabilitation team to help the person identify the most suitable type of future job and the optimum build-up of hours over a period of time, once all factors are taken into account. Many people expect to be able to work a full day straightaway, and finding out that this is not possible for various reasons can really damage confidence and self-belief. It The Brain Injury Handbook 81

2 Meet Keeley... At just 21 years old, Keeley Parkes was living life to the full in Tenerife where she worked as a holiday rep. But a disastrous accident left her life hanging in the balance. In 2004 I fell through a skylight and landed head first on a solid surface. I was rushed to hospital and my family were flown out to be by my side. I d suffered a brain injury and shattered both my wrists. Two weeks later my condition stabilised and I was flown back to a UK hospital. As the days passed, I became more aware of my brain injury and its effects which included not being able to walk, and having short term memory problems and poor speech. I attended regular physiotherapy until I could walk again and was finally discharged on my twenty-second birthday. My home life was re-arranged to suit my needs: my bed was brought downstairs and my parents had to care for me full-time. As time went on my dad would take me out for short walks but I was embarrassed and ashamed because I still had a terrible limp and couldn t speak properly. 82 I found it hard to come to terms with what had happened to me and my confidence and self-esteem were at rock bottom. I stayed at home all day, every day. It was also hard for my family. My brain injury was affecting us all and we didn t know how to cope. I was determined to get my life back to normal. My speech and language therapist referred me to Momentum Skills. During my initial meeting with them I was nervous it

3 The consequences of brain injury Section 3 felt like I was starting school again. But when I met my group a few weeks later and realised everyone was in a similar situation, I felt not alone anymore. I attended the vocational rehabilitation programme four days a week, taking part in social skills sessions and learning strategies to aid my memory loss, stress and anxiety. And I even gained a recognised qualification in using computers. As well as the group sessions, I had oneto-one meetings with a psychologist who helped me to understand and overcome my daily struggles. I also took part in workshops in CV building and interview techniques. I was assigned one of Momentum s job coaches who helped me to choose three areas of work I was interested in. The job coach set up work-placements based on my choices one being working within the beauty industry. This led on to a weekend job as a beauty consultant. My confidence grew, my energy levels improved rapidly and I gradually increased my hours. I always wanted to travel and Momentum Skills helped me to finally find the confidence to do it. In 2007, I set off to work and travel around Australia. I returned home nineteen months later. After gaining a National Diploma in Beauty Therapy Science, I got full-time employment as a skin spa therapist. But, I d been bitten by the travel bug so decided to set off on another adventure. I spent three months travelling and studying to be a yoga teacher in India. I returned home in April 2013 and am now working as a therapist in another well-known company within the beauty industry. Momentum Skills helped both me and my family to understand and cope with the effects of a brain injury, and given me the tools to manage my new life on a daily basis. They helped me return to work and make the most of my life. I still feel I am growing and learning every day. My brain injury will never go away but I grow stronger knowing I can handle it. Momentum Skills provides a range of innovative vocational rehabilitation services for people with an acquired brain injury. Its brain injury rehabilitation programmes are offered in Aberdeen, Glasgow, South Lanarkshire, Ayrshire, the Scottish Borders, Newcastle and Birmingham. They offer comprehensive assessment, specialist training, job coaching, work placement and job retention support. For further information, visit The Brain Injury Handbook 83

4 Managing a return to work A gradual return to work is important, as are easier working conditions and tasks. This will allow the person to build up their stamina and capabilities; a situation that may need to continue for quite an extended time. Ideally, people returning to work should start with just a few hours per day, building up hours over time as stamina improves. However, before a gradual return to work is considered, there should be evidence that the injured person can maintain concentration and have sufficient stamina to work safely and effectively for a specified period in the working day. Easier working conditions may include a quieter working environment that is free from unnecessary distractions. Consideration will also have to be shown for any physical disabilities wheelchair access, adapted computers, etc. Such special aids can be obtained from a disability employment advisor, based at the local Jobcentre Plus, under the Access to Work scheme. Having someone to act in a mentoring capacity may be useful. While an employer or line manager might not be able to find the time to devote to this, having somebody take on this role can be mutually beneficial. None of us are the best judges of how we are managing with new tasks in our work. This is of particular relevance to somebody with brain injury, so the employer just has to use common sense in dealing with the situation. The advice to a person looking to re-enter the employment market following brain injury is that it is often better to start off with some voluntary work or maybe a short college course, where strengths and weaknesses can be identified early. If the person is still based within a hospital or neurological centre, the occupational therapist will be able to refer them to the local disability employment advisor who, in turn (depending on locality), can outline available options as appropriate. Ultimately, a successful return to work depends on: A good match between the job and current abilities/skills Sufficient stamina to get through the working day or hours agreed Attention and concentration adequate to carry out work tasks Acceptable interpersonal/social skills Mentoring/job coaching 84

5 Returning to work after a brain injury Section 5 Support from employers and co-workers The need for support from both a person s employer and co-workers cannot be overstated. It is very important that, at the very least, the employer or line manager or equivalent knows a little about the long-term effects of brain injury. With this knowledge, they will be able to provide support when and where necessary. Like many people, employers tend to view disability as a physical condition. When they see no obvious outward signs, such as a wheelchair, they might assume the person is fine. Brain injury is often referred to as a hidden disability, and as such can easily lead to misinterpretation. For example, loss of initiative or fatigue can be interpreted as laziness. Additionally, the person may be asked to stay late at work. Their commitment may lead them rarely to refuse such a request, but the required tasks may not be completed to a satisfactory standard. Because of these examples of potential misunderstanding, organisations such as Momentum Skills have job coaches whose role is to educate and support the employer as well as the employee with a brain injury. What about those who are unemployed pre-injury? Finding work is difficult enough for anyone, but there is no doubt that it is harder for people who have had a brain injury. The person may be unable to complete an application form pre-interview or may have difficulty sufficiently impressing an interviewer; they may suffer from a reduced speed of thinking or not have regained sufficient social/interpersonal skills to be able to undertake a successful interview. Make contact with the disability employment advisor at the local Jobcentre Plus when the time is right. They can be of invaluable help. Of course, starting work may be even more difficult for a young person who has not yet chosen a career or who has not had a job pre-injury. Choosing a suitable career or occupation without prior experience of the employment market is an incredibly daunting task. Support is available from the local Connexions or Careers Scotland Service or from the Jobcentre Plus disability employment advisor. Alternatively, get in touch with Momentum. (See Section 7, p109 for contact details.) The Brain Injury Handbook 85

6 Meet Wendy Wendy Foster talks about the changes in her life following her husband s stroke and describes how they coped. We were parents of three children; two daughters in their 20 s and a son of 18. We had also celebrated the birth of our first grandchild a beautiful little girl. The future looked bleak, the children and I were overcome with grief and disbelief and terrified of what the future may bring. On 20th May 2012, our whole family were devastated at the news of my husband s stroke. At the age of 48, it was a blow to us all. For the first few days it was touch and go as to whether he would make it. It took 16 weeks of hospital care before Paul could come home. This presented massive issues and lifestyle changes. Paul ran a successful steel erecting business and I was a primary school teacher. We both loved

7 The consequences of brain injury Section 3 our jobs but it soon became apparent that we would have to give our jobs up for the unforeseeable future. Now we are pleased to be a part of Momentum Skills which has been fantastic for recovery and self-esteem. After attending hospital for 16 weeks, 6 hours a day, the next challenge was to find suitable accommodation for him as he was at that time in a wheelchair. Our daughters became distant (fear I think), my son was very supportive but I wanted him to have a normal life for an 18 year old. Our week is now busy and full. We swim, we go to the gym, we go to Momentum Skills and we even volunteer at The Independent Living Centre. The rehabilitation process has been a long journey in which we have learned so much, met a lot of fantastic people and gained inner strength we never thought we had. Lots of friends and indeed family have kept away and this left us feeling lonely. As a full time carer, it s extremely hard. We were in a situation whereby we went from being at work, seeing each other at weekends, to all of a sudden being thrust together 24 hours a day. We decided that this disability would not beat us and set about setting targets, short, medium and long-term. Constant battles with authorities and bureaucracy ensued. We met some wonderful people on our journey and continue to do so two years on. My husband no longer uses a wheelchair and is able to do a lot more independently. (He doesn t cook or clean mind you he never did anyway!) Through persistence, we have overcome lots of barriers. We have had support from Sandwell Hospital, Moor Green and The University of Birmingham. All journeys are a learning curve, despite all the anguish and hard work we all feel more fortunate than others. We will succeed because of our drive and determination and we will continue our journey for as long as it takes. Momentum Skills provides a range of innovative vocational rehabilitation services for people with an acquired brain injury. Its brain injury rehabilitation programmes are offered in Aberdeen, Glasgow, South Lanarkshire, Ayrshire, the Scottish Borders, Newcastle and Birmingham. They offer comprehensive assessment, specialist training, job coaching, work placement and job retention support. For further information, visit The Brain Injury Handbook 87

8 legal help, when it really matters... legal help, when it really matters... Digby Digby Brown Solicitors help families in Scotland after a serious accident has has caused a loved a loved one one to sustain to sustain a brain a brain injury. As As a firm we are personal injury specialists but but that that doesn t doesn t really really tell tell the the story. story. For For over over years, the firm has been actively involved in in the the brain brain injury injury community, community, the the experience experience built built up up over over this time truly truly allows allows us us to to call call ourselves ourselves experts experts in our field. in our field. As a family member of someone who is a patient in hospital or has been recently As a family member of someone who is patient in hospital or has been recently discharged, you are still reeling from the immediate aftermath of a serious accident. You discharged, you are still reeling from the immediate aftermath of a serious accident. You will have many questions. We understand this, we have helped many other families in the will have many questions. We understand this, we have helped many other families in the same position, over time, come to terms with the situation and deal with the issues. same position, over time, come to terms with the situation and deal with the issues. We work alongside the Child Brain Injury Trust, Momentum, the Brain Injury Rehabilitation We Trust work and alongside the Huntercombe the Child Brain Group. Injury We are Trust, also Momentum, members of the the Scottish Brain Injury Head Rehabilitation Injury Forum Trust and and the the Brain Huntercombe Injury Network Group. We We are have also been members involved of with the Scottish Headway, Head both Injury locally Forum and and the nationally Brain Injury for many Network years Group. and have We written have been for Headway, involved Claiming with Headway, compensation both locally after and Head nationally Injury in for Scotland many years which and was have updated written in for Headway, Claiming compensation after Head Injury in Scotland which was updated in If you have questions about your circumstances, please call us, we are here to help. If you have questions about your circumstances, please call us, we are here to help. Call Chris Stewart on: Call Chris Stewart on: digbybrown.co.uk digbybrown.co.uk

9 Section 6 Legal issues Anyone who suffers a brain injury in an accident should seek preliminary advice from a specialist personal injury solicitor about the possibility of compensation as soon as they can. Compensation can be awarded for injuries received only if it can be demonstrated that another party was responsible for the accident, either wholly or partly. However, even if the injured party appears to be solely responsible, it is worth seeking advice in case limited negligence by another party can be identified. The initial interview is usually free of charge and will establish whether there is a case for claiming compensation. The solicitor will need to get a clear picture of the circumstances surrounding the accident and the nature of the injuries sustained. In the case of severe injury, the first assessment interview may take place in the hospital. The Brain Injury Handbook 89

10 Selection of the legal team Bill Braithwaite QC is a specialist in catastrophic personal injury cases and the author of Brain and Spine Injuries The Fight for Justice. Here he outlines the process of choosing legal representation where this is necessary. The following information applies to the legal systems in Scotland and England. In the event of a claim being considered, the selection of a legal team is extremely important. The process of making a legal claim is difficult and it can be made more so by lawyers who are not suited to either the individual or the type of claim. Catastrophic personal injury claims are now a specialised area of claim management and the legal team needs to be sufficiently experienced in this area of work. The key element in the team is the solicitor. They are the person who has the daily conduct of the claim and who communicates everything that matters to the person with a brain injury and their family. It is important for the individual who has sustained a brain injury to select an experienced solicitor, and to make sure that it is someone who will be able to carry out the claim from start to finish. In my opinion, it is important to make sure that you select an individual, not just a firm, as it is the individual who you will be dealing with, and who you must trust. It is beneficial for the team to be created at an early stage. It is almost universal that the solicitor would decide to use as a consultant a barrister who specialises in the preparation and presentation of this type of catastrophic claim. That would mean that the solicitor would select and instruct a barrister, and this should be done before the claim is too far advanced so that the individual with a brain injury, and their family if appropriate, can get to know the whole team early on, and the team can get to know them. The person with a brain injury, and their family, have the right to ask detailed questions about the solicitor and barrister before they commit themselves to instructing them. Appropriate questions 90

11 Legal issues Section 6 might include those set in the questionnaire opposite. Although it is important to meet the solicitor before deciding whether to instruct them, the questionnaire could be given (or sent) to more than one solicitor, so that some early impression can be gained of their experience. A good track record established by clear evidence is important, and should be explored in detail. It is not sufficient just to rely on a solicitor saying that they, or their firm, have done this type of claim before. You need to know much more: how many, at what value did they finalise, how long ago was it, what was the type of injury, and so on. The response of the solicitor may give some indication of their character; if they are embarrassed or offended by this questionnaire, or consider it impertinent or rude to be asked these questions, the reason may be based on lack of experience of this type of work. The individual and their family may also want to ask the solicitor how they intend to communicate with the client during the course of the case. Some people like to have frequent letters describing progress, some fear and dislike such constant reminders. Some prefer the phone, but others don t. Personal visits are an obvious possibility, but again not all people welcome the intrusion into their home. Personal contact is essential, however, because the relationship between the patient and the legal team, including the barristers, is so important. As the claim progresses, the injured person and family should build up complete confidence in the knowledge, experience, support and ability of the legal team. There is no right or wrong way, but there is likely to be a system that will suit the family in question. Sample questions to ask a solicitor Are you a member of any specialist organisation related to the conduct of brain injury litigation? If so, please give details. Have you been approved, franchised or accredited by any specialist organisation related to the conduct of brain injury litigation? If so, please give details. Have you received any training or education related to the conduct of brain injury litigation? If so, please give details. Have you ever conducted this type of claim before? If so, please give a brief description of each case, including the nature of the injury, the stage proceedings reached and the value of the claim as finalised. Do you have any system whereby the quality and efficiency of your work is audited by an independent body? If so, please give details. Do you expect to be in charge of the case throughout its duration? When going to see a solicitor take these useful questions with you. The Brain Injury Handbook 91

12 Setting Standards in Brain Injury Rehabilitation Are you looking for a range of specialist brain injury services designed to the meet individual needs for adults who have associated complex cognitive impairments and/or physical disabilities as a result of their brain injury? Look no further than The OakLeaf Group. With the brand new service The Cotswolds opened this May in Northampton, we now offer: 12 Week Assessment and Specialised Rehabilitation Community Services with Graded Support Maintenance and Long Term Service Bespoke Package in any Level of Service Within each service level, we have developed price bands to ensure commissioners receive best value for money and reducing care costs as residents make progress. To find out more, visit or to make a referral: [email protected] or Case Management Support Services We provide specialist case management and support services for people with an acquired brain injury and ongoing behavioural needs and/or cognitive impairment. Our teams are experienced and specially trained and as a charity focusing on acquired brain injury our services are cost effective. Our success in helping people to be their best after a brain injury spans over twenty years. With bases in East Anglia and the West Midlands, we support private and state funded clients across the UK. To me, Optua UK is the difference between existing and living. Tel: [email protected] Avenues-Rehab Ad 1/4p 85x120mm.indd 1 22/08/ :07

13 BRAIN INJURY Specialist long and short term 24 hour residential care and rehabilitation for adults in small homes in the heart of thriving communities prokare Est Visit our website NCM is a Practice of Health Care Professionals that provides specialist Case Management and Rehabilitation services throughout the North of England with offices in Leeds and North Manchester to support people with acquired brain injury and spinal cord injury and their families. It is our aim to empower people to develop their full potential and enrich their lifestyle through providing a comprehensive client focused service. Working with Solicitors, Deputies and other Professionals intervention by NCM on behalf of Clients broadly falls into the following categories: Please , phone or visit our website for a copy of our Service Users Guide. Career Opportunities We are always looking for good quality Care/Support Workers and Case Managers, so if you are interested in a career in Social Care or are a Health Professional interested in a career in Case Management please contact us for an informal chat. Head Office, Brenton Business Complex, Bond Street, Bury, BL9 7BE Leeds Office, Sugar Mill, Oakhurst Road, Leeds, LS11 7HL [email protected] Northern Case Management Limited Registered in England No

14 Further General Information Making a claim If you are happy with the initial advice received from a solicitor, you should instruct them to act. The solicitor will collect evidence from all concerned parties in order to establish a view on liability (the legal term for blame). This may include interviewing and obtaining evidence from witnesses and, in the case of a road accident, getting a police report. The time that this takes depends on the complexity of the case. Alleged medical negligence claims are particularly complex. If, after collecting the evidence, the solicitor thinks that liability can be established, they may apply to the court for what is called a Summary Judgement. This enables part of the claim to be dealt with quickly before going to trial. Alternatively, the issue of liability may need to go to trial before financial compensation is calculated. If you are worried about going to court, remember, the vast majority of cases are settled out of court. The solicitor will also need to collect evidence to establish the effects of the brain injury on all spheres of life: short-term, long-term, and future health and work prospects. This is necessary to calculate financial compensation (called Quantum ) and will involve arranging for specialist reports from a variety of professionals. These sources will vary depending on the nature of the injury but could include reports from any one of the following: Doctor (GP/specialist who may have been involved in early care), physician, surgeon (possibly a neurosurgeon), orthopaedic surgeon or plastic surgeon Neuropsychologist for an assessment of cognitive skills, personality and judgement regarding future prospects Consultant for an independent medical report to provide a medical overview Case manager (if one is involved) Reports may also be requested from an occupational therapist, psychiatrist, school or former employer and possibly an employment rehabilitation consultant to advise on occupational potential and earning capacity. In the case of severe brain injury, this part of the claim is likely to take a long time, not least because of the recovery time. 94

15 Legal issues Section 6 Time limits Where the injured person is an adult, the legal time limit for accident claims is normally 3 years. However, there are exceptions: There is no time limit for starting a case in serious head (brain) injury cases where the person is so seriously disabled that they are incapable of managing their own affairs. In some cases, particularly medical negligence cases, the injured person may not be aware that they have been injured as a result of someone else s mistake until after 3 years have passed. The solicitor will examine the circumstances surrounding the injury and then advise whether the injured person is still in time to bring a claim. If the victim is a child at the time of the accident, the 3-year time limit does not commence until the age of 18 years is reached. Calculating financial compensation Calculating a personal injury claim (PIC) is a highly specialised procedure. Both the person and their solicitor will need to ensure that every eventuality is accounted for and that records are kept so that claims can be made for every loss and expense. For example, PICs have two elements: special damages and general damages. Special damages are awarded to compensate for all direct financial loss incurred as a result of the accident, e.g. private medical fees, cost of equipment, travelling expenses, damage to vehicle and clothing, loss of wages, etc. General damages have three components: 1 Pain, suffering and loss of amenity (amenity refers to loss of capacity caused by physical or psychological problems). 2 Loss of earnings including future earnings or promotion prospects. 3 Care needs, e.g. cost of providing care, specialist rehabilitation/therapies, accommodation, special aids and adaptations, and transport. The Brain Injury Handbook 95

16 Interim payments You do not necessarily have to wait until the case is settled before receiving money. A solicitor can apply for an interim payment and should do so if at all possible. This involves applying to the defendant for some of the damages immediately or well before the case is settled. As detailed earlier, rehabilitation can make a tremendous difference to the quality of recovery and eventual independence. An interim payment will enable the injured person to obtain whatever is required to aid their recovery when it is needed, as opposed to waiting until the case is settled, which can take up to 4 years. Being awarded an interim payment involves the insurers of the defendant paying some of the damages before the case is finalised. 96

17 We are Specialists in Medical Negligence claims. Let us help you. Case Management and Rehabilitation Services 26 Redhouse Road, Tettenhall, Wolverhampton WV6 8ST Specialists in all aspects of case management and rehabilitation for adults and children with catastrophic complex brain and spinal injury, amputees and generic requirements. Case Managers are based throughout the United Kingdom, Ireland, Mainland Europe, Hong Kong and Australia. Community Case Management Services Limited 23 Blackwell Business Park, Blackwell Shipston on Stour, Warks CV36 4PE Tel: Website:

18 Brain injury and community care law Simon Garlick of Ben Hoare Bell LLP Solicitors, Newcastle upon Tyne, outlines how community care law affects people with brain injuries and their carers. The following information applies to the legal system in England. Individuals who have sustained brain injuries, their families and carers, must usually look to the state s statutory services in the form of the NHS or their local authority for the provision of appropriate care. In most cases, statutory services will be the only source of professional care and support in the longterm. For a minority of people, they may be used in the short-term only, until a private care package, funded from existing savings, insurance, or by a compensation payment, can be put in place. The NHS and local authorities are subject to many legal duties that oblige them to assess the needs of both the person with the injury and their carer(s). They are empowered, and often under a legal duty, to provide a range of services, which may include residential or nursing home care, nursing or social care at home, provision or adaptation of accommodation, short breaks (respite care), disability-related equipment, day centre services, assistance with travel, breaks and holidays, as well as counselling and befriending schemes. These services may be provided by the NHS or local government, using their own or agency staff. Alternatively, if certain conditions are met the services may be funded by handing over a budget to the individual, leaving them or their carer(s) to choose and to buy the necessary service this is called Direct Payments (also known as Personal or Individual Budgets). In many cases, statutory service provision is of a high standard, but sometimes assessments and services are not provided when they should be, whether because of a shortage of resources or staff, or due to a lack of understanding on the part of statutory services about what their powers and obligations are. In such cases, it is important that individuals with brain injuries and their families or carers have access to an advisor who knows about community care law, and who can ensure that statutory services fulfill their obligations, particularly in these times of cuts in local authority and NHS services. 98

19 Legal issues Section 6 Assessment Under Section 47 of the National Health Services and Community Care Act 1990, where it appears to a local authority that any person, including children, may be in need [ ] of community care services the authority must assess their needs and make a decision about what services are to be provided to meet those needs. This provision relates to the provision of social care for which local authorities are generally responsible, rather than nursing or medical care for which the NHS is responsible. Assessments must be carried out within a reasonable time, cannot be delayed or refused because of shortage of local authority funds, and will result in a person s needs being banded according to the level of risk to their independence that will result if services are not provided. Psychological, emotional and social needs are as relevant as physical needs. The four bands are critical, substantial, moderate and low. Most local authorities fund services to meet all critical and substantial risks, and a few meet some moderate band risks. Once a local authority has decided that a person s needs are serious enough to be funded, it must provide a service and is not entitled at that point to refuse or defer services on the grounds of shortage of resources. If there are alternative ways of meeting assessed needs, a local authority is entitled to take into account the relative costs in choosing which service to provide. Once a service has been assessed as necessary, the local authority is not entitled to withdraw or reduce the service without first carrying out a reassessment. The Department of Health s Guidance on the Provision of Adult Care (referred to as the Prioritising Need Guidance of 2010), which is binding on local authorities, sets out precisely how they must carry out the banding exercise. For example, needs for services will be banded as critical if in the absence of services the following (among other issues) would occur, or have already occurred: Significant health problems Inability to carry out vital personal care/ domestic routines Unsustainability of vital social support systems and relationships Unsustainability of vital involvement in work, education or learning Little choice/control over vital aspects of immediate environment Local authorities, like the NHS, must also take into account the rights of every individual under the European Convention of Human Rights (ECHR), which was incorporated into English law through the Human Rights Act Included are the right not to be subjected to inhuman or degrading treatment (Article 3) and the right to respect for private and family life (Article 8), which embraces many aspects of personal autonomy and independence. This last right is qualified, which means that it can be infringed if there is a lawful and proportionate justification, such as the genuine prioritising of limited resources. There are several other assessment provisions that are relevant to particular groups of people or types of services, including specific obligations on the NHS and local authority social services to carry out thorough assessments and put in place necessary services before the point of discharge from hospital. Assessment and provision of services to children (under 18), and in limited circumstances young adults, is generally carried out by local authorities in exercise of their functions under the Children Act Children with disabilities are Children in Need for the purposes of the Children Act, and so have the right to in depth assessments, and may (in many cases must) be provided with services (or Direct Payments in lieu) to meet their assessed needs. The Brain Injury Handbook 99

20 Carers There are thought to be over 5 million carers in the UK, of whom over 1 million provide more than 50 hours of care a week. The value of unpaid care is said to be about 118 billion per annum. Carers defined as those who provide a substantial amount of care on a regular basis have important statutory rights. Carers must normally be consulted by the local authority social services staff when they carry out an assessment. The assessor is under a duty to consider the ability and willingness of the carer to continue to provide care. However, carers rights are not confined to participating in the assessments of those for whom they are providing care. Carers and those intending to be carers have a right to request that a Carer s Assessment be carried out, either simultaneously with the assessment of the individual concerned or independently. Services that may be provided to carers may include physical help for example, with housework, shopping or collection of prescriptions or other forms of support such as training, counselling, a mobile telephone, travel assistance, driving lessons or provision of equipment. Services might include the provision of holidays or special trips and, often of great importance, the arrangement of respite or temporary care to give the carer a break. Although technically local authorities have a power, rather than being under a duty to provide services to carers, in practice they sometimes have no choice but to do so. Carers, like the person being cared for, have their needs assessed according to the level of risk that will apply in the event that services are not provided. The risk being measured is the risk to the sustainability of the carer s role. Local authorities not only have an obligation to inform carers of their rights to an assessment but, when assessing carers, must specifically take into account the effect of their caring role on their ability or wish to work or undertake education, their family and social responsibilities, their autonomy and their health. NHS or Social Services? Department of Health guidance states that when a person needs a certain intensity or level of nursing care, as opposed to social care, they should be assessed as being eligible for NHS Continuing Healthcare, the effect of which is that all care whether social or nursing and, in certain cases, accommodation is provided free under the NHS. This contrasts with the position of those people who remain the responsibility of local authorities, which are entitled to means test and charge for the provision of community care services, including accommodation. The borderline between social care and NHS care is a controversial area and is described in the Department of Health s National Framework for Continuing Healthcare (amended November 2012). In the past, the Health Commissioner (Ombudsman) has criticised Primary Care Trusts the NHS bodies responsible for assessing eligibility for NHS Continuing Healthcare for excluding many people who ought to have been assessed as eligible. When a person who has suffered a brain injury may need substantial nursing or medical care, it is important that advice about possible eligibility for NHS Continuing Healthcare is sought. On the other side of the coin, it is important to note that the NHS is not subject to the same individuallyenforceable duties as local authorities, as the legislation governing the NHS allows it far more discretion about how and when services are provided to patients. For example, once a local 100

21 Legal issues Section 6 authority has assessed a person as needing a community care service, it must provide that service. By contrast, even if a patient needs an operation, the NHS is quite entitled (subject only to European Court of Human Rights considerations) to put an individual on what may be a long waiting list. There is now scope for the provision of Direct Payments to those who are Continuing Healthcare patients. These are available by virtue of the NHS (Direct Payment) Regulations Capacity and consent Individuals who have sustained serious brain injuries, with enduring effects, often have impaired abilities to take certain decisions. These decisions may relate to the most important choices in life: where to live, whether or not to undergo serious medical treatment, how to spend income and savings, which people to have contact with, etc. If the injured person is an adult (or in most cases aged 16 or over), no other adult, however closely tied to the injured person, has the legal right to make these decisions on their behalf, unless specifically authorised to do so by the Court of Protection, or validly appointed to do so under a Lasting Power of Attorney. It may sometimes be difficult to decide whether a person does, or does not, have capacity to take decisions themselves. These issues are governed by the Mental Capacity Act 2005, which sets out that capacity is issuespecific (a person may have capacity to take certain decisions, but not others) as well as timespecific (capacity to take a particular decision may vary at different periods). There is a presumption that a person has capacity. who may be empowered to take certain decisions on behalf of patients, and independent mental capacity advocates, who assist in particularly vital decisions about where a person should be cared for and whether he/she should undergo serious medical treatment. If a person is assessed as lacking capacity in relation to a particular issue, any decision taken must be in their best interests. Best interests must always include consideration of the wishes of the person concerned (although if they lack capacity, their wishes will not be decisive) and should always include consultation with anyone engaged in caring for the person or interested in his/her welfare. Conclusion Community care law is a fragmented and technical area. As a glance at the government website will reveal, it is also an area that develops and changes with great speed. Many victims of accident or assault who suffer brain injuries with significant effects do not receive the statutory services to which they may be entitled. Often they, or those who care for them, are too worn down to question whether they are entitled to more than is offered. Many people are not aware that there are detailed laws and binding guidance that spell out the powers and duties of local authorities and the NHS towards those with disabilities. Lack of appropriate services can have serious consequences for a person with a brain injury and their carers and family. In contrast, provision of appropriate services can bring about substantial improvement in the quality of life for all concerned. The Act sets out how capacity should be assessed. It goes on to provide mechanisms for decisions to be taken for those who are assessed as not having capacity, including the appointment of Deputies, The Brain Injury Handbook 101

22 Social service provision and case managers in Scotland Chris Stewart, senior partner at Digby Brown Solicitors, outlines the financial issues that may arise in the case of litigation. The value of compensation When someone suffers a brain injury due to the fault of another party, it is reasonable for that person to seek fair and prompt compensation. While compensation cannot turn the clock back, it can pay for rehabilitation and proper care, which are often not available through NHS or social work services. In order to establish just what is needed, and to show the court that it will work well, it is good to set up a care regime as early as possible, so that the court can see that it is appropriate and effective. Funding the care regime Like the Claimant in England, the Pursuer in Scotland is able to seek interim damages and to use these to set up and manage a care regime. The law in Scotland does require that the Pursuer is certain of success and a full valuation of the case has to be placed before the court. If satisfied that interim damages should be awarded, then a reasonable proportion (perhaps up to 60%) can be given. It is, therefore, necessary for a written defence to be lodged, which inevitably means that the case will have had to proceed to an advanced stage. If the insurers accept liability at an early stage then as in England voluntary interim payments are often made. Alternatively, social work departments can provide support, possibly through Direct Payments. Lord Carloway in the case of Fletcher v Lunan did indicate that judicial thinking was moving in the same direction as England, with the court simply asking whether the claims in respect of 102

23 Legal issues Section 6 care are reasonable and awarding damages to pay for it if so found. Many insurers, however, continue to argue that, if the local authority will pay for a care regime, then the Pursuer has suffered no loss and the insurer should not be required to pay damages in respect of care. Will the State provide funding? The position in Scotland has been similar to that in England since the National Health Service and Community Care Act 1990 came into being. The statutory authorities (through social work departments) are required to carry out an assessment of need, and to try to meet that need from their resources. Certain sections of the Act do not apply in Scotland and the different legislative framework set out in the Social Work (Scotland) Act 1968 and the Community Care and Health (Scotland) Act 2002 leads to a different and less certain position in relation to financial assessment by the local authority for the provision of nonresidential care. In other words, when it comes to providing care in a person s own home, rather than nursing home care, there is a good deal of variation between one local authority and another. The Brain Injury Handbook 103

24 Financial assessment by local authorities in Scotland As in England, these arguments have necessitated a review of the law on financial assessment provisions for both residential and non-residential care. It is generally accepted in Scotland that for residential care these provisions are the same, with Charging for Residential Accommodation Guidance (CRAG) applying. Money derived from a personal injury held in a personal injury trust or to the order of the court, is excluded from the means-testing process in relation to capital and income. The position in relation to charging for non-residential care is entirely different, with local authorities maintaining that they have discretion as to whether to charge and the level of the charge. This is important because after a brain injury most people are living at home, rather than in a nursing home, and it means that in these cases the local authorities have discretion each can decide for itself and can change policy from time to time. In Scotland, the UK s Fairer Charging Guidelines issued under Section 7 of the Local Authority Social Services Act 1970 do not apply. The Convention of Scottish Local Authorities issued a voluntary guideline in January 2006, which makes no mention of money derived from a personal injury and specifies those items of income and capital that can be excluded. This guidance is not binding on the local authorities and, as a consequence, the financial assessment approach differs from area to area. However, the prevailing practical approach by many local authorities is to include capital and income derived from a personal injury this means that, if a person has received an award of damages, they will have to pay the maximum charge for any care received. While this may seem beneficial to those having to counter the insurer s place that the local authority will pay for the care regime, it does leave the Pursuer in a difficult position if the settlement is a compromise one in relation to care. This will frequently happen in cases where the Claimant is partly responsible for the accident, e.g. for not wearing a seatbelt. The result for the Claimant is that damages awarded for pain and suffering are used to pay for care. The solution It is clear that all Pursuers with brain injury should seek to set up and manage their care regime privately and that the appointment of a case manager will invariably be necessary. For that reason, expert legal advice will give access to the needed rehabilitation services in the form of an experienced rehabilitation provider, with case managers who are members of BABICM or CMSUK and who have proven experience in managing nonresidential care regimes for those with a brain injury. It is important that the Pursuer gets advice from experienced specialist personal injury lawyers. 104

25 Legal issues Section 6 The Court of Protection and the Office of the Public Guardian The Court of Protection and the Office of the Public Guardian make decisions about property and welfare for those who lack capacity to do so. The Court of Protection and the Office of the Public Guardian were created under the Mental Health Capacity Act (the Act), which came into effect in England and Wales on 1 October 2007 (separate arrangements exist for Scotland and Northern Ireland). The Court of Protection The Court of Protection makes decisions in relation to the property, affairs, healthcare and personal welfare of adults (and children in a few cases), who lack capacity. The court also has the power to make declarations about whether someone has the capacity to make a particular decision. The Office of the Public Guardian The Office of the Public Guardian (OPG) is an agency of the Ministry of Justice. The OPG supports and promotes decision-making for those who lack capacity or who would like to plan for their future within the framework of the Act. The head of the OPG is the Public Guardian. The Public Guardian is responsible for: supervising deputies appointed by the court keeping registers of deputies, lasting power of attorneys (LPAs) and enduring power of attorneys (EPAs) investigating representations, including complaints about deputies and attorneys acting under registered LPAs or EPAs The Mental Health Act The Act provides a basis to empower people to make decisions for themself as far as is possible, and to protect vulnerable people who are not able to make their own decisions because of the way their brain is affected: for instance, from illness, injury, disability or substance misuse. It sets out options for people who want to plan ahead, enabling them to appoint someone they trust to make decisions if they should lack capacity at some time in the future, and it clearly sets out the law on advance decisions to refuse treatment. The Act also gives further protection to vulnerable people by making a criminal offence the ill-treatment or willful neglect of someone who lacks capacity. In addition, it provides protection for carers and professionals working with people who lack capacity, who comply with its provisions. The Brain Injury Handbook 105

26 The Code of Practice The Code of Practice (the Code) provides guidance on how the Act works on a day-today basis. It has case studies and explains in more detail the key features of the law. Certain categories of people have a legal duty to have regard to the Code, they include: professionals and anyone who is paid for the work they do in relation to people who lack capacity, e.g. doctors, nurses, social workers, case managers, solicitors, police officers, paramedics, carers and attorneys appointed under the LPA or an EPA deputies appointed by the Court of Protection Family, friends and unpaid carers do not have a duty to have regard to the Code but will find the guidance helpful. Deputies Some people may feel that an LPA is not for them. If this is the case, and the person then loses the capacity to make important decisions in the future because of the way their brain is affected, then a relative, friend or a professional may need to apply to the court to be given authority to make decisions on behalf of this person. What is an LPA? An LPA is a legal document that allows a person (the donor) to choose someone now (the attorney) that they trust to make decisions about things such as property and affairs, or personal welfare, for them at a time in the future when they lack the capacity to make those decisions. An LPA must be registered with the Office of the Public Guardian (OPG) before it can be used. LPAs replace the previous system of enduring power of attorneys (EPAs). An EPA made before October 2007 is still valid, and must also be registered with the OPG should the donor lose capacity in the future. However, an EPA allows a chosen attorney to only make decisions regarding financial affairs. If a donor would like to appoint someone to make decisions about their personal welfare should they lose capacity, they would need to make a personal welfare LPA. The court can appoint someone to make a single decision, or it may appoint someone known as a deputy to make a series of decisions. In this instance, whoever the court appoints might not be someone who the person would have chosen themselves. 106

27 Legal issues Section 6 Working with brain injured clients in the Court of Protection Richard Shearing, solicitor at Rix & Kay, talks about the connection with the Court of Protection and how his own work is linked to brain injury. At Rix & Kay we act for many clients with acquired brain injury who have received significant personal injury settlements. The majority of our clients in this position have deputies appointed by the Court of Protection to assist them with the management of their property and financial affairs. My role is to support the financial deputy for a number of clients with brain injuries. This is really fulfilling work as you are closely involved in the process of helping people to put their lives back on track after experiencing life-changing injuries. You get to know your clients really well and see them progress and flourish. I have set out a case study below by way of example. JF: JF was born with cerebral palsy as well as learning disabilities and was already in need of a great deal of support when she sustained her brain injury. At the time of her accident JF was living at home but attended a day centre run by a well known disability charity. She was left unsupervised using the toilet where she fell and hit her head sustaining a brain injury. This had a significant impact on JF s mobility and independence. JF received a significant compensation package from her Personal Injury case which has enabled us to provide comprehensive levels of care and therapies from outside sources. With the assistance of her financial deputy and her case manager, JF has made huge progress since the accident and has defied all expectations. She has ambitions to travel to America with the aim of going to Disneyland. JF grows more independent with every week that passes and we never cease to be amazed at her determination and resolve. We help JF to achieve her ambitions by providing the professional and personal support that she needs and encouragement at every stage. The Brain Injury Handbook 107

28 Tracs Acquired Brain Injury (ABI) Services Our Acquired Brain Injury services across England and Wales are person-centred and dedicated to providing specialist support to the complex needs of individuals with an Acquired Brain Injury. We understand that no two people and no two brain injuries are the same, therefore, we offer different pathways of personalised support to suit different needs. Individualised Support Pathways Tracscare can offer varied specialised brain injury support: Transitional (short or medium term) rehabilitation goal focused placements Short term community skill assessments/cognitive assessment placements Specialist emotional/behavioural support placements Slow stream rehabilitation Long term residential care Supported living tenancies Specialist outreach support in your own home Vocational support Respite placements We also have neuro-disability services to support individuals with conditions such as early onset dementia and Huntington s care. Therapeutic Support All therapeutic input is integrated into daily strategies or functional measured goals in line with the individual s aspirations. Progress for individuals on a rehabilitation pathway is monitored through recognised outcome measures and reviewed regularly by the multi-disciplinary team. Individuals are able to access the local Tracscare Positive Steps and Thinking ahead workshops, to develop their cognitive and social skills under the guidance of our Clinical Lead Nurses, in a friendly and supportive atmosphere. These groups use cognitively based therapeutic work, with the aim of providing a focus on executive, attention and memory skills and social functioning. Participants are encouraged to increase their levels of cognitive functioning whilst having fun and engaging in social interactions. We are able to support individuals who have: Traumatic brain injuries Stroke/ aneurysms Alcohol related brain injuries (including Korsakoff s syndrome) Brain injuries as a result of hypoxia, encephalitis, meningitis and tumours Physical and mobility needs Diabetes, epilepsy and PEG care Behavioural, psychological, emotional and forensic needs Cognitive and executive functioning difficulties (memory, attention skills, information processing, insight, social, problem solving & planning difficulties) Dual diagnosis with Mental Health or substance misuse For more information call , [email protected] or visit

29 Section 7 Useful contacts and resources Rehab Group contacts Momentum Momentum (Head Office), Glasgow Pavilion 7, Watermark Park, 325 Govan Rd, Glasgow, G51 2SE T: E: [email protected] W: Momentum Brain Injury Services Momentum Care, Blyth 101 Waterloo Rd, Blyth, Northumberland, NE24 1BY T: E: [email protected] Momentum Care, Glasgow Pavilion 7, Watermark Park, 325 Govan Rd, Glasgow, G51 2SE T: E: [email protected] Momentum Skills, Aberdeen South Wing, Migvie House, 23 North Silver St, Aberdeen, AB10 1RJ T: E: [email protected] Momentum Skills, Ayrshire Bank St, Irvine, KA12 0HL T: E: [email protected] The Brain Injury Handbook 109

30 Momentum Skills, Birmingham Borough Buildings, John Bright St, Birmingham, B1 1BN T: E: Momentum Skills, Glasgow 7th Floor, Tower 77, 77 Renfrew St, Glasgow, G2 3BZ T: E: Momentum Skills, Newcastle Forth Bank House, Skinnerburn Rd, Newcastle, NE1 3RH T: E: The Chaseley Trust The Chaseley Trust, Eastbourne South Cliff, Eastbourne, BN20 7JH T: E: W: Rehab Group Rehab Group (Head Office), Dublin Roslyn Park, Sandymount, Dublin 4, Ireland T: E: W: Momentum Skills, Scottish Borders Galabank House, Galabank Business Park, Galashiels, TD1 1PR T: E: Momentum Skills, South Lanarkshire Room F.01, CTEC Building, 1 15 Main St, Cambuslang, Glasgow, G72 7EX T: E: [email protected] 110

31 Useful contacts and resources Section 7 Other organisations Ability Net Central England IBM UK, Birmingham Rd, Warwick, CV34 5JL T: W: Assist UK Redbank House 4 St Chad s Street, Manchester, M8 8QA T: Helpline: E: [email protected] W: Action Against Medical Accidents (AvMA) Freedman House Christopher Wren Yard, 117 High Street, Croydon, CR0 1QG T: W: Brain and Spinal Injury Charity (BASIC) 554 Eccles New Rd, Salford, M5 5AP T: E: [email protected] W: Brain Injury Rehabilitation Trust (BIRT) 3 West Gate Court Silkwood Park, Wakefield, WF5 9TJ T: E: [email protected] W: Brain Tree Training (Cognitive Rehabilitation Services) PO Box 79, Leatherhead, Surrey, KT23 4YT T: E: [email protected] W: Brainwave Centre for Rehabilitation and Development (North-West) Unit 602, Birchwood One Business Park, Dewhurst Rd, Birchwood, Warrington, WA3 7PU T: E: [email protected] W: Brainwave Centre for Rehabilitation and Development (South-East) Beechen House, Rear of 16 Newland St, Witham, Essex, CM8 2AQ T: E: [email protected] W: Brainwave Centre for Rehabilitation and Development (South-West) Huntworth Gate, Bridgwater, Somerset, TA6 6LQ T: E: [email protected] W: The Brain Injury Handbook 111

32 British Brain and Spinal Foundation 336 Canterbury Court, Kennington Park, 1 3 Brixton Rd, London, SW9 6DE T: E: [email protected] W: British Institute for Brain Injured Children Knowle Hall, Bridgwater, Somerset, TA7 8PJ T: E: [email protected] W: British Psychological Society St Andrew s House, 48 Princess Rd East, Leicester, LE1 7DR T: E: [email protected] W: Carers Trust (Head Office) Loman St, London, SE1 0EH T: E: [email protected] W: Case Management Services 350A Lanark Rd West, Currie, Edinburgh, EH14 5RR T: E: [email protected] W: Cerebra The Foundation for the Brain Injured Child Freepost SWC 3360, Carmarthen, SA31 1ZY T: E: [email protected] W: Child Brain Injury Trust (CBIT) Unit 1, The Great Barn, Barnyards Green Farm, Oxfordshire, OX27 75G T: E: [email protected] W: Connect The Communication Disability Network Marshalsea Rd, London, SE1 1HL T: E: [email protected] W: Contact a Family City Rd, London, EC1V 1JN T: E: [email protected] W: Headlines Craniofacial Support 8 Footes Lane, Frampton Cotterell, Bristol, BS36 2JQ T: E: [email protected] W: 112

33 Useful contacts and resources Section 7 David Lewis Centre for Epilepsy Mill Lane, Warford, Alderley Edge, Cheshire, SK9 7UD T: W: Disabilities Trust 1st Floor, 32 Market Place, Burgess Hill, West Sussex, RH15 9NP T: E: [email protected] W: Disability Law Services 12 City Forum 250 City Road, London, EC1V 8AF T: E: [email protected] W: Disabled Living Foundation Ground Floor, Landmark House, Hammersmith Bridge Road, London, W6 9EJ T: E: [email protected] W: Disabled Persons Transport Advisory Committee 2/17 Great Minster House, 33 Horseferry Rd, London, SW1P 4DR T: E: [email protected] W: Employers Forum on Disability Nutmeg House, 60 Gainsford St, London, SE1 2NY T: E: [email protected] W: The Encephalitis Society The Encephalitis Resource Centre, 32 Castlegate, Malton, North Yorkshire, YO17 7DT T: W: Epilepsy Action New Ansty House, Gateway Drive, Yeadon, Leeds, LS19 7XY T: E: [email protected] W: Headway The Brain Injury Association Bradbury House, 190 Bagnall Rd, Old Basford, Nottinghamshire, NG6 8SF T: E: [email protected] W: Karten Network of CTEC Centres T: E: [email protected] W: The Brain Injury Handbook 113

34 Leonard Cheshire Head Office, 66 South Lambeth Rd, London, SW8 1RL T: E: W: Margaret Blackwood Housing Association Craigievar House, 77 Craigmount Brae, Edinburgh, EH12 8XF T: E: W: MENCAP 123 Golden Lane, London, EC1Y 0RT T: E: W: Meningitis Trust Head Office, Fern House, Bath Rd, Stroud, GL5 3TJ T: E: W: MIND Broadway, Stratford, London, E15 4BQ T: E: W: National Centre for Brain Injury Rehabilitation St Andrew s Healthcare, Billing Rd, Northampton, NN1 5DG T: E: [email protected] W: National Society for Epilepsy Chesham Lane, Chalfont St Peter, Bucks, SL9 0RJ T: W: Neuropsychologists UK 37 Montieth View, Dunblane, Stirling, FK15 0PD T: E: [email protected] W: NHS 24 (Scotland) T: W: NHS Direct T: W: Parent Partnership Scheme Parent Partnership Service, The Liz Yates Centre, The Poplars, Lightmoor, Telford, TF4 3QN T: E: [email protected] W: 114

35 Useful contacts and resources Section 7 Physically Handicapped and Able-bodied (PHAB) Summit House, 50 Wandle Rd, Croydon, Surrey, CR0 1DF T: E: [email protected] W: Queen Elizabeth s Foundation (QEF) Leatherhead Court, Woodlands Rd, Leatherhead, Surrey, KT22 0BN T: E: [email protected] W: RADAR Royal Association for Disability and Rehabilitation 12 City Forum, 250 City Rd, London, EC1V 8AF T: E: [email protected] W: Relate Premier House, Carolina Court, Lakeside, Doncaster, DN4 5RA T: W: Royal Society for the Prevention of Accidents RoSPA House, 28 Calthorpe Rd, Edgbaston, Birmingham, B15 1RP T: E: [email protected] W: Shaw Trust Shaw House, Epson Square, White Horse Business Park, Trowbridge, Wiltshire, BA14 0XJ T: W: Stroke Association Stroke House, 240 City Rd, London, EC1V 2PR T: W: TRU Transitional Rehabilitation Unit Ltd Margaret House, 342 Haydock Lane, Haydock, St Helen s, Merseyside, WA11 9UY T: W: The Brain Injury Handbook 115

36 Services There is a wide range of services available in the community, some specifically for those with a brain injury or other disability. Listed here are contact details of some national organisations that may be able to help with activities, counselling, day services, education, employment, housing, support groups and voluntary work. Additionally, there may be a variety of services specific to your area. Any public library should be able to provide information. Alternatively, you might wish to consult the Yellow Pages (ww.yell.co.uk). The Citizen s Advice Bureau and Social Services may also have some information. London Rehabilitation units Blackheath Brain Injury Rehabilitation Centre and Neurodisability Service Blackheath Hill, London, SE10 8AD T: E: [email protected] W: Homerton Regional Neurological Rehabilitation Unit (RNRU) Homerton Row, Hackney, London, E9 6SR T: W: Hugh Myddleton House Care Centre 25 Old Farm Avenue, Southgate, N14 5QR T: W: National Hospital for Neurology and Neurosurgery (University College London Hospitals NHS Foundation Trust) Queen Square, London, WC1N 3BQ T: W: Royal Hospital for Neurodisability West Hill, Putney, London, SW15 3SW T: W: Wellington Hospital Wellington Place, St John s Wood, London, NW8 9LE T: E: [email protected] W: Wilsmere House Care Centre Wilsmere Drive, Harrow Weald, HA3 6BJ T: W: 116

37 Useful contacts and resources Section 7 South-East Rehabilitation units Brain Injury Rehabilitation Trust (BIRT) 3 Westgate Court, Silkwood Park, Wakefield, WF5 9TJ T: W: Chalfont Lodge Care Centre Denham Lane, Chalfont St Peter, SL9 0QQ T: W: Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, KT18 6JW T: W: Disability Resource Team, Amersham General Hospital Amersham Hospital, Whielden St, Amersham, Bucks, HP7 0JD T: W: Donald Wilson House Rehabilitation Centre St Richard s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE T: W: Essex Rivers Healthcare NHS Trust Lexden Road, Colchester, Essex, CO3 3NB T: W: Friston House Care Home 414 City Way, Rochester, ME1 2BQ T: W: Haslemere Hospital, Godwin Unit Church Lane, Haslemere, Surrey, GU27 2BJ T: Holy Cross Hospital Haslemere, Surrey, GU27 1NQ T: E: [email protected] W: Huntercombe Hospital Holybourne Avenue, London, SW15 4JD T: E: [email protected] W: The Brain Injury Handbook 117

38 Luton and Dunstable Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 6DZ T: W: Medway Maritime Hospital Windmill Road, Gillingham, Kent, ME7 5NY T: / E: W: Northwick Park and St Mark s Hospital, Regional Rehabilitation Unit The North-West London Hospitals NHS Trust, Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ T: W: Partnerships in Care Kneesworth House Hospital, Bassingbourn-cum-Kneesworth, Royston, Herts, SG8 5JP T: W: Paternoster House Care Centre Paternoster Hill, Waltham Abbey, EN9 3JY T: W: Peartree House 8A Peartree Avenue, Bitterne, Southampton, Hampshire, SO19 7JP T: E: [email protected] W: Queen Alexandra Hospital The Queen Alexandra Hospital Home Boundary Road, Worthing, West Sussex, BN11 4LT T: E: [email protected] W: Queen Elizabeth s Foundation Brain Injury Centre QEF Neurorehabilitation Services, Banstead Place, Park Rd, Banstead, SM7 3EE T: E: [email protected] W: Raphael Medical Centre Hollanden Park, Coldharbour Lane, Hildenborough, Tonbridge, Kent, TN11 9LE T: E: [email protected] W: Rayners Hedge Neurological Centre Croft Rd, Aylesbury, HP21 7RD T: W: 118

39 Useful contacts and resources Section 7 Regard Partnership Units 1, 6, 7, Princeton Mews, London Road, Kingston upon Thames, Surrey, KT2 6PT T: / W: Rehab Without Walls 27 Presley Way, Milton Keynes, Buckinghamshire, MK8 0ES T: W: Robinia Care, Kent 351 Maidstone Road Gillingham, Kent, ME8 0HU T: W: Royal Berkshire Hospital, NHS Trust London Rd, Reading, RG1 5AN T: W: Royal Star and Garter Home Richmond Hill, Richmond, Surrey, TW10 6RR T: W: Snowdon Neurological Rehabilitation Unit Western Community Hospital, William Macleod Way, Hampshire, SO16 4XE T: W: Southampton Rehabilitation Unit Tremona Rd, Southampton, SO16 6YD T: W: Sussex Rehabilitation Centre, Brighton General Hospital Elm Grove, Brighton, BN2 3EX T: ext W: Royal Buckinghamshire Hospital Buckingham Rd, Aylesbury, Bucks, HP19 9AB T: E: [email protected] W: The Brain Injury Handbook 119

40 Titleworth Healthcare Titleworth One to One, 1 3 Adelaide Rd, Surbiton, Surrey, KT6 4TA T: E: [email protected] W: Winchester House Care Home 180 Wouldham Rd, Rochester, ME1 3TR T: W: South-West Rehabilitation units Alfred Morris House Rehabilitation Unit Taunton and Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA T: W: Alphinbrook Unit, Lucerne House Care Centre Chudleigh Road Alphington, Exeter, EX2 8TU T: W: Cornwall Stroke Service Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ T: W: Dorset Brain Injury Service, c/o Poole Hospital, NHS Trust Longfleet Rd, Poole, Dorset, BH15 2JB T: W: Frenchay Brain Injury Rehabilitation Centre Frenchay Park Rd, Bristol, BS16 1UU T: E: [email protected] W: Glenside Manor, Wiltshire Glenside, Warminster Rd, South Newton, Salisbury, Wiltshire, SP2 0QD T: E: [email protected] W: Kenwyn Care Home Newmills Lane, Truro, TR1 3EB T: W: 120

41 Useful contacts and resources Section 7 National Star College Ullenwood, Cheltenham, GL53 9QU T: W: Plymouth Neurorehabilitation Unit, Derriford Hospital Crownhill, Plymouth, Devon, PL6 8DH T: W: Quantock Unit, Weston General Hospital Grange Rd, Uphill, Weston-super-Mare, Somerset, BS23 4TQ T: W: Roborough House, Plymouth Tamerton Rd, Woolwell, Plymouth, PL6 7BQ T: E: [email protected] W: Royal Devon and Exeter Trust, Devon Barrack Rd, Exeter, EX2 5DW T: W: Salisbury Healthcare NHS Trust, Wiltshire Salisbury, Wiltshire, SP2 8BJ T: W: Waters Park House, Plymouth Exmouth Rd, Stoke, Plymouth, PL1 4QQ T: E: [email protected] W: West Abbey Care Centre Stourton Way, Yeovil, BA21 3UA T: W: Rosehill Rehabilitation Service, Torquay Lower Warberry Rd, Torquay, TQ1 1QY T: E: [email protected] W: The Brain Injury Handbook 121

42 West Midlands Rehabilitation units Cannock Chase Hospital Rehabilitation Day Unit Brunswick Rd, Cannock, WS11 5XY T: W: Cherry Trees Care Home Stratford Rd, Oversley Green, Alchester, B49 6LN T: W: Craegmoor Healthcare 21 Miller Court, Tewkesbury Business Park, Tewkesbury, GL20 8DN T: E: W: Evesham and Malvern Hills College (Evesham Campus) South Worcestershire College, Davies Rd, Evesham, Worcestershire, WR11 1LP T: W: Evesham and Malvern Hills College (Malvern Campus) South Worcestershire College, Albert Road North, Malvern, Worcestershire, WR14 27H T: W: Guardian Care The Guardian Care Centre, Longton Rd, Trentham, Stoke-on-Trent, ST4 8FF T: W: Huntercombe Hospital Ivestsey Bank, Wheaton Aston, Stafford, ST19 9QT T: E: W: Robinia Unit 7, Marchington Industrial Estate, Stubby Lane, Uttoxeter, ST14 8LP T: Royal Leamington Spa Rehabilitation Hospital Heathcote Lane, Heathcote, Warwick, CV34 6SR T: W: West Park Rehabilitation Hospital Park Road West, Wolverhampton, WV1 4PW T: W: 122

43 Useful contacts and resources Section 7 North-West Rehabilitation units Acquired Brain Injury Service for South Cheshire Acorn Suite,1829 Building, Countess of Chester Health Park, Liverpool Rd, Chester, CH2 1HJ T: W: Clatterbridge Hospital, Neurorehabilitation Unit Clatterbridge Rd, Bebington, Wirral, CH63 4JY T: W: Clifton Hospital Pershore Rd, Lytham St Anne s, Lancashire, FY8 1PB T: W: Floyd Unit, Birch Hill Hospital Rochdale, OL12 9QB T: W: Gisburne Park Hospital Park Rd, Gisburn, Lancashire, BB7 4HX T: W: Glaxo Neurological Centre Norton St, Liverpool, Merseyside, L3 8LR T: Highbank (Neurorehabilitation) Walmersley House, Walmersley Rd, Bury, Lancashire, BL9 5LX T: E: [email protected] W: Leonard Cheshire, Oakwood ABI Service Radford Close, Offerton, Stockport, Greater Manchester, SK2 5DL T: E: [email protected] W: N-Able Services 2 Power Rd, Bromborough, Wirral, Merseyside, CH62 3QT T: W: Northern Case Management Unit 13, Brenton Business Complex, Bond St, Bury, BL9 7BE T: E: [email protected] W: Ways to Work 2 Champness Hall, Drake St, Rochdale, Greater Manchester, OL16 1PB T: W: The Brain Injury Handbook 123

44 North-East NHS and NHS Trust rehabilitation units Neurorehabilitation Unit, Monkwearmouth Hospital Newcastle Rd, Sunderland, SR5 1NB T: W: Phoenix Unit, Uni Hospital of Hartlepool Holdforth Rd, Hartlepool, TS24 9AH T: W: Rehabilitation units Brain Injury Rehabilitation and Development (BIRD) The Old Coach House, Church Rd, Eccleston, Chester, CH4 9HT T: W: Huntercombe Centre (Sunderland) Leechmere Rd, Sunderland, Tyne and Wear, SR2 9DJ T: W: Huntercombe House (Stockton) 3 Norton Rd, Stockton-on-Tees, TS20 2BL T: W: Neural Pathways Design Works, Felling, Gateshead, Tyne and Wear, NE10 0JB T: E: [email protected] W: Robinia (North) Unit B, Moor Park Business Centre, Wakefield, West Yorkshire, WF2 8PF T: E: [email protected] Hawthorns Care Centre O Neill Drive, Peterlee, SR8 5UP T: W: 124

45 Useful contacts and resources Section 7 Yorkshire and Humberside Rehabilitation units Magnolia Lodge Younger Disabled Unit Tickhill Road Hospital, Doncaster and South Humber Healthcare NHS Trust, Doncaster, DN4 8QL T: National Demonstration Centre in Rehabilitation Community Rehabilitation Unit, St Mary s Hospital, Green Hill Rd, Leeds, LS12 3QE T: REACH 14 The Stables, Newby Hall, Ripon, North Yorkshire, HG4 5AE T: W: East Midlands Rehabilitation units London Rd Community Hospital Head Injury Team London Rd, Derby, DE1 2QY T: W: Grafton Manor Brain Injury Rehabilitation Unit Grafton Regis, Northampton, NN12 7SS T: E: [email protected] W: Leicester General Hospital Gwendolen Rd, Leicester, LE5 4PW T: W: Lincoln County Hospital Greetwell Rd, Lincoln, Lincolnshire, LN2 5QY T: W: Linden Lodge Rehabilitation Unit and Nottingham Traumatic Brain Injury Services, Nottingham City Hospital Nottingham University Hospital, City Hospital Campus, Mobility Centre, Hucknall Rd, Nottingham, NG5 1PJ T: W: Oakleaf Care Hilltop House, Ashton Rd, Hartwell, Northamptonshire, NN7 2EY T: E: [email protected] W: Richardson Partnership for Care The Richardson Mews, Kingstand Gardens, Kingsthorpe, Northampton, NN2 7BH T: E: [email protected] W: The Brain Injury Handbook 125

46 East Anglia Rehabilitation units Anglia Case Management Ticehurst Yard, Beyton Rd, Tostock, Bury St Edmonds, Suffolk, IP30 9PH T: E: W: Brain Injury Rehabilitation Trust (BIRT) 32 Market Place, Burgess Hill, West Sussex, RH15 9NP T: E: W: Lewin Rehabilitation Unit, Addenbrooke s Hospital Cambridge University Hospitals, Hills Rd, Cambridge, CB2 0QQ T: W: Livability, Brain Injury Rehabilitation Centre Chilton Way, Stowmarket, Suffolk, IP14 1SZ T: W: Meadow House, Norfolk Norwich Rd, Swaffham, Norfolk, PE37 8DD T: W: Norfolk and Norwich University Hospital NHS Trust Colney Lane, Norwich, Norfolk, NR4 7UY T: W: Oak Farm Physical Rehabilitation Unit 276 Fakenham Rd, Taverham, Norwich, NR8 6AD T: E: [email protected] W: Oliver Zangwill Centre for Neuropsychological Rehabilitation The Princess of Wales Hospital, Lynn Rd, Ely, Cambridgeshire, CB6 1DN T: E: [email protected] W: Papworth Trust Bernard Sunley Centre, Papworth Everard, Cambridge, CB23 3RG T: / E: [email protected] W: Northern Ireland Rehabilitation units Brain Injury Team, County Antrim T: W: 126

47 Useful contacts and resources Section 7 Scotland Rehabilitation units Aberdeen Brain Injury Grampian Group Chaplain s Office, Royal Aberdeen Children s Hospital, Westburn Rd, Aberdeen, AB25 2ZG T: E: [email protected] W: Central Scotland Brain Injury Rehabilitation Centre Huntercombe Services Murdostoun, Bonk, Newmains, Wishaw, ML2 9BY T: W: Centre for Brain Injury Rehabilitation, Royal Victoria Hospital Jedburgh Rd, Dundee, DD2 1SP T: W: Child Brain Injury Trust (CBIT) Norton Park, 57 Albion Road, Edinburgh, EH7 5QY T: E: [email protected] W: Community Treatment Centre for Brain Injury 70 Commercial Rd, Gorbals, Glasgow, G5 0QZ T: W: Edinburgh Headway Group Headway House, Astley Ainslie Hospital, Canaan Lane, Edinburgh, EH9 2HL T: E: [email protected] W: Fife Rehabilitation Service Cameron Hospital, Windygates, Fife, KY8 5RR T: W: Headway Ayrshire Beresford Court, Beresford Lane, Ayr, KA7 2DW T: / E: [email protected] W: Leonard Cheshire, Pinewood Acquired Brain Injury Service 3 St Andrew s Way, Livingston, EH9 2HL T: W: Scottish Brain Injury Rehabilitation Services Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL T: E: [email protected] W: Seven Arches Unit, South Grange Care Centre Grange Rd, Monifieth, DD5 4HT T: W: The Brain Injury Handbook 127

48 Wales Independent/other rehabilitation units Awel-y-Mor Care Centre Brynafon Rd, Gorseinon, Swansea, SA4 4YF T: W: Morriston Hospital Heol Maes Eglwys, Morriston, Swansea, SA6 6NL T: W: Welsh Spinal and Rehabilitation Unit, Rockwood Hospital Fairwater Rd, Cardiff, CF5 2YN T: W: 128

49 Useful contacts and resources Section 7 Brain injury specialists Behaviour/cognitive problems Brain Injury Rehabilitation Unit (BIRU) Edgware Community Hospital, Burnt Oak Broadway, Edgware, HA8 0AD T: W: Kemsley Unit, St Andrew s Healthcare Billing Rd, Northampton, NN1 5DG T: W: Robert Ferguson Unit, Royal Edinburgh Hospital Morningside Place, Edinburgh, EH10 5HF T: W: Sports/activity for the disabled Disability Snowsport UK Cairngorm Mountain, Aviemore, PH22 1RB T: W: Organises winter sporting activities and holidays in Scotland, Austria and the USA for people with disabilities. Duke of Edinburgh s Award Gulliver House, Madeira Walk, Windsor, Berkshire, SL4 1EU T: E: [email protected] W: Provides a programme of activities to develop young people aged between 14 and 24. Extend 2 Place Farm, Wheathampstead, Hertfordshire, AL4 8SB T: E: [email protected] W: Aims to improve the mobility of older people and mentally/physically disabled with movement to music. Head4Adventure T: E: [email protected] W: Providing outdoor activities and respite breaks for people with a brain injury across the UK. Jubilee Sailing Trust 12 Hazel Rd, Woolston, Southampton, SO19 7GA T: E: [email protected] W: Promotes integration of people of all physical abilities through the challenge of sailing tall ships on the open sea. London Sports Forum for Disabled People Unit 2B07, London South Bank University, Technopark, 90 London Road, London, SE1 6LN T: E: [email protected] W: Develops sport and recreation activities for disabled people. The Brain Injury Handbook 129

50 Discrimination Disability Law Service 12 City Forum, 250 City Road, London, EC1V 8AF T: E: W: Counselling Samaritans Chris, Freepost, RSRB-KKBY-CYJK, PO Box 9090, Stirling, FK8 2SA T: W: The Equality and Human Rights Commission (England) Fleetbank House, 2 6 Salisbury Square, London, EC4Y 8JX T: E: [email protected] W: The Equality and Human Rights Commission (Scotland) 151 West George Street, Glasgow, G2 2JJ T: E: [email protected] W: The Equality and Human Rights Commission (Wales) Ground Floor, 1 Caspian Point, Caspian Way, Cardiff Bay, CF10 4DQ T: E: [email protected] W: 130

51 Index to advertisers Index to advertisers Advertiser Page Advertiser Page 3L Care 74 Freeths 40 Adams Neuro Physiotherapy Ltd 46 Glebe House inside back cover Admiral Group Plc 18 Harris Fowler inside front cover AICS Group 63 AJ Case Management 97 Allied Neuro Therapy 22 Anthony Gold Solicitors 69 Asons 6 Bakers Personal Injury Solicitors 22 Beecham Peacock Solicitors 18 British Psychological Society 74 Carpenters Solicitors 6 Community Case Management Services Ltd 97 Complete Neuro Physio 32 Consensa Care ABI Ltd 69 Dame Hannah Rogers Trust 46 Helping Hands 40 hlw Keeble Hawson 63 Hobbs Rehabilitation 69 Homerton University Hospital - Specialist ABI Outreach Team 12 Huntercombe Group 26 Irwin Mitchell 54 Langley Wellington LLP 32 Leo Abse & Cohen Solicitors 47 Livability Icanho 22 Mercia Case Management 32 Milkwood Care Ltd - The Lodge at Castleford 33 Mistreatment.com 133 Danshell Group 54 Mistreatment.com back cover Digby Brown LLP 88 First ScotRail Limited 46 Motability 40 Neil Hudgell Solicitors 59 The Brain Injury Handbook 131

52 Index to advertisers Advertiser Page Advertiser Page Novero - Jubilee Court 47 Novero - Oak Court 63 Oakleaf Group 92 Optua UK (Avenues Group) 92 Thompsons Solicitors 4 Thorneycroft Solicitors 97 Tracscare Group Ltd 108 V P Forensic Ltd 33 PJ Care Ltd 74 Powell Spencer & Partners 18 Proactiv Rehabilitation & Reintegration Services 6 Prokare Ltd 93 Pryers Solicitors LLP 97 Queen Elizabeth Foundation 46 Rehab Options Ltd 63 St George Healthcare Group 37 Sussex Healthcare 41 Team Brain Injury Support 93 The Children s Trust

53 The Brain Injury Handbook 133

54 Notes 134

55 Notes Notes The Brain Injury Handbook 135

56 Notes 136

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