The Cost of Brain Injury – Legal Perspective BIRT Seminar “ Counting the costs of brain injury rehabilitation – the benefits of neurobehavioural rehabilitation” Coed –Y- Mwster Hotel – 13 th November 2013 Prepared by Andrew Harding

September 2013 – BBC/Prof Rodger Wood “Wales does not have the services to deal with the growing number of people suffering disabilities caused by head traumas” Rehabilitation Units for patients after they leave hospital can save millions every year in care costs but the provision (in Wales) is not there. “Year on year the number of people is growing and the level of services for them is still very very poor.”

Welsh Government Spokesperson “ We recognise that many individuals who suffer a traumatic brain injury need effective coordinated care to deal with both the physical and psychological effects” Work is ongoing to improve their care through the development of a delivery plan for neurological conditions and the implementation of the recommendations of a Welsh Adult Neuroscience review by local health boards

Funding Two tier system Health/social services – who pays? Personal health budgets (in Wales) Independent user trusts 3 rd party contracts

Funding Governance/Control Flexibility Trust Board members as Trustee Employment Appropriate care standards registered No private top up (difficulty enforcing in England when direct payments under personal health budgets)

The Care Bill Implementation begins 2015 Major reforms start April 2016 ? Apply to Wales Eligibility criteria – current LA resources to be taken into account. Low, moderate, substantial or critical needs Variations across the country - concern

The Care Bill – National Eligibility Criteria Proposed: An adult needs meet the eligibility criteria if those needs are due to physical or mental impairment or illness and the effect is that the adult: a) Cannot carry out one or more basic personal care activities leading to significant risk to well being b) Cannot carry out one or more basic household activities leading to significant risk to wellbeing

c) Unable to carry out caring responsibilities for a child d) Needs support to maintain family or other personal relationships leading to significant impact upon wellbeing e) Unable to access and engage in work, training, education or voluntary work leading to significant risk to wellbeing f) Unable to access necessary facilities or services in the local community leading to significant risk to wellbeing Interpretation of “significant” Likely still that resources will be taken into account

Damages Cases – Post Settlement Double recovery Full/partial recovery of damages Partial recovery – statutory funding provides a base upon which to build necessary care packages? LA – compensation relieves them of statutory duty and should be included in means testing

Peters –v- East Midlands Health Authority 2009 Undertakings No duty on case manager or deputy to seek full public funding so as to achieve double recovery If partial recovery should we expect deputy or case manager to seeking funding – suggested so

Out of Area (Nation) Funding Tadworth Court (children) Putney Walton Bath BIRT Collumpton Stoke Mandeville Units/Beds/Resources in Wales

Case Studies – Miss W Injury 2006 – Brain stem/spinal cord Rehab out of country 2007/8 Extent of rehab and approach to care LHB – would not consider any “innovative” funding approaches Almost impossible to fund care & rehab/maintenance package within her partial recovery settlement

Case Studies – Miss P Injured at birth – CP now 19 Partial recovery of damages Was provided for through education Transition to adult services Fulfils continuing health care criteria Existing privately employed team Attends college 3 rd party contract LHB initially resistant but now fully engaged

Case Studies – Miss R Injured car accident aged 18 some 7 years ago Severe traumatic brain injury Cognitive deficits across the range. Speech and gait problems. Memory (short term) issues Rehab Morriston – partial. No bed availability Rookwood BIRT Collumpton Parental resistance Lives alone with support in own home Volunteers, useful life with quality