After being treated for a brain injury in hospital, many people may continue to need ongoing support and care. This will be provided by either health or social care services (or both), depending on the support requirements.
Commissioning of health and social care services
Across the UK, the following bodies are responsible for the commissioning of health and social care services.
England – Integrated Care Boards (ICBs) are responsible for commissioning healthcare services. ICBs are relatively new and replaced Clinical Commissioning Groups (CCGs) in 2022. Local authorities are responsible for commissioning social care.
Scotland - Health and Social Care Partnerships (HSCPs) jointly run by the NHS and local authorities commission adult social care, adult primary care and unscheduled adult hospital care, NHS Boards are responsible for commissioning all other health services. Please note that in Highland, all adult health and social care is commissioned by NHS Highland.
Wales - Local Health Boards are responsible for commissioning healthcare services. Local authorities are responsible for commissioning social care.
Northern Ireland – The Strategic Planning and Performance Group of the Department of Health is responsible for commissioning both health and social care services, which are then addressed by Local Commissioning Groups.
Channel Islands – the States of Jersey and States of Guernsey Health and Social Care Departments are responsible for commissioning health and social care services.
Isle of Man – the Department of Health and Social Care is responsible for commissioning health and social care services.
Assessment and funding of care
Funding healthcare
If the brain injury survivor’s main care needs are primarily health related, then they could be eligible for NHS continuing healthcare. This will cover the cost of care needs that the survivor has such as health needs, personal care needs or care home fees.
A team of healthcare professionals will first use a checklist to initially assess whether the survivor is eligible for the full assessment for NHS continuing care. A decision about eligibility for the full assessment should be made within 28 days.
Assessment process
The survivor's needs will next be assessed by a team of healthcare professionals to see whether they classify as having a "primary health need". Whether or not someone has a primary health need is assessed by looking at all their care needs and relating them to:
what help is needed;
how complex these needs are;
how intense or severe these needs can be;
how unpredictable they are, including any risks to the person's health if the right care isn't provided at the right time.
It is important to note that the need for care from a registered nurse alone is not sufficient reason for the provision of 100% NHS funded Continuing Health Care.
The team's assessment will consider the survivor's needs under the following headings:
behaviour
cognition
communication
psychological/emotional needs
mobility
nutrition (food and drink)
continence
skin (including wounds and ulcers)
breathing
symptom control through drug therapies and medication
altered states of consciousness
other significant needs.
These needs are then given a weighting, marked "priority", "severe", "high", "moderate", "low" or "no needs".
If the survivor has at least one priority need, or severe needs in at least two areas, they should be eligible for NHS continuing healthcare. They may also be eligible if they have a severe need in one area plus a number of other high needs, depending on their nature, intensity, complexity or unpredictability.
For further information on how the survivor's level of need in particular areas will be measured, you can read through the ‘Decision support tool for NHS continuing healthcare’, which is the document used to make these decisions.
Further information and guidance on the assessment process for NHS continuing healthcare is available on the NHS website.
For independent advice on NHS continuing healthcare assessments, contact Beacon’s free helpline.
Outcomes
Being eligible for NHS continuing healthcare
If someone is found to be eligible for NHS continuing healthcare, their budget may be managed directly by the NHS on the person’s behalf. In this case, the NHS team and brain injury survivor (or their representative) will discuss what the care and support needs are, what budget is available and how this will be spent. This will then be set out in a document called a care and support plan.
The plan will include the type of care to be provided based on the survivor’s needs and whereabouts it will be provided (i.e. in a rehabilitation unit, in a nursing/residential care setting, at home, etc). The survivor and their carer/family will be included in these discussions and should have the opportunity to share their views and preferences.
Once set up, the care package will be regularly reviewed to see if it needs to be changed, for instance if the survivor’s needs have changed over time.
Through their NHS continuing healthcare package, the survivor might be given the option of having a personal health budget. This is where they will receive funding from the NHS for their healthcare, but they can choose what treatment, equipment and care to spend it on (known as a direct payment).
If someone has some health needs, but they are not eligible for NHS continuing healthcare, they might receive a ‘joint care package’, which is partly funded by the NHS and partly funded by the local council.
Not being eligible for NHS continuing healthcare
If someone is considered to not be eligible for NHS continuing healthcare, but is assessed as requiring nursing care in a registered care home, they will be eligible for NHS funded nursing care.
If someone is found to not be eligible for any NHS continuing care, they will be directed to their local council who might be able to provide support. Eligibility for local council funding will depend on how much the survivor has in savings and whether they own their own property.
People also have the option to fund and arrange for their own healthcare. It is helpful to try, where possible, to find brain injury specialist healthcare professionals such as neuro-physiotherapists, neuropsychologists or speech and language therapists with experience in neurological conditions/brain injury.
Money Helper is a service that can also offer free guidance on this issue.
Funding social care
Social care includes support for things such as cleaning, personal care, meals on wheels or the provision of specialist equipment. A brain injury survivor might be able to have this arranged or funded by their local council. They will first need to undergo a free needs assessment, through which the council will identify whether they need support and if so what kind.
If the local authority considers that adaptations to the home are necessary to meet the survivor’s needs, and that the work is reasonable and practical, then a means-tested Disabled Facilities Grant (DFG) should be available to help to meet the costs. This is available in all parts of the UK except Scotland, so Scottish residents should consult their local authority for information on any grants that are available.
If there has been no provision of social care, you can purchase social care services, including home (domiciliary) care, from independent providers. It is important to remember to try, wherever possible, to utilise services with some knowledge and experience of working with clients who have had a brain injury. You can search for care services from the following:
• The Care Quality Commission (CQC) has a search directory of care providers in England and inspection reports for each service.
• The Care Inspectorate in Scotland and Care Inspectorate Wales in Wales inspect the quality of care and support improvements where needed.
• A comprehensive list of homecare providers, committed to the United Kingdom Homecare Association (UKHCA) Code of Practice.
• Social services departments may be able to provide a list of their approved organisations in your area.
• The Community Care website offers information on social care services.
• Another directory to search for home care, nursing care and live in care providers is available at Homecare’s website.
Challenging an assessment decision
If you disagree with a decision made during an assessment, make sure you obtain a copy of it and the reasons why the help cannot be offered. You are able to challenge healthcare commissioners or the local authority, in writing, using their complaints procedure.
The organisations listed on this page are provided for information purposes only. Their inclusion does not imply endorsement, recommendation, or approval by Headway. Users should make their own assessment of any organisation or service before engaging with them.
