Complex rehabilitation for acquired brain injury

Some people with an acquired brain injury may require intensive specialist rehabilitation outside of hospital following their hospital stay. This ensures that patients with an acquired brain injury can receive support to enable them to return to their maximum functional ability.

Where possible a person will leave hospital with support from NHS services and this will include therapy from the community Acquired Brain Injury Rehabilitation Service. In some cases, however, the level of therapy and support provided may be at a level which that service cannot provide and/or the person requires a placement in a specialist setting for a period of time in order to meet their rehabilitation goals.

Eligibility is for patients registered with a Dorset GP who have recently been admitted or are awaiting admission to an NHS England funded specialist rehabilitation unit. In exceptional cases, other applications may be considered on a case-by-case basis.

Complex rehabilitation can be provided in a local residential unit or an out of area specialist unit. Sometimes it can be provided in your own home. The location will be determined by your specific health and rehabilitation needs and how they can best be met. You and your family or other representative(s) will be involved in the care identified.

The care provided should be delivered in such a way that it provides:

Referrals will come from the Dorset Neurorehabilitation Service, with a recommendation from your consultant as to the level of rehabilitation, specifically the nature and frequency of therapy, that is appropriate for you, and the type of location where that may be best provided. Please note that members of the public cannot apply directly for complex rehabilitation.

As part of the referral, you will be asked to provide consent in order that NHS Dorset can share information with your family or representative.

If approved by NHS Dorset, funding and initial support is usually put in place for three months and is related to agreed rehabilitation objectives. Any ongoing funding after this will be dependent on an ongoing review of progress towards the rehabilitation goals. If you continue to have further rehabilitation needs that cannot be met by therapy provided by NHS community rehabilitation services assessment then funding will usually be extended until that position has been reached.

NHS Dorset will inform your consultant of the outcome of an application in writing. Where people are funded for complex rehabilitation, they will have a dedicated case manager who will support them with regards specific enquiries, be responsible for the ongoing review of progress towards rehabilitation and the review of rehabilitation goals, and the setting of any new ones as situations change. They will also work closely, where appropriate, with the care providers, social care colleagues, and housing.

NHS Dorset will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, NHS Dorset can also take other factors into account, such as the cost and value for money of different options.

It can take some time to source care, which is dependent on individual circumstances, the level of care required and the availability of care in the area in which you live. There is a national shortage of care workers across all health and care services which may impact on the availability and choice of care offered to you. Where the care needed is specialised, this is provided in a small number of facilities. This may mean that the most appropriate placement for you is outside of the immediate area. If you do require a placement outside of the immediate area, as your care is reviewed throughout your stay, it may be possible to transfer your care to a less specialist, and more local, setting as your rehabilitation progresses.

The care that NHS Dorset offers will always be determined as clinically safe. Due to the restricted availability of care, the option provided will be the best that NHS Dorset is able to offer. You always have the right to decline care and to source and fund an alternative yourself should you decide to do so.

Your review will be organised by your NHS complex rehabilitation case manager. They will complete an initial review with you and your representative within six weeks and will include the local authority and your carers. Follow up reviews will take place until the funding ceases. On discharge other available support will be considered, and if appropriate an application for continuing healthcare will be made.