National quality standards for neuro rehabilitation in a community setting: Do they achieve their purpose?

Rationale: There is known variation in neuro-rehabilitation service provision, however, the extent of service variation and impact on people who experience an acquired brain injury (ABI) is not articulated in the literature. The aim of this study was to assess and determine the extent to which neuro-rehabilitation services in one part of the United Kingdom (UK) are meeting national quality standards. Method: A mixed method design, across five community neuro-rehabilitation providers and six districts in South London, comprised of ABI population incidence data, web-based surveys to determine compliance with the National Institute for Health and Care Excellence (NICE) Head Injury Quality Standard, and focus groups to understand the patient perspective of community neuro-rehabilitation service provision. Results: The population incidence of ABI amongst districts demonstrated differences between the datasets analyzed, resulting in an inability to determine whether service variation was based on population need. The web-based surveys revealed that five community neuro-rehabilitation providers have variations between the models of care provided, including clinical referral criteria, duration, intensity of therapy interventions, and overall cost per patient, which was correlated with workforce capacity and patient waiting times. Focus group discussion highlighted current key challenges of service restraints, disconnect between services and limited professional support, as well as improvement opportunities pertaining to access, flexible, local and timely health and social care services. Conclusion: This study indicates that despite the publication of the NICE Head Injury Quality Standard, there is variation in the local provision of community neuro-rehabilitation across six districts in South London. Each district partly meets the recommendations, highlighting variability in the model of care delivered, that impacts consumers/carers accessing quality neuro-rehabilitation services. A disconnect remains between evidence-based quality standards and implementation. No standardized ABI data set is available in the UK, which impacts planning for future clinical service delivery.