Dear

Mr Bryant,

We are writing to you in your role as head of the All Party Parliamentary Group
for Brain Injury. We are a team of clinicians and scientists, working with
traumatic brain injured patients in North West London.

Brain injury is common and has the potential to be utterly devastating. There are
almost twice as many hospital admissions per year for brain injury as for heart
attacks 1-2. Traumatic brain injury, a major cause of disability in the young, is a
particularly pressing public health problem.

Traumatic brain injury survivors often have a range of long term consequences.
These include major cognitive, psychiatric and physical disabilities, which are
life-changing3. The personal cost is huge. Many patients are unable to continue
to work or study, and relationship breakdown is common.

The cost to society is even higher. Over half of those who have a traumatic brain
injury are of working age, meaning that any burden of disability has widespread
and severe effects4, as people lose the ability to provide for their families and
companies lose valuable employees. A conservative estimate is that 5 billion is
lost each year due to on-going care costs and loss of economic productivity5.

Yet, for such a common problem, with such a high personal and societal
impact, our current care provision is simply inadequate. We can, and
should, do so much better.

A patient having a heart attack has seamless care from the hospital into the
community. There are national guidelines and service frameworks which specify
gold standards of care for once patients leave hospital.

A similar framework is needed for traumatic brain injury patients. Patients now
receive excellent hospital care, in specialist major trauma centres. Life-saving
treatments are delivered by highly skilled clinical teams. However, there is a
huge drop-off in their care once they leave hospital. Very limited rehabilitation
services are available, there is high geographical variation in availability, and the
pathway to finding and accessing any available services is obtuse and tortuous.
People struggle on their own, often failing to cope and losing jobs, university
places, homes and personal relationships. Many of these issues were identified
sixteen years ago in the Health Select Committee's Third Report Head Injury:
Rehabilitation (Session 2000-01, HC307O) but progress remains stubbornly
slow.

There is an assumption that patients who can walk out of hospital are fully
recovered. This is often not the case. Their hidden disability is real, but
often masked by their apparent physical recovery.

We know that intensive rehabilitation can be of real benefit6. But there are no
coordinated systems in place to ensure that every survivor has access to
specialist post-hospital care. Over the last decade, survival rates from traumatic
brain injury have increased. However, the long-term care that is available for
traumatic brain injury survivors remains inadequate. These patients are as
capable of rehabilitation and regaining of function as any other neurological
condition.

We have got much better at saving lives, but not much better at restoring
lives.

We need a network of rehabilitation centres, led by traumatic brain injury
specialists. This could be delivered through a national framework, which sets the
standard for post-hospital care in traumatic brain injury.

The cruel nature of brain injury is that traumatic brain injury patients, with their
cognitive and psychological difficulties, are often the least able to advocate for
themselves. We hope that you will be the advocate for them, at the time when
they need it the most.

Yours sincerely,

Professor David Sharp MRCP PhD (Consultant Neurologist & NIHR Professor, Imperial
College London)
Dr Tony Goldstone MRCP PhD (Consultant Endocrinologist & Senior Clinical Research
Fellow, Imperial College London)
Dr Lucia M. Li MBBChir MRCP (Neurology Registrar & Clinical Research Fellow, Imperial
College London)
Professor Narinder Kapur (Visiting Professor of Neuropsychology, UCL)
Mr Daniel Friedland MA Clinical Psychology (Consultant Clinical
Psychologist/Neuropsychologist, St Marys Hospital Traumatic Brain Injury Clinic)
Dr Ines Violante PhD (Lecturer, University of Surrey)
Dr Sara de Simoni PhD (Research Scientist, Imperial College London)
Dr Neil Graham MBBS MRCP (Neurology Registrar & Clinical Research Fellow, Imperial
College London)
Mr Karl Zimmerman MRS (PhD Candidate, Imperial College London)
Ms Emma-Jane Mallas MSc (PhD Candidate, Imperial College London)
Dr Maria Yanez Lopez PhD (Research Scientist, Imperial College London)
Ms Amy Jolly MSc (PhD Candidate, Imperial College London)
Dr Peter Jenkins MBBS MRCP (Neurology Registrar & Clinical Research Fellow, St Georges
Hospital London)
Dr Gregory Scott MRCP PhD (Neurology Registrar & Clinical Research Fellow, Imperial
College London)
Dr Nikos Gorgoraptis MRCP PhD (Neurology Registrar & Clinical Research Fellow, Imperial
College London

1 : British Heart Foundation Cardiovascular Disease Statistics 2014
2: https://www.headway.org.uk/about-brain-injury/further-information/statistics/
3: Whitnall L, McMillan TM, Murray GD, Teasdale GM. Disability in young people and adults after head
injury: 5-7 year follow up of a prospective cohort study. J Neurol Neurosurg Psychiatry. 2006;77(5):640-5.
4: Faul M, Xu L, Wald M, Coronado V (2010) Traumatic Brain Injury in the United States: Emergency
Department Visits, Hospitalizations and Deaths 20022006. In: Centers for Disease Control and Prevention,
editor. Atlanta (GA).
5: Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, et al. Cost of disorders of the brain in
Europe 2010. Eur Neuropsychopharmacol. 2011;21(10):718-79.
6: Malec JF and Kean J. Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National
Outcome Info Database. Journal of Neurotrauma 2016; 33: 1371-1379