Against a backdrop of growing need for specialist brain injury beds to support rehabilitation, the further development of resource at St Andrew’s Healthcare is a welcome move. NR Times speaks with Dr Muthusamy Natarajan, Consultant Psychiatrist and Clinical Director for the Neuropsychiatry Service at St Andrew’s Healthcare, about the creation of a new brain injury ward to strengthen its existing pathway, as well as plans to use the provider’s expertise to create new levels of provision in ABI nationally.

As the creator of Kemsley, the UK’s first specialist neurobehavioural unit for brain injury patients, St Andrew’s Healthcare has been an esteemed name in brain injury care and rehabilitation for over 40 years.

Accepting patients from across the country into its Northampton hospital, St Andrew’s has a long-established pathway of rehabilitation, enabling people to rebuild lives and maximise independence even after the most serious of brain injuries.

And now, St Andrew’s is growing its provision even further, with the creation of a new dedicated ward for men with brain injury.

Church ward - opening in the Spring and accepting referrals now - becomes the fifth specialist ward within the male brain injury pathway, adding to the existing Rose, Tallis, Allitsen and Tavener wards. This will, in total, provide 69 male and 12 female inpatient beds on Elgar ward, which also feed into the hospital registered houses adjacent to the main campus.

As well as delivering vital additional beds with rehabilitation starting at the earliest stage, it also creates another step in the St Andrew’s brain injury pathway.

“This creates another layer to our pathway, as well as providing more beds - we know the demand that exists and that the wait for a bed for people nationally can be very long, and we want to help more patients wherever we can,” says Dr Muthusamy Natarajan.

“We are seeing pressure across every region for specialist neurobehavioural care, particularly for those people with complex co-occurring cognitive and physical health needs. Church will enable us to respond more quickly to the individual needs of people that are admitted.

It absolutely makes sense to open Church ward and the neuropsychiatry team are very excited about it. We have over four decades of experience in complex brain injury, and we have the expertise which is changing lives.”

The role of Church ward

“Church will enable us to triage people to the most suitable environment at the point of admission, when their needs are at their most complex.”

With the significant demand nationally for specialist brain injury beds, resource at St Andrew’s too is under great pressure.

There is a waiting list in place across St Andrew’s; Tallis acute admissions ward, as well as on Allitsen and Tavener wards which take patients as they move through the brain injury pathway.

“The waiting list can be long and last year we saw higher levels of referrals than we have done previously,” says Dr Natarajan.

“We know patients are waiting for suitable placements, which they can’t always find elsewhere, so we wanted to create more capacity at the beginning of the pathway to enable more admissions.

The creation of the ten bed Church ward will enable people with a complex ABI or TBI to secure a placement that they so badly need whilst adding a crucial additional step in the move between admission and rehabilitation.

Church, like Tallis, will be an admissions ward, and will support people with complex needs;

“Patients who have a high acuity with significant personal care needs or complex physical health can go to Tallis or Church - but in Tallis, we admit patients with more significant personal care needs where we need a lot more space to meet those needs.” says Dr Natarajan.

“Patients who, for example, need several members of staff to deliver personal care will still go to Tallis, but we will now also have a ward which can admit people with a complex brain injury, but who perhaps do not need this level of support.

“We want to achieve the best flow through our wards so that we can then look at patients going on to residential community settings. Those patients who move from Tallis to Church will get a different type of input, then hopefully they’ll be ready to move on to Allitsen or Tavener, and then into the community or residential care.

After supporting patients through the initial and more acute phase of their recovery on admission, rehabilitation becomes a priority as soon as possible into their time with St Andrew’s. With MDT-led rehabilitation, delivered through a neurobehavioural approach, the Charity is known for the quality of outcomes it achieves for patients.

“Some patients are with us on Tallis for 18 months or two years, which is a long time to be on one ward. But rehabilitation will start as soon as possible - once we have done the admission, assessment of needs and assessment of treatment, we’ll then look at a plan to enable the rehabilitation,” says Dr Natarajan.

“We’ll enable the transition through the pathway starting on Tallis and maintaining the continuity of higher care need for as long as that is required, but then moving on from there, focusing on things like enabling patients to engage in supported activities, regaining independence as much as possible, and looking at a move into the community.

“What we deliver is enabling patients to move on, and that is very important.”

The creation of Church ward is fully supported by St Andrew’s, with a number of existing staff members set to support patients on the new ward, as well as a number of new recruits.

“Sometimes with a service development change, people can be a little bit apprehensive - but when we talked about Church, everyone recognised that we needed this service and there was no hesitation,” says Dr Natarajan.

“It’s very positive, and we are delivering training ahead of opening so that every member of staff is able to work to the same neurobehavioural principles. This gives us a common language and aligns goals for our neuropsychiatry team across the service. As Clinical Director, I’m very encouraged.”

Ongoing development of brain injury care

Acutely aware of the demand that exists on a national basis, St Andrew’s is keen to support patients on as wide a scale as possible.

While patients from across the country have been admitted to its Northampton site for the past 40 years - with the network of support also extending to their families - the provider is looking at ways to use its expertise to best effect.

With a focus on enabling independence for people at the end of the brain injury pathway, St Andrew’s is looking at ways it can deliver more support in the community.

“We can only create a certain amount of inpatient beds, so we want to look at patients being enabled and supported in their own homes,” says Dr Natarajan.

“We want to look at what care closer to home looks like. Our Brain Injury unit is a national inpatient service so our expertise is based here in Northampton, but as we look to expand our offering, realistically we can’t just reach out into 20 places across the country and expect the same level of expertise there straight away.

“It’s very important to consider this in the future when modelling care delivery, and when assessing what the need is for step-down services. Demand is there in a fairly uniform pattern across the country, so in the future, we will be looking at in-home packages and outreach models.

“I think this is something that is very much needed, rather than necessarily looking at how we can increase inpatient capacity. We will have 81 patients (male and female) in our service at St Andrew’s; we would like to be able to look at community provision for those patients and how we might also partner with the wider system and stakeholders.”

Support for other neurological conditions, including the growing focus on Functional Neurological Disorder (FND) within neurorehabilitation, is also being looked at.

“We are looking at a possible clinic option. Of course, FND is a potential inpatient service delivery, but our focus is on non-bed services for this activity,” says Dr Natarajan.

“We want to make sure we are in several spaces, not just inpatient, and non-bed services are a very important way of us being able to achieve this.

“It is very exciting for us to be able to look at options like this, which will be in addition to developing our core services, but will also allow us to expand into new areas of provision.

“We are mindful of the scale of demand and the need that exists - and we hope to find ways of using our expertise to help support this.”

To find out more visit Neuropsychiatry services - brain injury » St Andrew's Healthcare (stah.org) or to discuss a referral into Church or one of St Andrew’s other brain injury wards please speak to Kenny Ajayi in the Admissions team on 01604 872 754.