The challenges facing the UK's neurorehabilitation charity sector 

This summer has sadly seen the closure of another brain injury charity group. Despite many efforts of supporting bodies and individuals, this group is one of many impacted by the lack of funding available in the sector.

Many small but highly valued services such as these were never truly able to recover from the COVID closures, which left them in a precarious position to try and climb the mountain of challenges that the charitable sector as a whole is facing. 

The landscape of the charitable sector in the UK currently is marked by a series of formidable challenges that have prompted a wave of closures among charitable organisations.

Whilst the UK is widely regarded as one the biggest donors to charity in the world, and have a formidable reputation when it comes to public fundraising, the smaller charities quite simply cannot keep up.

With a heavy reliance on public funding, the knock-on impact of the cost of living crises couples with never ending budget cuts have had a disastrous impact. The herculean efforts of those employed in the sector are simply not enough.

The resultant closure of these specialised brain injury services further pushes individuals living with complex issues further away from rehabilitative services and into heavier reliance on public funds. 

Economic uncertainty

The persistent clouds of economic uncertainty have cast a shadow over the fundraising efforts of charities, creating obstacles in securing essential financial support. Long gone are the days of hearing the heavily coined shake of the charity bucket in the street.

The extra change being dropped into the not so discretely placed bucket on the bar or at the end of the supermarket checkout is a rare sight, quite simply due to the move to a more cashless society.

Even for those with the coins in their pocket, it’s no surprise that many opt to save them for themselves whilst purse strings are being squeezed even further. 

These extra £50 filled buckets repeated over the year that are now lacking, has a considerable negative financial impact. Card readers, yes, but at a cost and with fees. 

Decreased consumer spending, coupled with an unpredictable financial climate, has led to a reduction in donations and sponsorships, making it arduous for charities to sustain their operations and meet their fundraising targets effectively.

Legacy donations have dwindled and even the larger corporate budgets which in the past have funded larger “charity bashes” that would often being a main income source for the year have faltered. Reduced budgets for specialist fundraising staff result in an ‘all hands on deck’ approach but the skilled bid and grant writers approaches are where the differences are made.

Classic chicken and egg of course, when it can take two years to break even on such an investment, in a struggling charity with more immediate needs, such roles have to take a back seat. 

Many of these specialist services are self funded by the members, not always via personal payment budgets which may not meet the costs, resulting in individuals having to top up to meet their needs. Added to a cost of living crises, especially in an inner city setting, once again the finances fail to meet the needs. Private funding via medico-legal claims increase affordability, but often in these cases, the specialist need cannot be met in these settings and one to one input is favoured. 

Of course, the largest impact in this sector has come from the lack of statutory funding available to support placements to specialist providers.

Too often a social worker assessment results in a recommendation to a day service setting that does not meet the specialist needs of those individuals living with brain injury. Is it cheaper? A little, not always.

The cognitive, emotional and psychological needs require a trained and competent staff with an understanding of the impact of a brain injury, which are (not through lack of desire) met in the ‘standard’ day provision.

A lifeline for many individuals with complex needs and disabilities, but not suitable for many of our clients.  Community support worker provision that is often provided by these charity groups rarely even breaks even, especially when a base is covering a wide geographical area. 

Initiatives in the neurorehabilitation sector to improve the understanding of brain injury needs within the social work sector is making changes for the better, but where funding is not available the alternatives are still favoured and recommended.

The frustration of having to convince commissioners of the need for funding for brain injury provision is felt throughout the services, I saw a recent assessment budget of community support for a complex brain injured individual agreed at just over £13 an hour.

A recent increase in brain injury service day provision cost in one borough was rejected despite there being no uplift of fees for over a decade. A small uplift in another to ensure services could continue in the community was rejected. In another local authority there are payments outstanding and still not forthcoming. 

Never the same person to speak to, commissioner and CEO relationships lacking due to staffing changes, lack of awareness of brain injury needs and a pulled budget isn’t quite the recipe for a positive outcome.

The resultant pressure on these small charities is simply not sustainable. 

Compliance and Regulatory Hurdles

The charitable sector is grappling with a number of regulatory changes and compliance demands, adding layers of complexity to organisational governance.

Navigating through the intricate web of regulatory frameworks requires significant resources and expertise, posing challenges for charities in maintaining compliance while striving to fulfil their missions.

Costs of compliance and regulatory requirements alone can push a charity further into financial difficulty, despite the availability of some grants which can take considerable skill and time to obtain.

Once again, the specialist understanding required in the neuro rehab sector requires more expensive staff to take on the complex governance issues, deliver a specialist service and evidence positive outcomes for further funding. 

Competition, Differentiation, and Strategic Positioning

Despite the challenges and high level of closures of charities, the increased growth of charitable organisations can lead to heightened competition and overcrowding, making it challenging for individual charities to differentiate themselves and carve out a distinct identity, particularly in the neurorehabilitation sector.

Arguably it should be the more the merrier, as there are so many people in need, but conversely the thinner the donations and funding. 

Strategic positioning, effective communication, and innovative approaches are imperative for charities to stand out amidst a sea of similar causes and missions, capturing the attention and support of potential donors and stakeholders.

Where does the funding come for these skilled and neuro experienced strategists? Trustees hold a large responsibility in this area, and a wide range of experience and expertise is always a necessity, but as a voluntary role, is not always available consistently or on a large enough scale for the smaller charities. 

As charities navigate the multiple challenges of the current landscape, resilience, adaptability, and collaboration emerge as key pillars for sustainable growth and impact. The funding and budgets provided must provide a solid foundation for these pillars.

Sadly, it is currently rather rocky footing and the risk of further closures looms large. 

Natalie Mackenzie is Director of BIS Services www.thebiss.co.uk and also provides group services as The Brain Injury Therapist. She sits on the board of Headway SELNWK and the committee of Kent Acquired Brain Injury Forum.