Personal Views

Brain injury rehabilitation: jaw jaw not war war

BMJ 1996; 312 doi: (Published 06 April 1996) Cite this as: BMJ 1996;312:916
  1. A N Bamji

    In February 1995 Minerva expressed in the BMJ a widespread anxiety that a charity, Headway, was covering up the deficiencies of the NHS in brain injury rehabilitation. I outline here the attempted development of a brain injury rehabilitation unit in the old South East Thames Regional Health Authority—a development that seems appropriate and necessary.

    My theorem for new service development runs as follows:

    • ”If you wish to develop a new service, then I am afraid that the money will have to come out of some existing service” (director of public health, commissioning authority)

    • ”We cannot accept responsibility for funding a new service unless commissioning authorities are prepared to underwrite the development by agreeing to use it” (regional officer)

    • ”We cannot commit ourselves to funding a new service out of existing resources unless we have some evidence that it is effective” (manager, commissioning authority).

    Proof: Commissioners will not buy a new service until they can see what they are buying, but providers cannot provide it until commissioners put up the money, which they do not have. This is alternatively known as Catch 22.

    Corollary 1: He who chairs a working party must be prepared to become a non-person.

    Corollary 2: It is probably easier not to bother.

    In 1989 I was asked to chair a regional working party in brain injury rehabilitation. Our remit …

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