Dr Krystyna Walton
President, British Society of Rehabilitation Medicine
Rehabilitation services make a real difference to the lives of patients and generate NHS cost-savings, says Dr Krystyna Walton, President, British Society of Rehabilitation Medicine.
For any society, rehabilitation services are not simply a ‘nice to have’. They are absolutely vital because of the contribution they make to the quality of the lives of patients and their families. Rehabilitation following an acute event, or deterioration in an existing condition, is an essential component of the journey for that person from being a ‘patient’ to being a ‘person’.
Imagine if no rehabilitation was available after major surgery or injury, or a traumatic health event such as a brain haemorrhage. Without the support of expert rehabilitation teams, patients may not be able to return to the lives they led before, go back to work, fulfil their parenting or other relationship responsibilities, or generally optimise their health outcomes.
And while it’s true that people who have suffered severe brain injuries may never be able to achieve any level of autonomy or independence, specialised rehabilitation can ensure their quality of life is the best it can be. It means they can be cared for in a non-hospital environment, that all their medical needs are met and that their families are well-supported, too.
Recognising and overcoming the barriers to rehabilitation
Effective rehabilitation does not come from a single source. Instead, it is powered by teamwork from, for example, occupational therapists, physiotherapists, psychologists and other practitioners who have an understanding of the medications and treatments that will enhance an individual’s rehabilitation — and those that won’t.
But this type of specialism requires funding and, while some local areas have good rehabilitation service provision, others do not. For instance, The National Clinical Audit for Specialist Rehabilitation following Major Injury (NCASRI) found that only 40% of individuals in Major Trauma Centres (MTCs) receive specialist in-patient neurorehabilitation. It also highlighted a shortfall of 330 beds, and a lack of health professionals, including consultants in rehabilitation medicine.
It’s a variable picture. I’m fortunate to work in a very pro-rehabilitation environment; although I’m aware of colleagues who do not. They have to deal with low staffing levels, a reduced-skills mix and a nagging feeling that their contribution to patient care is being undervalued. Funding issues within the National Health Service can also make it difficult to access rehabilitation-enhancing technology.
Positive developments and cause for optimism
Dealing with these challenges is a complex task in the NHS, where there is no unified commissioning across the whole of the patient pathway and where different Clinical Commissioning Groups have different priorities for community provision.
That said, positive developments give cause for optimism in the area of trauma rehabilitation. For example, the Getting it Right First Time (GIRFT) Project, led by NHS England, recently ran a workshop on aspects of rehabilitation. The British Society of Rehabilitation Medicine is still continuing to drive the major trauma rehabilitation agenda and, thanks to a programme of Major Trauma Centre peer review panels, there are standards that MTCs have to meet.
As NCASRI revealed, there is robust evidence to suggest that rehabilitation doesn’t just make a difference to individuals. Used well, it can make a difference to the economy in terms of cost savings to the NHS, too.
It’s another reason why we should cherish and champion our rehabilitation services.