Many groups of patients would benefit from rehabilitation management. We need an integrated workforce to care for them, say Allan Cole, Miriam Duffy, and Jane Dacre
We know that if you want to achieve the best health outcomes for patients who are recovering from a serious injury or disease in as short a timescale as possible, then it requires early and active intervention. The benefits are twofold: patients experience improvements in their quality of life, and society reaps the savings of the downstream costs that would have been accrued had they not intervened.
Rehabilitation medicine as a separate specialty in the UK was created in the 1980s to address this need. Trauma management and the acute treatment of many diseases has significantly improved during that time, with patients benefitting from significantly increased odds of survival from major trauma, as well as many diseases which had previously been resistant to treatment. This progress has increased the need for rehabilitation medicine, but in the UK the specialty has grown very little, with less than 200 rehabilitation medicine consultants currently in post. Proportionately, this is a small fraction of the numbers in comparable developed countries.1 Consequently, the specialty has had to focus almost exclusively on the pressing needs of neurorehabilitation patients.
In fact, many other groups of patients require rehabilitation management and would benefit from it. Spinal injury rehabilitation is provided by a number of highly skilled and effective units in the UK, but these are not large enough to provide a service for all of the people who would benefit. Patients recovering from musculoskeletal injury and disease, patients with cancer, and those recovering after prolonged stays in ITU require expertise in rehabilitation but many specialties provide rehabilitation in a fragmented and often inadequate manner. The covid 19 pandemic has now resulted in another large group of patients requiring rehabilitation and it has been observed that it has “exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services.”
All these different, fragmented rehabilitation services, however, which aim to reduce dependency and improve a person’s quality of life, have remarkably similar clinical principles, requiring the skills of a similar broad range of disciplines and professions. Coordination of the care and interventions requires a multidisciplinary team (MDT) approach similar to that used in cancer and other areas of clinical practice with multi-professional input. What we need is an integrated workforce specifically trained to provide rehabilitation services to realise the benefits of this care across all the areas of rehabilitation practice. In our opinion, this unified rehabilitation workforce will require a new training and education strategy. There are also great opportunities for academic development in the discipline of rehabilitation, involving engineering, healthcare, and social science, among others. Yet making all this happen will only be possible with the development of a comprehensive national rehabilitation strategy.
Recent developments can facilitate this change. Progress is being made towards the creation of a new facility, known as the National Rehabilitation Centre (NRC). The aim of the NRC is to provide a UK centre of excellence in rehabilitation, with an inpatient facility and national outreach. It is an opportunity to refocus on research, education, and training in rehabilitation, and to improve care.
The UK Defence Medical Services have world class expertise in the rehabilitation of its personnel. This was focused in Headley Court, a bespoke facility, which has now been transferred to a new site, Stanford Hall Rehabilitation Estate in the East Midlands, funded through charitable donation. The charity provided the land to build an NHS facility on the same site with the aim of encouraging the sharing of facilities. The government has supported the funding of this national facility, which is hoped to open in 2024.
With the advent of this opportunity and the pressing needs of patients, it is time to focus much more on rehabilitation in our healthcare system. The success we have had in treating serious disease and injury needs to be broadened so that the long term outcomes of independence, improved quality of life, and return to work are seen to be as important as cure and survival. The socioeconomic benefit to our society of supporting people to return to their former lives has been well established in the National Clinical Audit of Specialist Rehabilitation following major Injury (NCASRI). There’s no time to lose in rehabilitating rehabilitation medicine.
Allan Cole, clinical adviser, National Rehabilitation Centre Programme, Nottingham University Hospitals NHS Trust.
Competing interests: Employed by the NRC Programme through Nottingham University Hospitals NHS Trust.
Miriam Duffy, director of National Rehabilitation Centre Programme, Nottingham University Hospitals NHS Trust.
Competing interests: Employed by NUH NHS Trust as programme director for the NRC project
Jane Dacre, professor of medical education, UCL Medical School.
Competing interests: none.
References
Gutenbrunner C, Ward AB, Chamberlain MA. (Eds) The White Book of Physical & Rehabilitation Medicine in Europe. J Rehab Med 2007 41 (Suppl. 1).