How is the National Rehabilitation Centre being developed?

The content that follows is provided by the NHS sponsor of the National Rehabilitation Centre (NRC) – Nottingham University Hospitals NHS Trust (NUH)

The programme to deliver the National Rehabilitation Centre (NRC) is being led by Nottingham University Hospitals Trust (NUH) and as such, NUH is the official NHS sponsor and is responsible for the programme of work. It is the ‘National’ element of the overall Defence and National Rehabilitation Centre (DNRC) Programme.  The ‘Defence’ element is complete and has been treating patients since autumn 2018 – and its full title is the ‘Defence Medical Rehabilitation Centre’ or DMRC.

How are we getting on?

Over the past 18 months, we have worked closely with professionals and patients who have experienced rehabilitation to harness the ideas that people have to make the most of the opportunity at the NRC.  

We have taken great care in developing our new clinical rehabilitation pathway which will transform how people will benefit from rehabilitation by proposing:

• The opportunity to benefit from rehabilitation is broadened out to a much wider group of people than at present. 
• Dramatically shortening the time people wait for rehabilitation.
• Delivering an intensive programme of rehabilitation early on in people’s recovery so that the impact is greatest and patients can more likely get back to work and life. 
• Ensuring that people go to the right place for rehabilitation across the East Midlands region (not everyone’s specific clinical needs will be suitable for the NRC).
• Making sure that patients are involved in the decision about where they go. 

We plan to complete the government business case process in early 2021 so that, subject to agreements, we can start the building work soon after that. The NRC will take two years to build and the target is for it to be treating patients in 2024. 

We have also recently appointed the academic leaders who will deliver training and education, research and innovation in the NRC. The clinical and academic services will be intrinsically linked so that the centre will accelerate the advances in rehabilitation medicine both in regard to clinical input but also with technology and engineering products. 

We are delighted that the academic partners with Nottingham University Hospitals are two local universities: The University of Nottingham and Loughborough University. Together – and working with a wider network of institutions across the UK – these universities will lead this important national activity.
 
We are at an exciting stage as we develop additional detail on the NRC and prepare to go out to public consultation.

The public consultation is a key part of the overall decision-making process and will build on the work we have already done with patients and the public in working up the clinical model.  Details for that are currently being developed by the Clinical Commissioning Groups (CCGs) which will lead the public consultation process.
  
More information on the public consultation will be added to this website (and widely publicised by the group running the consultation) in due course.

When launched, the public consultation will enable anyone who is interested in the proposals for the NRC to contribute their views. This is really important because it will ensure that we have captured as many ideas and opinions as possible in making the NRC the best it can be for patients in the East Midlands. The service will predominantly treat East Midlands patients but once we have proved the success for our new clinical model there is the opportunity to roll this out to the rest of the country.

How the N will be designed to follow the D

The NRC is part of a wider body of work which is being delivered by the DNRC Programme.

The Defence facility is now built and operating, treating Armed Forces patients who have sustained an injury from either training and exercise or in active service.  It has approximately 200 beds.  It has always been the intention that both centres will work closely together but important to note that patients will be treated at separate times if they are using equipment (eg pools) in the Defence facility.

The Defence facility is the catalyst for the NRC and it has always been envisaged that there will be a high degree of collaboration including some access to specialist facilities.  The exact nature of any sharing between the NHS and Defence Medical Services is being determined this year.

Some potential areas for physical sharing of facilities are outlined below but, more importantly, the skill and expertise in rehabilitation which resides within Defence medicine will also be shared - and expertise within the NHS will flow back in the other direction.  This will be done through a collaborative programme of research, training and education.  Collectively, this will improve knowledge and expertise.

There will be opportunities for staff to work alongside each other for the first time and share knowledge and expertise in their particular field.  This will contribute to pushing the speciality forwards in knowledge and in terms of the quality of outcomes it delivers for patients. 

The physical facilities which could be shared with patients with the appropriate clinical need, subject to the proper arrangements being put in place and under agreed terms with Defence Medical Services, are:
  • The diagnostic capability at the Defence facility - this includes X-ray, ultrasound and the MRI units.
  • Hydrotherapy pool - there is no routine access to a hydrotherapy pool at present for rehabilitation patients in the NHS.
  • The gait laboratory - this is cutting-edge technology and the longest gait laboratory in clinical use in Europe.  There are more cameras giving detailed images than any other facility, enabling clinicians to benefit from technical detail on muscle activity and gait patterns like never before.  Rehab programmes are changing already due to this enhanced level of information into the clinical teams. 
  • The virtual reality CAREN (Computer Aided Rehabilitation Environment) is one of only six in the world and the only one currently being used to treat patients.  Early use has shown significant benefits particularly in patients with a head injury on their balance system. 


Governance and key stakeholders

The NRC Programme is led by and has been set up by Nottingham University Hospitals NHS Trust (NUH) with key government departments, including the MoD, involved. The Programme Board meets every month and oversees progress of the project.

How would the NRC fit into the East Midlands NHS region?

Rehabilitation is an area of medicine which has not received the right amount of investment for a long period of time.  Consequently, there is a lack of rehabilitation resource in the East Midlands NHS region as in many other regions of the country.  This is common across England.

Sadly, at present, there are not enough rehabilitation beds to treat everyone who needs this type of specialist care.  Against current national standards there is a shortfall of 155 rehabilitation beds for the region.  This means that many patients do not get the benefit of rehabilitation and either take longer to recover than they need to or never recover fully enough to go back to life as usual or work.  The NRC will provide a further 64 beds.   

The region of the East Midlands spans the counties of Nottinghamshire, Derbyshire, Lincolnshire and Leicestershire.  The region and its hospitals are shown in the map below: 



Thew new centre will treat patients presenting with a wide range of illnesses and injuries which leave them in need of rehabilitation. 

There are specific and distinctive reasons why we know that people will require this type of specialist clinical rehabilittion.

Firstly, the East Midlands trauma region treats over 1,700 major trauma patients per year, most of whom will require some form of rehabilitation.  The NRC will cater for those who require specialist clinical rehabilitation before they can go home.  These are the most seriously injured patients from accidents including sporting accidents, road traffic accidents, farming accidents and urban crime.  The M1 and A1 motorways run through the region.

An illustration of the some of the sources of injuries in the Region is shown in the diagram below:



Secondly there are over 2,500 patients per year with neurological problems and lastly over 300 patients per year with complex musculoskeletal trauma, all of whom require rehabilitation.  There will be other patients who come from different causes of illness who also require rehabilitation and they are also included in the case.
 

New facilities could deliver better outcomes

The new pathway proposes to increase the number of beds and the scope of current rehabilitation services on offer.  There will be access to intense rehabilitation at the right time for patients and the opportunity to leave a hospital bed much sooner.  The development is part of looking at how the whole of the rehabilitation in the East Midlands is organised to make sure we are making best use of all facilities. 

With access to state-of-the-art facilities, quick transfer to rehabilitation and an intensive programme in the NRC, we are expecting people to recover their function more quickly and return more quickly to life and work.