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 National Rehabilitation Centre (NRC) opportunity is being developed through the new NRC Programme which came into being in January 2019 and is led by Nottingham University Hospitals Trust (NUH) as the NHS sponsor.
This section elaborates on the NRC Programme, its work and what it is setting out to achieve by giving seriously injured people a better opportunity to regain fitness, function and quality of life.
As we develop the proposals for the NRC, we are involving patients and members of the public as much as possible in the design of the service.
Best practice needs to be informed by the current available standards, guidelines and research evidence available but also by those who have experienced the service first hand.
Our aim is to develop a centre which will accelerate the advances in rehabilitation medicine both in regard to clinical input but also with technology and engineering products. We therefore need to harness the ideas that people have in how to deliver this so that we make the most of the opportunity we have.
To this end we are doing three things:
- First, we ran four focus groups in April and May 2019 with patients to ascertain views on what the new service should deliver. Those patients who have been invited have either been through a period of rehabilitation or are waiting to do so in hospital. The ideas that patients gave us in these sessions were being taken into account when developing the options for the delivery of the service.
- The second way we are involving patients and the public is through the websites of NUH, CCGs and DNRC where we published a discussion paper, outlining the opportunity and asking for feedback particularly around key questions.
- The third way of gaining as wide opinions as we possibly can during this process is by asking the experts. We have therefore sent the discussion paper to key professional bodies with which we are engaging and asking them their opinion of the proposal and how this could be shaped and delivered. Once again, these bodies will be involved all the way through the process.
In order to benefit from the views of patients and the public all the way through the business case process, we will be updating the information on these websites with the opportunity to feedback any views.
How the N will be designed to follow the D
The National Rehabilitation Centre (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.
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 will be 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.
There are four reference groups which meet regularly beneath the Programme board whose role it is to shape the NRC and what it will deliver. The process of writing the business case which will go through the NHS capital business case approvals route is the purpose of the project management team.
The timeline for the project is that the pre consultation business case is presented to CCGs and to Health oversight committees during 2019. There will be a decision as to whether there needs to be further public consultation. After this, the business case itself will be presented through NUH Trust Board and will then go through the approvals route of NHSI Department of Health and Social Care and HM Treasury.
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.
The British Society of Rehabilitation Medicine recommend 60 rehabilitation beds per million of the population. The population of the East midlands is 4.6 million and there are only 79 rehabilitation beds. This is a shortfall of 191 rehabilitation beds for the region.
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:
The East Midlands trauma region treats over 1,700 major trauma patients per year, most of whom will require some form of rehabilitation. 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:
The regional neurosciences centre treats over 2,500 patients per year and the complex musculoskeletal trauma services treat over 300 patients per all of whom require rehabilitation.
The total volume of patients who go through the rehabilitation unit beds per year in the East Midlands is 446 (2017-18).
The volume of patients who could benefit from rehabilitation compared to the number of rehabilitation beds and the numbers of patients who do access those beds is stark.
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.
There are approximately 15,000 hospital bed days taken by patients who are in the wrong place. Through the development of the NRC we are hoping to address this so that patients do not have to wait to get the rehabilitation they need which will overall shorten the time they spend in hospital and enable them to gain better outcomes.