What is rehabilitation?
When people think about rehabilitation, it is often based upon their own experience or that of the people closest to them. It is quite likely that they will see it in terms of physiotherapy sessions or an exercise programme to be followed at their local community hospital, or in the local gym or at home.
But often rehabilitation is far more complex than that. It needs to be given to people at the right time and in a very specialist way to give them back their lives after the setback of serious injury or illness – for example a road traffic accident, sporting injury, neurological problems following meningitis or multiple sclerosis. In such cases, rehabilitation means access to specialists and equipment not available at local level.
The formal definition from the Department of Health (DH) and the British Society for Rehabilitation Medicine (BSRM – which represents doctors and other professionals such as physiotherapists and occupational therapists) is:
'Rehabilitation is a process of assessment, treatment and management by which the individual (and their family and carers) are supported to achieve their maximum potential for physical, cognitive, social and psychological function, participation in society and quality of living.'
There is the question of how well rehab is done in England. In 2012 there was a breakthrough in the ability to treat serious injury. In that year 22 trauma centres were established across England with an associated paramedical service to ensure that those who suffer serious injury receive the full range of care within the shortest possible time.
The trauma centres have been an undoubted success with 20% more people now living despite having sustained a serious injury. That achievement needs to be reinforced by ensuring that what happens subsequently is equally successful in returning people to their former lives and ideally some form of work. The truth is that whilst there is considerable rehabilitation expertise available in this country, neither the number of specialists and the range of multidisciplinary resources allocated to it mean that rehab outcomes are not what they should be.
To put some facts and figures on this, in some cases taking the East Midlands NHS Region (which is where the new Defence facility is located) as the example:
The East Midlands has an opportunity to address these problems in the form of the development of the first National Rehabilitation Centre in its region.
- The likelihood of individuals returning to work after a period of injury or illness requiring rehabilitation is less than in other countries in Europe and much less than in the case of serving members of the Armed Forces.
- The BSRM has stated that there needs to be a 38% increase in rehabilitation consultants to meet the needs of patients across England.
- The BSRM recommendation for rehabilitation in-patient beds in the East Midlands is 270. In fact there are 79, a shortfall of 191.
- In the East Midlands, specialist rehabilitative care can often result in patients waiting a very long time to access beds. The average waiting time to get into the rehab bed is 29 days. We know that at the three month point the mental health of many patients has deteriorated to the extent that their chance of returning to a meaningful life is at risk.
- But we know that improving repair rates is possible, not least as the success rate for repairable injury and return to fitness in the Armed Forces is at approximately twice that of the NHS, informed by its considerable rehab expertise following operations in Iraq and Afghanistan.
It would be created on the Stanford Hall Rehabilitation Estate. It would operate independently but be able to share expertise and a range of specialist facilities with the Defence rehab establishment 400 metres away where those facilities are directly relevant to the clinical rehabilitation of the patient.
It would be a regional centre to which, like other regional centres such as for major trauma or neurosciences, people would travel with the prospect of significantly better long-term outcomes in terms of returning to a full life and, potentially, work.
Put simply, we are not as good at doing clinical rehabilitation as we could be. There is a significant opportunity to get better at it, improve lives, develop world-leading expertise and, at the same time, save the NHS money.