The value of rehabilitation to UK society

In a recent series of interviews on Rehabilitation, the top clinicians and experts I spoke to agreed – rehab works, it’s cost-effective, and there isn’t enough of it in the UK.

Professor Karen Middleton, Chief Executive at the Chartered Society of Physiotherapists (CSP) explains that physiotherapy – a key area of rehab – is used for people of all backgrounds after events like stroke, head injury or heart attack, as well as in supporting children with learning disabilities or ongoing conditions like cerebral palsy. “There’s no area of medicine where physiotherapy isn’t involved.”

Composition of Youth V
Composicion de jovenes V by artist and physiotherapist Jenifer Carey

“Falling off a cliff”

While acute rehab within hospitals is recognised and “pretty good”, the CSP is concerned about what happens when the patient goes home. “TV presenter Andrew Marr told us that the inpatient treatment for his stroke was fantastic but that life after discharge was like falling off a cliff – and he’s one of the fortunate ones who can pay for ongoing treatment.”

Dr Ganesh Bavikatte, Consultant at The Walton Centre, says: “We are seeing more, and more various, neurological and critical patients being saved. However, quality of life afterwards and ongoing disability have to be addressed at the same pace. This is what rehab focuses on.”

Recovery can be a long, slow process, with late-stage setbacks, but Prof Middleton is convinced that good ongoing services save the NHS money.

“If people have home rehab, they are less likely to turn up at A&E or at the GP’s. There are long-term savings to the system as well as maximised potential for the individual – it’s a win-win policy.”

“To get the best benefit, rehab needs to be specialised, local and timely,” says Chloe Hayward, Executive Director of the United Kingdom Acquired Brain Injury Forum (UKABIF). “Too often people are sent straight home with no support in the home environment.”

Part of the problem, she says, is that the position of National Clinical Director (NCD) for Rehabilitation and Recovery in the Community, held by John Etherington from its introduction in 2013, was abolished last year. “It was set up to link some of the issues together, work with the Department for Work and Pensions (DWP), and find solutions which would help reduce long-term costs.”

“No reason was given for the demise of the post,” Colonel Etherington said in this interview. “We don’t spend enough money on rehabilitation, and the loss 
of the NCD post means that there’s nobody that can argue that need at a high level. Rehabilitation needed to be re-aligned so it could stand alongside cancer and heart disease, and the way to do this is to convince the budget holders.”

Double-whammy: Reducing suffering and financial costs

Professor Diane Playford, President of the British Society of Rehabilitation Medicine (BSRM), says there is “a wealth of evidence to show that medical rehabilitation works. The difficulty in Britain is that we have very small numbers of beds and of multi-disciplinary teams of specialised physicians.” This is partly because rehab was established as a speciality later than others, and partly because it is still seen as less important for funding when measured against immediate priorities for saving lives such as emergency helicopters and trauma units, she explains.

Consultant neuropsychiatrist Dr John Holloway agrees that the lack of resources is “frustrating”, especially given the evidence of immense savings, both human and financial, to society. One UK Rehabilitation Outcomes Collaboration (UKROC) study demonstrated that all levels of patients showed a significant reduction in dependency after sustained rehab, considerably reducing the cost of ongoing care and repaying the financial outlay in just 14 months, Dr Holloway points out. “Discharged too early from acute care, patients may require another 40 years of full-time care.”

“The problem is that the funding for specialist rehabilitation comes from Health Budgets but the decades of savings to be made in the future would be accrued normally by Social Care, therefore there is a disconnect,” he says.

“The realisation of the savings to society that rehabilitation can provide has not been followed up.”

All cite research by Lynne Turner-Stokes which demonstrates the value of ongoing rehabilitation support services.

To read more of these and other interviews in the Rehabilitation series, click here.


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