New guidelines aim to help people who need rehabilitation after traumatic injury
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The National Institute for Health and Care Excellence (NICE) has produced comprehensive recommendations on rehabilitation after traumatic injury. This is very welcome and is hoped will see a much needed improvement in the outcomes for those who suffer traumatic injury.
The key points are:
- Initial assessment and early intervention
This means keeping a closer eye on patients who have suffered a traumatic injury so that any injuries to sense or brain injuries are detected early, treating their acute injuries as quickly as possible so they can start their rehabilitation, and ensuring that their rehabilitation needs have been thoroughly assessed so that the medics who treat them will be able to better meet their needs.
- Multi-Disciplinary Team (MDT) rehabilitation needs assessment
The committee who put these recommendations together had no evidence in this area, so instead used their own knowledge and experience. This recommendation is intended to provide a comprehensive approach to needs assessment which also includes a focus on patient engagement with the process. People who suffer traumatic injuries, especially to the brain, can often struggle with this aspect so it is a welcome addition.
- The Importance of goal setting
Having a defined set of goals to strive for can help to stop patients from feeling overwhelmed by the rehabilitation process. The committee felt it was important that this be formalised into the guidelines.
- The rehabilitation plan
A rehabilitation plan provides the roadmap for a patient’s recovery from their injury. Because progress needs to be consistent, this recommendation also states that if the patient’s own multi-disciplinary team won’t be able to help them in time, they should make a referral elsewhere so that the momentum of recovery isn’t lost.
- Communication, co-ordination and collaboration in the rehabilitation process
These guidelines are intended to make sure that patients receive clear communication about their injury, how it will affect their needs, what goals they should strive for as part of their rehabilitation, and to ensure that multi-disciplinary teams are working in a way that supports the rehabilitation journey of their patients.
- Broad coverage of rehabilitation needs both physical and psychological
These are recommendations about the planning, commissioning and coordination of rehabilitation and related services, and the design of the care pathways which plot their delivery.
The recent history of rehabilitation in the NHS
Rehabilitation within the NHS is something which has been looked at before. In 2010 the Clinical Advisory Group (CAG) produced a report to advise on a patient-focused approach intended to improve services and outcomes for patients suffering from Major Trauma. It was recognised then that rehabilitation had usually been either a closing recommendation, or worse, simply ignored. The CAGs recommended that improving rehabilitation should specifically be given more priority, on the grounds that the need to improve both acute and specialist rehabilitation, and community or generalist rehabilitation, was one of the biggest considerations informing trauma care pathway redesign.
A number of key themes were discussed and recommendations made to improve rehabilitation services and ensure improved outcomes. It led to the introduction of the rehabilitation prescription which would be provided to all trauma patients with identified needs. The rehabilitation prescription would describe the patient’s physical, cognitive and psycho-social needs framed in the context of their pre-injury life, and was to state how these needs would be addressed. The prescription would be an extension of a discharge/transfer summary and would include ongoing health and social care plans.
As a result Major Trauma Centres were born, with the first major trauma centre opening in England in 2012.
My thoughts on the future of rehabilitation
However, without any criticism to medical professionals, commissioners and all those within the NHS responsible for delivering rehabilitation services, there have been restrictions to how effective the outcomes have been for patients suffering traumatic injury. Fundamentally it does come down to resources, and with the NHS ever more stretched because of COVID-19, there is more pressure than ever on the NHS to deliver.
The new guidelines from NICE certainly provide a broader perspective, and it is welcome to see that rehabilitation after traumatic injury is being looked at more broadly and it is recognised that communication and collaboration will improve outcomes. What is now important is that the resources are there so this can be delivered in the best way for those who have suffered traumatic injury.
As a specialist personal injury lawyer who acts for individuals who have suffered traumatic injuries, I believe it is important that NHS provision is combined with private provision funded by insurance companies to ensure that rehabilitation is maximised and individuals who suffer traumatic injury can return to the quality of life they had pre-injury.