A clinical perspective (Dr Ian McCurdie, Consultant in Rehabilitation Medicine)
The recently published Guidelines on Rehabilitation following Traumatic Injury from the National Institute for Health & Care Excellence (NICE) are welcomed by all those working with victims of life-changing major trauma. This is especially important for those suffering major musculoskeletal (MSK) injuries, such as multiple fractures, limb loss and peripheral nerve injuries. These complex injuries have traditionally been considered to not require specialist rehabilitation – as evidenced by the paucity of training and lack of service provision in this particular field of rehabilitation medicine in the NHS, where resources are almost exclusively directed at primarily neurological conditions. Indeed, MSK rehabilitation has long been the ‘Cinderella’ of specialist rehabilitation.
In England, admissions to the network of Major Trauma Centres (MTC) have more than doubled over the past 10 years and survival from major trauma has increased from 50% to nearly 70% over the same period. Given that a significant proportion of these cases are primarily MSK trauma, there is an urgent and ever-increasing need for specialist trauma rehabilitation. Despite this increasing demand, the NICE Committee “explained that in spite of the existence of trauma networks, there is still considerable variation in practice around planning, commissioning and coordination of many aspects of rehabilitation” and that “there is significant variation in practice, with no national network of services.” It is hoped that these NICE guidelines will complement other initiatives, such as the Trauma Audit & Research Network (TARN) database and the Rehabilitation Prescription system, to better inform those planning and delivering specialist MSK rehabilitation to ensure that outcomes are improved through better access to appropriate, prescribed rehabilitation.
Whilst the NICE guidelines set out what “good practice principles” look like, they are not directly responsible for seeing that these are delivered. However, they do go so far as to say that “where this is not happening, it would involve repurposing existing resources / funds in a way that meets the outlined principles.” Thus, the resources required to enable access to this specialist rehabilitation – both in terms of training of doctors and therapists to develop the expertise and in creating systems for clinical delivery – will need to be funded by the NHS and commissioning bodies before any effective change in current service provision is realised.
The individual and socio-economic benefits of MSK specialist rehabilitation have been under-recognised and under-valued for too long. Hopefully, these NICE guidelines will help to focus attention on this much needed area of specialist rehabilitation and so improve training, resourcing, and service provision to the many thousands of victims of major trauma whose independence and quality of life could be better restored by access to appropriate rehabilitation. Like Cinderella, MSK specialist rehabilitation may finally have been invited to the Ball.
A legal perspective (Tim Jones, Legal Director, Enable Law)
When someone suffers MSK trauma they may be entitled to compensation for the injuries they have suffered. As a result, they will need a specialist lawyer to support them and to advise them on the legal process. So what does this have to do with the NICE guidelines?
Firstly, there will inevitably be the issue of resources. If there is a personal injury claim, a specialist lawyer can provide the support to access the funding needed for rehabilitation services (that are not available on the NHS because of lack of resource) through the private sector.
Secondly, a specialist lawyer with an understanding of MSK trauma will be better informed about the quality of such services in the private sector. The emphasis here being on quality in rehabilitation as well as access to rehabilitation. A specialist lawyer will also be better informed as to how best to use the services that are available, which might be a combination of both private sector and NHS services.
The NICE guidelines are very welcome. Now there needs to be effective consultation and discussion between all those involved in working with victims of major trauma to deliver better access and to quality care.
What is the Major Trauma Group?
Major Trauma Group is a network of specialist serious injury law firms, experienced in dealing with claims following major trauma. We assist clients throughout England and Wales in getting compensation to support their recovery. Our emphasis on early rehabilitation is supported by a medical clinician with rehabilitation expertise, as well as highly experienced independent financial advisers and case managers; all working with you to support your claim.