Rehabilitation is no one’s responsibility. This is true in many ways. There is no profession of ‘rehabilitation’; no UK national organisation representing rehabilitation; in health services, everyone supports it – but it is no one’s priority; patients will be familiar with professionals who signpost them to services but do not provide them. I hope this site fosters the founding of a UK national rehabilitation society (association, college, foundation or another collective name) representing all parties interested in rehabilitation – patients, families, rehabilitation professionals, provider organisations, Social Services, NHS and other commissioners. This website aims to improve the rehabilitation services offered to patients by increasing access to services and the quality of the services. The second aim is to stimulate and facilitate a national organisation whose purpose is to promote specialist training in rehabilitation for clinicians from any profession, standards for all services providing rehabilitation, and eventually validate and certify the training programmes, achievement of expertise, and the standards of services.
Table of Contents
The purpose of this site
The primary purpose of this site is to achieve a UK national organisation that is officially recognised as representing rehabilitation, not as part of some greater responsibility, and not as a conglomeration of different organisations ‘with an interest’. It must have rehabilitation as its primary concern, recognising it as a specific area of professional and clinical expertise additional to but separate from any professional expertise.
The closest equivalent at present is the Community Rehabilitation Alliance, which advocates for rehabilitation in the community. However, this alliance, at present:
- Has no independent identity or organisation
- It is located within the Chartered Society of Physiotherapy, and they provide all the resources
- Is focused on community rehabilitation; not all rehabilitation
- Does not include all interested parties
The proposed national organisation is needed to:
- represent all services delivering rehabilitation at all levels of the health service organisation, from the Department of Health and Social Care to the local general practice;
- advocate for service development and improvement in all geographic areas and all services and provider organisations;
- develop and validate professional qualifications so that members of any profession can demonstrate that they are also experts at rehabilitation in addition to their professional expertise;
- advocate for actual multi-disciplinary high-quality academic departments in all major universities and hospitals providing undergraduate teaching to students of any healthcare profession;
- advocate for genuine patient-centred and holistic healthcare services, and a culture that pays more than lip service towards supporting and enabling people with long-term conditions to live as independently as possible;
- ensure that the concerns and interests of patients and families are sought and considered at all levels, from individual care to the national design of services;
- develop service standards and mechanisms to certify service quality.
Why is this needed?
The public has little awareness or understanding of rehabilitation. Many people, perhaps most people, do not know what rehabilitation is. What could they expect when referred ‘for rehabilitation’? Who should or should not be referred ‘for rehabilitation’? Is it only for people with drug and alcohol problems? Or people in prison? How would you know whether the person or service knew what they were doing?
Within the healthcare system, rehabilitation has a low priority because no one knows what it is. Commissioners need to know what they are getting for their money and why they should pay. Patients do not campaign for it because they do not know what they are missing. Healthcare professionals with power and influence cannot see any reason to support rehabilitation in preference to their speciality. This especially applies to education and training. Doctors, surprisingly, are the only profession with specialist training in rehabilitation. It is surprising because medical students and doctors in their early foundation years and core medical training receive little exposure to rehabilitation.
Currently, no national (to the UK) organisation is promoting rehabilitation. Indeed, only one national organisation devoted to rehabilitation are known to me. The Society for Research in Rehabilitation is a genuinely multidisciplinary organisation focused on rehabilitation, founded in 1978 and still going strong.
The deficits in awareness and understanding of rehabilitation combined with the lack of a powerful national organisation to advocate for it have three serious consequences.
Services are patchy and poorly organised, with no coherent or systematic organisational framework to inform commissioning. I have discussed this in the context of Covid and traumatic brain injury.
Second, resources allocated to rehabilitation are insufficient, and the resources allocated are not used effectively or efficiently due to the lack of organisational principles.
Thirdly, and following the first two, access to expert rehabilitation is limited. This is accompanied by considerable inequity between conditions, geographic areas, socio-economic groups and ethnic groups. The quality of services offered is patchy, with many not offering full rehabilitation. Although the best services are undoubtedly good, many services labelled as rehabilitation offers an incomplete rehabilitation service, with no dedicated multi-disciplinary team and lacking essential professional and treatment resources.
Why should the NHS care?
The UK NHS constitution, published in 2012, said:
“The NHS belongs to the people. It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives.”
The NHS Constitution. the NHS belongs to us al. 8 March 2012. (see here)
Rehabilitation is essential to achieve the second purpose: “… and, when we cannot fully recover, to stay as well as we can to the end of our lives.” For rehabilitation to help the many patients who ‘cannot fully recover’. In addition, the NHS has a responsibility for people who have losses from birth. To fulfil this duty, the NHS needs a focused rehabilitation service in which all staff have specific expertise in rehabilitation in addition to their professional expertise. At present only doctors have specific training in rehabilitation.
Therefore, one of the site’s objectives is to explain, advocate for, promote, improve access to, and generally raise awareness of rehabilitation as a healthcare activity requiring specific expertise over and above the specific professional expertise of the healthcare professionals involved. This site is independent of any specific profession and will encourage the development of rehabilitation knowledge and skills across all professions.
Why should you care?
Almost everyone will, at some point, need some rehabilitation, and everyone will certainly know someone who could benefit from it. Therefore, rehabilitation matters to everyone:
- to patients with long-term health problems;
- to families living with some who is disabled;
- to employers who have an employee with a disability;
- to care homes because all their patients have some disability;
- to all organisations in healthcare because;
- most inpatients and many outpatients have significant disabilities;
- rehabilitation can reduce long-term health and social care costs;
- to society who bear the costs of caring for people with a disability;
and most of all
- to you , the reader, who will one day need rehabilitation whether you know it or not.
How will this site help?
This site introduces readers to a small proportion of the information, ideas, debates and uncertainties relating to rehabilitation. In other words, it covers rehabilitation matters:
- scientific knowledge, covering many different disciplines, from social sciences to neurophysiology;
- theories underlying the processes involved in rehabilitation;
- philosophical ideas relating to the nature of illness and health;
- practical information concerning treatments, care, resources etc.;
- discussion of service design and delivery;
- sources of further information;
- training in rehabilitation;
- blogs, and (eventually) much more.
However, throughout the site, I emphasise the vital role of a multi-professional team, the crucial need to treat each patient as an individual adapting service delivery to their needs, to the importance of a holistic approach both to the patient and, even more essential, to service design and organisation, and to considering the broader legal, moral, and social aspects of healthcare within society.
I hope that in ten years’ time, we will always know who is responsible for rehabilitation in any geographic area for any patient, whether in providing a service, paying for a service, monitoring the quality of professional rehabilitation practice, ensuring services meet quality standards or, most importantly of all, ensuring that each patient needing rehabilitation receives it.