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The Rehabilitation Prescription – Is it doing its job?

27th May 2021

The Rehabilitation Prescription – Is it doing its job?

Steven Santy, Associate in the Personal Injury team at Higgs & Sons, looks at the importance of the Rehab Prescription – and where it is falling short.

When a personal injury lawyer speaks to a seriously injured client for the first time, invariably they will ask to see a document given to all patients on discharge from hospital. That important document is entitled ‘Major Trauma Summary Report and Prescription of Rehabilitation’. 

This document is very informative. It sets out, amongst other things, the name of the clinicians that oversaw the patient’s treatment, the precise diagnoses for each injury, details of any scanning and surgery undertaken, and medication requirements. 

In recognition of the fact that the patient would benefit from further therapeutic provision post-discharge, there is also a section entitled ‘Ongoing Rehabilitation Needs’, hence the commonly used nickname for the document, the “Rehab Prescription”.  The idea is that the patient will receive specialist rehabilitative follow-up as necessary, with the result that this helps them to achieve the optimal possible recovery.  Unfortunately, however, the reality is often quite different.

At Higgs & Sons we are passionate about rehabilitation.  Clients that have sustained serious injuries often have complex needs and require extensive, intensive input from a range of different specialists forming part of a multi-disciplinary team.  We are pleased to be able to routinely support clients pursuing damages claims, by working with compensators to ensure that where there is a need, this can be met - and funded - within the private sector, rather than relying on statutory services to pick up the tab.

However, situations inevitably arise where a client cannot get access to private provision.  Most commonly, where liability for the injury may be disputed by the defendant’s insurer, thus they refuse to fund the joint instruction of a rehabilitation case manager or to release any interim payments to allow the claimant to do so unilaterally.

In such circumstances, a client has no option but to look to the NHS and the Local Authority for a safety net in terms of therapy provision.

There is no doubt that the Rehab Prescription is very useful to the patient, their family, GP and lawyer alike.  If completed properly, it shows what clinicians in the acute setting had in mind in terms of how the patient’s physical, psychological, social and cognitive needs should be addressed as an outpatient. 

It is disappointing, therefore, that the results of the National Clinical Audit in October 2016 entitled ‘Specialist Rehabilitation for Patients with Complex Needs Following Major Injury (NCASRI)’ report showed that although all 22 Major Trauma Centres reported that they routinely complete a Rehabilitation Prescription, in two-thirds of the centres the prescription was not passed on to the patient.  Of course, this does not necessarily mean that there is no follow-up post-discharge, but it does mean that a patient (and possibly their GP) is in the dark as to what rehabilitation pathway a treating clinician felt was necessary at the point at which they left the hospital.

But, regrettably, the principal problem for all patients in terms of receiving timely and adequate therapeutic provision, particularly since the pandemic, is stretched resources across all statutory services.  The coronavirus pandemic will have huge impacts on the National Health Service (NHS). Patients suffering from the illness are placing unprecedented demands on acute care, particularly on intensive care units (ICUs). This has led to an effort to dramatically increase the resources available to NHS hospitals in treating these patients, involving reorganisation of hospital facilities, redeployment of existing staff and a drive to bring in recently retired and newly graduated staff to fight the pandemic.

These increases in demand and changes to supply will not only affect patients with the coronavirus but will have large knock-on effects on the care provided to the wider population.  To deal with coronavirus cases, the amount of resources available for non-coronavirus patients has already been reduced, though there are no real-time publicly available data available to be able to precisely quantify by how much and for whom.  This means that often, patients wait long periods between discharge and an appointment date for community-based rehabilitation such as physiotherapy, occupational therapy, psychotherapy, speech and language therapy.

A client that I represent was recently discharged from a Major Trauma Centre after suffering a traumatic brain injury.  She was knocked over by a car in a hit and run incident.  The Rehabilitation Prescription referenced the fact that a referral had been made to an NHS Rehabilitation Consultant, who would organise the involvement of specialist therapists as necessary.  When my client chased up the referral around one month after discharge, she was told that it would likely be around 6 months before she received an appointment with the Consultant.  In a brain injury case, time is of the essence and this was understandably a massive source of frustration for my client and may ultimately impact upon her outcome.

So, the Rehab Prescription is a valuable tool; but clearly it is of limited use if, due to lack of resource within statutory services, the therapies required and recommended by the acute team within the hospital are not followed up and delivered post-discharge. 

And in every case, a copy must be given to every patient or family member – and copied to the GP - with clear instructions as to what rehabilitative provision needs to be picked up and put in place.

These measures together will ensure that every patient is given the opportunity to achieve the best possible outcome following serious injury.

 

 

 

 

 

 

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