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The Rehabilitation Prescription - An invaluable but unutilised tool?


Background

2010 saw the publication of a report by the Clinical Advisory Group for Major Trauma Services.  This lead the pathway for the introduction of a number of major trauma centres across the UK known as "The Major Trauma Network".  It's purpose?  To better coordinate pathways of care for adults following major trauma.  Along with it came the recommendation that all seriously injured patients ought to be given a Rehabilitation Prescription on discharge setting out their needs together with a plan as to how these needs could be met following discharge. 

This was followed by NHS England Guidelines "Implementing the Rehabilitation Prescription" in 2013.  The Guidelines set out four main goals for the Rehabilitation Prescription namely to:- 


1. Describe all needs relevant to rehabilitation at specified times including both a patient's immediate and long-term needs without needing to identify the particular service or organisation expected to meet them.


2. Engage patients in the process of rehabilitation and to empower them to ensure that all information concerning the management of their ongoing needs and long term goals was passed between all services during their journey


3. Improve the overall service quality, monitoring and outcome nationally across the networks.


The Benefits 

In theory the Rehabilitation Prescription was set to revolutionise the UK's approach to rehabilitation by providing an opportunity to focus of the rehabilitation needs of patients together with their long-term recovery.  It would provide a comprehensive document prepare by those with expertise in rehabilitation medicine which could be referred to by everyone working with a particular patient.

A further recommendation was that patients and GPs ought to be provided with a copy of the Rehabilitation Prescription.  If this was the case as suggested, this one document alone would provide useful information to GPs to both understand their patient's injuries, their ongoing difficulties and to assist them in working with the patient to facilitate access to rehabilitation within the community with a view to maximising the patient's potential. 

Additionally, the Rehabilitation Prescription could be used to better utilise public money.  As a patient's independence increases their reliance on family members and the state to provide long term benefit support decreases enabling the state to save funds in the long run. 

The Difficulties 

Unfortunately, this does not appear to have been the case on a practical level.  A recent information request by the United Kingdom Acquired Brain Injury Forum (UKABIF) sought to determine the use of Rehabilitation Prescriptions for patients discharged with an acquired brain injury. 


Whilst the overall response to this request was limited, those who did respond provided somewhat disappointing answers. Although Rehabilitation Prescriptions are being provided it seems that only third of those who responded confirmed that they send copies to patient and GPs.  What also came out of the responses is that Rehabilitation Prescriptions are not always completed fully and there remains little awareness of them particularly in more local hospitals

The Present Position 

Presently, neither NHS England or the British Society of Rehabilitation Medicine require Trusts to issue Rehabilitation Prescriptions.  The Guidance is merely guidance alone.  In May of this year, the ABI Alliance launched a campaign for the review of Rehabilitation Prescriptions.  The aim of which is to highlight the role of Rehabilitation Prescriptions, to ensure that patients with an acquired brain injury and their GPs are provided with a copy and for patients to have an appointment with their GP to discuss the content of the prescription and a plan of action moving forward following discharge.   The call for Rehabilitation Prescriptions to be made mandatory was also presented in the House of Commons last month as part of the ABI Debate along with the sentiment that "A life work saving has to be a life worth living".

What can Lawyers do?

Whilst it is of course, the primary aim of personal injury lawyers to obtain an initial needs assessment from a case manager at an early stage, this is not always straight forward particularly in cases where liability is yet to be determined. 


It is therefore important that personal injury lawyers are aware of the Rehabilitation Prescriptions existence as they can provide a way to quickly and effectively identify the client's needs before a full assessment. They can be used to demonstrate the nature and extent of the client's injuries and their need for rehabilitation to the defendant's representatives which may assist in accessing an early interim payment to meet the client's needs. 

Lawyers should be asking their clients whether they have a rehabilitation prescription and if so, request a copy.  If the client is not aware, then the hospital records ought to be thoroughly checked to see whether there is one lurking within the records. 


Lawyers should seek to build cooperative relationships with the NHS. If a lawyer suspects that one ought to have been completed but cannot find it they should write to the hospital to specifically ask if one was completed and if so, request a copy. 


The client should be advised to take a copy of this to their GP with a view to accessing services.  Where the NHS are unable to readily provide a recommended service then private intervention can be considered to meet these needs and in turn ease pressure on the NHS following the payment of an interim payment.   


Finally, lawyers ought to be aware of other avenues of support.  For example, since 2014, patients with deemed to have a primary healthcare need have the right to request a personal health budget to be used to meet their needs.  Where the CCG refuses a request they must provide their reasons as to why.  If refused personal injury lawyers ought to also consider whether the client would benefit from separate legal advice from lawyers with other expertise such as public law to see whether they may have grounds to challenge a decision.

In summary, it remains crucial that personal injury lawyers continue to recognise the importance of rehabilitation and the issues surrounding access to services.  With the recent campaign raised by the ABI Alliance and the ABI debate commenting on the implementation of a mandatory Rehabilitation Prescription perhaps now is the time for change? #rehabilitation #traumaticinjuries #personalinjury #rehabilitationprescriptions

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