The rehabilitation process has been hampered by a distinct lack of co-ordination. But, as Joy Reymond explains, the newly-formed UK Rehabilitation Council aims to change that
Judging from the buzz surrounding rehabilitation in the UK, people could be forgiven for assuming that it is alive and well. But they could not be more wrong as there are many problems in the field today and no magic bullets.
The many different areas of rehabilitation provision need to work together if there is to be a thriving and large-scale rehabilitation market that provides reliable and high-quality services. The newly-established UK Rehabilitation Council promises to provide that focus and a real step towards change for rehabilitation.
Because rehabilitation has the potential to make such a difference to the outcome for someone with a disability, the problems it is experiencing in the UK are of vital importance, not just to its clients, but also to insurers, business and financial advisers who rely on rehabilitation's skills to achieve better outcomes.
There are many associations already devoted to rehabilitation in all its many forms, including:
n The British Society for Rehabilitation Medicine
n The Vocational Rehabilitation Association
n The Case Management Society of the UK
n The British Association of Brain Injury Case managers
n The British Association of Supported Employment
Most of these are relatively small organisations of a few hundred members, and, in most instances, the relationships between them are cordial but uncoordinated. If anything, they tend to focus on differentiating themselves from one another. Even a commonly agreed definition of rehabilitation has eluded them.
Disciplines
Many different disciplines embrace various aspects of rehabilitation, but there is no 'centre' or 'core discipline' onto which all of these branches of rehabilitation can attach themselves. There are many views on what constitutes rehabilitation, but no agreed body of knowledge at the foundation of all of these views. Many practitioners bring their knowledge from other disciplines or from other countries - Australia and Canada being two popular sources.
Regulation
Rehabilitation is an unregulated activity, except insofar as it is covered within the activities of another regulated profession. There are no constraints on practitioners upon using the term rehabilitation in their job title. Likewise, the use of the term in a practitioner's job title does not provide any guide as to what skills the practitioner possess. So how does a purchaser know what they are buying?
On the positive side, there are now many encouraging signs, with the Government acknowledging the importance of rehabilitation being one of them. In 2006, the Civil Justice Commission (CJC) raised concerns about the possibility for 'rehabilitation farmers' to emerge in the unregulated rehabilitation field. For the CJC, the key is consumer protection.
In October 2005 the Government launched its Health Work and Wellbeing strategy, led by Dame Carol Black, the national director for health and work. It aims to improve the health of the working age population, prevent work-related injury or illness, intervene early when health problems arise, and provide rehabilitation support.
For the Department of Work and Pensions (DWP), the key importance of rehabilitation is whether it can provide another solution to the problem of the appalling number of people who continue to fall out of work and into incapacity benefits, never to return to the world of work.
Calling on employers to do more to support their employees, the DWP minister, Lord McKenzie, this summer, launched a new vocational rehabilitation task group to help ill and injured people stay in or return to work. The task group - made up of people from the Government, customers, business and insurers - will identify what services are currently available, why businesses do not provide more support, and what needs to be done to increase understanding and ensure wider provision of support services.
Speaking at London conference 'Vocational Rehabilitation - Removing the Barriers', Lord McKenzie said: "One million people take sick leave every week: 3,000 of these will not return within six months, and, of these, 2,500 will still be on incapacity benefit five years later, having lost much of their dignity, independence and involvement with society."
He added: "Rehabilitation is not about forcing people back to work. Work, in fact, is often a crucial step in helping people return to full health. And businesses have much to gain in terms of reduced sickness absence, and improved staff engagement and retention. But very few employers offer occupational health or vocational rehabilitation. This task force will identify why this is the case, what barriers are preventing wider provision, and what needs to be done to change this. We cannot do this alone - employers must recognise that rehabilitation is not purely medical, but also a management activity and they must do more to help their employees return to work."
Clearly there is a strong willingness to engage in rehabilitation. But no leading body to respond and ensure that a high-quality service can be delivered.
For some years, the rehabilitation community has accepted the need for a lead body to co-ordinate activity and provide a voice for medical and vocational rehabilitation in the UK, but there has been no impetus to make it happen. With all this renewed enthusiasm for rehabilitation in the wider community, the time seemed right for its creation. In November, nearly 40 leading rehabilitation professionals met in Dorking, Surrey, to examine, and, ultimately, endorse a proposal to create the UK Rehabilitation Council.
The rehabilitation community recognises that there are many existing rehabilitation associations and stakeholder groups. The Council is not intended to replace, nor to control them. Instead, it seeks to co-ordinate and, where appropriate, provide a strategic steer.
To get started, a Shadow Rehabilitation Council has been struck. Its sole purpose is to do the groundwork to enable the full Council to be established. Its objectives are as follows:
n Access to quality medical and vocational rehabilitation in the UK equal to with the best internationally;
n A seamless partnership between the many different agencies that provide rehabilitation or related services in the private, not-for-profit and public sectors;
n Agreed, enforceable standards for those who provide these services;
n Rehabilitation fully integrated into the legal culture;
n A widely recognised voice for rehabilitation that acts as an effective advocate for best practice, and has the confidence of the Government, the professions and users of rehabilitation.
The Council will support all types of rehabilitation. Return-to-work may become the biggest work stream, but the scope will be as inclusive as practical. The Shadow Council has agreed the following working definition of rehabilitation: "A process of active change by which a disabled person achieves optimal physical, psychological and social function."
The key functions of the council will be as follows:
A. Engaging the partners
n Representation - to make the case for rehabilitation and provide a voice for those who wish to see it play a greater role.
n Engage with key stakeholders - in particular, Government ministers, departments and agencies - to ensure joint working and sharing of agendas and priorities.
n Engage with partners within the rehabilitation community to ensure the widest range of views are considered and optimum delivery of Council aims and policies.
n Co-ordination/communication - ensure that all with a stake in rehabilitation are aware of what others are doing. Including information exchange.
B. Ensuring quality
n Certification/accreditation - support and provide a kite mark/stamp of approval for the growing number of qualifications/courses becoming available.
n Accreditation of practitioners
n Endorsement - identify and support best practice.
n Standards/enforcement - draw up, communicate, agreed professional standards.
n Research - disseminate, recommend and (where funds permit) commission research relevant to rehabilitation.
All rehabilitation groups, including the 10 participants at the November meeting, may belong, from which 10 to 15 Council directors will be elected. The categories of organisation that would be represented include the Government, medical (NHS and private), rehabilitation professional associations, legal practitioners, trade associations, employers associations, insurers. Scottish and Welsh interests will be represented on the Council and committees, where relevant.
Aims
The council's priorities are to look at the most urgent needs:
n Enforceable standards for rehabilitation practitioners. These will not duplicate those already in place. Where, for example, a nurse is working as a nurse they will be covered by the existing RCN standards. Where, on the other hand, they work as a rehabilitation manager, the new standards will apply.
n Accreditation for practitioners.
n Advice to universities and other teaching bodies identifying gaps in training.
The Council will, ultimately, deliver the following benefits:
n A one-stop shop for any person or organisation requiring information about rehabilitation. The Council will not always have the answer, but will be able to point them in the right direction.
n An authoritative source of standards for rehabilitation providers.
n Recommendations and endorsement of best practice.
n Recommendations as to further training required in universities and other educational establishments.
n Active engagement with stakeholders, especially Government ministers, departments and agencies, to ensure joint working and sharing of agendas and priorities.
n Information exchange, so that groups with an interest in rehabilitation communicate effectively and avoid duplication.
n Increased understanding of the benefits of rehabilitation in the country at large.
This is a grand venture for the Shadow Rehabilitation Council. It deserves both Government and private sector support, and, indeed, is seeking funding from the Government over this summer.
Joy Reymond is head of rehabilitation services at Unum
n For more information, contact the chair, Stephen Duckworth at [email protected]; or Mark Baylis at [email protected] or Joy Reymond at [email protected]
