Cinderella service could save millions

With the debate about the future of the NHS and adequate funding of healthcare already taking centre stage in the run up to the general election and set to continue beyond, one area that should increasingly be of concern to healthcare professionals, decision-makers and society at large is rehabilitation.

Imagine that you have an accident and suffer serious and life-changing injuries. Perhaps you have an accident at work or you’re involved in a car crash. You’re treated in hospital for your acute injuries and then you begin the long, slow journey back to health or at least to some kind of independent living. But how? With what help? And who pays?

According to Irwin Mitchell, the country’s leading serious injury specialist law firm, the quality of rehabilitation provision in the UK is currently extremely variable, with major disparities in the levels of service around the country. Put bluntly, where you happen to live can affect your entire quality of life following an accident.

Irwin Mitchell graph2

“Over 13,000 people are seriously injured in road traffic collisions every year, requiring long-term health care. But current rehabilitation provision can be a postcode lottery,” says Colin Ettinger, a partner at Irwin Mitchell and one of the country’s foremost legal experts on rehabilitation. “Our research shows that rehabilitation is already a Cinderella service within the NHS. The UK has fewer rehabilitation specialists per head of population than any other country in Europe, apart from Ireland.”

Discharging people more quickly with proper support would reduce bed blocking and cut costs, he says.

To explore this issue further, in November 2014 the UK Rehabilitation Council, in conjunction with Irwin Mitchell, hosted a one day conference called Rehabilitation: Maximising Outcomes From Existing Resources – What Can We Achieve? It was attended by more than 180 healthcare professionals, rehabilitation specialists and others involved in the field, whose views were surveyed on what can be achieved with our current rehabilitation provision.

Many of the attendees identified the same problems. Patients are often discharged too early from statutory services, and there is frequently a lack of understanding of their needs and in practice no truly multidisciplinary approach at the statutory services level. The provision of long-term rehabilitation was strongly criticised by attendees who cited limited specialist in-patient rehab services and time-limited community interventions.

Other problems identified included the absence of a full rehabilitation pathway post discharge and inadequate communication between healthcare teams. The biggest barrier, it was reported by those taking part, involves getting local clinical commissioning groups to understand the benefits of complete rehabilitation. These teams must also realise that clients sometimes present needs that have not been anticipated so they must demonstrate a strong case for the correct rehabilitation unit to be identified.

Irwin Mitchell graph

There was a belief among attendees that services must be more responsive to patients’ needs rather than patients being expected to fit in with the services provided. Better funding is required, said delegates, but so is education. There must be increased awareness of all the benefits a proactive rehabilitation structure can have on the individual. This is a message not just for the individual, but also for their family, employer and all healthcare professionals, particularly GPs.

One solution that received widespread support was the adoption of an NHS case management system that would manage patients through the various stages of recovery, from bed management while an in-patient, to discharge planning, GP relationships and employer liaison.

However, there was encouraging news and spirit among delegates. For example, a remarkable 92 per cent said their organisation could make an economic argument for improved rehabilitation services, while 84 per cent reported they had the technical capability to deliver rehabilitation in their organisation.

There must be increased awareness of all the benefits a proactive rehabilitation structure can have on the individual

In keeping with this positive, constructive tone among experts, Irwin Mitchell has put forward a simple, four-point plan that, it believes, can help hundreds of thousands of people get back on the road to health and independence more quickly and save the health service hundreds of millions of pounds.

First, rehabilitation data should be recorded across the country in a consistent manner. This would allow for more accurate comparisons. Second, healthcare professionals and others need to work together to identify and promote examples of best practice as well as demonstrating the financial benefits generated by fast, effective treatment. Third, the NHS needs to calculate the life-long rehabilitation needs of patients and pool funding in order to deliver it through a single body. Finally, care at home needs to be improved through more specialist community rehabilitation services.

“The good news is that some of these initiatives are already being put into place, and patients and hospitals are starting to feel the benefit,” says Mr Ettinger. “But we believe more can be done. The more quickly we can get people back into independent living and into the world of work again, the better it is for them, for the NHS and for the country as a whole.”


Irwin Mitchell is a leading UK law firm that employs more than 2,000 people at offices throughout the country. It was recently awarded Claimant Solicitor of the Year in the 2014 Post Magazine Rehabilitation First Awards for the fifth time.

With decades of experience, Irwin Mitchell has seen how rehabilitation can transform the lives of its clients. The firm’s expert solicitors work with case managers, its own client liaison team plus support groups, charities and care providers to help its clients to get the care and rehabilitation they need.