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Power of professional case management

Founded in 2003, HCML – Health & Case Management Ltd – has pioneered professional rehabilitation case management. The firm has ambitious plans for the case management profession to be better understood and better utilised.

Its 70 healthcare specialists cover the UK, handling brain and spinal cord injury, amputation, burns, musculoskeletal injury including whiplash, paediatric care, and wider physical, psychological and behavioural problems.

HCML chief executive Mr Bushnell says the job is like being a project manager for an individual’s recovery. “Our case managers help people who have been injured or have mental health issues to navigate a confusing world of NHS provision in hospitals and in the community, possible private healthcare provision and employer absence management programmes. They signpost the best clinical pathway to early and maximum recovery, and can also help the families affected,” he says.

“Usually they are instructed by insurers or solicitors handling employer, public liability or road traffic accident cases, but increasingly employers brief them directly for early intervention after a couple of days absence or to assess and progress staff on long-term absence. They advise on modified duties and other workplace adjustments to minimise absence and maximise recovery.”

The case manager’s work starts with assessing the injured rehabilitation client in hospital, at home or at work by phone or face to face as appropriate, providing independent reports on the best recovery plan. They liaise with all interested parties – insurer, solicitor, employer and healthcare professionals – re-assessing the client as their condition changes.

The recovery plan could include physiotherapy, hydro-therapy, occupational or psychological therapy, wheelchair hire, gym sessions, short-term taxi accounts or driving assessments and vocational help to help the client return to their old job, possibly part-time initially, or retrain in a new one.

The case manager’s job is to navigate all this and, acting as an expert purchaser, pick skilled professionals and signpost clients into the best, most cost-effective interventions, mapping the best clinical pathway.

HCML’s medical advisory board has designed a unique recovery model built on the principles of stepped care, evidence-based early intervention.

Hcml graph

Stepped care enables case managers to motivate the client to fully understand their injury or illness, with clear, agreed goals to empower them to get fully involved in their own recovery.

An early intervention principle means giving the injured client speedy access to support and targeted therapy, and is based on clinical evidence that this speeds up recovery, while delays can set recovery back.

For Mr Bushnell, the costs of delaying early intervention hurt everyone. “Delays cost the individual, but statistics show they cost the insurer, the employer and the taxpayer too,” he says.

“The patient with a physical injury and associated mental health issues recovers much faster with early help, and that is also cheaper. Fewer than 50 per cent of people out of work for more than six months ever return to work.”

HCML has gone beyond the traditional model of rehab, which treats the injury alone, to create a biopsychosocial model that puts medical intervention in the wider context of the client’s social and psychological needs.

“Serious accidents, such as a car crash or trapping an arm in a machine, are traumatic events and, if not treated holistically, can have lasting psychological effects. People may be unable to face the car or machine room again. We don’t just treat the injury; we look at the person and their family. Failing to address the mental recovery can block the overall recovery. In fact, anyone off work for weeks or months can face depression long after they are healed physically,” says Mr Bushnell.

HCML has gone beyond the traditional model of rehab, which treats the injury alone, to create a biopsychosocial model that puts medical intervention in the wider context of the client’s social and psychological needs

He also wants to not only help people return to work, but prevent them going off in the first place. HCML has expanded into absence management services, including supporting employee wellbeing and preventative services to tackle the nation’s £25-billion absenteeism costs.

To ease growing mental health problems, such as stress and anxiety, which people struggle to discuss, but cause as much absence as physical problems, a new HCML service, It’s The Time To Talk, directs staff to health professionals for discussion, assessment and care, often self-help or treatments, with fast action and all parties updated on progress.

Another early-intervention scheme sees companies paying less than £15 per head a year to give immediate physio or mental health treatment to workers absent for more than three successive working days. Unlike private medical insurance schemes for senior management, this is a rare, cost-effective scheme for “the troops”, says Mr Bushnell.

He also sees HCML’s proven track record in musculoskeletal recovery making serious inroads into NHS spending, with a role for HCML’s professional case management approach in cutting the crippling “ticking time bomb” of NHS funding of long-term conditions as the population ages. He has a team of senior medical professionals designing new models.

Mr Bushnell believes that the holistic approach, rather than passing patients sequentially to different clinical disciplines and budget centres, would substantially cut costs to the NHS, the taxpayer and employers, and improve the quality of life for millions.

“In five to ten years’ time, there will be greatly enhanced private involvement in the NHS and we plan to be at the forefront of better outcomes for the benefit of all,” he concludes.

For more information contact hcml.co.uk