What the New Rehab Code needs to be – HCML wades in with its opinion on the imminent new rehabilitation code


Architects of the revised ‘dysfunctional’ Rehabilitation Code have a one-off chance to make it fit for purpose for personal injury clients and the market, claims HCML, who are lobbying for ‘real change’.

The rehabilitation case management company wants the IUA – ABI Rehabilitation Working Party to tackle round two of consultation on the voluntary code with a mission to cut the delays over assessments, treatment and care which set patient recovery back and increase costs to insurers and potentially cause harm to injured parties.

HCML says a better designed code will help injured individuals, solicitors and defendants by creating a clearer direction for rehabilitation during personal injury cases.

Keith Bushnell, HCML’s chief executive said: “The point of the code is to allow early intervention even when liability is unclear. Yet time after time we see necessary rehabilitation held up by delays in agreeing liability.

“The code needs a mechanism for the injured person to get care when it is needed, and when liability cannot be agreed promptly, the only mechanism currently is single instruction for the most serious injuries.

“Also the code makes no reference to mental health which is fast becoming the biggest single cause of lost working days in the UK and is often a major barrier to recovery once the physical injuries subside.

“The new code must address when it is appropriate to treat mental health problems which can be a significant added complication to recovery from physical injury, making coordinated intervention critical.

“Delays cost both individual and insurer dearly. The probability of a good recovery for musculoskeletal pain with a mental health component is increased with early intervention: less than a quarter of people out of work for more than six months ever return to work. Speedy access to an appropriate assessment and intervention is key to maximising rehabilitation outcomes.”

They say the code must be extended to encompass rehabilitation delivery after assessment with the same case managers instructed to assess and manage continuing rehabilitation plans.

They welcome plans that create separate arrangements for fast-track cases and all other cases including catastrophic injury.

Yet they say the concept of Immediate Needs Assessments (INA) should be reserved just for catastrophic injury - brain, spinal cord injury or major limb amputation - where there is a clear difference between immediate needs and ongoing, long-term care and where outcomes are much less predictable at the outset.

In all other cases, they say, the expectation should be that treatment, care and return to work support will naturally follow on from the assessment.

In fast-track cases rehab should proceed through accredited providers with immediate medical assessments by qualified clinicians taking a stepped-care approach with the number of treatments decided on solely clinical need allowing early intervention to proceed smoothly.

“Car repair and hire is agreed immediately in these cases – rehab should be no different”, argues Bushnell. “A high proportion of cases can be effectively resolved through well managed self-help programmes.”

In mid-range cases recovery and return to work are the expectation and again early intervention with a commitment to seeing the case through is the most effective strategy and should be enshrined in a new code that is fit for purpose.

“All these delays just jeopardise outcomes”, says Bushnell. “Momentum needs to be maintained by imposing a 14 day deadline for responses to assessment and recommendations for all parties - insurers, solicitor and rehab providers.

“While integration with NHS and state social care provision should be the default position for rehab intervention, delays at key points of recovery sometimes make private care the best choice to accelerate recovery.  A stop-start approach to client care does more than delay recovery. It can reverse progress to recovery.”

HCML support moves for compulsory standards for accredited case managers being introduced and managed by the appropriate professional bodies.

“We have evolved our model to meet the needs and future direction of clients and customers anticipating changes to the code. We are adapting our assessments and expanding our catastrophic injury team to provide end to end case management for every different level of injury,” adds Bushnell.

“We put individuals on the best clinical pathway and expedite assessments and treatment intervention to avoid costly, over-medicalised rehabilitation. It is an effective, sensitive model that gives the individual, insurer and solicitor certainty on what happens next. We just need a framework in the new code to support this aspiration.”