Navigating a Fractured Healthcare System – The Role of Case Management

HCML’s head of clinical operations, Andy Pepler, explains the NHS conditions that make the case manager’s navigational role in major injuries more critical than ever.

As recently as July 2017 it was reported in the media that the NHS has been ranked by a US think-tank as the number one healthcare system in the world. This may seem surprising given that barely a week passes without reference in the news to various crises facing the NHS both now and in the coming months and years.

Interestingly, within a month of this report being published, Head of NHS England, Simon Stevens, pledged to end the “fractured” health and social care system that leaves too many patients “passed from pillar to post”.

He announced plans to provide better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS. It is encouraging to hear but there remains scepticism and concern as to how and when this will be achieved.

Looking more specifically at those requiring treatment and rehabilitation following major injury, a study published in October 2016 by the National Clinical Audit of Specialist Rehabilitation following Major Injury highlighted the key findings as being:

  • The current capacity within in-patient specialist rehabilitation services caters for about 950 patients per year – which is about 5% of the adults admitted to major trauma centres following major trauma
  • Provision is varied considerably across the country, ranging from 1 to 8 beds for adult trauma patients per million population
  • Within the specialist rehabilitation services, under-commissioning was a significant problem.
  • Involvement of Rehabilitation Medicine (RM) consultants within the major trauma centres (MTCs) varied
  • Some networks funded sessions and had up to 6 RM consultants working in major trauma, while 18% of the centres had no RM consultant input at all
  • Only half of the major trauma networks currently use a specialist rehabilitation prescription to direct the care for patients with complex needs after they leave the MTCs

Looking at these findings, and considering the experience of case managers week in, week out working with their clients, the importance of the case manager in coordinating the rehabilitation of their clients has never been greater.

Case management places the injured party and their needs at the centre of the rehabilitation journey and this should remain at the forefront of every case manager’s mind from the INA right through to closure.

In doing so, the case manager, and those that commission them, can be confident that whether rehabilitation interventions are provided via the NHS, privately or in combination, the injured party is being provided with the best opportunity to achieve their goals.


Andy is on the board of the Case Management Society UK (CMSUK), which is at the forefront of developments and advancements in the rehabilitation industry.