Thriving and surviving catastrophic injury. Winning the rehab battle.

While survival rates in catastrophic injury have risen, society is far more vocal in demanding that patients also thrive.  HCML CEO, Keith Bushnell, explains why there is a gap here that case managers can help fill.

The year 2012 was a turning point for the seriously injured UK patient.  The NHS took a leap forward, creating 22 major trauma centres with all the specialities needed to save lives, with skills developed in Iraq and Afghanistan.  The media was full of rehab stories from Help for Heroes. The London 2012 Paralympics saw the catastrophically and severely disabled injured athlete enter the nation’s psyche as elite sports people.

Society’s image of what life could and should be for people with life changing injuries or disabilities was transformed.     Today every injured person expects to survive and thrive and yet there are still gaps between that expectation and reality.

Six years on, Dame Carol Black writes that the UK is just not very good at restoring injured people back to function and that we must follow the armed forces and win the rehab battle.

She writes that while the armed forces returns some 85 per cent of seriously injured people to function, among civilians it is about 30 per cent, “a gap too stark to ignore”.

She writes that people with serious injury need proper rehabilitation managed by experts and integrated into the clinical setting.   No-one can dispute that, let alone our clinician case managers with their many case studies of lives turned round.   We have also seen cases like the firefighter with a below knee amputation returned to front line duties as early as 2006.  We all see the benefits to individuals, the NHS and society, in human and economic terms.

The gap that we see is one of expectation and ambition among the stakeholders involved in the process of rehabilitation and compensation, including the NHS, insurers, solicitors and employers.

Case managers are at the heart of a revolution in changing mindsets among all stakeholders. They are uniquely placed to see the potential in the injured individual along with advances in care and technology at home and at the workplace to transform outcomes. As advocates for the individual they continue to work with stakeholders to break down barriers and maximise recovery.

This starts in the hospital or acute setting where they can raise the NHS’s aspirations to plan discharge and post-acute health support with the expectation that the client will ultimately lead a full and productive life. Limitations to state resources dampen NHS aspirations and case managers need to advocate at those early stages to plug gaps that, if left unaddressed, could hinder maximum recovery. Where the state cannot do so case managers need to enlist the support of treating clinicians in validating what is possible with the right inputs.  That includes early mental health provision, given this can deteriorate within months when patients – typically -  are released from hospital as soon as it is "safe" to do so, according to Carol Black.
Secondly, stakeholders must be shown the cost benefit of investing to help the injured person thrive. The case manager needs to provide a coherent and compelling rehab plan with demonstrably better outcomes to engage compensators. The focus should be on how can this person be returned to as close as is possible to where they were immediately before the accident. This is not about blades for every occasion but real solutions that enable people to support themselves or at least live a fulfilling life.

Thirdly given employment is good for people’s wellbeing and happiness, case managers should help employers understand what is now possible in terms of return to work, and engage early on with bosses and manage their expectations positively.

We need to close the gap between expectations and reality.  Case managers can play a pivotal role in creating a new norm where every injured individual wins their personal rehab battle.