Rebuilding individual’s lives is part of everyday life for CEO Keith Bushnell’s team, helping people recover speedily from physical and psychological injury, from minor slips and trips to life changing catastrophic injuries.
Founded in 2003, HCML – Health & Case Management Ltd – has pioneered professional rehabilitation case management and has ambitious plans for the profession to be better understood and better utilised in the UK.
Its 70 healthcare specialists cover the UK, handling brain and spinal cord injury, amputation, burns, musculoskeletal (MSK) injury including whiplash, paediatric care and wider physical, psychological and behavioural problems.
Bushnell says the job is like being a project manager for an individual’s recovery. “Our case managers help people who have been injured and/ 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 families affected by the injured individual.
“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 conditions change.
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 clients return to their old job, possibly part-time initially, or retrain in a new one.
The case manager’s job is to navigate all of this, and acting as an expert purchaser, picking skilled professionals, and signposting 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 three principles of stepped care, evidence based early intervention.
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.
The evidence-based process puts the client on the best medical pathway to recovery.
The early intervention principle means giving the injured client speedy access to support and targeted therapy, based on clinical evidence that this speeds up recovery, while delays can set recovery back.
In real life, delays do happen, usually as insurers and lawyers agree on liability, or await medico-legal reports. Bushnell is lobbying for a re-design of the Rehab Code, a voluntary code supposed to stop such delays.
For Bushnell, the costs of delaying early intervention hurt everyone. “Delays cost the individual but statistics show they cost the insurer, the employer and the tax payer too.
“The patient with a physical injury and associated mental health issues recovers much faster with early help and that is also cheaper. Less than 50% of people out of work for more than six months ever return to work.”