Keith Bushnell maps out HCML’s vision for better catastrophic case management.

Thanks to modern medicine, there has never been a better time to transform the lives of clients facing life-changing personal injury, such as spinal cord injury.

But ask any of the stakeholders working in catastrophic injury, and they will tell you that the discipline of re-building shattered lives is more challenging than ever.

After creating our nationwide dedicated spinal cord injury team and then trebling our catastrophic case-load in 2017, we see two challenges in particular.

Modern trauma care has been transformed, after the wars in Afghanistan and Iraq, so that British acute care is world class, and more people survive major incidents than ever.   The Royal London Hospital says every day a severely injured person who would have died 10 years ago survives, through the care it gives patients in “the critical first hours”.

Challenge one – expectations and reality

Such advances in acute care, in medicine and prosthetics, have driven patient and family expectations ever higher. However, more people now survive but do not necessarily thrive. Individuals can find that their hopes for recovery and independence fall short of the heroic media image of Paralympians and war veterans leading remarkable lives.

In the real world, the NHS and social care services battle to keep pace with demand, and our case managers regularly trouble-shoot problems in areas like hospital discharge planning and support, which can be very patchy, and in post discharge which can be a complete lottery. The NHS should do more but is constrained by scarce resources.

The acute NHS and social care services also often act in silos, which does not help.

It can take all of our case managers’ clinical expertise and skills in navigating complex healthcare systems to ensure clients get the right treatment and support at the right time, in order to avoid setbacks in their journey towards recovery, and then improve outcomes. Hence our plan to have the strongest team of specialist case managers with clinical excellence in all catastrophic injury fields, spinal cord injury included.

Challenge two – discount rate change

The second big challenge is the recent discount rate change, a development which makes the case for what we do even more urgent. The changes to the Ogden rate have thrown insurers into turmoil, forcing them to massively increase their reserves, and prompting many to forecast a rise in periodical payment offers (PPOs) in place of final settlements, when most clients prefer the security of the latter.

The British Insurance Brokers’ Association (Biba) described the recent case of a 7 year old boy who had suffered catastrophic injury. Where the reserve at 2.5% discount rate had been £10.4 Million, the change to the new rate of -0.75% saw this increase to £22.7 million.

Setting aside the issue of clients of living with cash settlements in flux, it is clear that helping them to maximise recovery and independence is more compelling than ever. It is our mission to lead this market so while we will work tirelessly to rebuild the lives of each patient in our care, we will also speak up for a better health landscape in which UK case managers can also thrive and secure even better patient outcomes.