Only 5% of NHS trauma patients receive specialist rehabilitation audit finds

Published: 26 Oct 2016

Significant variations in NHS provision of rehabilitation services for patients recovering from traumatic injury are highlighted in a report published today, Friday 28 October. The National Clinical Audit of Specialist Rehabilitation following major Injury (NCASRI) is the first to examine the provision of specialist rehabilitation following major trauma in adults. The audit found that in-patient specialist rehabilitation services care for about 950 patients per year, which represents about 5% of the adults admitted to major trauma centres. Major trauma injuries have the potential to cause prolonged disability which, in addition to the impact on patients and families, place significant cost burdens on the NHS and social services.

View full report here 

The establishment of major trauma networks in England in 2010 has led to marked improvements in care for patients who have suffered severe injuries. Many of those who would previously have died at the scene of the accident now survive thanks to the coordinated care they receive in major trauma centres.

However, the rehabilitation of very severely injured patients is complex, and for some patients it will be many months before they are ready to leave hospital and get back home. Treatment involves a wide range of specialists, and often special equipment and facilities, which can only be provided in specialist rehabilitation units. Without the specialist input they need, patients may miss out on the opportunity to optimise their recovery and be left with lifelong disabilities – some of which could potentially have been avoided with the right care

Key findings from the report include:

  • 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. In comparison with national standards, between half and two-thirds of the specialist rehabilitation units had insufficient staffing to manage a complex caseload
  • Less than three quarters of patients had cost efficiency data available. These data are important to continue justifying the effectiveness of specialist rehabilitation
  • Involvement of Rehabilitation Medicine (RM) consultants within the major trauma centres (MTCs) also 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
  • Provision was particularly poor in London where there was only one MTC-funded session for an RM consultant across the 4 large networks in London
  • 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

When the major trauma networks were established no provision was made for the establishment of specialist rehabilitation. The shortfall in capacity of the specialist rehabilitation services causes a backlog in the acute services, with many patients having to be sent back to their local general hospital to wait for a specialist rehabilitation bed, which may or may not materialise.

Consultant specialists in Rehabilitation Medicine (RM consultants) can play a key role within the trauma networks by identifying the patient’s needs for rehabilitation and preparing a ‘specialist rehabilitation prescription’ to direct them to the appropriate services and speed up their transfer as soon as they are ready to leave the major trauma centre. The national standards require that an RM consultant should visit each MTC at least 2-3 times per week.

This NCASRI report focuses on the organisation of services for adults and their degree of integration within the major trauma networks across England. It makes recommendations to improve access to appropriate rehabilitation services and so enhance the recovery of very severely injured patients.

The report’s key recommendations include:

  • Commissioners and providers within each major trauma network should work together to review the capacity and pathways for specialist rehabilitation following major trauma, especially services that focus on cognitive behavioural and ‘hyper-acute’ rehabilitation for patients with challenging behaviours or high levels of medical dependency.
  • MTCs should ensure that patients with complex rehabilitation needs are seen by an RM consultant and directed to the appropriate specialist rehabilitation service to meet their needs in a timely manner
  • MTCs that do not currently have sufficient funded sessions for an RM consultant to visit at least 2-3 times per week to should fund these positions
  • Service commissioners within NHS England and Clinical Commissioning Groups should ensure that the commissioned rates for specialist rehabilitation services are sufficient to provide safe and effective care that meets the national standards
  • Rehabilitation providers and commissioners need to investigate reasons that are causing the delays in accessing specialist rehabilitation to avoid a negative impact on long-term outcomes for those patients

Prof Lynne Turner-Stokes, Consultant in Rehabilitation at Northwick Park Hospital, UK Rehabilitation Outcomes Collaborative chair and The British Society of Rehabilitation Medicine president said:

“The results in this report show the need for better access and provision of specialist rehabilitation provision in some major trauma networks. It highlights the lack of adoption of some national standards, especially in terms of access to consultants in rehabilitation medicine and the completion of the specialist rehabilitation prescription for more complex patients. From the recommendations of the report, I encourage major trauma networks and their commissioners to find ways to improve access to specialist rehabilitation.”

The NCASRI audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit (NCA) Programme. The NCASRI audit is led by the London North West Healthcare NHS Trust, which hosts the UK Rehabilitation Outcomes Collaborative (UKROC), together with its subcontracted partners:

  • The Trauma Audit and Research Network (TARN), based at University of Manchester
  • The Cicely Saunders Institute, King’s College London (KCL)