The Rehabilitation Prescription – is it working?
Rehabilitation after discharge from hospital is a key part of a patient’s care when they have suffered a brain injury. Without specialist rehabilitation, a patient’s outcome will inevitably be compromised. Those with complex needs will need prolonged involvement from an interdisciplinary team with expertise in rehabilitation and others may have highly complex needs and require specialist rehabilitation.
The Rehabilitation Prescription – what is it?
The rehabilitation prescription is a key tool for improving the rehabilitation of individuals with a brain injury. Rehabilitation prescriptions came into being after the Clinical Advisory Group on Major Trauma recommended in 2010 that they be introduced for patients who are discharged from one of the Major Trauma Centres. What was envisaged was more of a set of standards rather than an actual prescription, however what was clear was the need to maintain a continued focus on the patient’s longer term recovery.
The rehabilitation prescription describes the patient’s physical, cognitive and psychosocial needs, considered in the context of their pre-injury life and states how these will be addressed after discharge. Having these in a single document is incredibly helpful for the patient, their family and also for their GP.
The prescription is an extension of a discharge/transfer summary and should also include ongoing health and social care plans so that everyone is working from one document, which is regularly reviewed and updated.
The British Society of Rehabilitation Medicine has also published a pro-forma Specialist Rehabilitation Prescription (SRP) for individuals with the most complex rehabilitation needs who require specialist rehabilitation services, which may require them to continue to be an in-patient.
The SRP should be completed or signed off by a Consultant in rehabilitation medicine or their deputy, at discharge from the Major Trauma Centre or Trauma Unit. The pro-forma details the individual rehabilitation needs in all areas including medical, physical, basic functions, activities of daily living, cognitive/psychosocial, discharge planning and equipment needs.
Is the Rehabilitation Prescription being widely used?
There is room for improvement in how rehabilitation prescriptions are being used. The results of the National Clinical Audit in October 2016 entitled ‘Specialist Rehabilitation for Patients with Complex Needs Following Major Injury (NCASRI)’ report showed that although all 22 Major Trauma Centres reported that they routinely complete a rehabilitation prescription, in two-thirds of the centres the prescription was not passed on to the patient.
A Freedom of Information Request was sent last year to all Clinical Commissioning Groups (CCGs) by the United Kingdom Acquired Brain Injury Forum (UKABIF) asking about their use of rehabilitation prescriptions. The response rate was poor, only four CCGs were positive and there were reports that rehabilitation prescriptions were rarely copied to patients and their GPs.
There have been concerns that the rehabilitation prescriptions are not being adequately monitored or followed up and that the CCGs also need further help understanding the routes available for rehabilitation.
Benefits of using the Rehabilitation Prescription
The rehabilitation prescription is a valuable tool that documents the rehabilitation needs of the individual with a brain injury. However, it is of limited help if the patient and their GP don’t receive a copy. If neither know what rehabilitation is required then access to services cannot be planned or implemented.
The rehabilitation prescription should be given to every individual – both children and adults – with an acquired brain injury, upon discharge from hospital, with a copy sent to their GP. This will then provide a useful resource for both to work from, to facilitate access to rehabilitation services in the community, maximising the individual’s health outcomes.
The rehabilitation prescription is a simple, but invaluable tool for an individual with a brain injury, which should be used on discharge throughout the UK. It will not only improve patient care, but could help the NHS and the independent sector to manage service provision more efficiently and cost-effectively.
Use of Rehabilitation Prescription in compensation claims
Where a patient has a legal claim for compensation relating to their injuries, the rehabilitation prescription can also be helpful in terms of supporting requests for private funding being made from a defendant insurer or body. It provides an objective analysis of the patient’s needs. At an early stage of a compensation claim, when private funding may not be available, the rehabilitation prescription provides a clear indication of needs that should be met by the NHS and other organisations in the meantime. It provides a focus for efforts to be made for the rehabilitation to be coordinated.
The development of the rehabilitation prescription is a welcome one. We must now also ensure that the full benefit of their use reaches the patient, to optimise their outcome and quality of life, as was intended.
Suzanne Trask is a solicitor, the head of the Adult Brain Injury team and a partner at Bolt Burdon Kemp. If you or a loved one is concerned about the treatment you have received, contact Suzanne free of charge and in confidence on 020 7288 4834 or at firstname.lastname@example.org. Alternatively, complete this form and one of the solicitors in the Adult Brain Injury team will contact you. Find out more about the Adult Brain Injury team.