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Notes on Dr John Etherington's presentation at the OT SHOW

Dr Etherington focused on the following: Background – reminding the audience of the vision that NHS England have set out for rehabilitation, which is:

Rehabilitation will be key to every episode of care. It will maximise mental and physical health, independence and occupation. And that rehabilitation is everyone’s business.

 Rehabilitation Programme Activities

  • Rehabilitation Programme Board
    Stakeholder Engagement
    Commissioning Guidance
    NICE, HQIP, NHS IQ
    Working Parties

 The programme board have been engaging with working groups to focus:

• Creating arguments that rehabilitation can contribute significant to the country’s economic growth
• Developing commissioning guidance with incentive and levers
• Addressing issue to support vocational rehabilitation
• Children and young people
• The important of rehabilitation to support the workforce

There is fantastic enthusiasm across the NHS to improve rehabilitation service. However, the stakeholders have identified key areas that need addressing:
• Dissatisfaction with current provision i.e. resources and access
• Rehabilitation service need to be more focussed on patient need and that there is currently a lack of focus on outcome, particularly with vocational rehabilitation
• Current commissioning structures are an obstacle to care

In terms of engaging with NICE, Dr Etherington highlighted NICE’s interest in developing guidelines for:

• Rehabilitation for Chronic Neurological Disorders (including Traumatic Brain Injury)
• Rehabilitation after Traumatic Injury (including restoring full vocational, social, physical and mental health after traumatic injury)
• Rehabilitation in People with Severe and Enduring Mental Illness

The evidence to support the importance of rehabilitation is still a key requirement. There are some studies that Dr Etherington highlighted that support the role vocational rehabilitation including ‘The Australian Vocational Rehabilitation study and the ‘Canada Pension Plan Disability Vocational Rehabilitation program’.

He said that the NHS needs to embrace broader societal outcomes which includes work, wellness, injury and illness prevention.

By improving outcomes, we will be able to generate national financial savings by reducing: • Welfare costs
• Impact on the justice and education system

Also we will see improvements in life expectancy, work and recovery and by supporting children and young people, patient/parents and carers can return to work.

Highlighting funding opportunities, Dr Etherington mentioned a number of possibilities including:
• The Injury Cost Recovery Scheme (ICRS), which currently generates £220m pa from insurance companies for patients who suffer injury
• Alternative Legal Business Model – the change in legislation allows firms to form companies with charities

Dr Etherington offered thoughts on tactics that could employed to tap into funding streams to help support the delivery of rehabilitation services which includes using:
• Trauma Rehabilitation – is establishing good evidence for the importance of rehabilitation services
• Rightcare – The primary objective for the NHS Right Care programme is to maximise value, which we define as:

- the value that the patient derives from their own care and treatment, the personalisation of difficult decisions is optimised by patient decision aids http://sdm.rightcare.nhs.uk/pda/ and shared decision making
- the value the whole population derives from the investment in their healthcare and there are two aspects to this
- Allocative value, determined by how the assets are distributed to different sub groups in the population, for example to people with cancer or to people with mental health problems,
- Technical value, determined by how well resources are used for, this is measured by relating outcomes to the resources used, where the resources are not solely financial but include the time of patients and clinicians. Neither is it measured only with respect to the patients treated but to all the people in need in the population because there is under provision to some groups and the population based approach to technical value or efficiency is essential for increasing equity as well as value The inverse of value is waste which is any activity that does not add value

Further details of the Rightcare programme can be found at www.rightcare.nhs.uk

• Health and work unit – DH/DWP