Rehabilitation is getting some attention, but progress is slow and a shift in focus towards quailty of life for the claimant is needed, says Lord Hunt
Doctors often use abbreviations in medical records, including one that should be welcome to any injured person, FTW, or "Fit to work".
Working improves long term physical, mental and economic health and removes substantial burdens on both the health service and benefits budgets. But focusing on return to work misses the true value of a full functional recovery from injury, because those who recover completely can lead full and active lives, the loss of which can never be properly measured in compensation.
These concepts have become familiar recently in the "rehabilitation" debate, but does this label sufficiently convey the positive benefits that we are seeking to achieve?
Rehabilitation was first discussed in the context of catastrophic injuries, but over the last few years the focus has moved on to lesser injuries that prevent people returning to work, many of them musculo-skeletal in origin. Despite work by many key bodies, including the British Society of Rehabilitation Medicine, to make rehabilitation an automatic consideration, progress has been slow. But why has it been slow, when there are potential benefits for everyone and, unlike most good ideas, there is already money in the system that could deliver it?
The biggest single distorting factor is our tort-based compensation system, which ensures that the greatest financial rewards go to those who are least successful in recovering from injury.
It is frequently damages for future loss of earnings that distinguish claims for traumatic injury settling for under £25,000 from those attracting awards of £100,000 or more.
Moreover, apart from this direct cost, which feeds back into the economy through insurance premiums, a complicated web of systems for recovering all or part of the state's expenditure on benefits and healthcare has developed.
Of course, if there was nothing that could be done about the extent of a patient's recovery, this approach would be exactly right. The worst injured should be the best compensated because their needs are greater. However, today's modern, effective rehabilitation techniques mean that most recoveries can be significantly enhanced by early intervention.
So what stands in the way of reorganising the system so that funds are channelled into the health service to permit it to perform its original function. That function is restoring people to fitness for work and play, instead of providing long-term care for those unfortunate enough to have nobody to blame for their injuries?
There are many potential answers to that question and they vary according to one's perspective on the present system. The Civil Justice Council has intervened to bring together all those with an interest in the question. And there have already been meetings at which the focus was firmly on functional, rather than financial, outcomes for injured people.
Some important concepts are already emerging. Education about the value of rehabilitation is greatly needed. Individuals need to understand why it is right for them, and professionals in the field must be able to describe the benefits convincingly and then deliver them.
Equally importantly, corporations, public bodies and others who interact with employees and the public must not see rehabilitation as the complete answer. They must work safely and successfully to prevent accidents happening in the first place.
Beachcroft Wansbroughs is holding a workshop on 23 April to highlight the benefits of this change of focus. Delegates from insurers and the NHS will hear from Tony Redmond, a professor of emergency medicine, about his successes with early assessment techniques.
Perhaps during this debate we will hit upon a better word to describe what we want to achieve, one that sums up the benefit for society and the individuals within it when we are fit to work and fit for life.
