Where are the staff?

When it comes to rehabilitation, it seems that insurers, employers and the government are finally singing from the same hymn sheet. However, just when its benefits are starting to show, a lack of qualified staff is threatening to reverse the trend.

While Australia and the US are well-known for their knowhow in rehabilitation programmes, the industry in the UK is facing some teething problems. And even though rehabilitation is well on its way to becoming the next big thing in the UK health industry - with the government making a massive efforts to promote the benefits of rehabilitation - recruitment and retention issues are putting providers to the test.

Rehabilitation is not a well known discipline among UK nurses, physiotherapists, occupational therapists and other medical staff. And with difficulties in recruiting at home, providers are looking elsewhere for professionals. The majority of staff employed by Health and Case Management Ltd (HCML), for example, is from Australia, New Zealand and America.

Melanie Summers, managing director of AIG Medical & Rehabilitation, says that overseas staff bring in solid experience in case management, but recruitment costs can be astronomical, especially if recruits do not stay with the company for very long.

"One of the main issues is finding people with experience in a market which is still very small," she adds. "We spend a lot of time and effort providing in-house training."

Shortage of clinical staff is a common feature of the NHS, but rehabilitation providers are aware that they have an uphill battle to fight.

Summers says: "People need job security. We are competing against the NHS which gives staff a huge amount of job security and generous benefits. We need to make sure our basic salaries and benefits are comparable."

She adds: "Rehabilitation companies have to bite the bullet and accept that if we want to be accepted as professional people we need to introduce proper training and qualification, which in turn will keep people in the industry."

But in a environment where there is no recognised qualification framework for rehabilitation staff, this is easier said than done.

Masters degree

And to get the ball rolling, AIG Medical & Rehabilitation has teamed up with Brighton University and launched a two-year masters degree on case management. Summers says that providing such training is a good way of retaining people as well as encouraging others to join the industry.

RTW Plus is another example of a provider trying to find solutions to fill the skills gap. The company developed its own training course, as many other providers do, but it went a step further and obtained accreditation for the programme from Middlesex University.

RTW Plus director Richard Boothman says: "We want to provide something of real academic value and we see this as an opportunity to recruit more people as well.

"Rehabilitation is another career path for clinical staff and gives them an opportunity to get involved and work in a different field."

Boothman argues that the government could do more to help address some of the recruitment and retention issues by providing a qualifications framework for rehabilitation.

"There is no recognised training or qualification programme through medical schools which would equip people to do the job," he says.

Boothman adds that although the government is making the right noises promoting the benefits of rehabilitation, it has so far failed to put the right structures in places which would help the industry to develop.

Providers recognise there is still a lot to be done, but could the skills gap jeopardise the progress rehabilitation has made so far?

"It is a real danger. If service provision does not meet the expectations of either the person being rehabilitated or those paying the bill - if you don't achieve the goals you set out to achieve - you quickly lose credibility," Boothman points out.

Helen Merfield, managing director of HCML, believes the rehabilitation industry has been caught in a 'chicken and egg' situation. "Unless there is a rehabilitation industry people won't get qualified. We are at an embryonic stage," she explains.

She adds that HCML, which has its own in-house training programme and over 60 case managers, is promoting rehabilitation as a career path by giving talks at universities.

"The more people who hear about it in the UK, the more they will be interested. People working in nursing, physiotherapy and occupational therapy will want to join in."

Raising awareness

Efforts to raise awareness about rehabilitation is paying off, according to Maureen Chung, national sales manager at recruitment company Berry Medical.

"Candidates are becoming more aware of rehabilitation. It opens a lot of doors for physiotherapists, for example, as they can go into case management.

But a lot of people are also worried that if they go into case management they will lose their clinical skills." But she adds there are people looking for a career change and for whom rehabilitation is an attractive path.

Jo Berry, recruitment consultant for Pulse and a qualified nurse, agrees.

"Some people are looking for a more challenging career pathway within a commercial environment," she says. "The most important thing is that they have a good understanding of their role, commercial awareness and broad clinical background so they can assess their cases."

Berry emphasises that previous clinical experience is crucial for those going into rehabilitation and that therefore having a qualification at entry level would not necessarily be the best option.

"It is very important that you get experience in the profession you trained in before going into rehabilitation. Once you qualify, you need to have exposure as a professional. The clinical skills you acquire are important. You cannot be as successful if don't have hands-on experience."

It may well be that the rehabilitation industry is slowly growing to achieve maturity but, if the NHS example is anything to go by, recruitment challenges will not go away.

Yet, despite the challenges, providers show no signs of despondency.

"We are dealing with recruitment in the correct way," concludes Boothman.

"Rehabilitation gives us a real opportunity to make a huge difference for insurers and those suffering from long-term disability. We knew recruitment would be an issue, but we are doing whatever we can to bring the right people onboard."