December 2006
Welcome to the HCML monthly rehabilitation news bulletin for December 2006.
Our aim in this bulletin is to give you an overview of what is happening in rehabilitation, and what is contributing either to early returns to work after injury, or causing injuries and other conditions to last longer than they need to.
We welcome users’ comment or suggestions for new subject areas we might monitor. If you would like to know more about HCML please visit our site
Plantec improves PI claims process via rehab
Claims management company Plantec has secured a rehabilitation support contract with Kynixa. The healthcare firm will assess the requirements of road accident victims and develop effective personal injury claims settlements.
Lee Evans, managing director of Plantec, commented: “The decision for us to start working with Kynixa stems from our appreciation of the impact that injuries sustained in road traffic accidents can have on the victim, as well as their family.
“We firmly believe that our clients are entitled to benefit from changes in attitude toward early intervention and a proactive stance regarding rehabilitation. The term rehabilitation covers all aspects of injury from telephone triage to long term vocational rehabilitation.”
Martin Hynes, chief operating officer at Kynixa, said “Plantec Holdings have recognised that early intervention will improve the likelihood of a more rapid recovery and faster return to work for the injured individuals concerned.
“This new approach reflects the growing acceptance by claims management companies and insurers that rehabilitation has a vital role to play in the effective management of accident victims. We are delighted to be working with Plantec in changing the way rehabilitation is used.”
Letter - Industry discussion needed over the role of regulation
I read with interest Simon Machell's comment regarding the current provision of rehabilitation services (Post, 9 November, p6).
At my firm, we recognise the value of the evidence base, which is why we are supporting the College of Occupational Therapists with an annual research award of £1000 to promote research in the development of the evidence base in vocational rehabilitation.
We only use highly experienced occupational therapists to undertake our initial and worksite assessments and develop the return-to-work plans but would welcome discussion by the insurance market on the Health Professions Council's position on Competency to Practice. This would arguably ensure that the practitioners involved are suitably qualified; however, if discussions led to the call for regulation then this could only be a good thing in terms of ensuring quality through practitioners who are suitably qualified.
Regarding the use of overseas trained staff, it is true that there are many occupational therapists and other qualified health professionals working in the UK rehabilitation sector. This does not mean, however, that the UK is not capable of producing skilled practitioners. Indeed, the Sheffield Hallam University runs an MSc in Vocational Rehabilitation for those who wish to become more expert in the area.
Rehabilitation Specialists has conducted a pilot research project on the use of occupational therapists in facilitating a safe and sustained return to work and are currently seeking advice from academics regarding the statistical analysis to make a wider study valid.
The results of our pilot study are commercially sensitive and it will be some time before our larger study, if validated, proves the use of occupational therapy as being most effective in the return-to-work process.
I think Simon Machell is correct that rehabilitation will be central to the government's position on the UK compensation system as it has moved away from a position during its own incapacity benefits reform process where there was no pre-requisite in pilot schemes for assessments to be completed by a qualified practitioner. It is now opening up the process under condition management, where we expect relevant qualifications to be considered as a prerequisite.
Miles Washbrook, Director, Rehabilitation Specialists, London
Hospital adverts could help rehab
The prospect of hospitals advertising their services could lead to increased standards of rehabilitation if they target the insurance sector, it was claimed this week.
The Association of British Insurers this week told Post that it welcomed the prospect of NHS hospitals being given the opportunity to market their services, claiming it could lead to increased specialisation and greater emphasis placed on rehabilitation.
"While we don't want to get involved in the political debate about the use of advertising in the NHS, if a hospital builds a reputation for having good rehabilitation services it's a bit of a no-brainer. Of course we would welcome it," stated a spokesman. “However, rehabilitation services are not key performance indicators in the NHS at the moment."
The ABI's comments followed news leaked from the Department of Health that NHS hospitals are to be allowed to advertise in order to attract patients. However, the prospect failed to address the true problems, according to Bob Rabbitts, technical claims manager at Allianz Cornhill, who said that insurers continue to be frustrated by the poor quality and availability of aftercare following their discharge as an in-patient.
He said: "It is one thing to advertise services but another to deliver them in a prompt and thorough manner when they are needed. Professional and comprehensive patient care must remain the number one goal for the NHS, and it must not be allowed to start slipping toward second place at the expense of exploring pure financial gain."
Mismanagement of the long-term sick is costing UK employers billions of pounds a year
Employers are losing billions of pounds by mismanaging workers on long-term sick leave, according to an expert.
CBI data shows that absence costs the UK £12bn per year, and insurance company UnumProvident believes up to 75% of this cost is from the long-term sick.
UnumProvident chief medical officer, professor Michael O'Donnell, insists many employees could be brought back to work from long absences. But he says managers are shutting down vital communications with sick workers for fear of harassment claims.
O'Donnell said: "The real issue for many of those off work with long-term health problems is not what caused their sickness but the barriers that are preventing them from recovering." HR staff should ensure managers understand the issues influencing absent employees so they can communicate more effectively, he added.
"There is a big concern that if managers call people while they are off sick, they will be accused of harassment. In fact, most people are happy to be called at home and this is important as it stops people feeling isolated."
Just asking workers in for a cup of tea can break down the psychological barriers to returning from long-term sick, O'Donnell added.
Stance on rehab needs a helping hand
The UK has a compensation system that has been carefully built, layer by layer, over time - yet there is an inefficient focus on the process rather than an injured party. As the government looks at ways in which to reform the system, rehabilitation should become a significant part of the process.
Rehabilitation not only provides insurers with early contact with claimants but enables them to recover more quickly, reducing life cycles and ultimately lessening the amount paid out in claims costs. Although at present there is limited data to support this, rehabilitation may also deter fraudulent claimants who are being challenged far earlier in the claims process.
That said, if rehabilitation is to become compulsory - which insurers are fully in support of - then there has to be a real focus on how it is delivered effectively. The industry needs to ensure that there is sufficient, properly accredited and trained professionals who can deliver the required treatment. Within the NHS and, to a lesser degree, the private sector, there is a limited supply of rehabilitation services. This leaves individuals struggling to find timely and appropriate advice and treatment to help restore them to their former selves.
Despite improvements in some parts of the NHS, provision and quality of rehabilitation services remains inconsistent across the UK, in that evidence-based medicine is not always delivered.
The few rehabilitation practitioners that the UK has operate in a largely unregulated or unaccredited system. At present, rehabilitation service can be offered by anyone. There are no compulsory qualifications, competence standards or regulations for rehabilitation practitioners. In fact, most practitioners in the UK come from abroad where, in many countries, there are graduate and post-graduate clinical and non-clinical rehabilitation courses. Arguably, there should be such courses available in the UK, funded and regulated by the government with additional funding or sponsorship from key stakeholders such as insurers.
Hopefully, with ongoing efforts such as companies adopting an evidence-based medicine rehabilitation approach to whiplash or evidence-based medicine back schemes, the government realises just how significant it would be for rehabilitation to be at the heart of the UK's compensation system.
Simon Machell, CEO of Norwich Union
NU whiplash rollout
Norwich Union has announced the rollout of a new approach to rehabilitation for whiplash claims. Working with Rehabilitation UK and a university-based academic team, the insurer has reviewed the treatment of hundreds of whiplash injuries to establish a best-practice protocol using evidence-based medicine. Since 2005, the insurer has been collating information from its pilot rehabilitation centre in Maidenhead.
Government to spend £10m on occupational health services
The government has pledged £10m to improve the provision of occupational health (OH) services to NHS staff. The cash will also be used to increase the availability of NHS Plus, the network of NHS departments that provide OH services to small- and medium-sized firms.
The funding will be used support between 10 and 12 pilot sites of good practice in OH care. These will then be made available for other companies to learn from. The funding could be used to move OH services closer to the workforces using them. NHS OH services are usually based in trusts providing acute services. It would cost between £500,000 and £750,000 to build and fit out a unit to house OH services in a business park, to provide better access for the people they are aiming to serve.
Health minister Rosie Winterton said: "NHS Plus provides a valuable OH service to small- and medium-sized companies. If your staff are off sick because of back pain, stress or any other work-related problem, your business suffers. A healthy workplace makes for good business."
NU acquisition 'murky water'
Concerns have been raised over a potential conflict of interest following Norwich Union's recent acquisition of Rehabilitation UK.
One source said: "This is a massive conflict of interest - will claimants be told that Rehabilitation UK belongs to Norwich Union? There appears to be murky waters between NU and its rehab provider."
NU hit back and remains adamant that it will be driven by an evidence- based approach. The service is delivered by Norwich Union Occupational Health, a separate organisation to NU insurance.
Dr Martin Strudley, director of rehabilitation, Norwich Union Occupational Health, said: "We will be driven by the experts and research evidence, not what we want to do as an organisation. We will go with the evidence that's out there, even, for example, if it's to the detriment to NU costs."
Fraser Whitehead, partner at Russell Jones & Walker said mistrust stemmed from a long history of dubious behaviour by liability insurers. He added that the independence of Rehabilitation UK would not cause a conflict of interest.
Norwich Union announces new approach to whiplash claims
Norwich Union has announced the rollout of an innovative and ground breaking approach to rehabilitation. Working with Rehabilitation UK and a university based academic team the insurer has reviewed the treatment of hundreds of whiplash injuries to establish a best practice protocol using evidence based medicine (EBM).
Since 2005 the insurer has been collating information from its pilot rehabilitation centre in Maidenhead. The results show that an EBM model delivers positive clinical and claims outcomes. Consequently the approach is to be adopted on all Norwich Union whiplash claims and is being implemented in conjunction with three preferred partners IPRS, Rehabworks and Rehabilitation UK.
Norwich Union currently handles 50,000 whiplash claims a year about 80% of their total bodily injury claims volume. A personally tailored programme is delivered by clinically trained telephone based handlers who provide the injured person with information on their condition and advice on how they can best control and manage their own recovery. If the claimant requires physiotherapy then this is arranged via Physiotherapy Networks.
The new rehabilitation model is a more holistic approach and has achieved positive clinical outcomes for injured people returning them back to health far quicker:
- 40% of injured persons supported to full recovery without needing hands on treatment
- where physiotherapy is required the average number of sessions is four as opposed to eight
The time taken to settle claims under £5000 has reduced by two thirds. There has also been a reduction in the overall claims costs though not due to a decrease in damages but in a reduction in the amount paid to claimant lawyers.
Norwich Union believes that whiplash claims are typically straightforward and capable of fair and swift resolution and do not need to generate disproportionate legal costs. Claimants favour the use of rehabilitation and nearly 90% of them said they were happy with the new approach.
Historically the compensation system has focused on making payments to an injured person rather than concerning itself with their wellbeing and helping them recover.
Dominic Clayden, director of technical claims says “We would like to see rehabilitation at the heart of the compensation process and more willing engagement with claimants and their representatives focusing all stakeholders on the injured person’s quick recovery rather than the size of a cheque”.
All news reported in this bulletin and on the HCML site is taken from the sources quoted. It is intended to inform readers about the news that has been reported in a given month and is in no way indicative of any attitude or policy of HCML.