Rehabilitation challenges for the future nick kendall


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Rehabilitation challenges for the future nick kendall

  1. 1. Rehabilitation challenges for the future Nick Kendall Health services consultant, London
  2. 2. Today: ‘celebration for rehabilitation’ <ul><li>Rehabilitation has come a long way </li></ul><ul><li>Standards </li></ul><ul><li>Future challenges </li></ul><ul><li>Vocational rehabilitation (example) </li></ul>
  3. 3. We’ve come a long way… <ul><li>Rehabilitation grew in response to the large number of injured soldiers </li></ul><ul><li>Progressed with social, cultural, political, and economic change </li></ul><ul><li>Transformations, e.g. effects on functioning, Dis ability  A bility </li></ul><ul><li>Reducing distinction: ‘acute’ vs. ‘rehabilitation  Early Intervention </li></ul>
  4. 4. Injury Disease Damage Symptoms Treatment Cure Activity Work Military Battlefield Wounded Soldier Field Hospital ‘ Fighting Fit’ Industrial ‘ Battlefield’ ‘ Wounded’ Worker Worker’s Clinic ‘ Fully Fit’ for Work post - 1664 WW1 & WW2 post - WW2 Short History of Rehabilitation and Occupational Medicine
  5. 5. Standards <ul><li>Expected input, processes, outcomes </li></ul><ul><ul><li>Customer-centred </li></ul></ul><ul><ul><li>Problem-focused </li></ul></ul><ul><ul><li>Outcome-oriented </li></ul></ul><ul><li>Quality, efficiency, value, outcomes </li></ul><ul><li>Publicly Available Specification 150 </li></ul><ul><li>Serve to inform service users </li></ul><ul><li>Support (do not hinder) excellence </li></ul>
  6. 6. Challenges <ul><li>Clinical excellence, best practice </li></ul><ul><li>Cost-effectiveness, £-constraint </li></ul><ul><li>Academic excellence </li></ul><ul><li>Research </li></ul><ul><li>Staff recruitment and retention </li></ul><ul><li>Inter-disciplinary </li></ul><ul><li>Creativity </li></ul>
  7. 7. Example: Vocational Rehabilitation <ul><li>Major challenge for future </li></ul><ul><li>Importance of work-focused healthcare and rehabilitation </li></ul><ul><li>Paradigm shift </li></ul>
  8. 8. Work is generally good for health and well-being, so… The imperative is to help people stay at, or return to work People who want to work should have the help they need (but this is not the same as ‘being made to work’)
  9. 9. <ul><li>Recommendations to VR Task Force </li></ul><ul><li>Strong evidence base, business case </li></ul><ul><li>Not a matter of healthcare alone </li></ul><ul><li>Work-focused healthcare and accommodating workplace </li></ul><ul><li>Should be fundamental government strategy </li></ul>Vocational Rehabilitation: What works, for whom and when? Gordon Waddell, Kim Burton, & Nick Kendall: TSO Books, 2008
  10. 10. Making a Difference  enabling and facilitating  disabling and sabotaging <ul><li>a bility not dis ability </li></ul><ul><li>what can you (still) do? </li></ul><ul><li>how have you been feeling? </li></ul><ul><li>‘ let pain/fatigue be your guide’ </li></ul>‘ do not let what you cannot do interfere with what you can do’ John Wooden
  11. 11. Work as part of recovery <ul><li>Work can be part of the recovery process </li></ul><ul><li>Provides protective factors, e.g. </li></ul><ul><ul><li>Structure to the day </li></ul></ul><ul><ul><li>Social contacts </li></ul></ul><ul><ul><li>Self-esteem </li></ul></ul>
  12. 12. Accommodating Workplace <ul><li>Alter work tasks or environment to reduce physical demands </li></ul><ul><li>Alter work organisation </li></ul><ul><li>Change the job </li></ul><ul><li>Allow flexibility </li></ul>
  13. 13. Accommodating Workplaces What is reasonable? Light duties Alternative duties Modified work Selected duties Duration - temporary vs. long-term
  14. 14. Hierarchy of Return to Work Goals <ul><li>Same Employer </li></ul><ul><li>same, modified, or different job </li></ul><ul><li>Different Employer </li></ul><ul><li>same, modified, or different job </li></ul><ul><li>Retraining/study </li></ul><ul><li>new skills </li></ul><ul><li>Voluntary work </li></ul><ul><li>building tolerance,resilience </li></ul>Adapted from Kendall & Thompson, 1998
  15. 15. 50-80% Baseline Graduated Approach to improve tolerance, build resilience Gradient Duration
  16. 17. Paradigm change, cultural shift Current: Shift to: Work is a ‘ risk ’ and (potentially) harmful to physical and mental health. Work is healthy, therapeutic & the best form of rehab. But Work can also be a hazard therefore therefore Advice to stay off work Sick certification Risk assessment ‘ Protect ’ person from work Advice & support to remain in/ return to work and Safe, healthy work
  17. 18. ‘ work should be comfortable when we are well and accommodating when we are ill or injured’ Norton Hadler