rehabilitation challenges for the future nick kendall
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Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
Rehabilitation challenges for the future
Nick KendallHealth services consultant, London
www.kendallburton.com
April 2010Rehabilitation - future challenges
Buy PAS 150 at www.bsigroup.com/pas150
Today: ‘celebration for rehabilitation’
Rehabilitation has come a long way
Standards
Future challenges
Vocational rehabilitation (example)
April 2010Rehabilitation - future challenges
Buy PAS 150 at www.bsigroup.com/pas150
We’ve come a long way…
Rehabilitation grew in response to the large number of injured soldiers
Progressed with social, cultural, political, and economic change
Transformations, e.g. effects on functioning, Disability Ability
Reducing distinction: ‘acute’ vs. ‘rehabilitation Early Intervention
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
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
April 2010Rehabilitation - future challenges
Buy PAS 150 at www.bsigroup.com/pas150
Standards
Expected input, processes, outcomes– Customer-centred– Problem-focused– Outcome-oriented
Quality, efficiency, value, outcomes Publicly Available Specification 150 Serve to inform service users Support (do not hinder) excellence
April 2010Rehabilitation - future challenges
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Challenges
Clinical excellence, best practice Cost-effectiveness, £-constraint Academic excellence Research Staff recruitment and retention Inter-disciplinary Creativity
April 2010Rehabilitation - future challenges
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Example: Vocational Rehabilitation
Major challenge for future Importance of work-
focused healthcare and rehabilitation
Paradigm shift
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
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’)
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
Recommendations to VR Task Force- Strong evidence base, business case
- Not a matter of healthcare alone
- Work-focused healthcare and accommodating workplace
-Should be fundamental government strategy
Vocational Rehabilitation:
What works, for whom and when? Gordon Waddell, Kim Burton, & Nick Kendall: TSO Books, 2008www.workingforhealth.gov.uk/documents/vocational-rehabilitation.pdf
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
Making a Difference
enabling and facilitating
disabling and sabotaging
ability not disability what can you (still) do? how have you been feeling? ‘let pain/fatigue be your guide’
‘do not let what you cannot do interfere with what you can do’John Wooden
April 2010Rehabilitation - future challenges
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Work as part of recovery Work can be part of the recovery
process Provides protective factors, e.g.
– Structure to the day– Social contacts– Self-esteem
April 2010Rehabilitation - future challenges
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Accommodating Workplace
Alter work tasks or environment to reduce physical demands
Alter work organisation
Change the job
Allow flexibility
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
Accommodating Workplaces
What is reasonable?
Light duties
Alternative duties
Modified work
Selected duties
Duration - temporary vs. long-term
April 2010Rehabilitation - future challenges
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Hierarchy of Return to Work Goals
Same Employersame, modified, or different job
Different Employersame, modified, or different job
Retraining/studynew skills
Voluntary workbuilding tolerance,resilience
Adapted from Kendall & Thompson, 1998
April 2010Rehabilitation - future challenges
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50-80%Baseline
Graduated Approach to improve tolerance, build resilience
Gradient Duration
April 2010Rehabilitation - future challenges
Buy PAS 150 at www.bsigroup.com/pas150
April 2010Rehabilitation - future challenges
Buy PAS 150 at www.bsigroup.com/pas150
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.ButWork can also be a hazard
therefore therefore
Advice to stay off work Sick certificationRisk assessment‘Protect’ person from work
Advice & support to remain in/ return to workandSafe, healthy work
Buy PAS 150 at www.bsigroup.com/pas150Rehabilitation - future challenges
April 2010
‘work should be comfortable when we are well and accommodating when we are ill or injured’
Norton Hadler