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LETTERS: Andrew O Frank What is intermediate care?: A flawed substitute for rehabilitation in the United Kingdom BMJ 2004; 329: 686-b [Full text]

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Intermediate Care & Rehabilitation

Peter K Tun   (17 September 2004)

Intermediate Care & Rehabilitation 17 September 2004
Peter K Tun, Associate Specialist Berkshire Neuro-rehabilitation Service, Battle Hospital, Reading, RG30 1AG Send response to journal: Re: Intermediate Care & Rehabilitation	Dear Andrew, Your letter is very good and thought provoking. It made me to think what will be the best way for the patients ("customers" as the Department of Work & Pensions call them), doctors, nurses, therapists and support services to run a smooth well funded stress free rehabilitation services in UK. I have met a paraplegic patient who sat in a wheel chair for 6 hours waiting for a hospital transport to take him home after a 15 minute appointment with a rehabilitation doctor at the hospital out patient clinic. There should be more public transports going to hospitals, general practices, residential & nursing homes where disabled patients can easily access propelling their wheel-chairs up the ramp. There have been cases of severe cognitive, mental, behavioural disability, social distress, loss of livelihood and family breakdown of patients after traumatic brain injury, who failed to have disability living allowance or incapacity benefit. This shows lack of awareness of the disability assessing doctors working in the Deparment of Work & Pensions. The excessive prices of disabled equipments & home adaptations like £4000 for a mechanical hoist, £9000 for a through-floor lift, £ 4000 for a wheelchair that is convertable into a standing frame, has to be paid or funded by many patients themselves even if there is no chance of earning a livelihood in the future. There should be more training at technological colleges to design & build these basic useful things instead of far flung space explorers & advanced missiles to destroy the humanity. There are too many delayed hospital discharges & "bed blockers" because there are not enough disabled friendly homes to return. They have high steps, narrow doors, split level floors, absence of downstairs toilet at patients' home which are difficult for the wheelchair mobility. All future engineers in training should be aware of these needs to prevent such delays. Furniture & car makers should know what is the best height for the chairs, beds, toilet seats & car seats for easy wheel chair transfers. There should be a National Standard or handbooks, rules & regulations, as well as incentives for them to follow (eg. less tax for those who meet the standards). Many intermediate care teams provide some physiotherapy, occupational therapy & speech & language therapy for 6 weeks post-discharge, after which social services takes over sending carers to help wash & dress or prepare meals if required, but no more therapy support to follow up. There are delayed discharge wards in hospitals and local community hospitals run by nurses, sometimes with therapists & enthusiastic General Practitioners. They serve as "halfway houses" or "stepping stones", while waiting for the long term residential home or nursing home placements. Some of them are helpful (if there is some input from rehabilitation doctors say once a week), but some refused to accept the referrals if the patients are thought to be "heavy" or very dependent. The reason is they feel insecure & uneasy with disabled patients due to lack of training and understanding in rehabilitation. It can be very time consuming to travel for rehabilitation teams to visit many disabled people individually at homes. There will not be enough long stay hospital rehabilitation beds in the foreseeable futre also. If every body in each government department learns & give service to the disable people in the community, there will be less worry to the overstretched & under funded health & social workers. The only way forward is to incorporate teaching disability & rehabilitation in the basic education curriculum at GCSE & A-levels as well as for medical students & trainee nurses/therapist/social worker/ engineers/health economists/ teachers/ politicians (future education, health,trade, employment, social welfare, housing & transport ministers) so that many young adults will become aware of, feel confident & responsible for disability & rehabilitation in a concerted, uniformly sustainable way in the community and the Country as a whole. Peter Tun Competing interests: None declared