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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.
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
Competing interests: No competing interests