Clinical Review Recent advances

Recent advances in rehabilitation

BMJ 2000; 320 doi: (Published 20 May 2000) Cite this as: BMJ 2000;320:1385

Rehabilitation: a service vulnerable to the whims of policy

Given my involvement in the Topic Working Group concerned with
rehabilitation and the therapies in primary care for the Clarke Review, I
read the clinical review on rehabilitation published on 20th May with

The introduction of Primary Care Groups and Trusts are being
accompanied by the expectation that, in the future, the bulk of secondary
care services including rehabilitation will be commissioned and in some
cases delivered by primary care. However, there is a clear lack of
evidence to support this shift. Moreover, Wade and de Jong produce
persuasive arguements which favour specialist services. It would appear
that once again policy has been determined without due reference to what
is known, and more importantly, what is not.

I would suggest that the ability of PCGs and PCTs to commission and
deliver the rehabilitation agenda needs examining now so that service
development can be adequately informed. Alongside this, arrangements that
are most likely to lead to the delivery of high quality rehabilitation
services must be confirmed, The alternatives are the possible erosion of
the centres of well organised, multi disciplinary rehabilitation which
Wade and de Jong highlight as being the cornerstone of quality services.

Competing interests: No competing interests

13 June 2000
Gail Mountain
Research and Development Officer
College of Occupational Therapists