The UK’s National Institute for Health and Care Excellence (NICE) has published a summary of consultation responses along with its 2022 guidelines on ‘rehabilitation after traumatic injury’.
NICE is an executive non-departmental public body, sponsored by the Department of Health and Social Care. This body produces evidence-based guidance and advice, and plays a central role in developing quality standards and performance metrics for those providing and commissioning health, public health and social care services.
In July 2021, NICE published new draft guidance focused on rehabilitation after traumatic injury. Although Kennedys did not qualify as a stakeholder, Kennedys nonetheless provided our comments on the consultation, which NICE advised would still be considered, albeit not published in the final response.
Earlier this year, NICE published its consultation on draft guidelines – stakeholder comments table document spanning 262 pages, along with the 2022 guidelines.
In this article, we set out our initial thoughts with regard to the new guidelines and the impact these may have on compensators from a claims handling perspective.
The 2022 guidelines covers complex rehabilitation needs after traumatic injury, including assessment and goal setting, rehabilitation plans and programmes, physical, psychological and cognitive rehabilitation, rehabilitation for specific injuries, coordination of rehabilitation in hospital, at discharge and in the community, and commissioning and organising rehabilitation services.
The importance of self-management
The 2022 guidelines place emphasis on guided self-management rehabilitation programmes to allow the patient to engage in rehabilitation in their own time and by their own schedule, working with rehabilitation healthcare professionals and practitioners, with regular reviews to check on progress, provide ongoing reassurance and answer queries. As part of a self-management rehabilitation programme, the guidelines state that a tailored package of online education and learning materials should be considered.
Many people involved in accidents suffer consequential mental health issues such as low mood, anxiety, post-traumatic stress disorder and/or depression. Symptoms can be ongoing and in some cases, be more debilitating than the physical injury sustained. As such, obtaining an early diagnosis and accessing treatment is central to a patient’s rehabilitation and recovery.
The guidelines encourage discussion with the individual in terms of the psychological support available and what would be best for their recovery, as an integral part of their overall rehabilitation programme. In particular, we welcome the recommendation to urgently refer a patient to psychology services for assessment and treatment, if a patient’s rehabilitation is adversely affected by their psychological problems (including if the person is struggling to engage with the rehabilitation process).
An increased role for telehealth?
The NICE committee acknowledges that technology and telehealth can be suitable methods of improving flexibility and availability of specialist appointments. Therefore, as with the draft 2021 version, the 2022 guidelines state that consideration should be given to “technology-enabled follow-up, support and rehabilitation sessions if people request more local, accessible therapy or if rehabilitation practitioners are not available in their area, for example, in rural areas”.
However, we believe that NICE may have missed an opportunity to close the clinical knowledge gap around the role of technology via expressly referencing the importance of ongoing education and training of those advising on the solutions available to patients.
Interplay between the public and private sectors
In our view the guidelines lack detail and commentary around the role of insurers and the often overlapping role of the private sector, especially in relation to the coordination of care on discharge. Interestingly, a similar point was raised by First-Class Professional Rehabilitation Services (HCML), to which NICE responded that the guidelines do refer to services delivered by private providers. Nevertheless, we believe that NICE could and should have expanded on this further.
The new guidelines are a positive development in the arena of catastrophic injury.
Interestingly, the guidelines do not cover the management of traumatic brain injury, except in relation to early screening for onward referral and the coordination of services for people with multiple injuries, one of which may be traumatic brain injury. The delivery of rehabilitation services for traumatic brain injury will be covered in a new NICE guideline on rehabilitation for chronic neurological disorders (including traumatic brain injury) expected to be published in December 2023.