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Why are front-line health institutions still failing to provide adequate rehabilitation and aftercare services to spinal cord injured patients?
By Ben Lees
Jackie Bailey, head of outreach services for the Spinal Injuries Association, recently shared her team’s experience of the problems faced by people with spinal cord injuries in a care pathways document for NHS England. Her team’s work has revealed a concerning “lack of understanding of how best to treat and care for people with a spinal cord injury” in front line health services.
We have found that spinal cord injury rehabilitation services and aftercare are a common source of dissatisfaction for clients who have suffered a spinal cord injury. Our clients often point out that they are not assisted to mobilise anywhere near often enough, whether they are going to the bathroom, or simply seeking to change position in their hospital bed to avoid discomfort. Another frequent complaint amongst our clients is that hospital staff fail to monitor their condition at appropriate intervals. It follows that potential complications are missed and problems are allowed to deteriorate right under the noses of ward staff, which leads to an increasing number of spinal injury claims where compensation is sought for the additional injury suffered due to the inadequate care.
One particular example of this is a client of ours in whose case it is alleged that extensive knee pain and inflammation was not adequately monitored whilst she was recovering in a rehabilitation unit following a spinal injury. The extent of the swelling became so severe that she was unable to complete physiotherapy and hydrotherapy sessions that were of critical importance to her rehabilitation, and ultimately to her regaining some measure of independence.
In an article in the Guardian dated 19 April 2013, Jackie Bailey comments that “sadly, too many spinal cord injured patients wrongly end up in orthopaedic, or even elderly wards, and they can be the only spinal cord injured patient in the hospital. So they can be deprived of the specialist care that can be vital in the first six months after injury”. Jackie Bailey’s experience of day-to-day management of spinal cord injured patients certainly tallies with the complaints we receive from clients, and she too identifies that “staff can be reticent to move newly-injured people”. She goes on to point out that “even after eight hours of lying in the same position, pressure ulcers can set in, causing permanent scarring and skin vulnerability.”
The way forward
Often clients come to the Clinical Negligence Team with a complaint surrounding the management of the spinal cord injury itself and have concerns as to whether the full extent of the injury could have been avoided. But once the injury has occurred it is not the end of the story. The goal must surely be to ensure that patients receive the right treatment and attention following their injury and, ultimately, to ensure that patients with a spinal cord injury retain as much independence as possible.
Going forward, it is hoped that NHS trusts adopt and put into practice the rehabilitation process and key markers which are identified in the care pathways document.