3 Rehabilitation and aftercare |
45. Another main element of the work of the DMS is
rehabilitation and aftercare. The MoD's Defence Rehabilitation
Plan operates a tiered approach to the delivery of services. The
first point of contact is one of 70 Primary Casualty Receiving
Facilities, which treat around 80% of problems. The PCRFs, in
turn, can refer patients to one of 15 Regional Rehabilitation
Units (RRUs), staffed by multi-disciplinary teams including doctors,
physiotherapists and rehabilitation instructors, which concentrate
on the assessment of musculo-skeletal injuries and sports medicine.
The MoD's memorandum claimed that the benefits brought by the
use of RRUs included successfully treating more than four-fifths
of patients through physiotherapy and rehabilitation alone, with
no surgical intervention, and discharging the "vast majority"
of patients fully fit for task.
We visited an RRU in Edinburgh in October 2007.
46. The principle underlying the DMS's approach to
the treatment of musculo-skeletal injuries is that, wherever possible,
care should be provided at a local level, and should make the
best possible use of physiotherapy and rehabilitation rather than
surgical intervention. This has the additional benefit of avoiding
patients spending long periods on waiting lists for assessment
47. We were
very impressed by the services at the Regional Rehabilitation
Unit we visited in Edinburgh and commend the staff for their excellent
work. The MoD's approach to musculo-skeletal injuries is forward-looking
and sensible, and we are persuaded that it has been of significant
benefit to Service personnel as patients, and to the efficiency
and effectiveness of their units.
48. The final link in the rehabilitation chain is
the Defence Medical Rehabilitation Centre at Headley Court in
Surrey, which we visited in June 2007. The Centre, which was opened
in 2004, deals principally with patients suffering from polytrauma
and brain injuries. It has 220 staff, half military and half civilian,
with 156 patient beds, 36 of which are ward-based. It provides
physiotherapy and rehabilitation for complex musculo-skeletal
injuries and specialised neuro-rehabilitation for patients with
brain injuries. Since June 2006, it has also been home to the
Complex Rehabilitation and Amputee Unit, and has a contract with
a private company for the production of prosthetics. These are
manufactured on site and individually tailored to the patients'
49. The principle underlying the work of the Centre
is to return patients to functional independence, and, where possible,
to active military duties. Historically, around 95% of patients
have returned to military duties, but this has fallen to 85-90%
in the recent past, given the increasingly serious injuries with
which patients are presenting. Only around half of those patients
with serious brain injuries tend to return to military duties.
50. The facility had been requisitioned from Lord
Cunliffe by HQ Canadian Forces during the Second World War, after
which it was bought by the Estate Agents and Auctioneers Institute
(now the Royal Institute of Chartered Surveyors) to endow as a
rehabilitation unit for aircrew in memory of the deeds of RAF
aircrew during the War. It remains governed by a trust, the deeds
of which include the rehabilitation of all Armed Forces personnel.
51. The MoD told us that there was an ongoing review
of Headley Court, to look at future anticipated needs and development
of the site, and that Mole Valley Council had been involved in
discussions about the process.
The Minister maintained that Headley Court was currently "very
fit for purpose", but added that the MoD "want[ed] to
look at the longer, short to medium term future in terms of any
developments that need[ed] to take place".
52. There had been some press comment suggesting
that some of the facilities available at Headley Court were insufficient
to meet the demand placed upon them. Specifically, it had been
alleged that the lack of availability of the hydrotherapy pool
had forced the Centre to take patients by bus to Leatherhead public
swimming pool. It was further alleged that there had been an incident
in which members of the public had expressed dissatisfaction with
this arrangement on the grounds that the presence of obviously
injured personnel might distress other users of the pool, especially
53. We put this allegation to the Minister in November
2007. He explained that it was in part founded on a misapprehension
of the purpose of different types of pool. The hydrotherapy pool
at Headley Court was heated to a relatively high temperature,
and was not suitable for those with cardiovascular issues. For
those patients, a standard swimming pool was more suitable. Therefore,
it was not the case that the hydrotherapy pool was unable to deliver
the required capacity, but rather that some patients had different
Surgeon-General added that the administration at Headley Court
had at no point suggested that the arrangements to use the public
swimming pool in Leatherhead were ineffective, inadequate or inappropriate,
complaints to which the DMS would have responded.
54. We readily
acknowledge the extraordinary work which is carried out at Headley
Court and have nothing but praise for the staff, who have had
to cope with an increased tempo of operations and treat patients
with injuries which, only a few years ago, would have been fatal.
We regard this as a good example of the Government and charities
cooperating to provide those services which they can most appropriately
deliver. We were astonished by the ability of some gravely-injured
Service personnel to be successfully treated, and to return to
active military duty. However, we are concerned by reports of
problems with the local community in terms both of developing
the facilities at Headley Court and of using local authority amenities.
If it is true that some local residents objected to the presence
of Service personnel, we find that attitude disgraceful. The Government
should make the outcome of the current review into the facilities
at Headley Court fully available, and should explain what planning
it has done to account for the increased operational tempo and
its implications for Headley Court.
28 Ev 100 Back
Ev 92, information from visit Back
Q 417 Back
Q 419 Back
Q 420 (Lieutenant-General Lillywhite) Back