Handle with care

While the draft standards for rehabilitation have been welcomed in many quarters, some claim they fall short in terms of giving injured people more guidance on services and complaints procedures, writes Ana Paula Nacif

Debate surrounding standards continues to be a focus not only for rehabilitation service providers, but also for those footing the bill. And last month's publication of the UK Rehabilitation Council's draft standards for rehabilitation service provision has given the industry further food for thought (Post, 9 October 2008, p2).

While these standards have been welcomed in many quarters, some claim they fall short in terms of giving injured people more guidance on services and complaints procedures. Others have pointed out that, while regulation is still not on the cards, the UKRC should create mechanisms to monitor compliance or even create a rating system for rehabilitation companies.

As the final version of these standards will not be published until next spring, time has been given for stakeholders to have their say. Consultation on the draft version remains open until 21 November.

Government backing

"The council will rewrite and adjust the standards in light of the comments received," explains Mark Baylis, chair of the International Underwriting Association and Association of British Insurers' rehabilitation working party. "They will then be sent to the Department for Work and Pensions for comments before the final version is published in April 2009."

In fact, the government has given the project £80,000 of its total £85,000 funding so far. "The DWP is set to become one of the biggest commissioners of rehabilitation services," explains Mr Baylis. "With the department's support and buy-in from major insurers, suppliers will really have to demonstrate they comply with these standards to be successful in the market."

Kynixa's medical director, Dr Andrew Frank, who supports the standards, adds that "rubber stamping by the government will undoubtedly challenge some companies that have not put quality professional and business practices into place".

But not everyone agrees that government endorsement will be enough to get everyone on board or create a level playing field in the market. Stephen Roberts, head of UK claims at Brit Insurance, says that unless the UKRC creates mechanisms to police the delivery of the standards, it will be difficult to reinforce them. "We need to be careful with the connection between government rubber-stamped standards and something that is mandatory," he adds. "Commercially, a company that is not good enough will fail but this is a long route to improving standards."

Mr Roberts' suggestion is for the UKRC to create something similar to 'Charter Mark' for providers that meet the standards.

Mandatory standards

Another crucial point, according to Nancy Hempstead, head of healthcare for Europe, the Middle East and Africa at Crawford & Company, is the creation of a level playing field. "These standards are useful but they are not mandatory. How can we make sure everyone is going to use them? If you have standards, you need a level playing field so you measure the same thing for every provider."

It may well be that the UKRC will need to consider mechanisms to ensure its standards have teeth. But how about the standards themselves, are they up to the job?

Georgina Cooper, rehabilitation team leader at Allianz Insurance, says the current draft standard version "goes nowhere near what is required in terms of a useful and directive document for the end-user". She explains the industry is "desperately in need" of guidelines for people receiving the service: "A rating scheme where injured parties can clearly and easily identify what standards each provider has, like a hotel rating system, would be helpful."

Ms Cooper is at pains to point out that she is not being overly critical but emphasises that consumers can stir the industry in the right direction. "They need to know how to complain and providers will then start to realise that poor service will lead to complaints, which should be centrally monitored. Once this is achieved, providers will be forced to look more closely at their service and increase their own standards accordingly."

Mr Roberts believes the initiative has raised the bar only to a minimum standard, "although the talk was about maximising it". And he says in trying to be inclusive, some of the wording used in the draft standards is a "bit woolly".

"For example," he says, "directions on best practice suggest that the provider should refer to their own industry body where that exists. If it doesn't, what do you do then?"

Some market players are also confused about how this new set of standards will fit in. Rosie Corless, rehabilitation manager at QBE European Operations, says the UKRC's document shows a good knowledge basis. However, she questions how these standards will fit in with so many others, already adopted in the industry. "What impact are these going to have? What will they achieve?"

Spotting the difference

According to Mr Baylis, the UKRC's standards are different from others in the market for two reasons. "These are purchase-facing whereas the other ones are for providers and how they should be providing their services. They also give those buying rehabilitation services the knowledge they need to purchase them and manage the contract."

On the positive side, Ms Corless says the draft standards cover all the major points. As an example, she cites outcome measures: "No matter what size you are, you need to measure what you do. This is a vital element and the message is a little stronger now than it has been."

However, she also points out that the UKRC's document does not mention capacity, which is also key. "It would be a good idea to reference that in there too," she adds. "It is about companies being open and transparent about the work they can take on."

Like other people in the insurance industry, Ms Corless would like to see the rehabilitation arena completely regulated. "It's great that we are working on standards," she says. "The next step for the market is to talk about accreditation and regulation. That's when we will see real change."

Mr Roberts adds: "As a regulated industry, we would also like the services we purchase to be regulated."

But while regulation is not yet around the corner, Helen Merfield, chief executive of HCML and part of the UKRC's standards committee, says these standards are a real step forward. "We can't run before we can walk," she adds. "At some point in the next five years, we need to look into how we can self-regulate rather than have it imposed on us. As an industry, I'd like to think that we can do it ourselves and get it right."


Providers will be expected to provide evidence based on five underlying principles or questions:

1. What does the service do?

2. What skills do you have to provide the service?

3. How do you deliver the service?

4. How do you protect the consumer and customer?

5. How do you make the service work?


Rehabilitation First Forum and Awards
24 June 2009
Lord's Cricket Ground

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