Training, Education and Welfare - DEFENCE MANAGEMENT JOURNAL, Issue 53
Recuperating for duty
December saw the opening of the new Regional Rehabilitation Unit at Aldershot Garrison. DMJ discusses future RRU capability with RAF Air Vice-Marshal Chris Morris…
Following a tri-service agreement the previous year, the RAF, in 2009, accepted lead service responsibility for Regional Rehabilitation Units (RRUs) and the intermediate rehabilitation of injured military personnel. The aim of the venture was to standardise the delivery of rehabilitation, and to enhance the development of best practice through a constructive partnership with the other services, particularly with the director of defence rehabilitation. RRUs give military personnel rapid access to an assessment of their injuries and intensive courses of rehabilitation to shorten the time to recovery.
The return of injured personnel to resume their military duties is an overriding priority for the principal personnel officers of the three services, and here RRUs have a vital part to play in the rehabilitation pathway, presently employing a mix of 186 military and civilian personnel comprising doctors, physiotherapists, exercise rehabilitation instructors and administrative staff. To manage 12 RRUs in the UK and the transfer of two RRUs in Germany to RAF ownership in 2011, Director General of Medical Services Air Vice-Marshal Chris Morris has a headquarters team of five assisted by two finance officers.
Speaking to DMJ at the opening of new RRU Canada House, Morris emphasises how much the successful delivery of rehabilitation depends on the close collaboration between different agencies and individuals, not least the host units and their command headquarters. In the case of Canada House, Aldershot Garrison and
HQ Land were responsible for the construction of this purpose-built facility that will benefit the RRU and its patients for many years to come.
The Air Vice-Marshal stresses that the RRU's most important stakeholder is the patient, which raises the question on the long-term rehabilitative care of
personnel after leaving the services – what is the relationship between the RRU organisation and the NHS, and how can the correct level of support be provided for veterans?
"This is an area that is being reviewed," explains Morris. "Currently the RRUs admit regular military personnel and mobilised reservists for an assessment of their injuries and rehabilitation as appropriate to the diagnosis. With the level of training and operational activity at the moment, the RRUs are working to full capacity. After medical rehabilitation, the single services assign their personnel with significant injuries and impairment to the army's personnel recovery centres, the navy's Hasler Company and the RAF's personnel holding flight. These recovery facilities allow the servicemen and women time to recuperate and return to their duties, or to prepare for their transition to civilian life.
"The RRUs are working closely with the personnel recovery centres and Hasler Company to make sure the personnel assigned to them have access to the RRUs where there is an ongoing need for physical rehabilitation." The Air Vice-Marshal is keen to stress that long-term care has to be taken into consideration. "When servicemen and women leave the services, the NHS becomes the responsible healthcare provider. It is the role of the single service recovery centres to make receiving GPs aware of the ongoing needs of injured personnel before they are discharged from the services."
Morris makes the point that there will have to be improvements in NHS capabilities. "I have seen many changes over the past few decades in the delivery of rehabilitation and recovery within the services. There is an expertise now within defence rehabilitation that is not entirely replicated at the moment within the NHS, and I do see an opportunity for the transfer of knowledge and expertise to help. We'll have to see how this develops, but it's certainly an area for future work and development as the cohort of injured personnel moves on and the NHS takes responsibility."
Unlike other areas of defence expenditure, Morris says that the Strategic Defence and Security Review (SDSR) promises a welcomed increased investment in rehabilitation. "The SDSR has had an impact. Rehabilitation is one of the very few areas that will be enhanced with an uplift in clinical and, to a lesser extent, administrative positions." Morris explains that staffing levels have increased, utilising locum clinicians to meet the increased number of patients and the complexities of their injuries.
"The uplift in doctors, physiotherapists and exercise rehabilitation instructors to match the enduring high demand for rehabilitation will allow patients quicker access to diagnostic appointments and rehabilitation courses, and will allow the RRUs to run smaller courses of patients with specific injuries," he says. "This is very good news for the RRUs, and especially so for the patients as well as the operational commanders who want to see their injured personnel recovered and returned to duty as soon as possible."
Morris continues: "The number of physiotherapists within the RAF is set to increase, and this will have a positive influence on RRU staffing levels and aircrew conditioning on flying stations to prevent injury in the first place. This coming year we plan to recruit 12 direct entrant physiotherapists largely from the NHS. For their first appointments, many will be posted to primary care rehabilitation facilities on RAF frontline stations to give them experience of life in the RAF. With the benefit of military experience, their career pathway will take them to RRU assignments for subsequent tours in due course."
The intake of civilian expertise naturally leads to the question of the role of reservist physiotherapists in the RRUs – a situation that Morris explains is a distinct possibility given the current workload and the deployment of military personnel on tours of operational duty. "We do have two qualified physiotherapists serving in the Royal Auxiliary Air Force, and the Territorial Army has a much stronger cadre," he says. "The army has deployed reservist physiotherapists to rehabilitation teams in Afghanistan."
As far as their mobilisation to an RRU is concerned, the Air Vice-Marshal is a little more circumspect, but he does see that there could be professional advantages. "The part the reservist can play is sometimes limited to mobilisation for short periods of time, and continuity of clinical staff is important to the RRUs. Up to now, we have not needed to mobilise reservists to back fill vacated military posts while the incumbents are assigned to operational duties, but there is no reason why this shouldn't happen. In fact, it could be beneficial to the RRU and to the individual's own development and understanding of defence rehabilitation."
With the construction of Canada House RRU, Aldershot now occupies a state-of-the-art building with the capacity it needs for an intake of 45 patients. Morris and his RRU staff are delighted with the new facility, and with Aldershot Garrison and HQ Land for delivering such an outstanding facility that will serve the rehabilitation of injured personnel very well.