The Duke’s idea
The idea of creating a 21st century version of the existing Defence rehab centre, Headley Court in Surrey, in a new location to serve the future needs of serving members of the Armed Forces came from the 6th Duke of Westminster.
He raised it in the MoD in the late summer of 2008 with the Vice Chief of the Defence Staff for whom he was working at that time as the senior reservist in Defence as a Major General. The Duke had served in the Reserve Army for 40 years and knew, first hand, the high price that members of the Armed Forces can pay for serving the nation. He wanted to do something about it and ensure that seriously injured sailors, soldiers and members of the RAF would feel looked after and get the best possible care.
The idea was subsequently discussed with the Defence Secretary (Des, now Lord, Browne) who supported the Duke’s idea but asked whether he could at the same time ‘do something for the nation too’. This was put to the Duke who agreed.
Meetings followed in the Vice Chief’s office involving Dame Carol Black (then the Government’s adviser at DWP), the Surgeon General and Arup. They examined the basic feasibility of what was being proposed in terms of the clinical rehabilitation field of medicine.
The notion of a Defence and National Rehabilitation Centre (DNRC) programme was devised and put to the Duke at the end of 2008. In 2009 it was developed with the other government departments and was put to Parliament in a written Ministerial Statement in June 2009. That statement heralded the start of a year-long study in 2010, funded by the Duke, to examine the concept across government in detail.
The programme to deliver the National Rehabilitation Centre (NRC) is being led by Nottingham University Hospitals Trust (NUH) and as such, NUH is the official NHS sponsor and is responsible for the programme of work. It is the ‘National’ element of the overall Defence and National Rehabilitation Centre (DNRC) Programme. The ‘Defence’ element is complete and has been treating patients since autumn 2018 – and its full title is the ‘Defence Medical Rehabilitation Centre’ or DMRC.
Over the past 18 months, NUH have worked closely with professionals and patients who have experienced rehabilitation to harness the ideas that people have to make the most of the opportunity at the NRC.
NUH have taken great care in developing our new clinical rehabilitation pathway which will transform how people will benefit from rehabilitation by proposing:
• The opportunity to benefit from rehabilitation is broadened out to a much wider group of people than at present.
• Dramatically shortening the time people wait for rehabilitation.
• Delivering an intensive programme of rehabilitation early on in people’s recovery so that the impact is greatest and patients can more likely get back to work and life.
• Ensuring that people go to the right place for rehabilitation across the East Midlands region (not everyone’s specific clinical needs will be suitable for the NRC).
• Making sure that patients are involved in the decision about where they go.
The Defence facility is now built and operating, treating Armed Forces patients who have sustained an injury from either training and exercise or in active service. It has approximately 200 beds. It has always been the intention that both centres will work closely together but important to note that patients will be treated at separate times if they are using equipment (e.g. pools) in the Defence facility.
The Defence facility is the catalyst for the NRC and it has always been envisaged that there will be a high degree of collaboration including some access to specialist facilities. The exact nature of any sharing between the NHS and Defence Medical Services is being determined this year.
Some potential areas for physical sharing of facilities are outlined below but, more importantly, the skill and expertise in rehabilitation which resides within Defence medicine will also be shared – and expertise within the NHS will flow back in the other direction. This will be done through a collaborative programme of research, training and education. Collectively, this will improve knowledge and expertise.
There will be opportunities for staff to work alongside each other for the first time and share knowledge and expertise in their particular field. This will contribute to pushing the speciality forwards in knowledge and in terms of the quality of outcomes it delivers for patients.
The physical facilities which could be shared with patients with the appropriate clinical need, subject to the proper arrangements being put in place and under agreed terms with Defence Medical Services, are:
- The diagnostic capability at the Defence facility – this includes X-ray, ultrasound and the MRI units.
- Hydrotherapy pool – there is no routine access to a hydrotherapy pool at present for rehabilitation patients in the NHS.
- The gait laboratory – this is cutting-edge technology and the longest gait laboratory in clinical use in Europe. There are more cameras giving detailed images than any other facility, enabling clinicians to benefit from technical detail on muscle activity and gait patterns like never before. Rehab programmes are changing already due to this enhanced level of information into the clinical teams.
- The virtual reality CAREN (Computer Aided Rehabilitation Environment) is one of only six in the world and the only one currently being used to treat patients. Early use has shown significant benefits particularly in patients with a head injury on their balance system.