New Zealand Rehabilitation Association, Inc.

Good news! Our application for funding to redevelop the NZRA website has been accepted! We have been awarded just over $32,000 from the government's Community Partnership Fund in order to develop a more publicly-accessible web-based network for all stakeholders involved in rehabilitation.  As a result of this recent success, I find I have become increasingly bold in my thinking regarding the place of rehabilitation in the future of NZ's health sector. My opinion is that there is not yet enough emphasis on rehabilitation perspectives and principles in public policy or health service planning. Consider for example all the news items that you have read over the past few years regarding the number of surgical procedures completed (or not completed) by various District Health Boards (this one, for example). Surgery rates are undoubtedly a popular measure used by politicians and the media alike to evaluate whether or not a public hospital can been seen to be ‘doing its job'. Now think: have you once seen a news item reporting the functional outcomes achieved by various hospitals for the people on whom they perform their surgery? The implication is the while surgery is considered of vital importance to the health of the nation, rehabilitation following surgery is not.

Similar questions could be raised regarding the place of rehabilitation in public health or primary care. Recently the Ministry of Health launched a new (or rather a redeveloped) website on ‘Leading for Outcomes'.  The objective of this website is stated as being to ‘improve health and disability outcomes' with an initial focus on ‘reducing outcome disparities in CVD/diabetes and other long term conditions.' While this programme clearly has a primary care emphasis, it also relates to the service objectives of a great many rehabilitation providers. So when, a few months back, I saw a general request for feedback on this newly revised website I sent the following two comments:

1. There are a number of evidence-based rehabilitation programmes, with a demonstrated positive impact on health outcomes for people with long term conditions, and yet these programmes are not always fully implemented throughout New Zealand - to give just two examples: pulmonary rehabilitation programmes and stroke units. The ‘Leading for Outcomes' website would be an excellent forum for promotion of such initiatives.
2. The ‘outcomes' emphasised in the ‘Leading for Outcomes' website mainly relate to pathology, impairments and mortality rates. The website would benefit greatly from a broader perspective on outcomes for people with long term conditions - on measures of activity, participation and community integration for instance. It would also be of use to report the impact of environmental and social factors on the processes of disablement. The World Health Organisation's (WHO's) International Classification of Function, Disability and Health (ICF) is one framework that might be of use in this regard.

In my feedback I also offered, somewhat foolishly no doubt, my own time to talk to the ‘Leading for Outcomes' group about such matters. The response I received however was in essence: ‘Thanks. We'll take it into consideration, but we are a small team and have limited time to do so.'
To the Ministry of Health's credit however, their ‘Ten-Year Strategic Plan for a National Population Survey Programme' (which can be downloaded at the Public Health Intelligence's website) does contain reference to the ICF and to an intention to gather information on ‘functional impairments'. The NZ Health Survey thus includes measures of health status (the SF-36 and - every two years - the WHO Long Form). We will however have to wait to see what they actually do with this data.

So why does rehabilitation have such a low profile in the health sector? Part of the answer is no doubt historical. Pioneers of rehabilitation, such as Howard Rusk, often spoke about the challenges during the first half of last century to get rehabilitation recognised as credible medical speciality. Another large part of the answer however must be that rehabilitation is fragmented by arbitrary boundaries between professional disciplines, between service specialities and between the providers and recipients of those services. It's difficult to stand united if we don't all think we belong to the same group.

Having pondered these conundrums over the last few weeks I have come to the conclusion that we, in rehabilitation, set our sights too low. Sure, in the health sector, demand is always going to exceed supply - especially with our aging population and advances in expensive pharmaceutics and technology. But we - in rehabilitation services - should be arguing for a larger cut of the health dollar, if not for a larger health dollar! We also should be arguing for greater consideration of rehabilitation perspectives in the planning and development of our health services. (Is there much point to increasing the number of total hip joint replacement completed each year if there is inadequate retraining of physical function and fitness following surgery?) To be successful in these endeavours we need to raise the profile of rehabilitation in New Zealand and we need to develop more of a national body of rehabilitation stakeholders to champion the cause... I'm beginning to froth at the mouth - so that's usually a good place to stop.