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Firdous Ibrahim looks at the challenges facing people with spinal injuries, starting with a lack of equipment

Patients with spinal injuries suffer delayed discharge as NHS and Local Commissioners argue over funding equipment.

Young man with spinal injury
Firdous joined the clinical negligence team at Leigh Day after qualifying as a solicitor in August 2017.
Many patients with serious spinal injuries are finding themselves stuck in hospital for much longer than necessary because of disputes between commissioners and providers over the equipment they need to go home, it has been claimed.

Nearly a quarter (23%) of patients at the nine specialist spinal injury centres in England had their discharge delayed in 2016/17, NHS data shows.

The Health Service Journal (HSJ), which compiled the research, said it found the delays were often because providers and both NHS and local government commissioners, could not agree who should fund equipment. 

It told of one case where a patient was left in hospital for five months while he waited for the specialist equipment he needed to leave, while another waited nine months for respiratory equipment.

One clinician, who did not want to be identified, said: “Where somebody needs expensive, bespoke equipment it’s difficult to find out who is responsible for ordering that. It is a big deal.”

Spinal cord injury is the most devastating type of orthopaedic injury and with prolonged survival being the rule, discharge from hospital after rehabilitation is a highly significant step in the care of the spinal cord patient. Adjusting to life after sustaining these traumatic injuries is always difficult, which is why it is important to have the right equipment to allow patients to perform the everyday tasks we take for granted.  

There are different types of equipment needed for medical and personal care such as catheterisation devices to specialist furniture, but probably the most important single piece of equipment is a wheelchair. 

People with tetraplegia in which both their arms and legs are impaired often need special devices to help them eat. Their abilities can range from difficulty grasping a utensil to complete paralysis of the arms and will be dependent on feeding equipment.

People with lower level spinal injuries can be independent with their daily living tasks such as toileting and showering, but will need bathroom equipment including a shower chair, tab transfer bench  and a commode to assist with these tasks.

These injuries can also make it difficult to use technology as a result of loss of sensation in the hands and fingers. Despite the level of injury, there is a range of adaptive technology such as writing aids that can also serve as a phone dialler. 

Pressure ulcers in spinal injuries also represent a challenging problem for patients from sitting or lying in the same position for a long period. Pressure relieving mattress and cushions will help reduce the build-up of heat and moisture and allow pressure to be evenly distributed along the supporting surface.

A summary of the types of equipment that you may need include:
  • Manual lightweight wheelchair with power assist unit
  • Powered wheelchair
  • Wheelchair accessories
  • Portable ramps
  • Sliding sheet
  • Transfer board
  • Mobile hoist/Ceiling track hoist

Personal Care
  • Profiling double bed
  • Shower/commode chair
  • Washing and dressing aids
  • Clos-o-Mat

Home independence
  • Environmental control system
  • Door entry system
  • Food preparation
  • Domestic equipment
  • Over-bed table
  • Riser recliner chair 
  • Boiling water tap

Pressure relieving
  • Cushions 
  • Mattress
  • Mattress topper

From our experience of dealing with spinal injury claims we know that in the aftermath of a spinal cord injury, patients are faced with significant daily challenges and that often financial matters are the least of their concerns. 

It is inexcusable that the equipment and services they need are not immediately accessible to these patients, to help them improve their quality of life. 

Any prolonged delay in returning people with spinal injuries into the community is a waste of the combined hard work of the patient and the Spinal Cord Rehabilitation Centre, and a waste of NHS investment.  It is crucial that all stakeholders work together to minimise delayed discharges.

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