Purchasing neurorehabilitation in the UK National Health Service
Neurorehabilitation usually has two objectives: Managing the initial phase of patient improvement and ensuring long-term support for continuing disability. The UK National Health Service (NHS) provides acute neurorehabilitation within general hospital wards and specialist units, but arrangements for long-term placement are less satisfactory. NHS health authorities, administrative agencies responsible for the health of defined local populations of about half a million, hold resources for purchasing both acute and long-term medical and nursing services; long-term care usually also requires financial support from municipal social services departments. The patient's health status may be used in assessing the need for services, but little information on clinical outcome is available for purchasers. This paper describes purchasing for neurorehabilitation in a London health authority, and suggests how the arrangements could be improved.