15/11/2024
It wasn’t until I was completing the IPEM "state of the profession" survey that was recently circulated that I realised it was exactly 30 years since I nervously stepped through the door of Kings College Hospital Rehabilitation Centre in Crystal Palace with a freshly printed ID badge with Rehabilitation Engineer written across the front.
Engineer – yes, but Rehabilitation Engineer?
Before my application I’d never even heard of a Rehabilitation Engineer and 30 years on the vast majority of people still haven’t!
I consider myself very fortunate that I found myself part of a small team of extraordinary people (Paul, Liz, Heather, Susie and of course Dr Robin Luff) who were not only extremely generous with their time and sharing of knowledge but were also striving to push the realms of possibilities for the people we were working with.
We had extremely limited equipment resources available to us but what didn’t exist we made and if we couldn’t make it ourselves we found small companies who could. Most of it then was on a trial and error basis but we got results. (Not always the results we expected but results nonetheless!)
The problem was (and this often took the form of after-hours discussions with Dr Luff following a full-on day in clinic) that the more we achieved, the higher the expectation was, both from ourselves as a team and the clients we were working with.
As an engineer, the role of the Rehabilitation Engineer is a bit of a contradiction. Engineering is all about precision, things are either right or wrong, within tolerance or not, meet the requirements of the relevant standard or not - there’s very little in the way of grey areas.
Rehab Engineering is pretty much all about the grey areas. A solution that works for one person will not work for the next, a material that solves a specific problem for one may cause a very different and undesirable problem for someone else etc.
The real difference, as I see it, is that engineering is pretty much all to do with objects, how functional something is, how safe it is and how other things interact with them.
Rehabilitation engineering as all to do with people and how functional or comfortable we can enable them to be, using equipment, objects and materials that (in some cases) were never designed for the purpose we put them to.
Today I read the Wheelchair Alliance paper calling for national criteria and improved supply chain and procurement of wheelchairs for NHS wheelchair services.
Funnily enough we pretty much had that 30 years ago. I was issued with (and still have) a little brown Department of Health & Social Security Handbook of Wheelchairs, Bicycles and Tricycles as a reference guide and we were all issuing the likes of the 8LC, 8BL and big chrome E&J and Carters 8AU wheelchairs.
At that time the NHS Purchasing and Supplies Agency (PASA) were nationally responsible for the procurement of wheelchairs for NHS wheelchairs services. The problem was that they didn't really meet the needs of those we were trying to help as technology (even then) was developing at a much faster rate than the NHS contracts could keep up with or afford. PASA also played a major role in the procurement and contracting out of NHS wheelchair maintenance contracts.
That was all abolished when the thought of the day was to move everything from centralised or regional services to a local level and that in turn resulted in the vast differences in criteria, funding and commissioning of wheelchair services that we see today.
The Wheelchair Alliance is also calling for “the right chair at the right time”.
Firstly, anything that helps wheelchair services remain in the NHS and get the correct levels of funding is a good thing (no matter how many times around the hamster wheel some of us have been!) so I'm not criticising their efforts. However, for the reasons already discussed above, the “right chair” may not yet exist or if it does (just like the ones in the little brown book) it might only be the right chair for one person and completely useless for another.
The good thing is that we are still pushing boundaries and still asking more of the equipment and equipment manufacturers.
New technology is being developed all of the time and has undoubtedly come a long way in my 30 years as a Rehabilitation Engineer.
I sincerely hope that is something that never changes.
