Medical rehabilitation: Policy-making in the english health service

Abstract

This paper describes recent proposals for the development of medical rehabilitation in England, and examines the influence of the medical profession on the fact that they were not accepted into official policy. A central feature of the plan was to establish hospital consultants in rehabilitation. Psychiatrists and geriatricians, who have a substantial commitment to rehabilitation as part of their own specialties, opposed this. Several objections have been raised to the plan, such as doubts about the value of medical rehabilitation, particularly as a hospital specialty; but these objections do not explain the profession's lack of support. This lack of support appears to result either from antagonism to the proposed organization of rehabilitation, which challenges the clinical autonomy of other specialists, or from indifference to the subject as a whole. This case demonstrates the influence of the established leadership of the medical profession on matters of professional practice, despite the attempts of particular interests within the profession and of the Department of Health and Social Security to introduce changes.