THE BRITISH
SOCIETY OF REHABILITATION MEDICINE - THE FIRST TEN YEARS
Information
Source: Dr A.K. Clarke, F.R.C.P. Consultant in
Rheumatology & Rehabilitation
The British Society for
Rehabilitation Medicine was conceived in the
Council Room of the Royal College of Physicians of London in 1982. Dr Bill Mace, a rheumatologist working at Lewisham Hospital, was President of the British
Association of Rheumatology and Rehabilitation (BARR) and he asked the question,
"What has rheumatology Assessing
Rehab Potential ever done for rehabilitation?" at one of BARR's
council meetings. He had realized that the two specialities had to go their own
ways, with the rheumatologists joining with the scientists of the Heberden
Society and possibly the rehabilitationists combining with the Society for
Research in Rehabilitation (SRR), a multi-professional society. Negotiations
were soon underway. Dr George Cochrane, Medical Director of Mary Marlborough
Lodge in Oxford, was appointed to look at the arrangements for rehabilitation.
He gathered a small working party around him and finally recommended that a new
society, the Medical Disability Society (MDS) be formed. There was a strong
feeling at that time that there should be a society that represented doctors
alone as the speciality was embryonic and needed to be focused to allow
recognition at governmental and operational NHS levels. Good relations were,
however, established with the SRR which was to prove useful later.
At this point it is probably
worth digressing for a while to discuss why rehabilitation was linked with
rheumatology in Britain. The reason was that rheumatology grew out of physical
medicine in Britain, rather than internal medicine as it had in most other
advanced countries. Because of that most rheumatologists had been educated in
the physical medicine and had a rehabilitation bias. Britain was in the peculiar
position of being in the forefront of the development of rehabilitation but
without a separate speciality. Spinal injury services had been pioneered by
Guttmann at Stoke Mandeville, Phillip Nichols had created Mary Marlborough Lodge
to provide assessment for people with severe disability and Kit Wynn-Parry was a
founder member of the International Rehabilitation Medicine Association. There
was a strong tradition of rehabilitation in the Armed Services, which had
started in the Great War but really came into its own during the Second World
War. Amputation and wheelchair services had also started in the First War but
had come under the Ministry of Pensions, as these services were initially seen
as being provided for wounded veterans. This arrangement was to continue until
1991, even though veterans represented only a tiny proportion of users of the
services by the 70s. It is perhaps worth commenting that at the time the NHS was
established in 1948 three separate functions were envisaged, prevention,
treatment and rehabilitation. It would be over 40 years before the importance of
the first and third functions would be taken seriously.
BARR and the Heberden
Society officially wound themselves up at their respective Annual General
Meetings at the end of 1983. On winding up BARR split its funds equally between
the MDS and the newly created British
Society for Rheumatology. The steering committee proposed the new structure for
the MDS and the Officers and Members of the Executive Committee. These were
accepted at the first business meeting of the Society held on 4th July 1984 in
Oxford. George Cochrane, who had worked so hard to establish the Society, was
elected Chairman, with Dr Douglas Shaw, from the Bridge of Earn Hospital in
Scotland, as Treasurer and Dr Andrew Frank, Consultant in Rheumatology and
Rehabilitation at Northwick Park Hospital, as Secretary. £30,000 was received
from BARR but charitable status had not yet been achieved and therefore our
friends at the SRR held these funds for us until 1986 when the Charity
Commissioners allowed the Society to become a charity. The Oxford meeting was
also the first scientific meeting of the Society, held back-to-back with the SRR. I remember that the weather was beautiful, with some of the working groups
being held outside.
The AGM was held at the London
Hospital, the topic being 'The Present and Future Needs of Young Disabled
Adults'. By this time the Society was beginning to collect simple data about the
state of rehabilitation in Britain. There were 18 senior registrars in training
at that time, mostly as combined posts with rheumatology. It would be several
years before substantial numbers of proper rehabilitation training posts were
established. At this time the Society boasted 180 members, from a wide range of
medical and surgical specialities.
1985
was to see the establishment of the first of many working parties that the
Society has used to address important issues of the day. The topic of this
working party was on the role of the consultant in rehabilitation medicine.
Prof. Lindsay McLellan, Europe Professor of Rehabilitation at Southampton
University, chaired this working party. Lindsay's chair had been established by
Ted Heath as an enduring recognition of Britain's entry to what was then called
the Common Market. The only other academic post in Great Britain at that time
was that in Edinburgh, the Chair held by Cairns Aitken. It should be pointed out
that Lindsay is a neurologist and Cairns a psychiatrist - surely a good omen for
the catholic approach to the management of disabled people and the severing of
the links with rheumatology. Following the working party Lindsay published an
article in the British Medical Journal on the topics of consultants in the
specialty. This was to start a long association with that distinguished journal,
much assisted by one of their staff journalists, Daphne Gloag, who has kept
disability issues in front of the medical profession for the past decade.
In 1985 there were two
scientific meetings , the first in Nottingham on the topic of head injury,
hosted by Dr Elizabeth McClemont, who after her move to Lincoln was to play a
considerable role in the Society, because of her interest in medical
engineering. The second meeting was hosted at the Royal National Orthopaedic
Hospital by Mr Ian Bayley, on the topic of behavior modification. I have
personal fond memories of Ian, as he changed a cheque for me on the first time
we met. There are people I have known for twenty years who would not do that!
By 1986 the membership of the
Society had risen to 220. The summer meeting of the Society was held in
Manchester, as the guest of Dr Keith Andrews. Apart from an excellent scientific
programme, (which included a session on pressure sores at which I gave a very
mundane talk on the use of drugs on wound healing) the Society held an
Extraordinary General Meeting. This was on the topic of the publication of the
proceedings of the Society. It was to be a topic that was to run and run! The
meeting had no doubt that the Society should be associated with a journal but
there were two hats in the ring, Clinical Rehabilitation, edited by Keith
Andrews and International Disability Studies, edited by Dr Philip Wood and
co-incidentally with me as assistant editor. There were a lot of declarations of
interest at the meeting! No clear majority for either journal emerged at the
meeting and this was to be the case for years to come.
This year also saw the
publication of the Royal College of Physicians of London's (RCP) report
'Physical Disability in 1986 and Beyond'. This report urged that each health
district of average size (250,000 people) should have at least 10 identifiable
sessions weekly for disability services but did not insist on the appointment of
specialists in rehabilitation except at regional centres of excellence. The
Society expanded its activities by the appointment of two sub-committees, one on
policy and the other education and research.
1986 also saw the departure of
George Cochrane and the reins being taken over by Dr Richard Langton Hewer,
Consultant Neurologist in Bristol. This happened at the AGM hosted by Prof.
Kenneth Holt in London on 'the disabled school-leaver entering adulthood.
Richard was one of the first neurologists in Britain to embrace rehabilitation,
establishing the Avon Stroke Unit which led to a number of innovations, not
least of which was the introduction of a number of measurement scales. Richard
was secretary of the RCP Disability Committee and largely wrote the report
mentioned above.
1987
saw three scientific meetings. The first was a joint meeting with the Society of
Occupational Medicine, hosted by Dr Leitch. Later, the summer meeting was held
in Newcastle-Upon-Tyne. There were two topics at that meeting, the measurement
of disability and recovery of arm function. Our host was Prof. Simon Miller. He
is now President of the European Federation of Rehabilitation Research
Societies. The last meeting was another joint meeting, this time with the
Society of Community Medicine, held at the RCP.
Our relationship with the RCP
strengthened in 1988 when our postal address
moved to St Andrews Place, thanks to the good offices of Sir Raymond ('Bill')
Hoffenberg, President of the College who had supported the 1986 Report. Liamh
Lynch was appointed part-time administrator and the Society also splashed out on
a computer and printer. We also published the first of our regular Newsletters
for members.
For the first time the Society
met with a Government representative, in this case Sir Roy Griffiths, author of
the report on Community Care, to discuss the implications of that report. One of
the most influential reports the Society has produced to date appeared in this
year, that on 'The Management of Traumatic Brain Injury'.
There were two meetings again
during this year. 1988 was the 250th anniversary of the Royal National Hospital
for Rheumatic Diseases and therefore I invited the Society to come to Bath with
a meeting entitled 'Rheumatological Rehabilitation'. This was another
'back-to-back' meeting with the SRR. The MDS meeting was the first day of a
three day meeting and hence on that evening we had a very pleasant social event
at Lacock, visiting the House, home of Fox Talbot, the inventor of modern
photography, and then a barb-e-que at a local hostelry. The AGM was held at
Guy's Hospital at the invitation of Dr Brian Moffat, Consultant Neurologist and
Deputy Secretary of the Society, on the topic of 'Multiple Sclerosis'. It was
the end of Richard Langton Hewer's highly successful chairmanship. There was
some drama over the appointment of the new chairman, with Lt Col. Robin Garnett
finding the post thrust upon him, due to the lack of an obvious successor. As
Consultant in Rheumatology and Rehabilitation in the Army it was a daunting task
for him to assume, at a time that the NHS was beginning to undergo rapid change
and the specialty growing at an unprecedented rate. We should have known that
the man who had organized the hospital on the Falklands Islands at the immediate
end of our little misunderstanding with the Argentinians would have no
difficulty in steering the Society with consummate ease through such a period of
change. The Society also established a Regional structure and our Treasurer
recommended for the first time that the subscription should be increased.
1989
was a busy year. Two working parties were established, the first on multiple
sclerosis and the second on a model district rehabilitation service. For a
variety of reasons both working parties were to take some time to report and in
case of the second changed chairman and format four times! The Joint Committee
on Higher Medical Training established a Specialist Advisory Committee for
Rehabilitation Medicine and the Society was asked to supply three
representatives to that committee. The proper training and accreditation of
Consultants in Rehabilitation Medicine had started.
During this year Niamh Lynch
resigned as our Administrator and Sandy Weatherhead replaced her. This
appointment was one of the happiest things that has happened to the Society and
we are very fortunate that Sandy is still with us, having now kept three
Chairman on the straight and narrow and assuming more and more responsibility on
behalf of the Society.
Our summer meeting was in Derby,
at the invitation of Dr Christian Murray-Leslie, Consultant in Rheumatology and
Rehabilitation. The topic of the meeting was 'The Provision of Orthotics'. It
was at this meeting that the Regional Representatives met for the first time,
with Jaq Chawla, Consultant to the Welsh Spinal Injury Unit, at Rookwood
Hospital, Cardiff, being elected chairman. George Cochrane, who co-incidentally
had worked in Derby before moving to Oxford, was appointed chairman of the
Policy Sub-Committee. The first task this group was asked to tackle was the
Society's response to the Government's White Paper, 'Working for Patients'. Dr
Richard Greenwood, Consultant Neurologist and Director of the North-East Thames
Regional Neurological Rehabilitation Unit at the Homerton Hospital, was
appointed chairman of the newly formed Manpower, Training and Research
Sub-Committee.
The year was rounded of in the
most splendid way in Cambridge, where our host was Dr 'Jumbo' Jenner, Consultant
in Rheumatology and Rehabilitation. His two topics were 'From Monkeys to Man'
and 'From Man to Machine'. One of the highlights of the meeting was an address
from Prof. Stephen Hawking, using his speech synthesis system.
1990
was a year of crisis for the Society. We had been handsomely endowed by BARR on
our formation and had taken professional advice on how that money should be
invested. The bulk of our funds were placed with British and Commonwealth
Holdings which had performed well initially but quite unexpectedly the company
failed, the largest corporate failure in British financial history. This was at
a time that the activities of the Society was expanding and we had to take
emergency action. Robin Garnett and other senior members of the Society were
able to convince the Devonshire Hospital to finance the costs of the
Administrator for a year (a commitment that they have continued subsequently)
and the activities of the Regional structure was temporality suspended. Mr Neil
Fyfe, Consultant in Rehabilitation Medicine in Newcastle, was appointed Chairman
of the newly formed Financial Steering Group, who were able to raise £12,000 to
put the Society back on an even financial keel.
Robin Garnett also applied his
mind to certain administrative details to help the Society. The first was to
seek to re-name the Society. Both nationally and internationally the term
Rehabilitation Medicine was increasingly being used as the preferred name for
the specialty and a postal ballot agreed that the name should be changed to the
British Society of Rehabilitation Medicine (BSRM). The other detail was to
create the post of Chairman- Elect, so that there should be continuity of
leadership and the avoidance of the problems that Robin faced when he was
appointed. This again was achieved by postal ballot.
The two meetings for the year
where in Cardiff and London. Jaq Chawla hosted the summer meeting on the topic
of 'Non-traumatic Spinal Injury', while the AGM was held at the Royal Military
Medical College at Millbank, the two themes being 'Audit' and 'the Management of
Spasticity'. The AGM had a moment of high drama for Robin Garnett as the
election of the new Chairman led to a tied vote between myself and Brian Moffat.
Robin had to use his casting vote, and the Chair passed to me. I am still not
sure if this was an act of kindness or the passing of the poisoned chalice by
Robin! I also had my moment of high drama at the AGM, as George Cochrane and
agreed to hold the summer meeting in Oxford again in 1991. However with the
introduction of the NHS reforms George decided to take early retirement and I
and to identify a centre to take over at short notice. Luckily I spotted Dr
Victor Patterson, Neurologist from Belfast, who, with Dr John McCann, Consultant
Physician in Rehabilitation Medicine, at the Royal Victoria Hospital, readily
accepted the invitation. More of that later.
With the dawning of 1991
the Society officially became the BSRM. During the year the Government published
'Health of the Nation' and I was approached by Richard Langton Hewer to set up a joint working group with the SRR, the Disability Committee of
the RCP and the Rheumatology and Rehabilitation sub-committee of the Central
Consultants and Specialists Committee to prepare a combined response on behalf
of rehabilitation medicine, to try and get rehabilitation recognized as a major
priority area. The working party met in a delightful hotel near Melksham and
consisted of myself, Richard, Lindsay McLellan, Prof. Anne Chamberlain,
Professor of Rehabilitation in Leeds, Dr Pam Enderby, the doyen of Speech
Therapy from Bristol, and Dr Stuart Munday, from the Department of Health, there
as an observer, but provider of some very helpful advice. We produced a combined
report which did not get rehabilitation in the first wave of topics, but which
ensured that the profile of the specialty was significantly raised. The Government also established an Advisory Group on Rehabilitation,
chaired by Lord Holderness. Ann Chamberlain was appointed to the group to
represent the BRSM.
On the first of April 1991 two
significant things happened. The first was the launch of the new NHS, with the
introduction of Trusts and Fund Holding, the Purchaser/Provider Split and the
Internal Market, and the second was the abolition of the Disablement Services
Agency, a move that had been set in motion five years previously by the then
Minister for Disabled People, a little known politician called John Major.
Residual monies were available to allow the formation of the Amputee Medical
Rehabilitation Society, with Dr Linda Marks, Consultant in Rehabilitation
Medicine at the Royal National Orthopaedic Hospital, being elected President.
The new Society sought affiliation to the BRSM, which was readily accepted, with
Linda becoming a member of the BSRM's Executive Committee.
The meeting in Belfast was
magic. The title that Victor Patterson and John McCann chose was 'Community
Rehabilitation'. We were able to learn the advantages of combined Health and
Social Service Boards, a model which might still be adopted in the rest of
Britain. Apart from the scientific meeting we also had a most excellent social
programme, the highlight of which was a dinner in the dungeon of Carrickfergus
Castle. The AGM was held at St Bartholomew's Hospital, at the invitation of
Richard Greenwood. The topic was 'The Effectiveness of Rehabilitation. At this
meeting we were able to announce two awards. The first was the Philip Nichols
Prize, in memory of one of the giants of British rehabilitation. The winner was
Dr Lynne Turner-Stokes. The second one was the 'Opportunities Bursary' given to
Dr Robin Luff, Consultant in Rehabilitation Medicine at Dulwich Hospital, to
enable him to visit various places in Germany to examine amputation services
there. The dinner was held in the Great Hall of Bart's, with Nicholas Scott,
Minister for Disabled People, as our guest of honour. Anne Chamberlain was
elected Chairman-elect.
In 1992,
the year that rehabilitation medicine was the fastest speciality in Britain, the
Society launched three reports. The first was a combined report of the BRSM, the
Association of British Neurologists and Neurocare, the umbrella organisation of
the neurological self-help charities. Although arthritis and rheumatism
represents the largest group of disabling diseases (including those people with
the severest levels of disability) because of the traditional linkage of
rheumatology and rehabilitation, it is the neurological diseases that require
the most attention. The report was received by one of the junior health
ministers, Tim Yeo (a former Director of the Spastics Society) at Richmond
House, the headquarters of the Department of Health (DoH), followed by a press
conference at the House of Commons. It was particularly gratifying that the DoH
issued their own press release based on the report. In simple terms the report
pointed out the importance of neurologist acting as the gate keepers of
rehabilitation, with the need for rehabilitation medicine provided in each
district. The second report was on
Multiple Sclerosis (MS), long time in gestation, but very worthwhile. The report
emphasised the particular needs of people with MS at the local level. This
report was endorsed by the MS Society. The last report was from the Manpower,
Training and Research Sub-Committee. Written by Prof. Ray Tallis, Professor of
Geriatrics in Manchester, it addressed the topic of 'Undergraduate Teaching of
Disability and Rehabilitation'.
One of the most significant
events of the year was the delegation that presented the requirements
of the specialty to JPAC, which led to the release of many new senior registrar
posts, including a number of part time and academic posts. This was an important
step for rehabilitation medicine, ensuring that there will be adequate
candidates for the expected expansion in the speciality. It has not been plain
sailing, as there has been considerable difficulty getting funding for all the
posts.
The DoH asked the Society to
assist in the development of the Environmental Controls service. Two working
parties were established, on to look at the technical specifications of new
equipment and the other to look at the administrative arrangements for the
assessment and provision of the equipment. From this the Society encouraged the
formation of an affiliated Special Interest Group, with Elizabeth McClemont as
Chairman, and Dr Rajiv Hanspal, Consultant in Rehabilitation Medicine at
Hillingdon, as Secretary.
I was invited by the Centre for
Coding and Classification, in Loughborough to establish a Specialty Working
Group to develop Clinical Terms in Rehabilitation, as part of an ambitious
project to produce an national medical language to enable the widespread
introduction of information technology.
The summer meeting was held at
Keele University, at the invitation of Dr A.B. (Tony) Ward, Consultant Physician
in Rehabilitation Medicine at Stoke and Secretary of the Society. The topic was
'Community Care'. Tony, Anne Chamberlain and myself met up in Dresden at the
meeting of the International Federation of Physical Medicine and Rehabilitation
and spent a considerable amount of time at the meeting of the Physical Medicine
and Rehabilitation Monospecitaly Committee discussing the harmonization of
training throughout Europe. This meeting was held almost exclusively in French.
Anne and I were grateful that Tony's mother if French!
The AGM was held at Church
House, in London. Dr John Goodwill, Consultant in Rheumatology and
Rehabilitation at Kings College Hospital was the organizer of an excellent
meeting entitled 'Rehabilitation, Measurement of Disability Compensation and the
Law'. The meeting itself was held in the chamber used by the Synod of the Church
of England and I enjoyed the pleasure of sitting in the place of the Archbishop
of Canterbury. Our guest at dinner was Bert Massie, Director of RADAR. At the
AGM Anne Chamberlain took over as Chairman. The Society was to be in safe hands.
Dr (now Professor) Michael Barnes, Consultant in Rehabilitation Medicine in
Newcastle, was elected Chairman-elect
With 1993
the long running saga of linkage to a journal was finally settled by postal
ballot, with Clinical Rehabilitation as the clear winner. Some anxiety was
expressed that a number of members might resign because of the considerable
increase in the subscription, especially among members who primary specialty was
not rehabilitation. Some loss did occur but the strengthening of the Society is
undoubted.
The Environmental Controls
Special Interest Group was asked to prepare a report on Environmental Control. A
Working Party was established, chaired by Elizabeth McClemont. Following the
success of the combined brain-storming group on 'the Health of the Nation' a
similar exercise on training in the specialties was undertaken, with Dr John
Harrison,Consultant Geriatrician, writing the report.
The constitution of the Society
had not been substantially revised since its formation. The adoption of Clinical
Rehabilitation as our official journal offered the right opportunity for such a
revision. This task was entrusted to me and among the changes that were accepted
was the substitution of the post of Chairman by that of President to bring the
Society into line with the majority of other learned medical societies.
The summer meeting was held in
Chichester, at the invitation of Dr Brian Owen-Smith, Consultant in Rheumatology
and Rehabilitation. There were two important events at this meeting. The first
was that Dr Kenneth Calman, the Chief Medical Officer, opened the meeting. The
second was that the Environmental Control Special Interest Group met for the
first time, with Elizabeth McClemont in the chair. The dinner was held at
Goodwood House, home of the Dukes of Richmond. What a wonderful setting! The AGM
was held at Northwick Park Hospital, hosted by Dr Andrew Franks, on the topic of
'Back Pain'. Douglas Shaw stood down as Treasurer, the mantle being taken up by
Neil Fyfe.
1994
was the 10th anniversary of the Society. The Summer meeting wasl held in
Lincoln, at the invitation of Elizabeth McClemont, around the topic of
'Engineers and Rehabilitation. The speciality had come on a long way and the
influence of the Society had been of major importance in the development that
had occurred.
The reminiscences of other members, especially from the
earlier days, together with photographs and other memorabilia are welcomed by
the Society such that a proper archive may be established. Please contact Sandy
Weatherhead with any such memorabilia.
