The First 25 Years

The British Society of Rehabilitation Medicine (BSRM) is still a young society. Why is this? Rehabilitation Medicine is a new specialty when compared to the majority of other disciplines. The main reason is that rehabilitation in Britain initially was part of rheumatology, that specialty having arisen out of physical medicine rather than general internal medicine as in North America and continental Europe. However, spinal injury arose as a separate specialty at Stoke Mandeville, and amputation and wheelchair work was associated with the Ministry of Pensions and the rehabilitation of wounded servicemen in the Great War. It was in 1983 that the two main rheumatological societies, the British Society for Rheumatology and Rehabilitation, and the Heberden Society, set up a working party to look at the future of the two specialties. Rehabilitation was represented by George Cochrane, Director of Mary Marlborough Lodge in Oxford and he was to become the first Chairman of our Society, which was then called the Medical Disability Society (MDS). The rheumatologists formed their own society, the British Society for Rheumatology.

Not surprisingly the first meeting of the new Society was held in Oxford in the Spring of 1984, back to back with the Society for Research in Rehabilitation (SRR), a multidisciplinary society with which the MDS and subsequently the BSRM have worked closely. By the time the first Annual General Meeting of the MDS was held at the London Hospital there were 180 members from a wide range of specialties. The majority of the 18 Senior Registrars in Rehabilitation Medicine were in joint posts with Rheumatology.

In 1985 the MDS produced its first report, on the role of the Consultant in Rehabilitation Medicine. The working party was chaired by Lindsay McLellan, Professor of Rehabilitation Medicine at Southampton University, at that time the only Chair in England, with the second British Chair being in Edinburgh, held by Cairns Aitken. The scientific meetings that year were held in Nottingham and the Royal National Orthopaedic Hospital. The working party report led to a publication in the British Medical Journal, raising the profile both of the specialty and the Society.

In 1986, at the Manchester meeting, a debate was held as to whether the Society should become affiliated to a journal but at that time there were two British-based journals and no firm decision was made. 1986 also saw the publication of the Royal College of Physicians of London (RCP) report entitled 'Physical Disability in 1986 and Beyond'. The report recommended that each health district of average size (250,000 people) should have 10 identifiable sessions in Rehabilitation Medicine. There should also be centres of excellence which should be staffed by Consultants in Rehabilitation Medicine. It was also in this year that the Society established its first subcommittees, one dealing with policy and the other with education and research. At the Annual General Meeting that year Richard Langton Hewer, Consultant Neurologist in Bristol, took over the Chairmanship. Richard Langton Hewer at that time was the secretary of the RCP Disability Committee and had been responsible for the bulk of the College report mentioned above.

In 1987 somewhat unusually the Society held three scientific meetings. The first was a joint meeting with the Society of Occupational Medicine, the meeting was held in Newcastle upon Tyne and the third meeting was a joint meeting with the Society of Community Medicine. Also this year, as recommended in the McColl Report of 1985, the Disablement Services Authority (DSA - a Special Health Authority) was formed with the main aim of integrating the prosthetic and wheelchair services of the Department of Health into the NHS by April 1991.

We continued to have strong links with the RCP and in 1988 Sir Raymond ('Bill’) Hoffenberg, President of the College facilitated a new address for the Society, care of the Royal College of Physicians. The Society appointed a part-time administrator, Niamh Lynch, and also bought a computer and printer. The first newsletter for members was published. Also in this year, for the first time the Society made official contact with a Government representative, in this case Sir Roy Griffiths, author of a Government report on community care. The Society also produced a report on the management of traumatic brain injury. The Spring meeting was in Bath, back-to-back with the SRR, and the Annual General Meeting was at Guy's Hospital where Robin Garnett became the new Chairman. He was Consultant in Rheumatology and Rehabilitation in the Army and was responsible for a number of innovations within the Society including establishing a regional structure.

In 1989 two working parties, one on Multiple Sclerosis and another on a Model District Rehabilitation Service were established and the Joint Committee on Higher Medical Training established a Specialty Advisory Committee on Rehabilitation Medicine; the Society supplied three representatives to that committee. This represented both proper training and accreditation of consultants in Rehabilitation Medicine. It was also in this year that Niamh Lynch resigned and was replaced by Sandy Weatherhead; 20 years later Sandy is still very much the power behind the throne of the Society and much of the success of the BSRM is directly due to Sandy’s good stewardship and loyalty. Also In 1989 the first meeting of the regional representatives took place, as did the policy subcommittee, chaired by George Cochrane, which was to provide the Society’s response to the government’s White Paper 'Working for Patients'. The Society also established a manpower, training and research subcommittee. Meetings were held in Derby and Cambridge. The Cambridge meeting was addressed by Professor Stephen Hawking, using his speech synthesis system.

In 1990 the Society faced a crisis all too familiar in the new century, the loss of a large part of its funds due to the corporate failure of British and Commonwealth Holdings. Robin Garnett showed his true metal by not only convincing the Devonshire Hospital to finance the administrator for a year, a generous gesture that was repeated in subsequent years, but by establishing a financial steering group, under the chairmanship of Neil Fyfe. Neil Fyfe went on to become Treasurer and the group was able to raise £12,000 to put the Society back on an even keel. Robin Garnett convinced the Society that it should change its name from the MDS to the BSRM, to put it more in line with other similar societies internationally and he also created the post of Chairman-Elect to assist with continuity of leadership which had been a problem at the time of his appointment. There were two meetings that year, in Cardiff ’ and the second was at the Royal Military Medical College in Millbank in London. The next Chairman, on Robin Garnett's casting vote, was Tony Clarke. It had been intended that the next meeting would be in Oxford, hosted by George Cochrane, but he was extremely unhappy with the reforms in the NHS and took early retirement and therefore Tony’s first task was to find a replacement of Summer meeting at very short notice. We were very fortunate that our colleagues in Belfast very readily stepped into the breach.

In 1991 a joint working group with the BSRM, the SRR, the RCP Disability Committee and the Rheumatology and Rehabilitation subcommittee of the Central Consultants and Specialists Committee of the British Medical Association was established to produce a combined response for Rehabilitation Medicine to the document published by the Government entitled ‘The Health of the Nation'. Although there was no immediate change in Government policy this led to the establishment of an Advisory Group on Rehabilitation, chaired by Lord Holderness with Anne Chamberlain representing the Society. In April of 1991 there was a major reorganisation of the National Health Service and at the same time the integration of the DSA, mentioned above, took place. Following this the DoH provided some pump priming funding for the establishment of the Amputee Medical Rehabilitation Society. The Belfast meeting in the Summer of that year was memorable for both scientific content and wonderful Irish hospitality. The Winter meeting was held at St Bartholomew's Hospital and was notable for the award of a new prize, named after Philips Nichols one of the giants of British rehabilitation, which was won by Dr Lynne Turner Stokes. It was also at this meeting that for the first time the Society had a Government Minister, Nicholas Scott, Minister of Disabled People, as our guest of honour at the conference dinner. Anne Chamberlain, Consultant in Rheumatology and Rehabilitation in Leeds was elected Chairman-Elect.

In 1992 the Society produced a combined report with the Association of British Neurologists, and Neuro-concern (the umbrella organisation of neurological self-help charities), looking at the issue of neurological rehabilitation. This report was received by a junior Health Minister, Tim Yeo, on behalf the Government. The second report that year was the long-awaited one on Multiple Sclerosis and the last report was on undergraduate teaching of disability produced for us by Professor Ray Tallis. It was also during this year that the BSRM presented data to the Manpower Committee of the Department of Health which led to the release of a significant number of new Senior Registrar posts including a number of part-time and academic posts. However funding proved to be a considerable issue as we tried to get posts established. The Society was then asked by the Department of Health to assist in the development of the environmental control service and we established two working parties, one to assess the technical specification of new equipment and another to look at the administrative arrangements for the assessment and provision of this equipment. Following this work the Society formed a special interest group in assistive technology. The Society was also invited to join a Government sponsored working group looking at the expansion of the Reed codes to make them usable within secondary care. In 1992 Officers of the Society went to Dresden to a meeting of the International Federation of Physical Medicine and Rehabilitation, spending most of the time engaged in a meeting of the Physical Medicine and Rehabilitation Mono-specialty Committee discussing the harmonisation of training in Rehabilitation Medicine throughout Europe. The Winter meeting was held in Church House in London and Bert Massie, then director of RADAR, was a guest of honour. Anne Chamberlain took over as Chairman with Michael Barnes as Chairman-Elect.

In 1993 the long saga of a linkage to a journal was finally settled by postal ballot with Clinical Rehabilitation as the clear winner. The Society remains affiliated to that journal. Anxiety was expressed about the increase in the subscription but the majority of members retained their membership. We also produced a report on rehabilitation training within the various medical specialties, and another on advice to purchasers of the new NHS contracts. Tony Clarke was asked by the Society to revise its constitution and among the changes that resulted were renaming the Chairman to President. This brought the Society in line with most other specialist societies. The Summer meeting in that year was held in Chichester with French colleagues from SOFMERR, which included the first meeting of the Environmental Controls Special Interest Group and, just as significantly, the meeting was opened by Kenneth Calman, the Chief Medical Officer for England and Wales. The Winter meeting was held at Northwick Park Hospital on the topic of back pain. At this meeting Michael Barnes assumed the Presidency and we also bade goodbye to Douglas Shaw who had been Treasurer since the formation of the Society. His place was taken by Neil Fife who had given such valued service to the Society at the time of our financial difficulties in 1990. Neil held the post of Treasurer until 2008.

1994 was our 10th anniversary year and we met in Lincoln for the Anniversary celebrations, the topic being engineers and rehabilitation. There was a splendid dinner in the Masonic Temple. This meeting also marked the launch of the Society’s report entitled ‘Prescription for Independence ’ dealing with the provision of environmental control systems for individuals with profound disability. In December the Annual General Meeting was held at the Royal Hospital & Home in Putney, on the topic of the Management of Complex Disabilities.

In 1995 there were two meetings, one in Leeds, and the second at Northwick Park Hospital. The Society published a report on Seating Needs of Complex Disabilities. The addition of 4 to 5 posts per region for training was recommended. At the Annual General Meeting it was reported that the membership of the Society was 306. Although the Society was in reasonably good financial shape, the journal had increased its subscription rate and therefore the Society’s subscription rate was raised to £85 for ordinary members and £60 for junior and retired members.

In 1996 two meetings were held, with the Summer meeting in Sheffield combined with the British Association of Spinal injuries Consultants. There was a memorable dinner in the Cutler's Hall. The Winter meeting was held in Manchester. The main issues continued to be that of trying to increase the number of Specialist Registrars in Rehabilitation Medicine and to get the medical schools to include rehabilitation in their curricula. This last endeavour was supported by a Society document. Tony Ward assumed the Presidency and Lindsay McLellan was elected President- Elect.

1997 was a busy year for the Society. There were considerable concerns about manpower and in particular the lack of candidates to fill Consultant and Specialist Registrar posts. Therefore a new curriculum for trainees was developed and other specialties were urged to include rehabilitation skills in their training programmes. The Society worked closely with the Department of Health to ensure that Rehabilitation Medicine prospered. There was a very successful joint meeting with the SRR in Leeds and the Annual General Meeting was held at St Bartholomew's Hospital in London.

In 1998 the Society again urged the Department of Health to increase training numbers in the specialty and to support the training programme for trainees. Chris Ward held the first Advanced Rehabilitation Course and regional training programmes were introduced. This was the time when the Specialist Registrar grade was introduced. The Society was particularly concerned about non-consultant led amputee services and also discussions were held with the newly created Royal College of Paediatrics and Child Health about trying to introduce training initiatives, trainee rotations and service models for children with a disabling disorder entering the transition to adulthood. Links were strengthened with the Royal Colleges and the new President, Tony Ward, together with Lindsay McLellan, who was the President-elect, met with Paul Boetang, Minister of State at the Department of Health to discuss in particular Vocational Rehabilitation. There was a mismatch between the number of trainees and the increased number of consultant posts which meant that some individuals were being appointed to joint posts with other specialties. During this year there was an update of the traumatic brain injury report. This was also the year that saw the Society undertake its most ambitious overseas trip, to Sydney in Australia. At the end of the year Lindsay McLellan became President.

1999 saw the publication of the Society’s report on the orthotics service, a report which was widely circulated throughout the United Kingdom. The Summer meeting was held in Sheffield, again back to back with SRR although that society felt that they would prefer to discontinue the regular meetings at least for the time being. The second Advanced Rehabilitation Course was held jointly with the University of Nottingham, supervised by Chris Ward. The Winter meeting was another foreign adventure, being held in Amsterdam and it turned out to be an excellent combination of good science and excellent, if somewhat anarchic, hospitality.

2000 saw a number of important changes in the Society, not least of which was the decision by the Amputee Medical Rehabilitation Society to change from being an affiliated association with the BSRM to become fully integrated into the Society with the status of a special interest group. This raised the issue of whether there should be closer formal links with spinal injury rehabilitation. It was also in this year that the Devonshire Hospital ceased providing financial assistance to the Society as they were no longer involved in specialist medical rehabilitation but the gap was filled by the Wellington Hospital. The Summer meeting was held in Liverpool and the Annual General Meeting was held in Glasgow. Lindsay McLellan handed over the presidency to Andrew Frank and Rajiv Hanspal became the President-Elect. The membership was now at 342. A very important report on Vocational Rehabilitation was published and clinical standards for Rehabilitation Medicine were prepared and published in Clinical Rehabilitation. The issue of clinical governance was also addressed. The Society produced its own website.

2001 was marked by two excellent meetings in Belfast and Manchester. The Society through its new Special Interest Group for Amputee Medicine, produced a CD on how to prescribe a lower limb prosthesis and talks were held with Clinical Rehabilitation regarding publication of future BSRM reports. A lot of time and energy was expended on clinical standards and guidelines as well as on clinical governance. Botulinum toxin now was becoming recognised as a major tool in Rehabilitation Medicine and a set of guidelines were being produced. The first Advanced Amputee Rehabilitation Course was held in London. The Society also took part in the national scoping exercise for the National Service Framework for Long Term Conditions. The Forum for Academics in Rehabilitation Medicine was also established. Tony Clarke had been asked by the Society to update the constitution in the light of changes in the Charity Commissioners' rules. There was an insufficient number of members present at the Annual General Meeting for the new constitution to be approved and therefore it went out as a postal ballot to the membership and was adopted on a simple majority.

2002 saw the 13th European Congress of Physical and Rehabilitation Medicine, hosted by BSRM and SRR, being held in Brighton. This was an immensely successful meeting, with much of the credit going to a Past President, Tony Ward. The Annual General Meeting was held at the RCP. Honorary Membership was bestowed upon Bareld de Jong, from Amsterdam, Pam Enderby, Professor of Rehabilitation in Sheffield, and Richard Langton Hewer, a Past Chairman of the Medical Disability Society. Vera Neumann became the President-Elect and at the Annual General Meeting Rajiv Hanspal succeeded Andrew Frank as President. Rather alarmingly the retiring President suggested that e-mails were the way of the future!

In 2003 the Society produced the National Clinical Guidelines on Rehabilitation Following Acquired Brain Injury. The working party had been chaired by Lynne Turner Stokes. Guidelines were also produced for Amputee and Prosthetic Rehabilitation. The Society updated the Vocational Rehabilitation report. The Summer meeting was held in Cambridge and the Annual General Meeting was held again at the RCP. It was during this year that the negotiations for the new consultant contract took place and it would pass to Tony Ward who represented the Society and Tony Clarke to represent the British Medical Association at these meetings.

In 2004 Rajiv Hanspal handed over the presidency to Vera Neumann and Chris Ward became the President-Elect. The Society published reports on Musculo-skeletal Rehabilitation and guidelines on Specialised Wheelchair Seating. A third special interest group was established in Vocational Rehabilitation. The Spring meeting was held in Derby, jointly with the Royal College of Nursing Rehabilitation and Intermediate Care Forum, while the Annual General Meeting was held somewhat earlier than usual in September in Edinburgh during the 2nd UK-Dutch Rehabilitation Meeting. A set of core competencies for Rehabilitation Medicine were developed by Diane Playford and Chris Ward. Tony Ward, who has for many years been our representative in Europe, reported that the European Federation of Physical Medicine and Rehabilitation had superseded the European Society of Physical and Disability Medicine and the Society unanimously agreed to join the organisation. Very sadly during this year George Cochrane, the first chairman of the MDS died.

2005 saw the Spring meeting being held in Exeter, as a joint international meeting with the Posture and Mobility Group. The social event for this meeting was to the Eden Project near St Austell, in Cornwall. The Annual General Meeting was held at the Royal Armouries in Leeds. During the year two reports were published, the first on the treatment of depression following acquired brain injury and the second on undergraduate medical training in rehabilitation. The alterations to the structure of junior training posts were introduced and as ever this change represented a considerable challenge for the Society.

The 2006 Spring meeting was held in London, jointly with the SRR. The AGM was held at Loughborough University. The main concerns of the Society were related to revalidation, problems relating to musculoskeletal rehabilitation, an adequate spread of rehabilitation specialists throughout the country and increasing the evidence-base in rehabilitation. Chris Ward assumed the office of President and Christine Collin became President-Elect.

In 2007 the Spring meeting was held in London and saw Rehabilitation Medicine service providers, commissioners and managers in the same room. The meeting entitled ‘Rehabilitation Medicine Today and Tomorrow: Service models for specialist rehabilitation in hospitals and communities’ included an excellent array of posters describing different service models. The faculty included Valerie Taylor from Bangladesh who talked about community reintegration after spinal cord injury. Following an appeal at this conference BSRM members funded a baby taxi for the Centre in Bangladesh, with special adaptations to enable a paraplegic driver to return to work. The AGM was held at the Centre for Life in Newcastle. At this meeting Neil Fyfe announced that he would be standing down at the next AGM, having held the post of Treasurer for 15 years. During the year the Society had responded to Lord Darzi’s report ‘Our NHS, Our Say’. A report on the National position of Rehabilitation Medicine was published. The announcement of Payment by Results was recognised as a considerable threat to Rehabilitation Medicine and Lynne Turner-Stokes had responded and continues to work on this project on behalf of the Society. The research network continued to develop.

2008 saw Neil Fyfe succeeded as Treasurer by Mike Barnes, a Past-President of the Society. Christine Collin became our President and Chris Roy was elected President-Elect. The Spring meeting was held in Birmingham and the AGM was held in Ermelo, in the Netherlands, where another (3rd) successful conference was held with our Dutch colleagues. A public relations group was established. There were a number of constitutional changes, the most important of which was making the Officers of the Society the Trustees. The Secretary reported that there were 383 members of various designations. The Society produced two reports in this year, one on the rehabilitation of spinal cord injury, the other on the interface between rehabilitation and palliative care in long-term neurological diseases.

So we come to 2009, our Silver Jubilee Year. It has not been without incident. Christine Collin, the President, and her husband, Jack, cycled from Lands End to John O’Groats, joined by various members on differing legs of the route, as part of the celebrations. The Spring meeting was held in Dublin and was addressed by the President of the Republic, Mary McAleese, The Silver Jubilee meeting will see the Society in Oxford, back were it started 25 years ago. Entirely appropriately at this meeting the Society will launch its report on Vocational Rehabilitation for individuals with long-term conditions. What does the next 25 years hold for the Society? At the time of writing Britain is still gripped by a recession that every political party now agrees will require a major reduction in public spending to return the country to some kind of economic equilibrium. The challenge for the Society is to convince the Government that rehabilitation is not an optional extra in the healthcare system, but a vital part of the solution to ensure that as many of our citizens as possible are able to work and that rehabilitation will reduce dependency on state benefits and long-term care.

The BRSM is well placed to do that. We can now add experience (with which comes wisdom) to our other assets of enthusiasm and tenacity. In 2007 the Society started to develop a strategy for the advancement of rehabilitation and the BSRM. The strategy has been refined to the following five headings:

1. To promote the development of the understanding and management of acute and chronic disabling diseases and injuries, and their consequences for the individual patient, their carers, their medical and other attendants, and society at large.

2. To promote the specialty of Rehabilitation Medicine, being defined as the application of medical skill in the diagnosis and management of disabling disease and injury of whatever cause and affecting any system of the body.

3. To advanced the education of health and other professionals and the general public in the area of disability.

4. To develop and promote standards for clinical care and professional working in the specialty and mechanisms for audit, appraisal and review to ensure that those standards are maintained.

5. To promote and facilitate research in the field of rehabilitation to support the evidence base which underpins good clinical practice in the specialty. If the BSRM delivers on this strategy, then the future in this Silver Jubilee year will be golden.