Mind The (Rehab) Gap: Personal Injury vs Clinical Negligence Claims

We sit down with Helen Franklin, partner at Barcan and Kirby to unpack what rehabilitation really means in injury claims and why getting it early can change recovery, independence, and family life. We compare the personal injury rehab code with the clinical negligence reality, where delays on liability and NHS pathways often leave people without support for far too long.  

Helen and Emma discuss what “rehabilitation” means in the claims context, how the Personal Injury Rehabilitation Code works in practice (from initial needs assessments to case management, therapies, equipment and psychological support), and why insurers are typically willing to fund early intervention. They then contrast this with the realities of clinical negligence litigation: delayed claims, complex liability investigations, long NHS waiting lists, and the absence of an equivalent rehab framework.  

Transcript

Welcome And Why Rehab Matters

Emma 0:08

Hello everyone, welcome to the podcast. My name's Emma Wilson and I'm ATE Account Manager at ARAG Legal Services UK and host of the ARAG ATE Podcast. For this session, we're going to be talking to Helen Franklin and it's in relation to women in clinical negligence. And Helen is a solicitor and partner of the clinical negligence department at Barcan and Kirby. And we're going to be having a discussion about an important subject today: rehabilitation in personal injury and clinical negligence claims. So, welcome to the podcast, Helen. Thank you for joining us.

Helen 0:51

Oh, thank you for having me, Emma.

Emma 0:53

So today, Helen, we're going to be talking about rehabilitation, why personal injury claimants often get early rehab, but clinical negligence clients often don't. But before we compare the PI model and the Clin Neg one, could you please explain what we mean by rehabilitation in the claims context?

Helen 1:14

Of course, yes. So quite simply, rehabilitation means access to the appropriate professionals to offer either care, treatment, or therapies required as a result of the injury that they've sustained. We know that within the NHS that physiotherapy, for example, is offered for a simple fracture, but for somebody who is seriously injured, there is a significant care package and therapies that are required to support them for the remainder of their life, really. The principle behind any claim, whether it's in clinical negligence or PI, is to attempt to put the claimant back into the position they should have been in, but for the negligence. This is quite difficult in cases where somebody's suffered a significant or life-changing injury for very obvious reasons. But we also know that there is a greater chance that there will be some recovery if there is rehabilitation in place than without. It also improves things like quality of life and can mean that injured people can return to work or their hobbies a little quicker than they would have otherwise done without rehabilitation input. In catastrophic injury cases, in particular, case managers help to organise care, therapies, treatments, and that takes quite a lot of responsibility away from parents or other family members that would ordinarily do that. There's also an underlying principle that the claimant needs to mitigate any loss suffered. And so access to early rehabilitation sits nicely alongside that.

The Personal Injury Rehab Code

Emma 2:44

Thanks for that, Helen. So, in simple terms, what is the rehab code in PI and why was this introduced?

Helen 2:53

So, firstly, I'd just like to make the point I'm not a PI solicitor, so I've never had the opportunity to actually use this as part of my practice in the way that it was intended. But the we go back to the pre action protocol for personal injury, and that has a specific and quite long section in there about rehabilitation and the need to consider it at the earliest opportunity when bringing a personal injury claim. The rehab code itself dates back to 1999, and the current version is from 2015. The current code differentiates between what they refer to as a moderate injury, which is valued under £25,000, a major injury, which is between £25 and £250,000 in terms of the compensation, and catastrophic injuries, which are over £250,000, and sets out basically a proportionate amount that can be spent on each of those. It stresses that although it's a voluntary arrangement, it does place a specific obligation on the insurer on any refusal of rehabilitation. They have to basically explain why they are not willing to cooperate with that. It encourages early assessment on liability of the claim so that the rehab code can be utilized and is paid for by the defendant. And importantly, should the claim be unsuccessful, unless there's an issue with fundamental dishonesty or something similar, the claimant does not have to repay the amount that the insurer has paid for their rehabilitation. Communication between the parties is key here, so early communication as to claimant's potential needs, any benefit of rehab, liability discussions, etc., all help to kind of initiate this process as part of the rehabilitation code. The pre-action protocol and the rehabilitation code then stress that communication needs to be continued throughout and the parties need to consider ongoing rehabilitation, whether it's working, whether a different direction needs to be made. And it includes not only the provision of services but also any psychological support, aids and equipment and appropriate accommodation adjustments. The important thing is that the code actually uses both NHS and private provisions available kind of in sort of the local authority area.

Emma 5:04

That's really interesting. Who's involved and how does it work day to day for claimants?

Helen 5:12

It very much depends on the needs of the claimant and the nature of their injury and who they have to support them. Normally, some sort of initial needs assessment, which we call an INA, is performed by a case manager, and then it would sort of be taken from there, really dependent upon what the needs are. Some claimants may only require therapeutic input for a very short time, but others, a client with cerebral palsy, that's quite a good example. They will need, for example, a case manager, somebody who is normally either a trained occupational therapist or physiotherapist. They oversee the entire therapeutic process and they work out what the claimant requires and then tries to put those things in place, but in a very gentle, very holistic way. And it also obviously has a really positive impact on the family because it means that they then are not those the providers of physio or care. So they will get physiotherapists in place, occupational therapists in place, carers in place. Carers are a really important part of this, particularly in sort of catastrophic injury cases. Some claimants who will have ongoing medical issues where they will require trained nurses, for example, to administer physical care as if they were in hospital. There's others who are more of a supervisory role and that's a support worker or a buddy, and it's because that person is independent in doing something, but they just need to be assisted to do minor things or to make sure that they don't injure themselves in some way while while doing that thing. Some people who are seriously injured will need 24-hour care. Some will only need it for certain parts of the day. The whole point is to try and maximise independence and so to enable the injured person to have access to all of the things that they need to do through their carers or support workers. Occupational therapists are normally hired for equipment needs, basically enabling independence as much as possible. We all know what a physiotherapist does, but if you're really quite badly injured, and particularly if you are either bedbound or wheelchair bound, then the more physiotherapy you get the better, and actually that increases your life expectancy and all sorts of things because it's a really sort of positive input. The final thing that normally people need is either neuropsychological or psychiatric input. So if they have behavioural issues as a result of the negligence, they normally see a psychologist. If they have a psychiatric disorder that can be diagnosed and they see a psychiatrist. And again, that might just be for a short period of time, but it might also be long-term and lifelong depending on what the need is.

Emma 7:57

So you can see why the rehab code works so well in personal injury there. What difference does early rehab make for claimants?

Helen 8:08

I think articles and research all support that the earlier the rehab, the better the outcome on a really basic level. Not only does it prevent kind of worsening of any condition, because that's often the issue that we find with our clinical negligence clients, those that are seriously injured actually then suffer a deterioration post-discharge from hospital. But that sort of deterioration not necessarily can be prevented, but it can be managed and it and somebody can be looked after a little bit better. But it also, as I've said, can allow somebody to, depending on the injury, potentially return to work, be it in an adapted or modified way, or allow them to have access to their hobbies, which they might not necessarily have been able to do before. Quality of life is important too, and that's not only important for the person who suffered this injury, but also for their family and for the people that love them and surround themselves with that person. It's just a really positive way of kind of separating the family unit and the need for rehabilitation and those that offer the rehabilitation.

Emma 9:12

Okay, so why are insurers generally willing to fund rehab early?

Helen 9:18

I think unfortunately, like everything else in this life, it comes down to money. Insurers tend to have more of it because of the nature of the insurance, they're more likely to take on the risk versus benefit analysis. Whereas an NHS trust or NHS resolution or even their panel solicitors are less likely to have that immediate thought. Also, in some cases, admittance of liability is easier in certain PI cases. If you're in a car accident, for example, for clinical negligence clients, it's also about who is actually going to make that decision. Quite often, when we approach the trust, we say, you know, we think this is a clinical negligence claim. The trust deals with it for a period and then it gets passed on to NHS resolution, and then ultimately it gets passed on to one of their panel firms.

What Early Rehab Changes

Helen 10:05

It's normally the panel firms, once you get to that point and establishing liability, that they will then sort of come back and talk about sort of interim payments and how they're going to work. Um, but there is kind of a decision-making column almost where they have to get instructions from various people to be able to even make that decision about an interim payment early on. And the other quick thing that I just want to say is that there is quite a big difference between PI claimants and clin neg claimants in that PI claimants tend to ring up and make a new enquiry and potentially like three days after the accident, or you know, somebody else will. Whereas clinical negligence claimants, they tend to wait until 18 months, maybe two years down the line, because they don't really want to sue the NHS. What they want to do is they want to see how they're getting on, and then they suddenly realise that they're just not managing and then they need help. And so there has already been a period of time when they haven't been receiving sort of rehabilitation and help sort of post-injury.

Emma 11:05

Is it fair to say that everyone's incentives are aligned on this?

Helen 11:10

Yeah, I think the rehab code, the whole principle or underlying principle is all about a collaborative approach, really. Um it sort of sets out time um constraints for everybody and how everyone should be communicating with everyone. Um, it also underlines that following the initial needs assessment, the local authority is required to determine any eligibility for care. So there's an option there for sort of local authority provisions to actually get involved, so it's not necessarily a cost that is going to be borne by the insurer. How this actually works in practice, I don't know, because obviously that's what the code says, but there is kind of an option for that. I I would also like to say here that there's I'm sure that there are lots of PI cases where liability is disputed, and actually rehabilitation is not something that is being offered. But it appears that in the vast majority of cases, there is at least some open communication as to rehabilitation. It might not be everything that is required by the claimant, but at least it covers some things that they need.

Emma 12:13

So is it fair to say that rehab isn't just a kind thing to do, but it's actually a practical thing to do as well?

Helen 12:22

Yeah, it gives the claimant an opportunity to mitigate their loss, which is important in terms of the claim itself, but it also assists the claimant and defendant team in understanding needs and potential future needs of the claimant sort of moving forwards. I think that's something that in PI they focus on at the earliest opportunity, whereas in clinical negligence it tends to be something that comes later just because of the nature of the of the work and the the knowledge that an interim payment is not really going to be forthcoming to help with rehabilitation at the outset of the case. On a practical level, it helps us to understand what the case value looks like. If if rehabilitation is working, then it could potentially mean that their condition gets better quicker, or that we can then work out that actually they only need this for a fixed period of time or for a longer period of time, but it helps us to quantify the case. And my own view, seeing it from my client's perspective, is that generally they're as soon as they start to receive some rehabilitation, whether it's a psychological or a physical reaction, there tends to be some improvement in their outlook in life and to a degree also their condition, whether they're just slightly more mobile, whether they're in a slightly better headspace, whether their behavioural issues are because of the fact that they are trapped as a result of their injury. All of these things really make a difference to individuals and it can potentially lessen the amount of compensation they actually receive later on down the line because they're receiving it earlier on.

Emma 14:02

So thank you for sharing that about personal

Why Clin Neg Rehab Lags

Emma 14:05

injury and the rehab code there. Talking about clinical negligence rehab, how does rehab work for clinical negligence at the moment?

Helen 14:15

Basically, unless there's an admission of liability, either in part or in full, there's just no access to rehabilitation. We know that people, well, we can see from the medical records that when people are discharged from hospital, they're often left without support. There's significant delay in even potentially having a referral within the NHS services for that support. And we know that people can potentially wait 24 months to see a psychiatrist, for example, in a cerebral palsy case, which is one of the most serious injuries that we we deal with. If someone's left without rehabilitation and access to treatment, this can lead to other medical problems associated with being stuck in a wheelchair or being in an appropriate bed, and which can then add to greater reliance on other aids and support in the future, and so therefore can potentially mean that the case is worth more but at the detriment of the claimant receiving any early rehabilitation.

Helen 15:12 Helen 15:12 Helen 15:12 Helen 15:12 Helen 15:12

So what rehab routes do clients usually rely on? We normally end up signposting them to charities, and there are some excellent um charities out there, but of course they are charities, so they are reliant upon other people's funding. So for example, the Child Brain Injury Trust, the Brain Injury Group, Headway, Spinal Association, Limb Loss Association, and loads more, but very much dependent upon uh where you live. There is so much access to kind of help and support. And with a lot of these charities, it's not just about the fact that they can potentially offer equipment at either a low or reduced price, or sometimes just a loan, but they also obviously work with these types of um injuries all the time, and so therefore know kind of what support groups people would benefit from, what respite families could um benefit from, offer emotional support, any guidance, also benefits advice because there is an entitlement to benefits now where there might not have been before. But we know that in catastrophic injury cases where the need is so great that charities just can't be expected to fund everything that they need, it's just impossible.

Emma 16:28

So I can see that the pre-action protocol for clinical negligence it does mention rehab, but how does that compare to the PI code?

Helen 16:39

So uh the pre-action protocol for resolution of clinical disputes has a really tiny paragraph on rehabilitation and it basically comments that as early as possible we should be considering it. It doesn't give any insight into how that needs to be applied, and I think generally it is something that is overlooked because we know that it's just not something that's available to the claimants at the time because there's no admission of liability. I think there is a lot of potential delay in clinical negligence cases on both sides. Claimants, we have to fully investigate the case, and we use experts, and sometimes they have 24-month waiting lists in order to even uh notify the defendant properly of a case, it can take some time. And then the defendant needs to investigate that as well. So, in really serious cases where potentially five or six experts are needed by both sides in order to establish liability, you are looking at potentially five or six years to even get all of this information together. And then if the defendant doesn't want to admit liability, and of course there's no obligation upon them to do so, the chance of rehabilitation is is less and less as you as you work through. And so sometimes you you are at a point where you are two weeks away from trial and liability is then admitted, and you're eight years into the litigation, and that person has had no support for the entirety of that time, and it just makes it incredibly difficult.

Emma 18:11

So there is really an impact, isn't there, of not having a rehab code in clinical negligence? What are the real-world consequences for clinical negligence clients that you see? And what do you see in relation to delays and how does that affect the recovery and their independence going forward?

Helen 18:34

I mean it's catastrophic really for them. We see claimants who have suffered, for example, an amputation, they're being discharged home, no adaptations, no aids and equipment around the house, and if they've got steps to get in and out of their house and they've got n not got use of a prosthetic limb, for example, yet, they reach a point where they are completely housebound but only limited to the downstairs, they might only have a downstairs toilet, they end up sleeping in their lounge, washing in the sink in their kitchen, and have zero quality of life if they don't have anyone around them to kind of look after them. And these sorts of things, obviously, the more injured you are, the more of a massive difference it it makes to people. In CP and brain injury cases, we see parents having to give up their careers and their jobs in order to care for their children. This then obviously limits the amount of funds that the claimant and their family have access to, but it also changes the relationship that parents are having with their children. They end up trying to Google or watch YouTube on how to be a physiotherapist on what sort of wheelchairs their child needs, and they do the best for them, but it's not the same as having the professionals doing all of the correct assessments. We know that, for example, um wheelchairs need to be properly assessed, measured, and adapted for the needs of the individual. And if that isn't done, and if they're in an inappropriate wheelchair, then that can actually cause more damage. But parents aren't to know this, they they just don't have access to all of that information they need. So lack of access to appropriate support on discharge from hospital often leads to other associated problems, makes the claimant needing significantly more treatment and support at the time of settlement than immediately following the negligent event. Some local authorities do offer a few hours of care a week that can then at least provide a tiny bit of respite to the families. But therapy is expensive. These are specially trained individuals, and so they know that quite a lot of the time there needs to be sort of intensive rehab at the very outset, and which can then sort of tailor specifically to what that person needs either in the short, medium or long term.

Emma 20:53

Do clinical negligence clients generally wait longer than personal injury clients with less serious injuries, even though we know personal injury clients can have serious injuries too?

Helen 21:04

Absolutely, and um my impression from speaking to some of my colleagues and also reviewing the rehab code, it feels that actually almost the lesser the injury, the more chance of rehabilitation anyway. Although, you know, in in catastrophic PI injuries, they also do get a case manager in quite quickly, but actually getting the support they need isn't always perfect, but at least there is something. But in clinical negligence cases, almost regardless of the injury that you have, there isn't really any rehabilitation option until you either have a liability admission. And sometimes, actually, when you have a liability admission, um, if it's a fairly minor injury for clinical negligence cases, or if it's an injury that will resolve, the defendant is looking to settle the case at that point, in which case there isn't like an interim payment to do with that, it is literally settlement of the case. And and that's it. So they basically don't have any rehabilitation until the claim is complete. What impact does this have on their families and carers though? I mean it's a struggle as a human being to see families struggle so much. Um primarily it takes away any sort of normal familial relationships. Parents of injured children often, as I've said before, they have to give up work, suddenly finances are tight, benefits don't cover everything that they need to do. They then end up becoming a carer, physiotherapist, support worker, and they lose the ability to be mum or dad or brother or sister or child. Um I had a case, a cerebral palsy case where we were able to, after admission and liability, introduce some carers, some physiotherapists, case manager, um, and various other people to come in and help. And mum was finally able to be mum. She was able to take her son out with the assistance of a support worker and go for coffee with him and do all of the things that for the past sort of 15 years she'd not been able to, and then she could just chat with him as his mum. And I think those sorts of things are really important, and those are the things that are lost as part of the clinical negligence process when there's no access to rehabilitation. Because also the impact on other family members, if it is a child in a household and there are other children involved, then often those children don't feel like they get the time and attention from their parents, and so there is kind of almost a knock-on sort of psychological impact on the remainder of the family as well.

A Possible Rehab Pathway For Clin Neg

Emma 23:39

So if we imagined a rehab code for clinical negligence, what do you think that could look like?

Helen 23:46

I think this whole discussion that we're having has actually prompted me to kind of have a think about how it could work in practice. And I've never been a defendant solicitor, so I don't actually know how the process works anyway. But my feeling on it is, and because of all the talk about how much clinical negligence cases are costing generally, that it almost has to be some sort of accelerated pathway. So almost like a separate pathway that's introduced, whether it be um actual NHS provision or private provision, that when the trust or NHS resolution are notified of the claim, they move that person from sort of not what I'd call normal NHS follow-up into almost an accelerated pathway and almost adapting a little bit what the PI code is. So there is initial needs assessment so that we understand what those persons' needs are, and then where appropriate, and obviously with funding in mind, how some of those things can be initiated for that specific individual using provisions that are already apparently in place in that region. So it's not necessarily them spending money, but it's almost them prioritizing, which again I think could be controversial, but prioritising people who have been injured in a way that could potentially be clinical negligence, but before liability is admitted. I can't think of any way where they would actually use a rehab code where it's literally something is being paid for by um NHS resolution, NHS Trust, the panel firms, in addition. So I think it has to we have to be using the provisions that are already in place.

Emma 25:34

Right. So which parts of the PI code do you realistically think could actually translate into a clinical negligence setting?

Helen 25:44

I think there needs to be some sort of differentiation of what the needs are. I think there is a real need to as soon as possible have an initial needs assessment so that we can understand what the needs are. And even if we're unable to meet those with rehabilitation through any sort of clinical negligence rehab code, at least there's an understanding of what's required. But I sort of feel like if it's psychiatric input, for example, for CBT for 12 sessions, then this is something that can be put in place rather than the individual needing to go to their GP, needing to have an assessment through their GP, waiting for a referral, then there's another test and sort of initial assessment by the psychiatrist, and then there's a 24-month waiting list to actually see that psychiatrist. It feels like there can be a leapfrog opportunity for certain people, depending on what their needs are, and depending what the requirements for rehabilitation is. If it's just for a short period, this might be something that can be met with current NHS and local authority provisions.

Emma 26:47

How do you think early rehab could happen without it actually being seen as an admission of liability from the defendants?

Helen 26:58

I just don't think it's something that defendants are willing to do. I think it's a really difficult point for them because they are obviously holders of the public purse in relation to NHS money and they need to be responsible about it. I think when it comes to liability generally, the likelihood of them engaging um in any rehab code at any point before liability is admitted is just unlikely. I think that they would feel that they just can't commit to spending money on others if there is no admission of liability to kind of go along with it because there's no guarantee then that they would be able to be limiting their compensation going forward, or it would have any sort of positive reaction for the for the claim. So do you think this is something that could be tailored rather than copying the PI rehab model? I think there is a real opportunity here for compromise. There's constant criticism of claimants and their solicitors for uh the costs of clinical negligence cases and how difficult it is for them. But I feel like there is an opportunity for some sort of model whereby there's an accelerated pathway for treatment for those affected by alleged negligence. I think the difficulty with all of this is that any person who suffers an injury, whether negligent or otherwise, would expect to be rehabilitated after an injury in any event. So technically, this should be something that's accessible for everybody, regardless of whether there's any negligence. But we know that that just doesn't work, that rehabilitation is very limited in every context. Whereas I think an accelerated pathway, and although I've said before that I think it's controversial, because obviously there'll be a lot of people that are angry about the fact that they're not getting an opportunity to be on this accelerated pathway if they're not bringing a clinical negligence case, it sort of feels like we have to work within the existing framework because of the issue of cost.

Emma 29:02

Yeah, Helen, there are a lot of barriers, aren't there? But what do you think are the biggest challenges and obstacles to create a Clin Neg rehab code?

Helen 29:11

I'm going to touch on cost again, Emma. And I do think it is cost. The Public Accounts Committee reported on the cost of clinical negligence cases. And that report, drafted by MPs, basically say that there's a significant portion of Clin neg cases that offer future care and treatment. Case law states that this can be recovered on a private basis and not through the NHS. They also comment there is insufficient data to understand whether these claimants are using NHS provisions going forward, which therefore amounts to double recovery, i.e., that they're being paid to have it privately, but also using NHS provisions. And the issues that I have with this are threefold. First of all, we know that NHS provisions are unable to cope with the needs of those adversely affected by clinical negligence cases. We see our clients being discharged from hospital and they just don't have access to the rehabilitation that they need. And quite a lot of them, if they've got no ongoing medical issues, are actually discharged from all care and so they don't receive any follow-up at all. There is a massive waiting list for people who do need this input, and they are obviously on a normal NHS waiting list, and as we know, as we see on the news all the time, those are horrendously long. And then there's also the uncertainty about whether this provision will be available under the NHS in the future, remembering that most of the needs for those that are catastrophically injured will be lifelong. And then I think we have to come back to the fact that the NHS is funded by taxpayers, and therefore there's always a public interest decision in reducing the NHS spend. All of these discussions really never take into account that the claimant's life and those that love them are inexplicably damaged by the negligence, and this has a massive impact on them going forward. Compensation as it is and as it stands under our current system is already insufficient to cover everything they need. But we also have to understand that these are the things that are causing the greatest strain under the NHS. The bigger the case, the greater the financial strain. The other issue is things like carers, they're very difficult to get hold of. As we know, local authorities are already under pressure, they potentially can only offer a couple of hours a week, but there's no real support for the rest of the day, there's no help getting people out and about and enabling their independence. On a private basis, they are really expensive because there's so few of them, it's very difficult for families who are on low income or reduced benefits to be able to afford the requirement for um 24-hour care. And then, of course, we always circle back to the issue of liability. The defendant is just not going to be willing to pay out a significant amount of money if they're not sure that this case is going to be successful.

Emma 32:06

What can clinical negligence claimant solicitors do? What do you and your team do to support your clients with early rehab now, even though there isn't a code?

Helen 32:17

Again, it's just a signposting job, really. We try and have good relationships and are sort of either panel members or associated with a lot of the bigger charities that enable us to make referrals or signpost our clients again who can either provide equipment on loan or at reduced cost or emotional support or part-time carers or even support groups generally that can help the family and the injured person.

Emma 32:50

So, Helen, are you optimistic about progress in this area?

Helen 32:56

I have to say, I mean, this is quite depressing, but I don't think that there is. Um there's been increasing criticism over the cost of clinical negligence cases that have been primarily laid at the feet of claimants and their compensation and also claimant solicitors' costs. There is talk, and there has been for a long time, of fixed recoverable costs in what is deemed to be low-value clinical negligence cases, which we all know from experience are often some of the most difficult ones as well. And I think that if there is fixed recoverable costs in clinical negligence, there's going to be even less engagement in rehabilitation because there is then an opportunity for the compensation to increase and therefore fallout of a fixed recoverable cost rule. There are intrinsic delays in the system, anyway, in terms of actually bringing a clinical negligence claim and the difficulties that both the claimant and defendants have in actually trying to establish liability in these cases. And I think overall the real fear coming from the defendants is that the rehab will be offered and paid for, and for whatever reason, the case is unsuccessful. And although they would have potentially improved somebody's life in the grand scheme of things, it's probably deemed to be wasted money from the NHS pot that they simply don't have. The difficulty with all of this is that, regardless of whether there is negligence or not, if somebody has a physical or psychological injury whereby they need help and support from a treatment provider or providers, they should technically have access to it. But that unfortunately is not currently the world that we live in.

Emma 34:29

So if policymakers or NHS resolution were listening to the podcast, what's the one message that you'd like them to hear in relation to the clin neg rehab code or the lack of it?

Helen 34:44

I think it's a really difficult area and everybody is very much constrained by the issue about the public purse. I think as claimant solicitors, we are also aware of that. And obviously the defendants, a lot of their decision making is about public policy when it comes to spending money, cost of rehabilitation, and also ultimately, if unsuccessful, where is this money going to come from? However, on the flip side, I think later intervention and offer of rehabilitation much later down the track only increases the amount of compensation that the claimant actually needs because at that time there is uh deterioration in their condition. And I just wanted to say I realise like this sounds like I'm bashing the NHS and their representatives, I'm not. It's a really difficult job for everybody. And they also have this responsibility of the public purse, as I've said, as claimant lawyers, our own investigations into these claims take a long time because the amount of medical records we need, the delays caused by having some experts who are on really, really significant um waiting lists, and so it can be several years before we are even in a position to be able to put anything substantive to the defendant. So I think it needs a more collaborative approach if we are going to adopt any sort of early rehabilitation in clinical negligence claims.

Emma 36:00

And as a final takeaway, if there was one thing that you would like listeners to remember from everything we've discussed today, what would you like that to be?

Helen 36:11

I'm going to get on my claimant Clin neg pedestal and say that the injured person needs to be at the centre of everything that we do. We know that rehabilitation, regardless of the situation, has a positive physical and mental impact, and steps should be taken to support those that are injured and their families as much as possible at the outset.

Emma 36:28

Thanks so much, Helen. I've learned so much today. It's been really insightful. Thank you so much for joining us today.

Helen 36:35

Thank you so much for having me, Emma.