Society: New teams of specialists are on a mission: to stick up for those who can�t find the help they need to get their lives back. By Stephen Naysmith

Helen Cadden knows the frustration of recovering from a long-term injury. The crushing injury she suffered to her spine, while working as a nurse at the age of 21 has left her with permanent pain and affects the use of her legs, making walking difficult.

In fact, recovering is the wrong word - the effects of the damage to her spinal cord will affect her for the rest of her life - but she is clear that she and others can be rehabilitated and indeed must be helped to return to as fulfilling a life as possible.

She's attempted to return to work six times, but her back pain and the limitations her injury places on activities such as driving for long periods, have thwarted her.

But the frustration of her injury 17 years ago has been compounded by interacting with services over the years which have at times seemed to be actively hindering rather than helping her situation. Rehabilitation service have too often been patchy and getting different branches of the health service to communicate is an apparently unnecessary hurdle.

"People with long-term conditions generally want to work if they can, to contribute to society, even if that can't be paid work," she says.

"The same applies to people in care homes. People tend to write them off but there is an awful lot they could be doing and want to do."

All this could be changing due to the Scottish government's rehabilitation framework - an ambitious attempt to break down the boundaries which have in the past put added barriers in the way of people recovering from illness or incapacitation in the NHS.

This includes elderly people recovering from a fall, people with disabilities who need support to live independently in the community, and people managing with long-term conditions.

A key plank of the strategy is now in place, with most of Scotland's health boards h aving appointed rehabilitation coordinators, as required by ministers.

The post-holders are given a key role in the framework, tasked with working between health, social care, voluntary agencies, service users and carer groups to develop and improve services across each health board area.

The framework also includes a host of other initiatives, including pilot projects to explore ideas such as allowing those with long-term conditions to access physiotherapy services directly through NHS 24 rather than by seeking a GP referral and sitting on a waiting list. Another pilot is looking at falls prevention, while a third in NHS Tayside is assessing the benefits of vocational rehabilitation. Elsewhere, the Care Commission has appointed a rehabilitation consultant whose remit is specifically addressing the needs of elderly people in care homes.

It is all welcomed by Cadden, who chaired the long-term conditions group which fed into the rehabilitation framework.

"A lot of the problems arise when people are not really fit enough to fight for what they need. If they are working with rehabilitation coordinators and their teams, it will hopefully allow much more rapid access to help," she says.

For her, although pain is a constant, severe flare-ups can knock her back for months. The standard 16-week wait for referral to a physio is no use, she says.

"In that time people who have some kind of employment will lose what job they have. For anybody with a long-term condition, you know what you need a lot of the time, but it is about getting help when you need it. I have lived through flare-up after flare-up, but getting swift help can mean it lasts for one week, instead of six months to a year," she says.

"It has got better over the years but I'm really hoping the framework will make that easier. I'm hoping the rehab coordinators will provide this one stop shop, to get assistance timeously and to help give people the confidence to be able to manage their own care - knowing that that safety net is there when you need it."

John Wormersley, a disability consultant who works with charities including Disability Information Greater Glasgow, also welcomes the new appointments, having met most of the new post-holders and been impressed by their approach. He said: "In the past there were gaps all over the place. I think this is a huge opportunity.

"We are also well used to government bodies producing reports which are a huge source of waste because they are carefully compiled, yet there is nothing in place to force anyone to act."

Direct payments, which in theory enable disabled people to commission their own care are another example, Wormersley says. While they have benefited many, he argues some councils have been reluctant to promote them and hand control to disabled people.

"With these coordinators we have a link between the ideas people and the grassroots. If the rehabilitation coordinators can't change things, nothing will," he says.

Some have expressed concern that the new posts aren't sufficiently senior to tell managers what needs to be done to effect change, but Wormersley disagrees. "I think sometimes it is better to have people around who aren't terribly threatening, and need to use evidence and persuasion to bring others onside", he says.

What the job entails
Anne McAlpine and Claire Dobson job-share a rehabilitation coordinator post with NHS Fife:

• What does your role involve?

We have been in the post now for just over four months and the post is funded for two years. We have been given a national framework which has been consolidated into action points intended to achieve five high-impact changes. We will produce an implementation plan that will demonstrate how the agencies in Fife will deliver these changes.

Our role has involved speaking to service users/patients and colleagues in health and social care working in the field of rehabilitation about the services they receive or deliver and mapping out current activity.

• What has happened in the past and what will change?

There has been a great deal of excellent work in rehabilitation. The framework is concerned with making links across agencies, services and the range of policy initiatives to ensure that rehabilitation is delivered more effectively. It is also concerned with Scottish Government initiatives around delivering services as close to home as possible and to consider delivering them in settings other than health facilities. It is also about having easier access to services and having ser vices more linked/co-ordinated across Fife.

It is very much about working with all partner agencies, including Fife Council, voluntary organisations and, most importantly, patients/users. The work involved in developing the implementation plan in itself will raise the profile of rehabilitation. This can only help the many services that provide rehabilitation and the many groups of people who can benefit from the services.

• What did you do before?

Anne McAlpine is an occupational therapist and Claire Dobson is a physiotherapist. We are continuing clinical management duties for the remainder of the time. We think this brings the strengths of clinical background and direct contact with our colleagues in regular service delivery.