After the tragedy of the Manchester Arena bombing a pioneering new approach to rehabilitation has emerged
Mark Gould heard from one of the physiotherapists behind the scheme and one of the survivors who has benefited
‘The decision to leave early will be with me for the rest of my life,’ says Martin Hibbert, describing the night that changed everything for him and his daughter Eve. They had looked forward to the event for months.
The tickets had been bought early and he gave Eve hers as a surprise Christmas present.
‘We’d been to several concerts together,’ he says. ‘It was something I liked to do as a father-daughter thing.’
The gig was on a school night, a Monday, so Martin and Eve made the decision to leave at the encore. It can take a long time to clear the venue car park after an event and an early exit would give them a head start.
To get out before the rush, they ran across the foyer of the Manchester Arena as American singer Ariana Grande was wrapping up the show – and at the exact moment terrorist Salman Abedi chose to detonate his homemade bomb.
The explosion fired shrapnel – nuts and bolts – across the foyer with deadly effect. Twenty-two people, plus the bomber, were killed and well over 100 more, including Martin and Eve, were injured.
Martin was hit by 22 bolts and sustained a spinal cord injury. Eve was hit in the head. He thinks the fact that they were running saved their lives.
Fast forward from that night in May 2017 and Justine Theaker, currently lead allied health professional for the North West Nightingale Hospital in Manchester, is recalling a patient, whom she calls Chris, who was run over by an articulated lorry after falling from his moped.
‘He was an absolute mess,’ Justine says. He had suffered multiple fractures and a brain injury. But he was now stable and her first task in his long recovery was simply to get him sitting up.
A year later, he came into outpatients where she was holding a clinic. When she asked how he was doing, he said: ‘You saved my life but at what cost? I have no life to live.’
On leaving hospital he had had to battle for any sort of support. Physio appointments were too short to address his multiple needs. His partner had left him, he was lonely and isolated, and had mental health issues.
Justine says: ‘I just thought, my goodness, this is awful. We’re saving these people who would once have died but at what cost to them?’
She adds: ‘This was years ago but to this day we haven’t managed to pin down and deliver sound, effective rehab for these patients.
‘And it’s a national issue – it’s not regional, it’s not a north-south divide. This is a national problem.’
Martin agrees. After several weeks in Salford Royal Hospital he was transferred to a spinal unit in Southport, eventually leaving hospital four months after the bombing.
‘Blood, sweat and tears’
At the beginning of his rehab, simply being able to bring together the thumb and little finger of his badly damaged left arm, through which a bolt had passed, was a mark of progress.
But slowly, and with daily physiotherapy, he was able first to sit up, then move along the bed and eventually transfer to a chair.
‘I think the saying “blood, sweat and tears” originated in a spinal unit because, when I got to Southport, doing daily two-hour sessions of rehab was tough.’
But in small increments he progressed and he pays tribute to the NHS for the care he received in hospital.
‘They saved my life and we’re forever friends,’ he says.
But then he was discharged and, as with Chris, all the support he had grown used to abruptly stopped. He had assumed that once he was home rehab would continue in some form because it was keeping him fit, focused and motivated. But it wasn’t to be.
Instead he was facing up to life with a spinal cord injury and his wife was now his carer. The family also had to move because their old home was not accessible for someone using a wheelchair.
We were plunged into a new world without any help whatsoever. I still get very angry about it, very frustrated.
But for all its horror, the Manchester Arena bomb presented an opportunity for other major trauma patients, says Justine.
With funding from various sources, including the We Love Manchester charity, a package of enhanced rehabilitation was devised for those injured in the attack.
The service would offer three-hour sessions of rehab instead of the 20-minute appointments common in the NHS, and the sessions would be provided at the Manchester Institute of Health and Performance (MIHP), a world-class facility funded by various organisations including Manchester City Football Club, Manchester City Council and Sport England.
‘It has everything you could require,’ Justine says of the MIHP. Equipment and resources available are beyond the dreams of NHS physios and therapists, she adds.
Twenty-six of those who had survived the arena bombing took up the offer of intensive rehabilitation.
They came from all parts of the UK.
‘We opened this out to everybody and were able to provide them with accommodation so they could do a block of rehab every day for a week. Then they’d go home and carry on with the rehab independently before coming back for other sessions.’
Patients who lived locally attended every day or alternate days.
‘It was very much a bespoke, tailored package for each individual,’ says Justine.
Mental health support was also factored in.
‘These patients had been through a really tough time and we would expect them to have psychological challenges.
‘The team that delivered the rehab were trained to ensure they were able to address these challenges and they’re all mental health first aid practitioners now. That was all part of the service – to make sure we could provide this wraparound, holistic package.’
Physios drove him hard
For participants in the programme, Martin included, it offered a level of support not normally found in standard healthcare.
He found the MIHP rehab tough and the physios he worked with drove him hard. ‘At times they really did “beast” me,’ he says.
‘But at that point I wanted to be pushed and to prove everybody wrong about what someone in a wheelchair could do.’
The sessions helped him feel alive, he says. ‘I tried to go as often as possible, although it was a two-hour commute so it was a very exhausting time.’
Nonetheless, he would return home after a session feeling ‘amazing’, Martin says.
Despite the many benefits the programme brought to those who participated, Justine admits to some misgivings before it began.
She has worked with people who have suffered major trauma for much of her career and knew there was an unmet need for major trauma rehabilitation. But was it right that some should be given intensive support in ultra-modern facilities while others went without?
‘I did a lot of soul-searching, and discussions with colleagues and people I look up to, for reassurance that doing this was the right thing.
‘I thought why don’t we do this for everybody?’
She describes a young patient who had undergone significant life changing injuries following a traffic accident. In hospital, he occupied a bed next to someone caught up in the arena attack whose injuries were less severe.
Justine says ‘it didn’t sit well with me that one patient would have intensive support while the other would not.
‘How can you differentiate? I found that quite uncomfortable.’
But through reflection and following those conversations with colleagues she was able to rationalise it.
‘The way I reassured myself was that this was for the greater good. If we could get evidence and data that this kind of rehabilitation is what’s required for these major trauma patients – and the bomb survivors were the ones that gave us that – then we had to do it.’
She adds: ‘Never again would we have an opportunity where we were given a significant sum of money to treat 26 patients in a phenomenal facility. So my attitude was that this will provide us with a legacy to evidence to NHS England and our other stakeholders that this is worth doing and will benefit all major trauma patients in the future.’
Justine had also questioned whether the MIHP rehab package would be delivered too late after the bombing – a year on – to bring benefit. But the recovery gained was significant, she says.
We noticed that in the first three months, patients’ gait, speed and general walking efficiency and quality improved, and their satisfaction with their lifestyle also improved.
Importantly, there were changes to their mental health too.
‘Many of the group reported it just made them feel much better. It made them feel valued, they weren’t forgotten.’
Armed with the evidence that advanced rehabilitation is invaluable even a year after patients have experienced severe trauma, a business case is being compiled to build on work undertaken so far.
Beside the benefits to patients’ physical and mental health, the wider economic advantages offer a clear rationale for intensive rehab of this kind, Justine says.
She points to the comparative youth of those who experience major trauma, which means they would normally still be working. Therefore improving their fitness and function benefits the economy.
It also means that if the risk of – for example – cardiovascular disease, diabetes and long-term conditions can be diminished, patients are less likely to draw heavily on the resources of the NHS.
Building a business case
There’s work to do before the business case can be completed. A second phase of the study, involving a comparator group of patients not caught up in the bombing is planned. But Justine believes the evidence in support of advanced rehab is compelling.
Meanwhile, Martin has resumed his career as an agent for professional footballers, a business he launched shortly before the bombing after many years in private banking. His daughter Eve defied the expectations of doctors and despite a catastrophic brain injury is now walking with a frame and back at school. She continues to have physio three times a week.
For Justine, she was determined that something positive would come out of the atrocity committed that night back in May 2017. Improved outcomes for major trauma patients could be that legacy.
‘It was a really humbling experience to be able to steer and drive this,’ she says. ‘It’s definitely been one of the pivotal periods of my career.’
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