TRANSPORT AND ROAD RESEARCH LABORATORY Department of Transport R R L

Contractor Report 212

The cost of long-term disability resulting from road traffic accidents: Interim report

by R J Tunbridge (TRRL) and P A Murray, A M Kinsella and C S B Galasko (University of Manchester)

The work reported herein was carded out under a contract placed on University of Manchester by the Transport and Road Research Laboratory. The research, customer for this work is Road Safety Division,

DTp.

This report, like others in the series, is reproduced with the authors' own text and illustrations. No attempt has been made to prepare a standardised format or style of presentation.

Copyright Controller of HMSO 1990. The views expressed in this Report are not necessarily those of the Department of Transport. Extracts from the text may be reproduced, except for commercial purposes, provided the source is acknowledged.

Road. User Safety Division. Road User Group Transport and Road Research Laboratory Old Wokingham Road Crowthorne, Berkshire RG1 1 6AU

1990

ISSN 0266-7045

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CONTENTS

Introduction

Methodology

Population characteristics 3.1 Injury by road user type 3.2 Injury by age 3.3 Disability rate at 6 months and 12 months 3.4 Time off work

Costs 4.1

4.2 4.3

Health Service costs 4.1.1 Accident and Emergency costs 4.1.2 In-patient costs 4.1.3 Out-patient costs 4.1.4 Physiotherapy costs 4.1.5 Cost of mechanical aids 4.1.6 Cost of ambulance trips 4.1.7 Summary of Health Service costs Social Security costs Personal costs

Discussion 5.1 Population characteristics 5.2 Health Service costs 5.3 Social Security costs 5.4 Personal costs

Summary and Conclusions

Acknowledgement

References

Appendix Services included in Health Service Costs

Page

I

2 2 3 4 5

5 6 6 6 9 9

ii 13 13 15 17

18 18 19 20 21

22

23

24

25

Ownership of the Transport Research Laboratory was transferred from the Department of Transport to a subsidiary of the Transport Research Foundation on I st April 1996.

This report has been reproduced by permission of the Controller of HMSO. Extracts from the text may be reproduced. except for commercial purposes, provided the source is acknowledged.

THE COST OF LONG TERM DISABILITY RESULTING FROM

ROAD TRAFFIC ACCIDENTS

Interim Report

i. INTRODUCTION

During the period 1982-85 the Department of Orthopaedic Surgery at the

University of Manchester, under contract to the TRRL, carried out a study into

the long-term after effects (disability at 6 months) on people who had been

injured as the result of a Road Traffic Accident, (Galasko et al 1986). The

injuries identified as having the greatest long-term effects were fractures

of the upper or lower limbs and 'whiplash' i.e. soft tissue cervical spine

injury; these two injuries alone constituted 40 per cent of all injuries

resulting in long term disability.

Patients with these injuries were considered to be a readily identifiable

group worthy of further study and as a result of these findings the Department

of Transport (TRRL) commissioned a follow-up study. This sought to identify

the resources required to treat these injuries and to calculate the costs

associated with the long term effects, which are not at present fully

incorporated in national road accident costings. A principal objective of the

current study was to remedy this anomaly by calculating the costs not only to

individuals but to the community as a whole.

This interim report looks at the financial cost of both groups of injuries

during the first year after an accident (which occurred between July 1987 and

July 1988), by which time each patient had been followed up for one year and

had been interviewed and assessed on three occasions.

2. METHODOLOGY

The study commenced in June 1987 and was planned initially to last for a

period of three years, recruiting patients who attended the Accident and

Emergency Departments of three hospitals in the Greater Manchester area as the

result of a road traffic accident.

The hospitals involved were Hope Hospital, Salford; North Manchester General

Hospital; and Stockport Infirmary.

Because of the in-depth nature of the study it was possible to assess only

about one quarter of all patients who attended with the relevant injuries: for

whiplash patients 333 of 1334 were assessed (25.0 per cent) and for fracture

patients 82 of 395 (20.7 per cent). Patients were however randomly chosen for

inclusion in the study. For each patient, information on age, sex, date of

accident, injuries sustained and length of hospital stay was obtained from

hospital records.

All patients recruited to the study were to be interviewed initially at the

time of the accident, or as soon after as possible, and thereafter at six

monthly intervals until the end of the study or when they declared themselves

to have returned to pre-accident fitness. The interview questionnaire sought

to obtain information on the use of hospital facilities, general practitioner

attending and any change in work routine or time off work, or other

activities. It also sought information on compensation claims, changes in

income and any Social Security benefits being claimed. Finally, change in

lifestyle and activities of daily living were assessed.

The costs of appropriate outpatient facilities and other health department

resources used by these patients were obtained directly from the Department

of Health via the respective District Finance Departments. Information on

social security benefit rates were obtained from the Department of Social

Security. The majority of other cost information was obtained directly from

patients. All costs given refer to 1988.

3. POPULATION CHARACTERISTICS

3.1 Injury by road user type

The incidence of "whiplash" injury, fractures and the combination of both

injuries together is given for each type of road user in Table I.

2

TABLE I: Road User

Car Driver Car Passenger (Front> .... (Rear) Motorcycle Driver Motorcycle Passenger Pedestrian Pedal Cyclist H.G.V. Driver

" Passenger (Front) " " (Rear) P.S.V. Driver

" Passenger Other, E.g. Black Cab

TOTAL

'Whiplash'

210 70 26 2

2 i 4

2 2 5 9

333

Fracture

15 5 4

24 2

26 5 i

82

'Whiplash' + Fracture

4 3

i

Total

229 78 30 26 2

28 7 5

2 2 5 9

423

The road user groups who sustained the majority of 'whiplash' injuries were

car drivers and passengers, though it is of note that one pedal cyclist

sustained a 'whiplash' injury and another a combination of 'whiplash' and

fracture. Motor cycledrivers and pedestrians sustained the highest number

of fractures. Seven out of the eight patients with "whiplash" and fracture

were car occupants.

3.2 Injury by age

The incidence of injury by age is given in Table 2.

3

TABLE 2: Age Groups

Age

O- 14 years 15 - 24 " 25 - 34 " 35 - 44 " 45 - 54 " 55 - 64 " 65 - 74 " 75+ "

'Whiplash' (~)

5(1.5) 98(29.4)

102(30.6) 70(21.0) 33(9.9) 22(6.6) 3(1.0)

TOTAL I 333(100)

Fracture (9)

5(6.1) 36(43.9) 10(12.2) 7(8.5) 6(7.3) 8(9.8) 7(8.5) 3(3.7)

82(100)

'Whiplash' + Fracture (9)

3(37.5) 2(25.0) i(12.5) l(12.5)

1(12.5)

8(100)

i Total (9)

10(2.4) 137(32.4 114(27.0 78(18.4) 40(9.5) 30(7.1) 11(2.6)

3(0.7)

423(100)

Two hundred (60 per cent) of the 333 'whiplash' casualties were in the 15-34

years age group. Similarly 45 out of 82 (56.1%) fracture casualties were in

this age group. The remaining patients with fractures were fairly evenly

distributed amongst the other age groups, whereas 82.5 per cent of patients

with a 'whiplash' were under 45.

3.3 Disability rate at 6 months and 12 months

By the end of one year following the accident, 44% of 'whiplash' injury and

60% of fracture injury patients were still not totally recovered (Table 3).

The highest disability rate was for patients with a combination of both

injuries, 88%. At the end of the first year nearly half the sample 48% still

had some physical and/or psychological problem. In the present context

patients were still considered to have a disability if they had not returned

to their pre-accident fitness. This was based on self assessment backed up

by a detailed questionnaire and interview with a research sister.

TABLE 3: Disability Rate at 6 and 12 Months following the accident

Injury Type

'Whiplash' Fracture 'Whiplash'+ Fracture

TOTAL

Total Number Assessed

333 82

423

Number (percentage) not Recovered at 6 Months

213 64% 68 83%

7 88%

Number (percentage) not Recovered at 12 Months

148 44% 49 60%

7 88%

288 68% 204 48%

3.4 T i m e off work

The number of working days reported lost for all three injury groups was high.

The average number of days lost for fracture injuries was 72, for "whiplash"

injuries 31, and for whiplash and fracture together 95 days. These are

average times off work to date, patients having been followed up for one year

only; some had not yet returned to work. Further follow-up will be required

to determine whether these patients will ultimately return to work or remain

permanently unemployed. The personal cost~of these lost days is quantified

in Section 4.3. In addition to personal losses these working days represent

a loss to the community in terms of reduced output. This aspect is considered

in Section 5.

4. COSTS

In the following Section the cost of disabling injuries is assessed under

three headings; the figures given are 1988 costs. These are (i) the cost to

the Department of Health (ii) the cost to the Department of Social Security

and (iii) the cost to individual patients. The first two of these categories

effectively represent the cost of these disabling injuries to the community

as a whole. In addition, days off work represent a Cost to the community in

terms of lost production and loss of tax revenue.

The cost to the Department of Health is made up of several components the

more important ones of which are examined in the following sections. Unless

otherwise stated the number of patients" given in each table relate only to

those actually receiving the relevant treatment or using the services. A

summary of all Health Service costs to those receiving treatment is then given

in Table 9 with a summary of detailed costs averaged over all patients given

in Table I0. A detailed discussion on costs follows in Section 5.

Table 4. ACCIDENT AND EMERGENCY

Whiplash Fracture Whiplash + fracture

Number of initial visits

333 82 8

423

Number review visits

(patients)

315 (152) 22 (12) 2 (1)

339 .(165)

Average Number of review

visits

2.1 1.8 2.0

2•.0

Total Number of visits

648 104 i0

762

Cost £

13,776 2,211

212

16,200

4.1 Health service costs

4.1.1 Accident and Emergency costs.

All patients in this study had made an initial visit to the Accident• and

Emergency Department (Table 4). Although 'whiplash' injury patients had more

review visits at the A&E Department than those with fractures, the average of

2.1 per cent visits per patient is comparable to the fracture group where the

average was 1.8 review visits. Fracture patients tended to the referred to

a Fracture or Orthopaedic Clinic after an initial visit to the Accident and

Emergency Department. The total number of patient visits to Accident and

Emergency was 762, at a cost of £21 per visit, giving a total cost of £16,200.

4.1.2 In-patlent COSTS.

Sixty-five of the 423 patients were admitted to an Orthopaedic Ward and spent

a total of 1,590 days in hospital at a cost of £99 per day. The average

length of stay for a Road Traffic Accident fracture injury was 28.8 days

(Table 5). This was approximately three times the average length of stay for

orthopaedic patients who sustained injuries under other circumstances.

The figures in Table 5 represent on average for all patients although, two

'whiplash' patients requiring traction spent 18 days and 28 days respectively

6

in hospital which increased the average length of stay of 'whiplash' injury.

It should be noted that while 62 per cent of fracture patients required in-

patient treatment this was true of only 4 per cent of 'whiplash' cases.

Three patients, all with fractures spent a total of 22 days in the Intensive

Care Unit at a daily cost of £195; a total of £4,290. One fracture patient

spent 24 hours (one patient day) in the Neurosurgical Unit at a cost of £181.

The in-patient stays of these patients requiring special attention are

included in Table 5 but average in patient costs of £99 per day are assumed.

If the additional costs of Intensive Care and use of the neurological unit are

added the total costs are £1800 higher.

7

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4.1.3 Outpatient clinic costs.

Table 6 gives a summary of the attendances and corresponding cost of patients

attending outpatient clinics.

The clinic most frequently attended, by all patients, was the Out-Patient

Fracture Clinic with a total of 501 visits at a cost of £28 per ~isit. Twelve

'whiplash S patients, although not having sustained a fracture, made a total

of 53 visits to a Fracture Clinic to be examined by an orthopaedic consultant.

Eighteen patients made a total of 115 visits to a variety of other Out-Patient

Clinics, either as a direct result of the injury or because of complications

arising from the injury e.g anti coagulant clinic after deep vein thrombosis.

4.1.4 Physiotherapy costs.

The attendance of patients for both NHS and private physiotherapy and the

associated costs are given in Table 7.

The Hospital Physiotherapy Service was used by 171 (40~) of all patients, with

a total of 2,279 visits at a cost of £5 per attendance. Fifty per cent of

both fracture and fracture plus "whiplash" patients required physiotherapy,

the average duration per session being somewhat higher than that of the 38~

of °whiplash s only patients who required treatment.

The average number of attendances for both groups of patients was high, being

just over I0 for "whiplash" and nearly 22 for fracture casualties. A few

patients (19) attended aprivate physiotherapist at an average cost of £15 per

session. These costs were met by the patients themselves or were covered by

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particularly for whiplash patients (nearly 19).

4.1.5 Cost of appliances (Orthoses).

By far the most frequently used appliance was a collar. Three hundred and

seven 'whiplash' only patients (92%) were issued with collars as were all

eight 'whiplash' plus fracture patients. The cost of these collars was £5.35

each giving a total cost of around £1800. The only other aid supplied in any

significant numbers was a pair of crutches, of which 39 were issued to

fracture patients (48%) at a total cost of £520. Other items supplied in

limited numbers were sticks, slings and wrist braces, all at a cost of below

£5 each. These costs include no allowance for administrative or other

overheads. There are no costs available, at present, for supplying and

fitting artificial limbs.

Additional items of equipment, supplied to fracture patients, included five

wheel chairs at £161 each and five Zimmer frames at £12; a total cost of £865.

Three patients had to move house, including one to a disabled person's house

and six fracture patients had modifications carried out in their homes. One

had a hand rail installed in the shower, one had a hand rail installed on a

landing. These changes were arranged either privately or through the Social

Services Department; the costs are not known at this time. Two 'whiplash'

patients had to change to automatic cars as they could not cope with changing

gears in a manual car.

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4.1.6 Cost of ambulance trips.

The average cost to the Ambulance Service for a five mile round trip was £5

per patient per mile, i.e £25 per trip. The total number of round trips for

all patients was 1,016 (Table 8). The greater number of these trips (890)

were for the transport of fracture patients who made an average of 12.7 trips

per patient. Five fracture patients had a much higher than average number of

trips (see Footnote.) The trips by 'whiplash' patients were usually

immediately after the accident, when they were taken to the Accident and

Emergency Department. The total overall cost for all patients was £25,400.

TABLE 8: Ambulance Trips

injury Type

'Whiplash' Fracture 'Whiplash' + Fracture

TOTAL

Number of Trips

: : 119 890

7

1,016

Number of Patients

8 5

7 0

7

162

Average Trips Per Patient

1.-4 12.7 1.0

i 6 .3

Cos t £ ' s

2,975 22,25C

175

25,40C

*Five fracture patients had a relatively high number of trips: one had 130, one 170, one 68, one 134 and one 61; These last two had to have amputations and required several trips to the rehabilitation hospital outside the catchment area. If these extra miles, outside the area, were to be taken into consideration, ambulance costs would be higher.

4.1.7 Summary of Health Service costs.

Other health services, outside the hospital, were also utilised in the

treatment of these patients. The costs incurred by general practitioners are

difficult to assess since the general practitioners service receives a fixed

annual amount per registered patient, depending on age, no matter how many

visits are made. Of four hundred and twenty three patients 409 were under 65

years of age, and three patients were in the 75+ age group. Annual costs per

patient for these age groups were £8.25 and £13.15 respectively. These costs

should clearly not be fully allocated to the injuries being considered here

but do give a measure of general GP costs. Further research is being

conducted to estimate the cost of each patient visit to a GP.

13

The District Nursing Service was used by five fracture patients, who had

visits totalling 9.5 hours at £9 per hour (£85), and one 'whiplash' patient

who had visits totalling 5 hours (£45).

A summary of all Health Service costs associated with these injuries is given

in Table 9.

TABLE 9: Health Service Overall Costs - Summary

A & E Department Intensive Care Unit Neurosurgical Unit In-Patient Department Orthopaedic Clinic Fracture Clinic Other Out Patient Clinics Physiotherapy (NHS) Ambulance District Nurse Mechanical Aids

TOTAL

Whiplash' £

13,600

9,300 1,150 1,480

310 6,640 2,975

45 1,800

37,300

Fracture 'Whiplash' + Fracture £ £ £

2,200 4,290

180 146,000

590 11,700 2,660 4,460 22,250

85 1,390

195,805

200

2,400

820 250 300 175

60

4,205

Total £

16,000 4,290

180 157,700

1,740 14,000 3,220

11,400 25,400

130 3,250

237,310

A summary of Health Service costs per patient (averaged over all patients) is

given in Table i0.

14

TABLE I0: Health Service Costs - per patient

A & E Department Intensive Care Unit Neurosurglcal Unit In-Patient Department Orthopaedic Clinic Fracture Clinic Out Patient Clinics

• Physiotherapy (NHS) Ambulance District Nurse Mechanical Aids

TOTAL

'Whiplash' £

41

28 3 4 I

20 9 i 5

112

Fracture £

27 52 2

1780 7

143 32 54

271 i

17

2388

'Whiplash' + Fracture £

25

I00

102 21 38 22

8

526 1

Total £

38 i0 I

373 4 3! 8'

27 60 I 8

561

4.2 Social Security Costs

The range of Social Security benefits available to those who are sick or

injured is very broad, the principal benefit available to those previously

employed being Statutory Sick Pay. A summary of the number of people claiming

this and other benefits is given in Table ii.

Statutory Sick Pay (SSP) can be claimed by people in employment who have paid

the required number of insurance stamps to qualify. SSP was paid in two

bands, a lower rate of £34.25 per week to applicants whose weekly salary

ranged from £40 to £79, and a higher rate of £49.20 per week to applicants

whose salary was over £79. Any sick leave after an initial three day

exemption period is calculated on the basis of a five day working week. This

has been taken into account in assessing the number of weeks of SSP paid

(Table ii).

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Additional benefits cover all benefits quoted in the footnote to Table ii as

these are very varied and cover different periods of time, they are summarised

in terms of the number of patients claiming and the total amount claimed.

4 . 3 Personal Costs

A summary of income changes as a result of injuries sustained is given in

Table 12. One hundred and fifty seven patients (37%) lost some part of their

income through time off work, loss of bonus or overtime. These were

principally patients whose salary was not made up by their company al~hough

they may have claimed SSP, or who were self employed. 'Whiplash' patients

lost an average of £940, fracture patients £1,300, and 'whiplash' plus

fracture patients an average of £680. The total loss was £158,680. Four

patients, two with whiplash and two with fractures, actually gained income

after their injuries with transfer to a higher paid job e.g shop floor to

office for lighter duties. Details are given in Table 12.

These net losses (after any SSP payments) may, to some extent, be offset

against the gains in compensation claim settlements (Table 13). Settlement

figures ranged from £200 to £4,500. The discrepancy between income loss and

compensation obtained (Table 13) is apparent but this may be reduced when all

claims are settled.

TABLE 12: Income c h a n g e s

'Whiplash' Fracture 'Whiplash' + Fracture

TOTAL

Number of Patients (% with change)

121 (36%) 33 (40%)

3 (38%)

157 (37%)

Total Income Loss

£

113,740 42,900

2,040

Average Loss

Patients with income change

940 1,300

680

£

All patients

341 523

73

375

Income Gain £

300 (2 patients) 3,800 (2 patients)

158,680 i, 010 4,100

In addition six 'Whiplash' patients lost income but the amount was unknown.

17

TABLE 13: Compensation Claim Settled

'Whiplash' Fracture 'whiplash'+ Fracture

TOTAL

Number Settled

78 4 I

83

Total Amount £ (Range)

91,277(200-4500) 9,207(257-6000)

850(850)

[01,334

Average Amount £

1,233 (74 patients * 2,302

850

*Four 'Whiplash' patients were unwilling to disclose the amount of their compensation.

5. DISCUSSION

In this section the findings of the study with respect to population and the

costs of injuries are assessed. The three components of injury cost are

discussed separately as in Section 4.

5.1 Population Characteristics

The RTA casualties with the specific injuries selected for study were made

up of approximately 80 per cent with a "whiplash" injury and 20 per cent with

fractures. Because of resource considerations it was only possible to assess

about one quarter of all patients with these injuries attending the A&E

Department over the chosen period, but the patients selected for the study

were chosen at random.

Patients with "whiplash" injuries were mainly in the 15-44 year age group.

This is characteristic of most RTA casualty populations. Patients with

fractures had a wider age distribution probably due to the much higher

proportion of pedestrians with these injuries.

The incidence of disability associated with both types of injury was

remarkably high, with nearly half of the total population having significant

problems one year after the accident. This compares with an incidence of

disability for all casualty types in the previous study of 24 per cent at six

months (Galasko et al, 1985). These results justify the selection of patients

with these injuries for further study. Provisional results of the ongoing

18

study suggest that a high incidence of disability remains at 18 months and 2

years after the accident.

These high levels of disability are not surprisingly, associated with extended

periods off work and limitations of other daily activities, ranging from an

average of one month for patients with a "whiplash" injury to over three

months for a combination of "whiplash" and "fracture"

5.2 Health Service Costs

The costs given in Section 4 were the costs supplied by the Department of

Health. These figures represent only the day to day running expenses of

providing the clinical services. The figures quoted include an average

additional administrative cost of 31 per cent to allow for the provision of

general services e.g. catering and laundry (see Appendix, for complete list

of services). The quoted costs, however, mustbe regarded as absolute minimum

values, as they make no allowance for such conventional overheads as

replacement, rebuilding, refurbishment, or indirect staffing costs; nor do

they take account of the utility cost of the buildings used. If allowance

were made for these factors overheads of the order of 100-150 per cent, could

be added, effectively doubling all the costs given here. This factor should

be borne in mind when considering the "real" cost of disabling injuries.

Further studies are being undertaken to attempt to quantify these overheads.

Whilst 62 per cent of fracture casualties were in-patients, at a cost of

nearly £3000 per casualty, this was true of only 4 per cent of whiplash cases.

On average those whiplash patients who were admitted spent one week as in-

patients in hospital whereas fracture casualties spent one month, which was

three times as long as for non RTA orthopaedic cases.

Although in-patient treatment represents the largest single contribution

towards Health Service costs a considerable amount of resources go into

providing for out-patient facilities.

The principal sources of out-patient treatment were either attendance at an

out-patlent clinic or attendance for physiotherapy. On average whiplash

patients had fewer visits to out-patient clinics than those with fractures

but made considerable use of both NHS and private physiotherapy facilities.

19

The majority of attendances for physiotherapy were made by "whiplash"

casualties, but fracture casualties required more attendances on average, per

patient receiving physiotherapy, (20.6) than whiplash casualties (9.6).

The nominal NHS cost of E5 per session for physiotherapy represents the

marginal cost of providing such a service;, a more realistic cost is likely

to be close to the £15 charged for private physiotherapy. Further

consideration of these costs is in hand.

The cost of mechanical aids represents an apparently small drain on resources

although 92 per cent of "whiplash"" patients were supplied with collars.

Again, it is questionable whether the quoted cost (just over £5) represents

the real cost to the NHS; it does not include any allowance for general

service costs or other overheads.

Many mechanical aids are not returned by patients and some costs would

probably be recovered by improving the rate of return. However, a pilot

study using a deposit system suggested that any cost savings were outweighed

by the administrative costs of operating the scheme.

In relation to the injuries considered, ambulance costs were second only to

in-patient costs as a drain on NHS resources. The average cost of £5 per

mile is probably realistic and the assumed cost per patient of £25 for

ambulance use reflects this cost. Fracture patients in particular made

considerable demand on the ambulance service averaging 13 trips per patient,

with a few patients making over i00 trips.

5.3 Social Security Costs

Social Security payments were found to represent the second largest component

(after Health Service costs) of road accident costs to the Community; they

amount to just under half of the health service costs. Those people

previously employed, who have time off work as a result of their injuries, are

entitled to statutory sick pay. This was claimed by just over half of both

fracture and whiplash casualties and represented approximately two thirds of

the total of the Social Security payments.

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The remaining one third was made up of the several additional benefits which

may be claimed by those who are disabled and not in work.

Relatively few patients (Table ii) claimed what might be generally considered

as disability allowances ie mobility allowance, attendance allowance, severe

disability allowance or invalidity allowance. As the study progresses, it

will be interesting to see how the proportion of disability benefits, in

relation to total Social Security benefits paid, changes over time since the

accident.

5.4 Personal Costs

Just over one third of patients (37%) lost some part of their income through

time off work. The total financial loss to the 157 individuals (approximately

£150,000) represents a sum roughly midway between the Social Security and

Health Service costs.

These losses of direct income were to some extent mitigated by compensation

claim payments; 276 (65%) patients made compensation claims of which 83 (28%)

had been settled by the time of writing. These compensation settlements

amounted to approximately £i00,000 which represents about two thirds of total

income losses, although this figure is likely to increase with time. Many

more whiplash claims had been settled than those for fractures, probably

bcause the former reached a stable position more quickly than fractures.

However, there was some evidence to suggest that propensity to reach a

settlement was related to income group; this is being investigated further.

In addition to the personal losses discussed above, days off work as a result

of injuries sustained in RTA's represent a loss to the community as a whole.

In an industrial situation absence from work can result in lost production and

this factor should be taken into account when assessing overall costs. As

part of this study several firms in the Manchester area are being surveyed in

an attempt to quantify such losses; findings will be reported later. In

other work situations (eg offices) loss of output will be more difficult to

quantify. There is also a cost to the exchequer in terms of lost tax from

those no longer in employment.

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6. SUMMARY AND CONCLUSIONS

This report presents the findings of the first year's follow up on a selected

group of 423 patients who had sustained either "whiplash" or closed fracture

injuries, with a view to establishing the incidence and costs of long term

disability arising from these injuries. The principal conclusions can be

summarised as follows:

i. The disability rate from both injuries was high; after one year 60 per

cent of fracture patlents and 44 per centof 'whiplash' patients had not

fully recovered from their injuries.

.

.

The average number of working days lost as a result of the injury was

high for both groups of patients, being 72 days for fracture patients

and 31 days for 'whiplash' patients.

On average, 'whiplash' casualties who were in-patients (only 4 per cent)

spent one week in hospital whereas fracture casualties (62 per cent)

spent one month, which was three tlmes as long as non RTA orthopaedic

casualties.

. The principal sources of out-patient treatment were out-patient clinics

and physiotherapy. The vast majority of fracture patients attended a

fracture clinic. Whiplash patients had relatively few visits to out-

patient clinics but made considerable use of both NHS and private

physiotherapy facilities.

. Physiotherapy attendances were frequent for both types of patients,

averaging over 20 for fracture patients and i0 for whiplash patients.

. Mechanical aids eg collars were used frequently by patients but were

relatively inexpensive. Ambulances, however, were also heavily used and

were second only to in-patient costs as a drain on NHS resources.

. The Health Service costs given in this report, although supplied by

the Department of Health, must be regarded as absolute minimum values

as they made no allowance for replacement or rebuilding costs. If

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.

.

i0.

ii.

12.

allowance were made for these overheads it is estimated that the "true

costs" would be about double the quoted costs.

Statutory sick pay was claimed (from theDepartment of Social Security)

by just under half of all patients, and represented approximately tw~ ~'~ • q •

thirds of the total of social security payments.

Only 36 patients (8..5%) have claimed disability benefits, such as

mobility allowance, but this needs to be monitored with respect to time

after the accident.

In terms of personal costs, just over one third of patients (37%) lost

some part of their income through time off work. However, these costs

were to some extent mitigated by compensation claim payments; 276 (65%)

patients actually made compensation claims, of which 83 (28%) were

settled at the time of writing.

Many more whiplash compensation claims have so far been settled than

for fractures, probably because the former tend to reach a stable

position more quickly than fractures.

In addition to personal losses, days off work as a result of injuries

sustained in RTA's represent a loss to the community in terms of lost

output and production. They also represent a cost to the exchequer in

terms of lost tax. The quantification of these factors is also being

considered in the study and will be reported later.

7. ACKNOWLEDGEMENTS

The work described in this report was carried out under contract to the Road

Safety Division (Head: Mr D A Lynam) of the Safety and Transportation

Department of TRRL. Special thanks are due to the research sisters on the

projects, Mrs Carol Jordan and Ms Hannah Chambers. We would also like to

thank the Accident and Emergency Department and Medical Records staff at Hope

Hospital, North Manchester General Hospital and Stockport Infirmary for their

invaluable co-operation in this study. We are also grateful to the staff of

the Financial Department of Salford Area Health Authority, and to Mrs Blanche

Towers, for her secretarial help.

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8. REFERENCES

DEPARTMENT OF TRANSPORT (1989).

Costs 1988.

Highway Economics Note No i, Road Accident

GALASKO et al (1986). Long term disability following road traffic accidents.

Department of Transport TRRL Report RR59. Transport and Road Research

Laboratory, Crowthorne.

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APPENDIX

Services included in Health Service Costs

A. PATIENT TREATMENT SERVICES

a. WARDS

b. OUTPATIENT CLINICS c. DAY CARE FACILITIES d. A AND E DEPARTMENTS e. RADIOTHERAPY DEPARTMENTS f. AUDIOLOGY g. CHIROPODY h. DENTAL SURGERY i. DIETETICS

j. ELECTROCARDIOGRAPHY k. ELECTROENCEPHALOGRAPHY i. INDUSTRIAL THERAPY

m. MEDICAL ILLUSTRATION AND PHOTOGRAPHY n. MEDICAL PHYSICS o. NUCLEAR MEDICINE p. OCCUPATIONAL THERAPY q. OPERATING THEATRES r. OPTICAL SERVICES s. PATHOLOGY

i. CHEMICAL PATHOLOGY ii. CYTOGENETICS iii. HAEMATOLOGY iv. HISTOPATHOLOGY v. IMMUNOLOGY iv. MICROBIOLOGY

t. PHARMACY

u. PHYSIOTHERAPY AND REMEDIAL GYMNASTICS v. PSYCHOLOGY w. RADIOLOGY x. SPEECH THERAPY

y. MISCELLANEOUS PATIENT TREATMENT

B. GENERAL SERVICES

a. GENERAL MANAGER b. CATERING c. LAUNDRY d. LINEN e. ADMINISTRATIVE OFFICE f. MEDICAL RECORDS g. TRAINING AND EDUCATION h. DOMESTIC/CLEANING i. PORTERING j. TRANSPORT k. ESTATE MANAGEMENT

i. ENGINEERING MAINTENANCE ii. BUILDING MAINTENANCE iii. ENERGY

iv. WATERAND SEWERAGE v. GROUNDS AND GARDENS vi. GENERAL ESTATE EXPENSES

I. MISCELLANEOUS SERVICES & EXPENSES m. GENERAL SERVICES DIRECT CREDITS

The direct costs of providing the relevant services from those given above are given in the report. On average the cost of providing general services (B) made up 31 per cent of total costs (A+B).

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