The case for specialist units

There is considerable evidence that management in a specialist unit is beneficial both for the individual patient and for the economy. A specialised unit provides a focus for a campaign for prevention, for the improvement in care in areas such as orthopaedic, bladder, bowel, skin, etc and for the promotion of interdisciplinary work, combining the needs of public health, low-cost technology, and high quality. Strategy and training is dictated by the specific problems that occur in patients with spinal injuries, particularly the multisystem impairment, which is a feature of such injuries and can only be comprehensively dealt with in a specialised unit. For developing countries, training may be either on-site or in centres abroad, or a combination of both, and rather than training on an individual basis, it is preferable for a team to be trained together. The likely cost depends on local circumstances. However, even the cost of a purpose-built centre of 44 beds serving 3000 paralysed people in the UK is only the equivalent of the lifetime costs of about 12 people with SCI.