“Going into the community [without] the required support is really quite frightening”

“To solve the problem of the front door at hospitals, A&E and ambulance services, you really need to be looking at your investment in the community – keeping people well and in their own home.”

The words of Ruth ten Hove, assistant director of the Chartered Society of Physiotherapy, speaking about the new set of best practice standards issued by the Community Rehabilitation Alliance centred on improving community rehabilitation.

The Community Rehabilitation Alliance (CRA) was set up by The Chartered Society of Physiotherapy (CSP) and it has developed a set of seven recommendations aimed at patients and their families, clinicians and managers along with commissioners and policy makers.

The Alliance consists of more than fifty charities and professional bodies and the standards are funded by The Chartered Society of Physiotherapy Charitable Trust.

It aims to improve patient experience by delivering high-quality rehabilitation through community services and reduce local and national disparities in services.

Ruth ten Hove

Ruth ten Hove said: “I think things are moving in the right direction, however, there are wide variations in community rehabilitation – we know there are some pockets of good practice but actually we also know that this is very much an under-resourced area of NHS care.

“The standards are recognition that best practice in community rehabilitation requires a team approach.

“Physiotherapists are a key member of that team along with occupational therapists, speech and language therapists, dietitians, psychologists, nurses, rehab doctors – everybody needs to be involved as part of that multi-disciplinary team in terms of best care for the population.

“The standards are also about how you should make care person-centred – it is a really key area of policy development.

“If you have an older person, or someone with a long-term condition who needs to go into hospital, wouldn’t it be ideal if their community team were able to go into hospital with them in terms of managing their care or working closely with the team in hospital and then bring them out and to provide that continuity.

“We need to remove the barrier that ‘you work in a hospital’ and ‘you work in the community’ – there is a massive gap from when you leave hospital and go into the community.”

Regarding a person being ready to leave hospital, Ruth recognises the challenges.

She says: “I can understand from the hospital’s perspective and the family’s perspective that the thought of a person going into the community where there may not be the required support is really quite frightening.

“There is a balance about really trying to bring the community into the hospital space and that is why the development of an integrated care system should give impetus for a more co-ordinated and streamlined pathway.”

The CRA includes charities and organisations such as British Heart Foundation, Stroke Association, British Association of Social Workers, Macmillan Cancer Support, College of Paramedics, The Disabilities Trust, UK Kidney Association, The College of Podiatry and Sue Ryder. 

The need for the standards was identified as an ageing population living with complex needs means traditional models of rehabilitation may not fulfil a person’s needs. 

Ruth adds: “What has also been invaluable in developing these standards is that they have included social care, so this is rehab in health and social care recognising that a lot of the population who need rehab are in social care.

“This is helping carers understand the values of working in a rehabilitative way so they can be working more optimally to help that person’s rehab and recovery.

“If you can continue to look after someone in their home as soon as they are able to leave hospital to really recover and rehabilitate in their own houses, these things are better for people as well as better for the system.”

In order to deliver the recommendations, the CRA believes each care system should appoint a person with responsibility for rehab within that system and review existing rehab services in the community.

It says: “Rehabilitation makes people’s lives better. Many of those who would benefit from rehabilitation, however, face barriers to accessing services. A panel of experts from across the UK developed these standards, to help change that.

“Without access to high-quality, community-based rehabilitation people will continue to use the most expensive parts of the health and social care system, such as A&E services.”

The set of recommendations are:

• Referral processes are explicit, easy, efficient and equitable.
• Rehabilitation interventions are timely, co-ordinated and prevent avoidable disability.
• Rehabilitation interventions meet patients’ needs and are delivered in appropriate formats.
• Rehabilitation pathways should meet needs and be delivered locally with access to specialist services.
• Rehabilitation programmes should enable optimisation, self-management and review.
• Rehabilitation services are well led, adequately resourced and linked to other services.
• Rehabilitation services involve families.

A full version of the best practice standards can be found here.