Year published: 2019
This briefing highlights the commitments in the Long Term Plan for older people.
Key messages from the CSP and Agile on local implementation
- Multi-professional community teams should include physiotherapists and therapy support workers, and have a strong focus on reablement and rehabilitation to optimise older people’s independence
- Staff in community teams and hubs should be deployed to work across acute, primary and community interfaces to enable continuity of care to be realised for patients, whether they are in hospital or at home. Similarly, services and care pathways should be designed to allow acute based physiotherapists to look beyond the hospital admission and spend time working with patients, their carers and other health and care professionals in the community
- Physiotherapy and therapy support worker roles should be extended across community and primary care
- Services should be designed to optimise the physiotherapy profession’s role in comprehensive geriatric assessment, personalised care and support planning, and advance care planning
- Physiotherapists specialising in the care and rehabilitation of older people should be placed at the beginning of and throughout patient care pathways in hospital and in the community
- Services should be redesigned to ensure people with complex and/or multiple long-term conditions and fluctuating rehabilitation needs are able to access the services they need quickly and easily to prevent crises
- Localmulti-professional community teams will be aligned to new primary care networks and should be considered part of the wider health system which incorporates health, public health, social care and the voluntary sector. Forming new ‘Integrated Care Systems’, these health and care services need to work together to plan and deliver services which meet the needs of their local communities. This may require the redesign of existing rehabilitation care pathways.