There are strong economic, ethical and ‘quality of life’ reasons to improve access to rehab services, and it's time to make the UK health and care systems more rehabilitative as a whole.
To bring about the necessary changes and investment in community rehabilitation, we need to work with all those with a shared agenda in making this happen.
This is why the CSP initiated a Community Rehabilitation Alliance (CRA) – an alliance of approximately 50 charities and professional bodies who are all committed to improving commissioning, planning and delivery of rehabilitation. The priorities are:
- to gain political commitment to delivering universal access to rehabilitation to meet needs
- to improve the quality of rehabilitation through new models, better data collection, planning, commissioning and delivery of services
The rehabilitation issue
There is a strong and growing demand for quality rehabilitation. This is caused by improved mortality rates for many acute conditions and more people living longer with one or more long-term conditions. The demand for rehabilitation services is not currently being fully met, and this has got worse since the pandemic.
While there are excellent examples of rehabilitation services, they are not consistently available. Services are often not joined up between acute, residential and home settings, so people can easily be lost in the system.
Where people can access services, they often have to wait too long, making rehabilitation more difficult or less effective.
There is also poor awareness of the benefits of rehabilitation among the public, healthcare professionals and commissioners.
The rehabilitation imperative
Rehabilitation enables people to regain life skills, return to work, maintain mobility and manage symptoms. It can slow disease progression and optimise the effectiveness of treatments. It is also critical to prevention. It can reduce fragility fractures, the risk of falls and the development of long-term conditions. All of which helps to prevent readmission to acute services, reduces social care needs and helps to prevent disability, with its impact on people’s mental and physical health.
The imperatives for improved rehab services can be classified as:
- Quality of life – as a society we have made significant medical advances in life-preserving treatments. We now need to place as much focus on quality of life.
- Economic – quality rehabilitation reduces demand on the most costly and intensive parts of health and social care systems, and supports people and their carers to participate economically in society. Quality rehabilitation requires investment and solutions that are creative, responsive and evidence-based to make the health and social care system more sustainable.
- Ethical – people have a right to rehabilitation so that they can participate in their local communities. The failure of current health and social care systems in the UK to meet rehabilitation needs drives the cycle of disability, poverty and health inequality. This cycle needs to be broken.
Time to act
The World Health Organisation has identified rehabilitation as a priority for integrated healthcare systems. It must be recognised as a central tenet of healthcare alongside prevention, health promotion, medical treatment and palliative care.
The current focus of all UK governments is to integrate care across different parts of the system, and to shift focus into primary and community services. It is time to take this opportunity and make UK health and care systems more rehabilitative as a whole.
Covid-19 has shone a spotlight on rehabilitation. This has the potential to be a catalyst for lasting change.
In the run-up to the Westminster elections in December 2019, the CRA asked candidates to support a right to rehabilitation being included in the NHS constitution and the NHS mandate in England.
After the elections in February 2020, we launched 'Live Well for Longer' – a report produced with alliance partners about the importance of community rehabilitation to people’s lives – and co-hosted a parliamentary event in Westminster with Sue Ryder and the Royal College of Occupational Therapists.
Following the start of the pandemic, the alliance has participated in NHSE’s Ageing Well programme and the Long Covid taskforce, ensuring that rehabilitation is a key consideration for both initiatives. To meet these and other rehab needs, over the past year, the CRA has called for decision makers in England to appoint a national lead on rehabilitation, to develop a national rehabilitation strategy and to prioritise investment in community rehabilitation.
Alliances are also active on this issue in Scotland and Wales, and alliance activity is developing in Northern Ireland. As a result, the SNP, Scottish Labour and Scottish Lib Dems all included a commitment to delivering on the right to rehabilitation in Scotland in their manifestos ahead of the May 2021 elections. In Wales, rehab has been recognised as an essential service in NHS recovery plans, and the campaign secured a Senedd Covid rehab inquiry. In Northern Ireland, engagement with the CRA and all the main political parties is ongoing, focused on party manifestos ahead of Assembly elections in 2022.
The Community Rehabilitation Alliance
The CRA members include:
- Adult Cerebral Palsy Hub
- Age UK
- Alzheimer's Society
- Arthritis and Musculoskeletal Alliance
- The Asthma UK and British Lung Foundation Partnership
- The Black Stork Charity
- British Association for Cardiovascular Prevention and Rehabilitation
- The British Association of Sport Rehabilitators
- British Geriatrics Society
- British Heart Foundation
- British and Irish Orthoptic Society
- The British Psychological Society
- British Society of Rehabilitation Medicine
- The British Dietetic Association
- British Association of Social Workers
- Centre for Ageing Better
- Royal College of Podiatry
- Community Therapists Network
- The Chartered Society of Physiotherapy
- Headway – the Brain Injury Association
- ICU Steps
- Independent Neuorehabilitation Providers Alliance
- Later Life Training
- Leonard Cheshire
- Macmillan Cancer Support
- Meningitis Research Foundation
- MS Society
- Muscular Dystrophy UK
- The National Care Forum
- The Neurological Alliance
- National Voices
- Nuffield Health
- Parkinson’s UK
- Primary Care and Community Neurology Society
- The Queen’s Nursing Institute
- Rehabilitation Workers Professional Network
- Royal College of Occupational Therapists
- Royal College of Physicians
- Royal College of Speech and Language Therapists
- Royal Osteoporosis Society
- Royal National Institute of Blind People (RNIB)
- The Society for Research in Rehabilitation
- Spinal Injuries Association
- Sue Ryder
- Stroke Association
- Thomas Pocklington Trust
- UK Active
- The United Kingdom Brain Injury Forum
- Versus Arthritis