Tackling rehabilitation provision must be a priority for ICBs
By Natasha Owusu, Policy Lead (England) and Rachel Newton, Head of Policy at the Chartered Society of Physiotherapy (CSP).
Rehabilitation, long-term conditions and health inequity
It is not fair that a person’s ethnicity, socioeconomic situation, sex, age, religion, sexuality and disability can determine the level of access they have to rehabilitation services which can lead to worse health outcomes.
People in deprived communities and groups marginalised by discrimination live shorter lives and spend a greater proportion of their lives affected by long-term conditions and disabilities. The evidence of treatment outcomes for people with frailty, musculoskeletal, cardiovascular, respiratory, and neurological conditions, cancer, spinal injury, brain injury, and many more conditions, shows irrefutably that rehabilitation is as essential as medicines and surgery.
But rehab services are either unavailable, have long waiting times, or are poorly equipped to meet the needs of their communities, having been desperately under-resourced and under-staffed for decades. The impact of this is felt by those communities most in need, entrenching health inequity. Whether or not an individual accesses rehab affects not only their health but also their life chances, earning potential, likelihood of being in work, how active they are in their community, how likely they are to become socially isolated, and how happy they are.
Without rehab, people can be stuck in a downward spiral of worsening health, loss of mobility and poor mental health and multiple medication regimes. Ensuring everyone who needs rehab can access it can reverse this downward spiral, so that people cannot only survive but live healthy and active lives.
For decades rehabilitation services have been fragmented and developed in a piecemeal way. This has created a confusing system, which is hard for service users to navigate, or to know what to ask for or expect. GPs and hospital doctors are often unfamiliar with what rehabilitation is, what it can achieve, and the evidence supporting this. This means referral rates are low and when they do refer there is often poor communication with patients about what rehabilitation is and why it is an essential part of their treatment.
Rehabilitation is siloed, located in hospital department out-patients when it doesn’t need to be and there is inconsistency in what a ‘good’ level of provision and quality looks like. People who are marginalised, and those experiencing higher levels of deprivation, are more likely to be diagnosed with one or multiple long-term conditions, and this will be earlier on in their lives, with more severe conditions.
The same parts of the population with the greatest need for rehab also face the biggest barriers to access it. The sad fact set out in the CSPs 2022 report, Easing the pain: Rehabilitation, recovery, reducing health inequity, is that patients from deprived communities and marginalised groups are failed at every stage of the rehabilitation pathway.
This much we know. But there is so much we don’t know because data collection on rehabilitation needs, and provision is poor. Legally, all NHS and social care services must collect data about patients’ protected characteristics but there is a huge variation in how consistently and accurately this is done. This inconsistency is part of a wider issue of a dearth of data in community rehabilitation services.
The CSP’s Making Community Rehabilitation Data Count report, highlights the need for centralised data collection to best meet the needs of populations and to track the development of integrated rehab services.
The drive for improvement and innovation that has produced medical breakthroughs now needs to be applied to recovery and rehabilitation.
The role of integrated care systems
Rehabilitation sits at the intersections of health and social care sectors, taking place in social care, community, intermediate and acute NHS settings, and provided by multiple sectors.
The modernisation of rehabilitation can only be done by working across the whole system, rather than sector-by-sector or condition-by-condition. Through this approach, rehabilitation should be seen as a litmus test for integrated care systems.
There are many pockets of excellent rehab services for people with any long-term condition, that have designed their service to be accessible to all their communities, and take a holistic, integrated approach.
Scaling up this approach requires strategic leadership, adoption of consistent standards, the workforce to deliver and data.
The CSP has joined forces with more than 50 other professional bodies and national charities in the Community Rehabilitation Alliance (CRA) to recommend the following for ICBs:
- Appoint Single Accountable Leads for Rehabilitation operating at a strategic level to deliver expansion, integration and redesign of services and be accountable for key performance metrics.
- Adopt the Community Rehabilitation Best Practice Standards co-developed by the Chartered Society of Physiotherapy with our partners.
- Expand and develop the rehabilitation workforce. This includes making use of the growth in registered physio numbers, but also the non-registered workforce, exercise professionals and other AHPs, nurses and doctors involved in rehabilitation.
- Develop ICB data plans to show who is and isn’t accessing rehabilitation services, the consequences of this, the level of provision against population need, and performance on improvements.
CSP Member and Chair of the Birmingham and Solihull ICS AHP Council, Seema Gudivada, will be talking more about this approach at the panel discussion, Effectively addressing health inequalities in West Midlands (at the Birmingham ICS Delivery Forum on 18 April). Seema hopes delegates will be inspired after the event to action these recommendations to make equitable access a reality and improve outcomes for all patients across the West Midlands.
For further information or advice, please visit the CSP stand at the Birmingham ICS Delivery Forum on 18 April 2023 or email firstname.lastname@example.org.