NHS Reset: Pulling together to meet demand – tackling the rehabilitation challenge | Lauren Walker

Lauren Walker smiling

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Lauren Walker, professional adviser at the Royal College of Occupational Therapists, calls for a radical restructure of community rehabilitation services to meet the upcoming surge in demand caused by COVID-19, and hopes that the collaborative, integrated approach to the pandemic response can continue across the rehabilitation workforce.  

Much has been written about the extraordinary efforts of the health and social care workforce in adapting their working methods to respond to the COVID-19 pandemic.  The resourcefulness and resilience demonstrated under extreme pressure and uncertainty cannot be overstated.  

As NHS trusts rushed to create capacity in hospital wards and intensive care units, the Royal College of Occupational Therapists (RCOT) heard from members being redeployed from mental health, learning disability, rehabilitation and paediatric services into the unfamiliar territory of critical care, step-down wards and acute discharge teams. 

While some found this leap into the unknown daunting, many reported great support and collaboration within multi-disciplinary teams, with an increased appreciation for each profession’s unique skillset.  

Historically, occupational therapy has not had a strong presence within intensive and enhanced care. But, as a result of the pandemic, the value of an occupation-focused, rehabilitative approach within these settings has become more widely recognised.  Consequently, a number of trusts have created or increased permanent posts for occupational therapists in ICU, which is very welcome.

The redeployment of the workforce is just one of many ways that health and care services have adjusted due to COVID-19.  Some acute and community-based services have ceased operating entirely, and others have drastically cut back on the numbers of people they support and the format in which services are delivered.  While these adjustments have been necessary, some have come at a significant cost to the health and care system, not least community-based services supporting rehabilitation and recovery.  This cost is likely to be felt by the workforce and the public for a long time to come.

The right to rehabilitation

The chief allied health professions officers (CAHPOs) for all four UK nations recently published a statement outlining the increased demand for rehabilitation expected from the COVID-19 crisis, primarily arising from four groups: 

  1. People recovering from COVID-19.
  2. People whose planned or ongoing care has been paused during lockdown.
  3. People who have avoided accessing health services during the pandemic.
  4. People experiencing physical and mental health effects due to shielding and social distancing.

The challenge of meeting this increased demand should not be underestimated, as access to high quality rehabilitation was extremely inconsistent even before the pandemic.

Since 2019, RCOT has worked alongside other professional bodies and partner organisations to champion the ‘right to rehab’ for all, based on person-centred need rather than condition or location.  A public survey in February 2020 showed that alarming numbers of people were unable to access community rehabilitation services, and that women, BAME groups and economically deprived individuals were least likely to receive support.

If the health and care system was unable to provide equitable community-based rehabilitation before the pandemic, how can we hope to meet the tidal wave of demand that is anticipated in the coming months?  The simple answer would be that we require more rehabilitation staff and services, but while this is certainly true, doing ‘more of the same’ is not the most effective option.

Thinking differently about integration and collaboration

The initial response to COVID-19 demonstrated how effectively the system can work when barriers between professions and organisations are removed, and when staff are empowered to identify innovative solutions to achieve common goals.  Occupational therapists working in NHS, local authorities and the third sector have all noted how productive this integrated approach has been  and have expressed hope that this will continue once the crisis has passed.  

Integration of NHS and social care services is already a reality in some parts of the country, but true integration extends beyond the statutory sector and must include everyone involved in supporting the health and wellbeing of citizens: charities, voluntary and community groups, formal and informal carers, leisure and exercise professionals, and blue-light services.  Over the last four months the value of these groups has been more evident than ever, and they will be vital members of the rehabilitation workforce as we progress our national recovery from the pandemic.  

Currently, the majority of rehabilitation resource focuses on those with the most complex or specialist needs.  While it is right that these people must continue to be supported, we must take a whole population approach and consider how the entire rehabilitation workforce can be utilised to deliver targeted and universal initiatives that benefit the largest number of people, provide choice, and empower individuals to manage their own recovery in the manner that is most effective for them.   

As detailed in the CAHPO statement, allied health professionals are ideally suited to lead a move to a population-wide, whole-systems approach to rehabilitation.  We must radically rethink how we structure and commission community rehabilitation services, to ensure that all citizens have equitable access to effective support, delivered by the most appropriate person, in the right place and at the right time.   

Lauren Walker is a professional adviser at the Royal College of Occupational Therapists. Follow the organisation on Twitter @theRCOT  or follow Lauren on Twitter @LaurenWalkerOT        

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