The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness

Abstract

The problem: Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. History: Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system. System failure: After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems. The goals: The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services. A solution: The purpose of healthcare is to ‘ improve our health and well-being . . . to stay as well as we can to the end of our lives’. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.

Neuro-Rehabilitation OnLine (N-ROL): description and evaluation of a group-based telerehabilitation programme for acquired brain injury

“…The absence of a control group precludes attributing these gains to N-ROL. However, it must be remembered that the rationale for starting N-ROL was to offer treatment/support in their own homes for recently discharged patients with ABI who would otherwise receive minimal or no treatment 5 (75% of our patients). Future direct comparison with a no-treatment control group is unlikely to be feasible, but comparisons with existing community rehabilitation programmes, both in terms of clinical outcomes (general and domain specific) and cost-effectiveness would be of interest.…”

“…[1][2][3] The arrival of COVID-19 in early 2020 influenced stroke presentations 4 but reduced opportunities for rehabilitation. 5 The necessity to avoid face-to-face contact and to reach as many patients with as few staff as possible led to a three-way collaboration between University College London, University College London Hospitals NHS Foundation Trust (UCLH) and SameYou charity to set up a comprehensive, multidisciplinary group-based Neuro-Rehabilitation OnLine (N-ROL) programme. N-ROL involved physiotherapy, occupational therapy, speech and language therapy, neuropsychology and neurology.…”

“…Our first outcome measure was the Stroke Self-Efficacy Questionnaire (SSEQ), a Likert scale (0-3) questionnaire with 13 questions with good criterion validity. 6 Our second outcome measure, Neuro-Rehabilitation OnLine Outcome Measure (N-ROLOM), a novel Likert scale [1][2][3][4][5] questionnaire with seven questions for patients and two for carers/family (online supplemental appendix). The questions were constructed from themes derived from semistructured interviews with five early participants and two carers and so had good construct validity, reflecting the context (COVID-19 pandemic) in which the N-ROL programme was being delivered.…”

Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data

“…49, 50 The pandemic provides an opportunity for palliative care services to reflect on the provision of care directed to optimising function 20 . Rehabilitation should not be limited to the therapies allied health professionals provide, it is a process requiring integrated multi-professional teams with rehabilitation expertise 51 as exemplified by holistic breathlessness services. 9…”

Scope, context and quality of telerehabilitation guidelines for physical disabilities: a scoping review

“…Ensuring that the delivery of such services is both effective and equitable is pertinent, given the identified 'tsunami' of rehabilitation need 3 4 for people with a wide range of conditions from across the lifespan (including those recovering from COVID-190). 5 It is especially important to note that the practical application of telerehabilitation will not be the same across all conditions. More complicated conditions (eg, those with comorbidity) will likely require additional support than less complicated conditions.…”