Sara Hazzard, Assistant Director of Strategic Communications at the Chartered Society of Physiotherapy, continues our guest blog series responding to our 'You Only Had To Ask' report on what people with multiple conditions say about health equity.
A recent report from The Taskforce on Multiple Conditions, You Only Had To Ask, paints a disturbing picture of those struggling to make sense of a healthcare system in desperate need of a redesign.
From Nathan’s palpable frustration over being seen by condition not as a whole person, to Roger’s struggles as he is prescribed an exercise class for his heart, and a different set of exercises for his osteoarthritis – by two different healthcare professionals – it begs the question what would a healthcare system that was truly joined up with the person at its centre, not siloed by conditions, really look like?
The Community Rehabilitation Alliance (CRA) has one part of the answer - for rehab - and it is one that is already gaining the attention of different teams across NHS England.
Integrated Rehab Model
The Integrated Rehab Model was developed by the Chartered Society of Physiotherapy with its CRA partners. The idea is simple – a patient with rehab needs is seen by one team, who undertake a holistic assessment of their needs. And then, based on what is important to that person, the team agrees a programme to address their needs. Gone are the travel barriers as each team is based locally, in the community, with digital options providing even greater choice. Nor is there a ‘cliff edge’, as when individuals feel they need more support or treatment, they can return for a fresh assessment.
The model will see the creation of a new role – an Advanced Clinical Practitioner – with the skills and the space to lead high-quality assessment for every patient as a first step. They will lead a multi-disciplinary team that can deliver the full range of interventions, with a strong focus on building self-management skills to enable personal empowerment and confidence so that people can live well, on their own terms.
The team has all the skills to do so, as it includes Allied Health Professionals, rehab support workers, exercise professionals and experts with lived experience, who are all overseen by the multidisciplinary team. The idea of all professionals involved in each stage of the patient’s journey being part of one interlinked team means rehab can be personalised. For some patients, a group class may work, or a one-to-one could be better – both can be combined with digital programmes and refresher support.
The team also checks diagnoses and establishes baseline measures before the individual starts their tailored rehab programme, which includes physical activity, psychological support, lifestyle education and an opportunity for behaviour change. It provides ongoing support for patients until they are as well as they can be, checking diagnoses and ordering further tests or an onward referral if necessary.
Physical and mental health can be treated as a whole, with this team providing wellbeing coaching, motivational interviewing, digital health expertise, community education and volunteer support. Strong links to social prescribing will give the patient access to local resources that cater for more than just the physical.
This model will make rehab truly preventative, anticipating what people’s rehab needs will be once they are diagnosed and will offer treatment early. Similarly, it will make sure that once discharged a patient is rapidly moved into a full assessment of their rehab needs and provided with the right treatment for them. And this will combat the cycle of endless admissions where a patient has helpful treatment for a fixed set of sessions, then nothing, triggering a relapse. Patients can re-enter the rehab programme any time they need more treatment or support. And this is far preferable to landing in the revolving door of A&E or anywhere else in the system that isn’t set up to provide the care and help that is specific and sustainable.
So, how does it help, Nathan, Roger and other patients with multiple long-term conditions experiencing health inequities?
Being easy and accessible is a crucial part of how healthcare can combat the kind of barriers outlined in the report. The model will make use of neighbourhood spaces – leisure or community centres – wrapping care around the individual even if all they need is an assessment, some lifestyle advice and recommendations for a walking group they could join.
People won’t continue to ping-pong around primary care seeing different professionals at different times resulting in a bewildering jigsaw of advice. GPs will know there is a local service that can cater for all of a patient’s rehab needs, and refer them. Even better, the patient will not see their health deteriorate as waiting lists spiral, but can get help early to get them back on track.
Patients such as Nathan will not be treated for ‘the new condition’ at a single point in time and then put back in a waiting-list queue, but will have an unbroken pathway across health and social care services.
Roger will not flounder when his structured programme of rehab ends, nor will he be confused by several sets of unrelated exercises. Instead he will have one rehab programme, designed in a manageable way with those delivering classes acting as part of the wider rehab team ensuring his exercise is right for him from the start.
When patients describe their experience of multiple long-term conditions, it is often not in condition-specific terms. As Susan put it in The Taskforce on Multiple Conditions’ earlier report Just One Thing After Another, ‘It’s all just one big chunk of pain.’ It’s time healthcare services were designed in the same way they are experienced – by person, not by condition.
Sara is Assistant Director of Strategic Communications at the Chartered Society of Physiotherapy and Co-Chair of the Community Rehabilitation Alliance, a network of 50 charities and professional bodies campaigning for better access to high-quality rehab. Tweets @SHazzard