CALUM HIGGINS
COLUMNIST
THE Covid-19 crisis will change the way we think about rehabilitation services.
Here we look at how two professions involved in rehab, physiotherapists and occupational therapists, are changing the way they work to meet the immediate need, and what can be taken forward from this crisis into the development of the Right to Rehab Campaign, which is about creating an expectation that patients receive rehab services as a norm. Accessible community rehab reduces repeat hospital admissions while improving patient outcomes.
During the Covid-19 crisis, these rehabilitation services have obviously not been given “air time” as the NHS concentrates on meeting the needs of the very ill patients who need immediate care. From a physiotherapy point of view, respiratory physiotherapists are getting patients off ventilators and beginning their rehab journey.
Rehab begins in ITU, from respiratory issues to mobilising elderly patients who have been in a bed for considerable time.
The next challenge will be to ensure that the rehab work continues when patients leave hospital, so they aren’t readmitted.
That’s exactly what community resource teams in south Wales are doing, where physiotherapists are embedded in multi-disciplinary teams to facilitate early discharge and avoid readmissions.
From an occupation therapy point of view, the general state of play is that a large amount of existing community rehab work has stopped, so that occupational therapists can be redeployed to support hospital discharge and admission avoidance.
Where services are continuing, ‘visits’ are being conducted remotely where possible, using phone and video calls.
Occupational therapists in mental health services in north Wales are keeping in contact with patients by using regular telephone or video link conversations.
They are giving out information on self-help websites, 24-hour helplines and provide talking therapies over the phone.
This has helped with the prevention of conditions worsening and less use of emergency services and admission to mental health units.
Several occupational therapists have been drafted into GP practices in Conwy to support mental health issues for patients and staff.
Covid has also prompted an increase in the use of video by physiotherapists, with private practitioners and the NHS turning to video conferencing as a way of delivering service to clients.
In social care, occupational therapists in south Wales are working on written plans and redrafting illustrations to leave in clients’ homes to support both formal, informal and inexperienced people who are likely to be rallied to deliver care.
The next challenge for the NHS will be to meet the rehab needs of Covid-19 patients. These are emerging and are currently anecdotal rather than evidence-based. Some of the common emerging themes are: Breathlessness; Extreme weakness and fatigue; Neurological symptoms such as poor concentration and agitation; and
Anxiety and loss of confidence/ trust in own body’
The full extent of the rehabilitation needs of people recovering from Covid-19 are not yet known, however the NHS Discharge to Assess Model predicts that:
50% of people will not require health or social care input postdischarge;
45% of people will be able to be discharged home with support from health and social care;
4% of people will require rehabilitation in a bedded setting; and
1% of people will have experienced a life-changing event and will be unable to be discharged home from the acute setting.
In short, the rehab needs are going to huge. Inevitably, the media is currently focused on the 1% of the people who will unfortunately die from the condition but not on the 49% of patients that will require rehab.
These patients should have the right to rehab, and failure to meet this could mean their quality of their lives is diminished, with an increased possibility of returning to the health system at a later point.
Our campaign also believes that rehab needs to focus on the mental health and well-being aspects of this crisis as well as the physical. People will have experienced trauma from being admitted to hospital or being a relative of a patient who might be coming back into a world where they may have lost their job or lost friends or family. Rehab offers the opportunity to become physically and mentally better after engaging with the health service.
As the Right to Rehab campaign has highlighted, community rehab provision was already patchy and inequitable, and the current situation means that an increase in the availability and quality of rehab services is more important now than it has ever been.
As well as the rehab needs of people recovering from Covid, there will also be increased needs from people with other conditions whose rehab has currently ceased, and older people who become deconditioned and socially isolated. These non-Covid patients will need rehab as much as anyone.
When the initial Covid response is over, the right to rehab will be the key to achieving a healthier Wales.