Community Rehabilitation Alliance |Rehabilitation Workers Professional Network | British Association of Cardiovascular Across England

Our Ask: Equal access to community rehabilitation for all

What is community rehabilitation? Community rehabilitation means assessment, advice and tailored rehabilitation support that takes place in settings Not everyone gets the outside of acute hospital wards and that improves people’s health and wellbeing. Community rehabilitation helps rehabilitation they need people with long-term conditions, injuries or illness to • Just 15% of people with lung disease eligible live well for longer. for pulmonary rehabilitation are referred for it (1) Community rehabilitation can: • Only 50% of eligible people access cardiac rehabilitation after a cardiac event, this is even • Improve physical and mental lower for women, black and minority ethnic health and wellbeing groups and economically deprived patients (2) • Reduce hospital admissions • 44% of people with neurological conditions • Ensure further treatments have don’t have access to community rehabilitation for their condition(3) the best chance of success • Only 40% of the 1.3 million people living • Enhance self-management with traumatic brain injury receive neurological of long-term conditions rehabilitation(4) • Increase independent living • Most people with a cancer diagnosis are not given support before treatment to improve • Support a return to work. their fitness levels, diet and mental health.(5)

Why a ‘right to community The NHS – a service rehabilitation’ is so important that needs modernising Community rehabilitation enables people to achieve more A radical modernisation is needed to ensure of their potential and live as well as possible. It can also the quality and consistency of community save significant amounts of tax-payer money by reducing rehabilitation services, offering an approach that the need for more costly health care and social care. is tailored to meet people’s needs and priorities. Yet while medical breakthroughs now help many more Services need to be accessible and available in people survive illnesses and injuries that would have the community, with links to specialist teams as previously killed them, modernisation and investment needed. The NHS Long Term Plan in England in community rehabilitation has not kept up. This means commits to enhancing community rehabilitation. that despite community rehabilitation being every bit as This must be delivered on the ground and important as surgery or drug treatments, too many people followed through in local health and care with long-term conditions cannot access it at present. service planning decisions. | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The Neurological Alliance |Rehabilitation Workers Professional Network | British AssociationWE STAND of Cardiovascular READY Prevention and TORehabilitation WORK | Royal CollegeWITH of Occupational YOU TherapistsTO DELIVER | Royal College of Speech EFFECTIVE, and Language Therapy |Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular RehabilitationPERSON-CENTRED| Association of Chartered Physiotherapists COMMUNITY in Respiratory Care | BritishREHABILITATION Heart Foundation | British Lung Foundation SERVICES | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of CardiovascularTO ALL Prevention THOSE and Rehabilitation IN NEED | Royal College SO of Occupational THAT Therapists PEOPLE|Royal College CAN... of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | Britishonger Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The NeurologicalL Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of OccupationalLive TherapistsWell | Royal forCollege of Speech and Language Therapy|Royal COMMUNITY REHABILITATION: Transforming lives

ommunity rehabilitation helps people with When people cannot access community rehabilitation, it long- term conditions, illness, or injury to recover damages their quality of life, increases the risk of social their health, cope with chronic conditions, and isolation and poses greater costs for health budgets, social C slow the progress of degenerative disease. care budgets and the wider economy. Community rehabilitation can prepare people for treatment Too often people receive intensive rehabilitation in hospital such as chemotherapy, to ensure they get the best possible but then have long waits when they get home, if it’s available results. People supported with personalised rehabilitation at all. In a study by The Stroke Association, 45% of patients are more likely to regain their said they felt abandoned when independence, preserve their “The support, understanding and guidance they left hospital(6). While patients mental health, and achieve of staff at BASIC [rehabilitation service] has wait, their recovery is halted and their potential. assisted me immensely in rebuilding my life” can reverse – causing lasting Community rehabilitation disability, distress and is not universally available. Andrew, traumatic brain injury patient deterioration of health.

Rehabilitation is transformational

Despite living with a lung condition “Learning how to belly breathe and since childhood Annette, 67, was only managing walking to increase mobility introduced to pulmonary rehabilitation and muscle strength takes the fear out 2 years ago, in 2017. “It was the best of going out into the community and thing that I have done,” she says. “It has helped me no end. In the past I found helped me to understand my condition, it very depressing after an exacerbation how to improve it and, most importantly, as it felt like all the exercise I had been how to manage it.” doing was lost. Now I take a deep breath Annette has bronchiectasis, a lung and start again and enjoy the challenge condition that causes a persistent of getting more mobile again.” cough and excess phlegm. A permanent Annette, who lives in Norfolk, is now condition, it gets worse over time. She secretary for her local British Lung

also has chronic obstructive pulmonary Foundation support group, where 2019 disease and clinical depression. members discuss the benefits of PR. Pulmonary rehabilitation (PR) has had “We all agree that we want to see more a significant impact on her quality of life. people offered an initial programme of Similarly, community wellbeing sessions PR, but there should also be follow-up have helped Annette understand her sessions regularly available to remind depression and manage it. As she says, and support people to keep with it.” Photo: Taskforce for Lung Health for Taskforce Photo: | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The Neurological Alliance |Rehabilitation Workers Professional Network | British AssociationWE STAND of Cardiovascular READY Prevention and TORehabilitation WORK | Royal CollegeWITH of Occupational YOU TherapistsTO DELIVER | Royal College of Speech EFFECTIVE, and Language Therapy |Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular RehabilitationPERSON-CENTRED| Association of Chartered Physiotherapists COMMUNITY in Respiratory Care | BritishREHABILITATION Heart Foundation | British Lung Foundation SERVICES | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of CardiovascularTO ALL Prevention THOSE and Rehabilitation IN NEED | Royal College SO of Occupational THAT Therapists PEOPLE|Royal College CAN... of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | Britishonger Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The NeurologicalL Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of OccupationalLive TherapistsWell | Royal forCollege of Speech and Language Therapy|Royal

Patchy provision widens health inequalities What happens when Community rehabilitation provision is currently a postcode lottery, with people in many areas of support isn’t in place the country unable to access the rehabilitation they need through their local health care system. If people can pay At 46, Lizzie, a judge, mother of two and keen for private community rehabilitation, then they do so. runner, suffered a life-threatening subarachnoid But not everyone can afford to. brain-hemorrhage and stroke. Just three weeks after life-saving brain surgery, Lizzie was discharged home, paralysed and blind, and Only 40% of people from areas of high waited seven months for NHS community deprivation start cardiac rehabilitation, rehabilitation. Lizzie had to pay privately for compared to 54% from areas of low deprivation.” rehabilitation to help her learn to walk again, British Heart Foundation (3) and to treat the many other health issues caused by her stroke. This falls short of the NHS Constitution pledge to The lack of readily available, specialist provide a comprehensive health care system. As long community rehabilitation contributed to as community rehabilitation is unavailable in certain the breakdown of her marriage and enforced areas, then the system is neither comprehensive nor retirement from her job, leaving her with universal. This fuels health inequalities – contributing continued pain, depression and desperation. to the fact that levels of ongoing ill health and disability are greater in areas of deprivation.(7) “Whilst I survived a massive brain hemorrhage, there have been many “We know cardiac rehabilitation reduces the risk times since when I simply wished that of someone dying from heart and circulatory I had not lived because of the disease, having another cardiac event such as significant physical, mental, and a heart attack or needing to be readmitted to emotional pain I have endured over hospital. Rehabilitation services provide vital the last 8 years of post-stroke life.” support in addressing both physical and psychological factors to improve people’s quality Lizzie of life and help them to adjust to a new normal. But some groups, such as women, BME people and individuals from deprived areas are less likely “NHS gaps in provision can have to take up, complete and benefit from cardiac life-changing consequences, especially rehabilitation. Reimagining cardiac rehabilitation for people not in a position to pay for services, to build them around the needs of the private rehabilitation. Health person instead of institutions, will be vital to difficulties can then drive deprivation ensure that every single eligible patient is offered in other areas of life, for example if you cardiac rehabilitation to help them return to as are too ill or disabled to work, you’re high a standard of health as possible, whether likely to face a spiral of financial this is through services in the community, at problems that will further limit your home or online.” life chances. It’s a vicious cycle” British Heart Foundation The Chartered Society of Physiotherapy | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | CharteredWE SocietySTAND of Physiotherapy READY |Macmillan TO Cancer WORK Support | The WITH Neurological YOU Alliance | TORehabilitation DELIVER Workers Professional EFFECTIVE, Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK ActivePERSON-CENTRED | Vision UK | Spinal Injuries Association | VersusCOMMUNITY Arthritis | Muscular Dystrophy REHABILITATION UK | Age UK | Arthritis and Musculoskeletal SERVICES Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British SocietyTO of ALL Rehabilitation THOSE Medicine | Chartered IN NEED Society of Physiotherapy SO THAT | Macmillan PEOPLE Cancer Support CAN... |The Neurological Alliance |Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapistsonger in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society |L British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation WorkersLive Professional Well Network | Britishfor Association of Cardiovascular Prevention COMMUNITY REHABILITATION: Saving NHS money

ommunity rehabilitation can help tackle NHS any other treatment is used has been shown budget pressures. Rehabilitation reduces the need to improve outcomes, limit hospital stays and reduce for hospital admissions. If acute care is required, subsequent complications. C then community rehabilitation can reduce the level of care needed, the length of stays and thereby the costs. For people with serious mental illness, community rehabilitation often provides a better patient experience For cancer patients, a ‘prehabilitative’ approach that and improved outcomes when compared to inpatient provides physical, dietary and psychological support before care, while also reducing costs.(8)

Mr Jones, a retired bus nutritional screening driver, was diagnosed and dietary advice. with oesophageal cancer He was also made at 72. He attended a aware of the extra prehabilitation clinic psychological support directly after his available to him. diagnosis. He was Mr Jones reported that assessed as needing the prehabilitation a significant level of sessions made him feel support to get him more “more motivated to look physically active and after myself”.(5) improve his diet, and a moderate level of psychological support “Prehabilitation adds to cope with the surgery value by reducing and chemotherapy to complications and come. Mr Jones received resource use as free gym membership, 2 fitness sessions a week well as potentially in a small group, and a improving long-term heart rate monitor to behaviour and encourage him to walk health.” more. He saw a specialist dietitian, received weekly MacMillan (5) | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | CharteredWE SocietySTAND of Physiotherapy READY |Macmillan TO Cancer WORK Support | The WITH Neurological YOU Alliance | TORehabilitation DELIVER Workers Professional EFFECTIVE, Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK ActivePERSON-CENTRED | Vision UK | Spinal Injuries Association | VersusCOMMUNITY Arthritis | Muscular Dystrophy REHABILITATION UK | Age UK | Arthritis and Musculoskeletal SERVICES Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British SocietyTO of ALL Rehabilitation THOSE Medicine | Chartered IN NEED Society of Physiotherapy SO THAT | Macmillan PEOPLE Cancer Support CAN... |The Neurological Alliance |Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapistsonger in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society |L British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation WorkersLive Professional Well Network | Britishfor Association of Cardiovascular Prevention

“Shifting the focus and resource in mental health rehabilitation from inpatient provision, especially out of area, to early skilled rehabilitation assessment and intervention in the community is vital. This will enable more people who have lost skills and confidence due to their mental health needs, to access support to build on their strengths and achieve their aspirations. This will also reduce the number of people requiring more expensive, in patient rehabilitation, so that the very small number of people who do need that, can receive it closest to home.”

Clair Haydon , Clinical Advisor on NHSE/I Complex Care/Rehabilitation Programme and National Acute Out of Area Programme and Consultant Occupational Therapist at Cheshire Josh was 18 when a car crash landed him and Wirral Partnership NHS Foundation Trust. inhospital with severe brain injury. After his injuries were stabilised, intensive rehabilitation in a residential unit helped him relearn how to “Achieving an uptake rate for cardiac walk and talk. He was discharged home after 12 months and continues to receive rehabilitation of 65% in England among physiotherapy and occupational therapy. all eligible patients could release over He has neuropsychological reviews every £30 million per year in savings which 3-6 months, has been discharged from speech could be reinvested in rehabilitation and language therapy, and does not need any additional care beyond what his family and re-ablement.” provide. Josh has made huge progress in his NHS Improvement (9) recovery as a result of the neurorehabilitation he has received.

The costs involved in Josh’s rehabilitation were “If those currently least able to manage significant, totalling approximately £148,374. their conditions were better supported, However, his recovery meant that he needed less so that they could manage their conditions health and social care on leaving hospital and it is calculated that the rehabilitation costs were offset as well as those most able, this could in 27 months (for the higher costs of in patient prevent 436,000 emergency admissions rehabilitation) and in six months (for the lower and 690,000 attendances at A&E, equal costs of out patient rehabilitation at home). In to 7% and 6% respectively of the total addition, assuming a predicted life expectancy of 52 years, it is estimated that a total of £5.5 million in England each year.” has been saved in health and social care costs as Health Foundation (10) a consequence of his successful rehabilitation.(4) | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The Neurological Alliance |Rehabilitation Workers Professional Network | British AssociationWE STAND of Cardiovascular READY Prevention and TORehabilitation WORK | Royal CollegeWITH of Occupational YOU TherapistsTO DELIVER | Royal College of Speech EFFECTIVE, and Language Therapy |Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular RehabilitationPERSON-CENTRED| Association of Chartered Physiotherapists COMMUNITY in Respiratory Care | BritishREHABILITATION Heart Foundation | British Lung Foundation SERVICES | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of CardiovascularTO ALL Prevention THOSE and Rehabilitation IN NEED | Royal College SO of Occupational THAT Therapists PEOPLE|Royal College CAN... of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | Britishonger Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The NeurologicalL Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of OccupationalLive TherapistsWell | Royal forCollege of Speech and Language Therapy|Royal COMMUNITY REHABILITATION: Supporting social care

ommunity rehabilitation can reduce costs saving £59 million in emergency admissions, and significantly in social care, according to a similar amount in social care costs.(11) Hip fractures sector leaders. Community rehabilitation can currently cost £8,237 in social care and £9,739 in C improve recovery rates from illness and injury hospital care. Fracture liaison services are a proven and thereby limit the level of social care needed after model of community rehabiltiation that, again, if discharge from hospital. The savings are particularly universal, would save £400 million from social significant when the illness or injury occurs early in care and NHS budgets.(12) the patient’s life, since many decades of care costs Heart and circulatory disease is another leading can be avoided if the patient is supported with cause of disability in the UK. Substantial savings in appropriate levels of rehabilitation. Community health and social care costs can be made if people rehabilitation can also enable people to better are able to access cardiac rehabilitation. A recent self-manage their long-term conditions and slow study found that cardiac rehabilitation reduces the progress of degenerative diseases, both of which cardiac-related illness, promotes independent living, create knock on savings for social care budgets. fosters self-management skills and enables people Falls are a case in point. Falls are the sixth largest to return to work.(9) All features that reduce the cause of disability in the UK today(7). If falls need for social care support. prevention services were universal, it is anticipated The home environment can be a vital key to that a quarter of all serious falls could be avoided, unlocking rehabilitation potential and allowing people to live at home, rather than move into higher cost residential care. Home based assessments can enable community rehabilitation practitioners to advise Sight for Surrey people on how to live at home within their new constraints, while home adaptations – a cost benefit analysis can make it safer for people to stay at home longer. A Public Health England Sight for Surrey provides vision rehabilitation study found that for people at high risk to people with vision impairment in Surrey. After vision of falls, home assessments and home rehabilitation, vision impaired people are able to live adaptations could offer a return on more safely and independently, with reduced care investment of £3.17 for every £1 spent.(13) needs and lower emergency admissions. The RNIB commissioned a cost benefit analysis of this service. “The cost of providing early Their study showed that as a result of Sight for Surrey’s specialist rehabilitation for patients service, £3.2m in reduced, avoided or deferred costs with complex needs is rapidly offset were achieved in the health and social care systems per year in Surrey alone. A further £250,000 were by longer term savings in the cost of saved from the service users’ own pockets.(14) community care, making this a highly cost-efficient intervention.’(12) | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The Neurological Alliance |Rehabilitation Workers Professional Network | British AssociationWE STAND of Cardiovascular READY Prevention and TORehabilitation WORK | Royal CollegeWITH of Occupational YOU TherapistsTO DELIVER | Royal College of Speech EFFECTIVE, and Language Therapy |Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular RehabilitationPERSON-CENTRED| Association of Chartered Physiotherapists COMMUNITY in Respiratory Care | BritishREHABILITATION Heart Foundation | British Lung Foundation SERVICES | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of CardiovascularTO ALL Prevention THOSE and Rehabilitation IN NEED | Royal College SO of Occupational THAT Therapists PEOPLE|Royal College CAN... of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | Britishonger Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support |The NeurologicalL Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of OccupationalLive TherapistsWell | Royal forCollege of Speech and Language Therapy|Royal

‘Good social care provides care, support, and safeguards. It transforms lives, it enhances health and wellbeing, increases independence, choice and control. Supporting people to remain at home in their local community, living independent lives, is an outcome which social care strives for. Access to reablement and community rehabilitation is essential in achieving this. Everyday activities or tasks which many take for granted can become increasingly challenging or impossible Sue Ryder’s proactive care for some. Supporting people to saves £1m in future care costs continue to fully participate in daily life is the right thing to do for them A young working mother, Laura with some initial support from as well as reducing the pressure on was in her early 20s when she Sue Ryder and local council care staff, a social care system which is under suffered a brain haemorrhage that she moved home. left her severely disabled, paralysed intense strain’. Laura’s specialist care costs were high and unable to speak. The standard at the start of her time at Sue Ryder, Julie Ogley, President, The 12 week rehabilitation course Laura but her fast progress meant that Association of Directors of Adult received was unsuccessful and she these costs fell steadily over time. Social Services in England (ADASS) became very depressed. Her main Had Laura not received the proactive – the association of directors of adult depression trigger was the very care provided by the Sue Ryder social services in England limited time she was allowed with her centre, she would probably have young son on her high dependency stayed in the older persons’ hospital ward. After 6 months, Laura was ward for five years and then she fortunate to secure a place at a “Community rehabilitation is essential would have been moved to an older Sue Ryder centre, and her recovery persons’ nursing home. The likelihood to enable people with a broad range turned a corner. is that she would not have recovered of neurological conditions to be as She received patient and intensive her ability to walk, talk or live without active and independent as possible, rehabilitation including physiotherapy anti-depressants, but with her yet we hear from too many people and speech and language therapy. condition stable she would have This ‘proactive care’ helped her learn probably lived to an old age. It is that they don’t have access to it. to walk and talk again. She also estimated that the total cost of We know that community rehab received emotional support which Laura’s proactive care package – improves people’s quality of life, enabled her to come off over almost 6 years – is £660,415. anti-depressants. An important factor Assuming Laura lives an average life and helps keep them as well and here was that the centre allowed her span, the proactive care pathway able as possible, as well as potentially more time with her son, in more saves the state over £2m, compared reducing their reliance on services. suitable surroundings. After three to the reactive hospital-nursing home We therefore strongly advocate for years as a resident at the centre, pathway. Over £1m of the costs saved Laura moved to Sue Ryder supported by the proactive pathway are savings improved access to such services.” living for a further two years, and then, from social care budgets.(15) Georgina Carr, CEO, The Neurological Alliance | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | CharteredWE SocietySTAND of Physiotherapy READY |Macmillan TO Cancer WORK Support | The WITH Neurological YOU Alliance | TORehabilitation DELIVER Workers Professional EFFECTIVE, Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK ActivePERSON-CENTRED | Vision UK | Spinal Injuries Association | VersusCOMMUNITY Arthritis | Muscular Dystrophy REHABILITATION UK | Age UK | Arthritis and Musculoskeletal SERVICES Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British SocietyTO of ALL Rehabilitation THOSE Medicine | Chartered IN NEED Society of Physiotherapy SO THAT | Macmillan PEOPLE Cancer Support CAN... |The Neurological Alliance |Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapistsonger in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society |L British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation WorkersLive Professional Well Network | Britishfor Association of Cardiovascular Prevention COMMUNITY REHABILITATION: Modernising for the future ommunity rehabilitation services must be How will we meet this challenge? modernised to respond to today’s needs • Our services must be inclusive, timely and universal, and prepare for the future. We are already irrespective of postcode or severity of condition. Any failing to provide sufficient and appropriate C barriers to people accessing community rehabilitation community rehabilitation services to people with injury, must be thoughtfully addressed. mental and physical illness and long-term conditions. We are missing opportunities to improve lives and • Where necessary our services must be specialist, make savings across health and social care budgets. to support people with very distinct needs.

Over the next 17 years, it is projected that the number • Our services must be personalised, addressing each of people aged 65 and above will rise by more than individual’s multiple needs, not solely focused on one 40%, to over 16 million. On average, 30% of people condition. More person-centred services will enable over 65 fall at least once a year, 5% of falls lead to people to do more of what matters to them, be that fractures and hospitalisation.(16) Falls and fractures family life, work, community or leisure. are just one of the many injuries, illnesses and conditions • Our services must be integrated, with the right mix that require a community rehabilitation response, and of health and care professionals so that people can that could be prevented or limited with appropriate access the right help at the right time. Our services rehabilitation input. need to link together with existing sports, leisure, Our ageing population is one of several trends that are housing and voluntary sector activities to provide increasing the demand for community rehabilitation. a holistic community-based rehabilitation solution. We anticipate that the need for enhanced community Making greater use of digital innovation will rehabilitation services is only going to increase. strengthen integration.

Sue Ryder Leckhampton Court’s palliative rehabilitation

Sue Ryder’s day hospice Gloucestershire. Patients can tips and techniques or helping to programme at Leckhampton self-refer or be referred by their arrange for aids or modifications Court provides expert nursing GP or consultant. The service starts in their home environment.” care, occupational therapy, by listening, observing and asking It is rewarding for staff to be part physiotherapy, complementary what patients hope to achieve. of a person-centred service: “At Sue therapy, family and spiritual One of the occupational therapists Ryder we have time to spend with support and art activities. The explains: “My role is to support our patients. We can make a real team supports people living with patients in achieving what matters difference to people, and it is such cancer, lung disease, heart failure to them through patient and carer a privilege to be part of the or neurological conditions in education, the sharing of advice, therapies team.” (15) | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | CharteredWE SocietySTAND of Physiotherapy READY |Macmillan TO Cancer WORK Support | The WITH Neurological YOU Alliance | TORehabilitation DELIVER Workers Professional EFFECTIVE, Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK ActivePERSON-CENTRED | Vision UK | Spinal Injuries Association | VersusCOMMUNITY Arthritis | Muscular Dystrophy REHABILITATION UK | Age UK | Arthritis and Musculoskeletal SERVICES Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British SocietyTO of ALL Rehabilitation THOSE Medicine | Chartered IN NEED Society of Physiotherapy SO THAT | Macmillan PEOPLE Cancer Support CAN... |The Neurological Alliance |Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | UK Active | Vision UK | Agile | Ageing Better | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapistsonger in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society |L British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation WorkersLive Professional Well Network | Britishfor Association of Cardiovascular Prevention Greater Manchester’s Our Ask: Integrated Community Equal access to community Stroke Rehabilitation rehabilitation for all Service Before the launch of Greater Manchester’s Integrated What politicians can do to help Community Stroke Rehabilitation Service, stroke Ask your political party to commit to high quality, patients often waited six weeks to be assessed. accessible community rehabilitation for all Now, all stroke patients are seen within three days 1 of leaving hospital. An initial care assessment Use the parliamentary debate on the NHS establishes the patient’s most critical problem to ensure 2 accountability framework (due in Spring 2020) the patient sees the most appropriate professional to mandate delivery of universal community from the start. The service also ensures smooth rehabilitation transfer to the other NHS, social care, voluntary or wellbeing services that address the wider needs Use parliamentary scrutiny of anticipated changes of patients and carers for ongoing ‘life after stroke’ 3 to the NHS constitution to make people’s existing support. Patients can regain their independence rights to community rehabilitation explicit more quickly, return to work in a shorter time frame Visit a community rehabilitation service and can self-refer back into the service if needed. 4 in your constituency to see its impact first hand “Patients no longer feel abandoned at Ask questions of your local Clinical Commissioning their time of greatest need. More timely 5 Group or Health and Wellbeing Board about support and treatment results in better their plans to improve access to high quality community rehabilitation services. outcomes for the patient and staff don’t have to undo any negative impact that a delay in treatment can have.” For more information: Caomha Preston, Physiotherapy Lead Please email: [email protected] Or visit: www.RightToRehab.org While the team are stroke specialists, they are linked up with other services including Manchester’s integrated neighbourhood teams, which have been Or contact us at: set up to provide community health and social care services to populations of 30,000-50,000 people. The Chartered Society of Physiotherapy Tel: 020 7306 6666 “Having a flexible approach in how we 14 Bedford Row, London WC1R 4ED work with other parts of the NHS and Royal College of Occupational Therapists social care enables us to share our skills Tel: 020 3141 4600 and knowledge and support other teams 106-114 Borough High Street, London SE1 1LB wherever the patient is, and coordinate Sue Ryder care around the individual needs of Tel: 0808 164 4572 the patient.” 183 Eversholt St, London NW1 1BU Tracy Walker, Occupational Therapist, lead allied health professional With thanks to all the colleagues and patients that allowed us to tell their stories. Who are we? We are a collective of 24 charities, trade unions and professional bodies coming together to call on all political parties to ensure there is equal access to high quality community rehabilitation services for all.

Longer Live Well for

References 1 Royal College of Physicians, British Thoracic Society. Pulmonary Rehabilitation: steps to breathe better. London: Royal College of Physicians; 2016. 2 British Heart Foundation. National Audit of Cardiac Rehabilitation (NACR) Quality and outcomes report 2018 & 2019. London: British Heart Foundation; 2019. 3 Neurological Alliance. Neuro Patience: still waiting for improvements in treatment and care. London: Neurological Alliance; 2019. 4 United Kingdom Brain Injury Forum. Acquired brain injury and neurorehabilitation: time for change. London: United Kingdom Brain Injury Forum; 2018. 5 Macmillan Cancer Support. Prehabilitation for People with Cancer. London: Macmillan Cancer Support; 2017. 6. Stroke Association. A new era for stroke. Stroke Association: London; 2016. 7 Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386(9995):743-800. 8 The Chartered Society of Physiotherapy. The Pulmonary Rehabilitation Impact Model on Exacerbations (PRIME) tool . London: The Chartered Society of Physiotherapy; 2018. 9 NHS Improvement. Making the case for cardiac rehabilitation: modelling potential impact on readmissions. London: NHS Improvement; 2013. 10 Deeny S, Thorlby R, Steventon A. Briefing: Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions. London: Health Foundation; 2018. 11 National Osteoporosis Society, NHS Right Care, Public Health England. RightCare Pathway: falls and fragility fractures. London: NHS Right Care 2013. 12 Royal Osteoporosis Society. Fracture Liaison Service Benefits Calculator. London: Royal Osteoporosis Society; 2015. 13 Public health England. A return on investment tool for the assessment of falls prevention programmes for older people living in the community. London: Public Health England; 2018. 14 Ronca M, Peach B, Thompson I, et al. Demonstrating the impact and value of vision rehabilitation. London: OPM Group; 2017. 15 Sue Ryder. The case for proactive neurological care. London: Sue Ryder; 2018. 16 Public Health England. Falls and fracture consensus statement: supporting commissioning for prevention London: Public Health England; 2017. 001669 SPED 02/2020 700