Time to move out?

The pressure on the NHS and acute hospitals has never been greater. Accommodating the surge in urgent care, and stringent infection prevention and control measures, means space is now at an absolute premium. Difficult decisions about how space can and should be used must now be made.

Repurposing rehab gyms and physio areas with large bays have both been seen as a solution to relieve rammed emergency departments, provide Covid-19 assessment areas, storage areas or staff rest rooms. While we may not like it, should we really be surprised that outpatient physiotherapy space in acute hospital sites has been deprioritised in this way?

Care closer to home

Acute hospitals should only deliver care that cannot be delivered elsewhere. This is consistent with government policy in the UK. Instead, care should be offered closer to patients’ homes with the aim of keeping people well within their community. It’s difficult to argue against this ambition. 

What does this mean then for the traditional physiotherapy department on an acute hospital site? While we must ensure essential rehab continues, should we see the loss of acute space and a renewed focus on community settings as an opportunity? Can we recognise it may facilitate better and more accessible services to our patients? Can we think differently to future-proof our services? 

Let’s hope we don’t ever experience the horrors of a pandemic again but let’s be clear, when space in acute hospitals is needed to save lives and accommodate acutely ill people, outpatient physiotherapy rehab spaces will always be a target. Moving into communities to where our patients live has surely got to be an attractive alternative.

Reframe our ask

Could the energy we are expending battling to reclaim our acute space be better directed? Let’s seek solutions away from acute hospital sites. In reality, this argument is far more likely to be heard. Let’s also champion the value of physiotherapy in community and primary care settings. We must translate and understand health policy and local drivers to pre-empt what is coming and pro-actively position services to benefit individuals, communities and populations. Get involved and make sure the importance of optimal physiotherapy space is considered at the earliest stage. Consider what community settings are available such as community clinics, community centres, schools, leisure services…be creative. 

Some successful community rehab services utilise church halls, while others have moved to work alongside leisure services. Not only are community gym spaces often underutilised during the day, we also have an opportunity to positively impact on population health and embed sustainable lifestyle change. 

Robust process

Physiotherapy staff have an important role to play in leading these changes and ensuring that they result in accessible, quality rehab and personalised care. Working in the community can facilitate greater co-ordination between services and sectors, such as closer working with the voluntary sector and local community groups. We can position physiotherapy where it can have its biggest impact on health and prevention – enabling a proactive rather than reactive model of care. 

To be clear, we are not saying that the requisitioning of physiotherapy space without meaningful consultation is acceptable. The CSP will always support members who face such challenges. We are however supportive of the shift, but only when safe and effective alternatives for staff and patients can be found.

So let’s re-frame our argument. Let’s put patients at the centre and think about how their needs can best be met. Let us recognise that UK health policy is to provide care within communities and that physiotherapy outpatient and rehab services can be delivered away from acute hospital sites. Let’s be strategic, future-proof our profession and demonstrate to all the positive impact physiotherapy can have on population health. 

• CSP professional advisers Sara Conroy and Claire Fordham