Stand up for rehab

The coronavirus pandemic has highlighted the importance of physiotherapy and increased demand for rehabilitation in hospitals and the community as part of the response to the virus.

Yet CSP members across the UK have expressed concern that their rehabilitation services still remain fully or partially closed following the pause of services in the spring.

In the recent Covid-19 survey* undertaken by the CSP, only 15 per cent reported that the services they normally offer are now fully up and running.

Sara Hazzard, assistant director of strategic communications at the CSP, said that the pandemic had increased the need for rehabilitation services but some of the emergency measures introduced at the start of the outbreak had made it harder to access services that were already over stretched and under-resourced, increasing health inequalities.

‘Covid has taken its toll on people in a number of ways; people have become frailer and deconditioned as a result of lockdown and shielding. Many patients with long-term conditions have deteriorated, and now require more rehabilitation, alongside the ongoing needs of cardiac, stroke and respiratory referrals in the community,’ Hazzard said.

She said that research from Britain Thinks, funded by the Richmond Group of charities, shows how enormous the feeling of being let down and forgotten is among patients with long term conditions as a result of Covid, even when they recognise how hard NHS staff are working. Its report says: ‘These patients have suffered greatly during the pandemic and feel left behind – with delays in treatments and diagnoses exacerbating health problems’ and it identifies ‘considerable concern about the impact of the second wave’.

In addition to this, people who have been in acute hospital with Covid are coming out with a range of problems that require rehab, and there is now new evidence of need among people who were never admitted to hospital, recovering from what is being called Long Covid. Hazzard said that rehab services are essential for people recovering from Covid, and Long Covid patients left managing fatigue, pain, ongoing respiratory problems, deconditioning and poor mental health. 

Loss of space

In the survey of over 4,000 CSP members the most common barrier to restarting physiotherapy services cited was loss of space. In England 40 per cent of members highlighted this issue, with the figures rising in Northern Ireland (41 per cent), Scotland (46 per cent) and Wales (49 per cent).

In some cases, the space has been returned, however many members say that physiotherapy space is still being being taken away to be used for other purposes.

A CSP member in the north of England said rehab space has been reallocated for meeting rooms, discharge lounges, and most patient rehab has ‘virtually ceased’.

‘We are finding it very frustrating and noticing a massive increase in the elderly becoming more frail and vulnerable,’ the member said.

The loss of space is being felt equally in the acute and tertiary sectors with both community and primary care highlighting the issue.

Some departments are being offered alternative spaces from which to provide physiotherapy services. Where this is the case, the CSP expects a full and appropriate consultation of staff, involving the local CSP steward and health and safety representative.

Jim Fahie, CSP assistant director of employment relations and union services (ERUS), said that when making Covid-related changes, organisations need to consider the whole system and patient pathway, and invest in patient wellbeing by ensuring access to rehabilitation for patients with Covid and other conditions is accessible and deliverable by staff with the skills and ability to provide it.

‘Any proposed space for therapy services to be relocated to must be fit for purpose. The space on offer should be risk assessed to see if it is an appropriate environment for both patients and staff, with an equality impact assessment being undertaken to prevent any potential discrimination and make sure that services are accessible to all those who need them,’ he said.

The national NHS Social Partnership Forum of employers and trade unions issued a statement** in September 2020 that makes this very clear, stating: ‘When managing change, staff and their trade unions should be engaged early and consulted properly, with agreement sought in the usual way. This applies to proposals to extend temporary changes or make them permanent.’

Where therapy space is not being returned to enable services to re-open, Fahie said members should speak with their steward to consider how best to address the situation, and where they don’t have access to a local CSP steward, contact the CSP directly for guidance.

He said: ‘CSP members do not have a problem if changes are temporary as a result of Covid-19 but they have concerns where we have seen rates of Covid going down and no signs of space being restored for physiotherapy and they are not being provided with suitable alternative space.’

Using physiotherapy staff

As well as having space for rehab and physiotherapy services, having the workforce is critical to addressing these needs. There was redeployment during the response to the first wave of the pandemic including some rehab and community physios working in ITU.

At the start of the pandemic significant numbers of physiotherapy staff stepped up to be on temporary registers to help in an emergency situation. This included physios returning to practice, final year students, and physio staff who would normally work outside the NHS. Sara Hazzard said that in many cases these clinicians and staff were not used when they could have been employed to backfill the community services deprived of staff.

‘We must not make the same mistakes now. Full use needs to be made of physiotherapy staff currently working outside of the NHS, and from our current NHS workforce far greater use should be made of the many excellent support workers,’ she stressed.

Many NHS services have moved from face-to-face to online but Hazzard said that while there has been some excellent practice in moving to remote services, and this should undoubtedly be a part of services in the future, it cannot replace all face-to-face services. ‘Digital is not the answer for everyone and even digital services need staff, space and resources.’

Prioritising rehab

The CSP is part of the Community Rehab Alliance, made up of 35 charities, trade unions and professional bodies, which has called on the government to make rehabilitation a priority and to take a strategic approach to implementation. The Alliance has also pressed its case in evidence to the House of Commons Health and Social Care Select Committee.

NHS England said it was unable at this stage to make any comment on the concerns raised by the CSP. However Suzanne Rastrick, the chief Allied Health Professions (AHP) officer, has been put in charge of rehabilitation by the NHS England. Hazzard said while that leadership is important, the CSP wants assurances that rehabilitation will be prioritised: ‘Physiotherapy and rehab is a vital part of the Covid response plan which is all about patient flow – getting people discharged into the community, and having physiotherapy in the community to prevent readmission and prevent people’s ability to live independently from deteriorating. 

‘As the NHS gears up now for increased demands on acute beds and as it plans for what happens beyond this, it is vitally important that physio and other AHP leaders make their voices heard.’

If any member has concerns about barriers to restarting services, loss of space or redeployment contact your steward. 

If you want to talk about what is happening to rehab space where you are contact righttorehab@csp.org.uk and you will be forwarded to the CSP team covering your area. 

Guidelines and negotiations reap rewards

At Hywel Dda University Health Board musculoskeletal (MSK) space for the whole of the county of Ceredigion has been repurposed for use by the Medical Day Unit. As a result, physiotherapists have lost their main treatment area, gym and use of its equipment, patient cubicles and a private women’s heath cubicle. Outpatient services are only delivering between 10-30% of appointments with no ability to increase above 30% capacity due to lack of space. No other space has been identified or time frame for reallocation of space.

However negotiations between physiotherapy staff and managers at Cwm Taff Morgannwg University Health Board have resulted in a positive outcome. Initially clinical cubicles and associated office and reception space was lost at Ysbyty Cwm Rhondda.

Physiotherapists delivered virtual consultations through ‘Attend Anywhere’ and face-to-face consultations offered on another site if this was needed. Now there has been an agreement to share this space with other departments now so things are improving.  

The office space has been returned and scheduling clinics around one another when needed.  This has led to collaborative working across departments who are supporting each other for the benefits of the community.

Calum Higgins, CSP public affairs and policy manager for Wales, said the feedback received from members was concerning. ‘We know that rehab services are important and crucial in meeting the challenges of Covid-19, however the space required to deliver rehab with patients has been appropriated for other purposes. 

It’s important that rehab services are given priority and the right space to run services in an effective way. 

Guidelines*** from the Welsh Government stress the importance of rehab services and recognise that change has been rapid in response to the pandemic. Higgins said there have been positive examples where departments and health boards have used these guidelines to find solutions and develop collaborative approaches to restarting services.

‘We urge all Health Boards to follow this best practice, consult, risk assess, and plan for rehabilitation needs including space and facilities going forward. They must ensure that the rehab needs of all patients are met at this crucial time,’ he said.