Recovery and rehabilitation during and after the COVID-19 pandemic: framework for supporting people

10. Priorities to Achieve Objectives

A ‘National Advisory Board for Rehabilitation’ will be formed to provide expert advice to Scottish Government and support leadership in NHS Boards, Integration Authorities, Local Government, Independent and Third Sector.

This can be achieved by:

• Seeking reassurance from all NHS Boards and Integration Authorities that rehabilitation is a key feature of their remobilisation planning.
• Connecting health, social care and third sector colleagues involved in prehabilitation and promoting the sharing of best practice across Scotland.
• Commissioning a review of existing prehabilitation resources, which could be applied during and after the coronavirus (COVID-19) pandemic and then acting on any identified gaps.
• Linking in with the workstreams of the unscheduled care redesign taskforce to ensure rehabilitation features prominently in relevant discussions and has a role to play in the community hubs in ensuring the right individual accesses the right care at the right time.
• Ensuring patients who have been admitted to Intensive Care and other secondary care areas have a multidisciplinary assessment of their rehabilitation needs, are offered person-centred care, and are followed up appropriately after discharge.
• Exploring models of care that support mental health rehabilitation for those admitted to Intensive Care such as InS:PIRE programme and connecting with intensive care clinical networks and stakeholders across Scotland proposing a future model to address these needs.
• Engaging with the Scottish Government Realistic Medicine team to build bespoke atlases of variation that describe the impact coronavirus (COVID-19) has had across the Scottish boards and partnerships, capturing prevalence, outcomes, inequalities and other epidemiological considerations that will inform how we should configure services going forward.

10.1 Meet the individual’s immediate needs: coronavirus (COVID-19) Treatment Infrastructure, Covid Urgent and Elective Care

10.1.1 Remobilisation

People with rehabilitation needs will have access to the appropriate service for their needs. Rehabilitation services will be recommenced in NHS boards and Health and Social Care Partnerships as part of a whole system remobilisation with effective stakeholder engagement from the outset.

10.1.2 Early Intervention and Prevention

Rehabilitation approaches add real, proven value in reducing unnecessary expenditure and resource use by focusing on prevention, anticipation and supported self-management as per the Health and Social Care Delivery Plan and as part of a wider public health message for Scotland.

10.1.3 Prehabilitation

People whose function has declined because of coronavirus (COVID-19) will be offered opportunities to improve their physical function mental health and wellbeing ahead of definitive therapies (prehabilitation). This includes adopting the principles of preparedness to optimise function in the event of any future waves of the virus.

10.1.4 Unscheduled care

People accessing unscheduled care will receive the right help in the right place at the right time by the right professional. Unscheduled care is now being redesigned to take account of the very positive innovations that have been stood up in response to the pandemic and which must be continued when the crisis is over.

10.1.5 Intensive Care

People who have been admitted to ICUs will receive the best possible multidisciplinary rehabilitation support and treatment, which addresses physical, cognitive, psychological, spiritual and social needs.

This can be achieved by:

• Focusing on recovering reduction in abilities

and skills and enabling participation in daily living, work and social activities, which includes physical fitness and stamina, confidence, interpersonal skills and

social interaction with others, improved nutrition and communication, as well as psychological interventions.

• Interrogating social determinants and health

inequalities to ensure resource is allocated in ways that align with the principles of population health including vulnerable groups who may be more adversely affected by the coronavirus (COVID-19) epidemic.

• Working with NES to continue to develop a range of clinical educational and skills programmes establishing a fundamental common rehabilitation skillset across disciplines, inclusive of physical and mental health care and maximising workforce agility and wellbeing.
• Working with Workforce Wellbeing Champions Network and stakeholders across health and social care systemically to improve culture and wellbeing for staff, taking into account learning from the coronavirus (COVID-19) response phase.
• To build on the learning from the Fair Work in Social Group to further improve fair working practices for health and social care staff delivering prehabilitation and rehabilitation.
• Continuing to develop the provision of healthy lifestyle advice and support available both nationally and locally, including communication accessible materials and digital offerings.
• Continuing to develop the Scottish Government’s national campaign Clear Your Head Scotland to provide a range of resources, advice and support to improve the mental health and wellbeing of the population.
• As part of recovery we are planning the safe, gradual resumption of access to respite and day care to support unpaid carers and their families and are committed to support the use of self directed support to optimise options available to service users and their carers.

10.2 Changing Priorities: Pandemic Response, Staff and Carer Wellbeing

10.2.1 Fiscal challenges

The pandemic has significantly challenged our fiscal environment so it is essential we recognise the need for occupational health services and vocational rehabilitation to aid socio-economic recovery by enabling people to return to work or educational programmes.

10.2.2 Equity of access

People will have equitable access to health and social care irrespective of personal characteristics or geographical location.

10.2.3 Data-informed

Rehabilitation services will be supported to act on the available data, develop robust data systems and analytics and lead on audit, improvement and research projects in collaboration with Higher Education Institutions.

10.2.4 Psychologically resilient and supported workforce

We will continue to work with partners to build a resilient health and social care workforce, whilst supporting mental health and wellbeing.

10.2.5 Managing complications

We will seek to improve the health and wellbeing of the population with a view to reducing the prevalence of physical and mental health complications of coronavirus (COVID-19); this will include ensuring support for shielded groups in any area of health and social care.

10.2.6 Mental health

We will address the specific mental health needs of those affected by coronavirus (COVID-19) on an individual basis through the promotion of access to information, support, screening, digital therapies and treatment.

This can be achieved by:

• Engagement with organisations to support

a partnership approach to rehabilitation for care home residents learning from the Care About Physical Activity (CAPA) Care Inspectorate programme considering vulnerability, age, frailty and shielding.

• Ensuring digital strategies are considered in rehabilitation consultations where appropriate including provision of communication accessible information for Near Me users such as carers, residents and family members.
• Enabling digital approaches, which ensure equity of supports through multiple access routes and blended methods with specific

focus on those at risk of being digitally and / or communication excluded.

• Influencing public messaging communications to promote equitable supported self-management for rehabilitation.
• Exploring the potential of artificial intelligence platforms to support self-management using a holistic, biopsychosocial approach,

10.3 Renew Rehabilitation to a better health and care system: Innovation and Integration, Ensure Equity, Better Outcomes

10.3.1 Care Homes

We will develop principles and guidance to inform rehabilitation support for care home residents following a human rights based approach.

10.3.2 Virtual technology

We will encourage the acceleration at scale of digital first approaches including home and mobile health monitoring as well as apps for supported self-care in order to offer a blended model of service delivery in partnership with each individual should it meet their needs.

10.3.3 Public engagement

We will ensure the public are kept engaged in all developments through effective communications and messaging.

10.3.4 Community care infrastructure

We will work closely with partner agencies to ensure a joined-up infrastructure of care supports rehabilitation approaches and is predicated on bolstering community care through the promotion of the hubs, which have been established in response to coronavirus (COVID-19).

10.3.5 Innovation

We will encourage fostering of ideas, innovations, and solutions to enhance rehabilitation and recovery services.

10.3.6 Reablement

We will adopt a strengths-based, person-centred approach at home or homely setting that promotes and maximises independence and wellbeing enabling positive change using user-defined goals designed to enable people to gain, or regain, their confidence, ability, and necessary skills to live as independently as possible. which incorporates the physical, mental communication and social needs of the individual.

• Ensuring community hubs link across services especially community education and development, community pharmacy, the community respiratory response teams, mental health teams, social care and third sector and the vital role allied health professionals (AHPs) of all disciplines play across health and social care – in an integrated approach, not just to high clinical acuity, but in enabling, supporting and promoting population health.
• Identify proven innovations developed in NHS Boards, Integration Authorities and the third and independent sectors by sharing learning and taking these to scale where applicable including finding new solutions through Open Innovation via Scotland’s network of Test Beds facilitated by the Chief Scientist’s Office and NHS National Services Scotland Innovation Portal.
• Liaising closely and work collaboratively with third sector agencies who can support the care of those individuals with complex needs who may have issues such as addictions, offending, homelessness and domestic violence.