Maximising Recovery, Promoting Independence: An Intermediate Care Framework for Scotland

9. Links to the delivery framework for adult rehabilitation in Scotland

Published in 2007, this framework made six recommendations:

1. Rehabilitation services should be more accessible and there should be direct access.

2. Rehabilitation services need to be provided locally, with a strong community focus.

3. A systematic approach to delivering rehabilitation to individuals is required, promoting independence, self management and productive activity.

4. Rehabilitation services should be comprehensive and evidence based, should reflect individuals' needs at distinct phases of care, and should identify models to ensure seamless transitions.

5. Practitioners and providers in health and social care services need to be better informed about current evolving roles and expertise within rehabilitation teams.

6. Health and social care professionals need to critically review staff resource deployment through service re-design and skill-mix review.

In addition to these recommendations, individuals, carers and health and social care staff also highlighted the need for strategic co-ordination of rehabilitation services to drive changes across organisational and professional boundaries.

Much progress has been made on implementation of the rehabilitation framework, a number of services have undertaken major redesigns. Some examples include:

• Work is in progress to improve access to and capacity of rehabilitation services by using telerehabilitation and technology within NHS 24. For example in NHS Tayside remote pulmonary rehabilitation has been piloted using video conferencing to deliver an existing programme from a hospital.
• Many Boards are developing a single community assessment and rehabilitation service with a single point of access. An example is NHS Lanarkshire North Partnership, where this is integrated with the local authority and provides direct access to mental health services, re-ablement and care management.
• Several NHS boards, including Lothian and Fife, now have therapists as part of multidisciplinary accident & emergency teams, helping to prevent hospital admissions .

The Chief Health Professions Officer is developing a Delivery Plan for AHP's that will reinforce the need for integrated health and social care community teams, and will ensure that AHP's are utilising their skills, expertise and leadership to further drive forward this framework.

The Delivery Plan will identify how the Allied Health Professions will re-configure their services to accommodate the integrated model of delivery recognising the key contributions from all other health and social care practitioners.