Rehabilitation framework self-assessment tool: analysis of responses

Executive summary

1. In August 2020, the Scottish Government published its Framework for Supporting People through Recovery and Rehabilitation during and after the COVID-19 Pandemic (referred to as the Framework). A survey of frontline staff was carried out by the National Advisory Board for Rehabilitation to ensure that the implementation of the Framework was informed by an up-to-date picture of rehabilitation services across the country.

2. The survey received 280 responses from rehabilitation professionals and teams across the country. Respondents represented a range of inpatient, outpatient and community teams and services, and professional groups. Physiotherapists and occupational therapists (OTs) were the two professional groups most commonly represented – over half the responses included one or both of these professions.

3. The survey addressed issues relating to service delivery, workforce and patient wellbeing across three timeframes: pre-, during and post-pandemic. A summary of the main points made by survey respondents in relation to each of these issues is presented below, while a final section looks at the future development of rehabilitation services.

Survey findings

4. In relation to service delivery, survey respondents identified a great deal of good work and positive activity in relation to the development, delivery and ongoing improvement of rehabilitation services. Rehabilitation staff were proud of the services they provided. Respondents described a wide range of services that were (i) providing timely patient-centred care, prompt referrals and appropriate professional input, and (ii) achieving good outcomes for patients. They were committed to multidisciplinary and joined up working, with some noting this as a positive feature of current service delivery. However, others said there could be challenges – mainly practical and logistical, but also sometimes cultural – to this way of working.

5. The pandemic had significant impacts on services. Some services had been reduced or stopped, while others had to adapt to a new way of working – particularly in relation to the adoption of digital working and infection control procedures. Respondents were proud of the work undertaken by their teams during the pandemic. They were also committed to building on positive developments linked to the pandemic such as improved communication within and across teams and services, and making greater use of digital methods for working with colleagues and delivering patient-facing services.

6. However, survey respondents reported growing demands on services – in terms of increasing caseloads and the increasing complexity of individual cases – as a major challenge in service delivery. Teams were often said to feel under-resourced, with staff working to full capacity, and balancing the different demands of their job. The additional demands, related to patients affected by COVID-19, were seen as a compounding factor. Respondents highlighted the increasing need to respond to the psychological, as well as physical, needs of their patients.

7. Respondents highlighted variance in how services are delivered across the country. They also highlighted key challenges in service delivery related to resources (staff and non-staff), the availability and knowledge of local services, and the recognition and prioritisation of rehabilitation in service planning.

8. In relation to workforce issues, the survey highlighted ongoing challenges with staff recruitment and retention, with services often reported to be operating below their full complement. This was a particularly acute problem for services in rural areas. In addition, there was concern about staff workloads, staff morale and fatigue during the pandemic. Respondents thought that, going forward, further measures would be needed to protect staff health and wellbeing.

9. The survey responses described a highly skilled and committed workforce, but also identified a range of specific skills gaps. The survey also identified challenges in terms of achieving an appropriately skilled workforce – these included the cost and time implications of undertaking training and difficulties in undertaking supervision and on-the-job training alongside clinical duties.

10. In relation to patient health and wellbeing, a recurring theme in the survey responses was that, increasingly, patients were presenting to services with multiple and complex long-term conditions. Prior to the pandemic the ageing population was identified as a key factor in the deteriorating health and wellbeing of patients. Since the start of the pandemic, respondents noted additional concerns about the physical deterioration of different patient groups, and the impact that isolation (often linked to shielding) had had on mental wellbeing. It was noted that deteriorating physical and mental health in patient groups has led to increased demands on staff and services, and the type of services required – with respondents emphasising the need for holistic person-centred services that met the psychological and physical needs of patients.

The future of rehabilitation services

11. Overall, the survey responses suggested that the pandemic has not resulted in significant changes or new challenges for rehabilitation services, but rather the findings highlighted ongoing challenges and existing issues. Survey respondents saw a need for greater understanding and awareness of the role of AHPs and rehabilitation services and further strategic action at local and national level in order for rehabilitation services to meet the challenges ahead. More specifically, respondents called for:

• Greater recognition of the value of rehabilitation services in health and social care planning
• Improved leadership and communication – with more leadership roles for AHP and rehabilitation professionals and greater representation of AHP and rehabilitation services in strategic management
• Improved workforce planning (nationally and locally), and improved training and development opportunities
• Increased funding and resources for rehabilitation services
• Increased emphasis on multidisciplinary and joined up working
• Greater focus on preventative services
• Greater consistency and equity in service provision – including in community services
• Greater use of research, and evidence-based practice.