Rehabilitation and recovery: a person-centred approach

7. The Six Principles of Good Rehabilitation

The Six Principles of Good Rehabilitation were developed in partnership with key stakeholders such as NHS Boards, Health and Social Care Partnerships (HSCPs), leisure, third and independent sectors, and the NABR and sit at the core of the rehabilitation approach. They provide a standard for rehabilitation services in Scotland and should be used as a benchmarking tool.

The Six Principles of Good Rehabilitation set out what is required to deliver holistic, flexible and person-centred rehabilitation to all. Each principle can be applied across all types of rehabilitation as well as all health conditions or circumstances for which an individual may require rehabilitation.

Rehabilitation services are encouraged to use these Six Principles of Good Rehabilitation to identify opportunities to test and scale up improvements at a local level.

The Six Principles of Good Rehabilitation are:

1. Easy to access for every individual

2. Provided at the right time

3. Realistic and meaningful to the individual

4. Integrated

5. Innovative and ambitious

6. Delivered by a flexible and skilled workforce

Easy to access for every individual

What does this mean?

• Every individual has good rehabilitation accessible and available to them at the point of need.
• Individuals know how and where to access the support they need using single points of access where possible.
• Individuals can expect to access services in a format that is accessible to them and addresses any potential barriers to access.
• Accessing services should be straight forward, avoiding multiple stages and always progressing. Individuals should not experience barriers to accessing a service nor should they have to start again with a new request/referral.
• Services must be as easy to find and use as possible - recognising that individuals have different levels of understanding of health services. This will ensure access is equitable.

Provided at the right time

What does this mean?

• The 'right' time is different for every individual.
• Rehabilitation should be considered at the earliest opportunity in order to prevent the need for more intensive interventions later on.
• Earlier intervention acts as a preventative measure and, in line with what we know about the LifeCurve^TM,^[5] can help to reduce further deterioration.
• Timely access to the appropriate information, professionals and services including prehabilitation can improve outcomes.
• A dynamic and pro-active approach to self-management and intervention at all levels can ensure waits are minimised and outcomes optimised.
• Rehabilitation and prehabilitation are considered as part of planned treatment pathways to support people to "wait well".
• The contribution of non-NHS and self-directed rehabilitation resources for individuals is recognised e.g. third sector and digital resources.

Realistic and meaningful to the individual

What does this mean?

• Inclusive communication approaches should be used to facilitate shared decision making.
• Individuals should agree the outcomes they want to achieve in dialogue with the relevant rehabilitation professional through shared decision making.
• Individuals who require rehabilitation will be supported to understand the care, treatment and support options available and the risks, benefits and consequences.
• Rehabilitation should be based on evidence, good quality information and the individual's personal preferences, including involving their family/carers where appropriate.
• Consideration of the social determinants of health should be prioritised as a basis for establishing a personalised approach to rehabilitation.

Integrated

What does this mean?

• Good rehabilitation spans healthcare, social care, leisure, housing, education, third and independent sectors.
• Personalised rehabilitation should be provided across services, sectors and agencies rather than individuals slotting into existing services.
• Individuals should access the best support, care and equipment for their needs. This may be provided outside of NHS services.
• Individuals' needs are communicated from profession to profession and across sectors, while keeping them at the centre.

Innovative and ambitious

What does this mean?

• Moving away from linear access to pathway(s) to the provision of individualised and tailored responses, based on a person-centred assessment of need.
• Rehabilitation is outcomes focused and takes into account what matters to the individual. This may require a coordinated response from across a number of services.
• The interventions offered should be tailored to the individual's needs and at the appropriate level, thinking creatively about how best to meet individual outcomes.
• A range of interventions should be available and accessible from across traditional and non-traditional rehabilitation services at the intensity and frequency required to meet individuals' needs.
• Self-management resources should be prioritised where appropriate.
• Geography and population demographics should be considered to determine new or improved services. For example, user-led design to consider what people need.
• Consideration should be given to individuals that face barriers to digital access.
• Build research capacity and expand the availability of robust evidence for rehabilitation.

Delivered by a flexible and skilled workforce

What does this mean?

• The rehabilitation workforce is comprised of staff delivering rehabilitation across all sectors and includes non-registered staff such as carers, sports/leisure staff and social care staff.
• It includes workforce at all levels from support worker to advanced practice.
• A culture of flexible and adaptive working exists where staff are able to gain a wide range of core rehabilitation skills across their career.
• A sustainable and skilled workforce with attractive career choices and fair work where all are respected and valued for the work they do, in line with the National Workforce Strategy for Health and Social Care in Scotland.^[6]