Is rehabilitation a solution to hospital discharge delays?
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2343 (Published 11 October 2023) Cite this as: BMJ 2023;383:p2343
- Justine Gosling,
- Satish Mishra, technical officers
- Corresponding author: GoslingJ{at}who.int
Recent data from NHS England show that inadequate access to rehabilitation is delaying medically fit patients from being discharged from hospital.1 These patients continue to occupy much needed beds, putting more pressure on an already stretched health system. Access to high quality and timely multi-professional rehabilitation services can serve as a cost effective intervention that should be available to all, to support the efficiency of the hospital discharge system and help patient recovery.
Every day in August 2023 more than 2100 hospital beds in England were taken up unnecessarily by patients who were medically fit for discharge but couldn’t be released because of unmet rehabilitation needs.1 These unmet needs include patients waiting for community equipment, assistive technologies, adaptations to housing, or a decision from a therapist. Many were awaiting the availability of a rehabilitation bed in a community hospital or other setting.
The rehabilitation and support services that patients need to support their recovery and functioning are lacking, meaning that many can’t be safely discharged from hospital. These delays cause bottlenecks in the hospital system and tie up resources and staff. They also affect patients who may be anxious to return to their familiar surroundings and comforts, as well as their loved ones, who may be travelling far to visit the patient in hospital and taking time away from work or care duties to do so.
Benefits and cost savings
The benefits of having access to high quality and timely rehabilitation services are widespread and cost efficient for patients, hospitals, and the wider health and social care system. Rehabilitation can reduce the time spent in hospital,2 optimise intervention outcomes, prevent hospital admissions and readmissions, and reduce the risks of further complications.
Rehabilitation can also enhance quality of life by improving physical, mental, cognitive, and social functioning that may have become impaired by ageing or a health condition such as chronic disease, severe illness, or injury.3 Rehabilitation and assistive technologies can help people perform essential everyday tasks such as self-care, communication, or mobility. People with better function can more fully participate in everyday life. Thus, rehabilitation can cut the costs of ongoing care and support people’s participation in education, employment, and community life.2 It’s a wise investment and may be needed by anyone, regardless of age, gender, or socioeconomic status.
Rehabilitation services are typically delivered by professionals from a range of disciplines, including occupational therapists, physiotherapists, prosthetists and orthotists, and speech and language therapists.4 But even within hospital settings, managers and other healthcare professionals who work alongside rehabilitation professionals on the wards may have little understanding of what they do and the essential service they provide. Hence, many referrals are late, poorly communicated, or inappropriate, leading to delays in patients receiving rehabilitation services.
Often, a patient’s rehabilitation journey starts in hospital after severe injury or illness. It aids their medical recovery, facilitates mobility, socialisation, and functioning, and builds their independence and the confidence to manage their condition. Access to early, interdisciplinary rehabilitation, personalised to the patient, must continue for as long as needed, including after discharge in the community.
Population and demand
There’s a significant and increasing demand for rehabilitation services in the UK given its growing and ageing population, compounded by the rise of multimorbidity and non-communicable diseases. Evidence based on the Global Burden of Diseases study, presented publicly in raw data form in the World Health Organization’s European Health Information Gateway,5 shows that in 2019 more than two in five people in the UK population had a condition that could benefit from rehabilitation, including musculoskeletal and neurological disorders.6 These data from 2019 don’t account for the new rehabilitation needs and long term disabilities arising from covid-19 infection. A significant number of people are living with disabling symptoms and functional deficits—such as breathlessness, communication and cognitive challenges, and fatigue—that are amenable to rehabilitation.7
Rehabilitation services are under-resourced to meet current and future demand, with significant workforce shortages in many of the professions that are integral to delivering rehabilitation. It’s estimated that education and training places for the allied health professions will need to grow by as much as 25% by 2030-31 to meet demand.8 To meet this demand in the UK a further 71 000 allied health professionals will be required in the NHS. Recruitment drives need to raise awareness and respect for these professions: flexible roles, diverse leadership, and development opportunities should be accessible, and professionals need to be compensated fairly for their work.
The first ever resolution on rehabilitation was adopted at the 2023 World Health Assembly, WHO’s global decision making body. The resolution calls on governments to expand and integrate rehabilitation in health systems as part of universal health coverage, emphasising the importance of rehabilitation in primary and social care and as part of emergency preparedness and response. Taking heed, UK rehabilitation services and the workforce need to be expanded to meet the population’s needs.
By improving access to high quality rehabilitation, hospital discharges can be expedited and readmissions avoided. On this basis alone, rehabilitation is a worthy investment and should be prioritised to support hospitals and patient flow, particularly with the added seasonal pressures of winter approaching. It’s essential that rehabilitation services are fully staffed and resourced, with strong professional leadership, so that everyone who needs rehabilitation can get it when they need it.
Improving rehabilitation is a cost effective strategy to support hospital discharges and ease pressure on the system. This evidence should galvanise policy makers and commissioners in the UK to ensure access to high quality rehabilitation for those who need it.
Footnotes
The authors would like to acknowledge and thank the following for their contribution to this article: Steve Ford, chief executive of the Royal College of Occupational Therapists; Steve Jamieson, chief executive of the Royal College of Speech and Language Therapists; Ruth Ten Hove, director of practice and development at the Chartered Society of Physiotherapy; and Nicola Eddison, vice chair of the British Association of Prosthetists and Orthotists.
Competing interests: The authors declare no competing interests.
Provenance and peer review: Not commissioned, not externally peer reviewed.