Making intensive rehabilitation available to all

Traveling by plane was once a luxury only few people could afford. Advances of technology and efficient operation over the last fifty years have meant masses can now do so. Similarly, only thirty years ago expensive MRI scans were reserved for limited patients despite its effectiveness, and it took a decade to make this affordable and available to all.

We are now going to do the same for Rehabilitation – making available intensive therapy programs that are currently only reserved for limited patients with severe neurological conditions like extensive stroke or brain injury or trauma.

We know these programmes are effective and life changing. The Northern European model has taught us we can reduce the cost of three hours daily therapies through the use of technology, large-scale purpose-built centres and new processes.

The time where patients were parked on hospital beds receiving 15 minutes of therapy per day is soon to be over. Patients deserve to become as independent as they can so they can return to home and work. They deserve to be looked after by doctors working in multidisciplinary teams of therapists, addressing all medical, psychological and social care needs, in facilities similar to Northern Europe.

Massoud Fouladi, Group Medical Director

This new model of rehabilitation covers all models including step down, step up, reablement but using a programme of care that has only been accessible to limited patients in the UK.    

With Circle Rehabilitation Birmingham on the horizon, we are now moving at pace towards achieving our vision of building more facilities across the UK within the next five years and proving the benefits of large-scale, intensive rehabilitation care.

Our Reading facility provides the perfect incubator to develop this new model of care which we plan to roll out across the UK within the next five years, and we will soon transfer these learnings to Circle Rehabilitation Birmingham, due to open in 2019.

Offering 120 MSK, Cardiac and Neurological rehabilitation beds for varying levels of acuity, along with 20 day-case beds and outpatient facilities, large therapy areas and state of the art equipment, this will be our first opportunity to translate the Northern European model into the UK environment at true scale, and bridge the gap between hospital and Care at Home.

Patients will come as self-payors from Circle Birmingham hospital, CCG-funded patients (higher acuity neurological), and NHS-funded patients from local Trusts, or as ‘step-up’ patients from the community (avoiding need for admission to acute).

The benefits of scale and a purpose-built facility are clear.

A purpose built-facility allows for operational and clinical efficiencies, and the creation of an ethos and culture of active rehabilitation and well-being. This is rock and roll rehab with up to three hours intensive therapy every day.

Scale allows for the consolidation of full multi-disciplinary teams including consultants, GPs, nurses and nursing assistants, physiotherapists and rehab assistants, psychologists, dieticians, OTs and speech and language therapists.

This means patients with comorbidities and varying levels of acuity can be taken – reducing both barriers to entry to rehabilitation facilities which many Trusts face for example (in terms of supply and facilities which acute clinicians will trust to discharge to), and reducing the need for readmissions to acute.

Scale also allows a step-down model of rehab provision within one place. We can offer acute rehab beds, general rehab beds, recovery and remobilisation beds, as well as day-case and outpatients – all within the same facility. This is much more efficient, and convenient for the patient not having to transfer, nor suffer from delays nor loss of care between transitions.

Scale and new models for staffing and operation also allow for cheaper bed night prices than acute or other specialised rehab facilities, while at the same time providing a better environment for recovery and achievement of rehabilitation goals.

Along with significant cost savings and smoother integration between different parts of the pathway, this model will help ease other challenges within local health care economies.

DTOCs within the NHS remain a huge challenge with more than 2m bed days lost in 2016/17. These acute hospitals are running hot, with bed occupancy above the recommended maximum of 85% since 2012/13, and hitting the highest ever at 91.4% in Jan – Mar 17.  Waiting time and four-hour emergency access target failures also reflect that these severe pressures are now all year long.

Acute beds have reduced by half in the past 30 years, with the NHS currently trying to find 3000 extra beds just to cope this winter. England has the least beds for their population compared with any other country in the European Union – 2.3 per 1,000 people, compared with an EU average of 3.7 – and the estate that is there isn’t in great shape.

Meanwhile, the Nuffield Trust estimates a further 12000 to 17000 beds will be required by 2020 – not even accounting for demographic changes such as a growing aging population – and plans for where these beds will come from are few. There also remains a large shortage of intermediate care beds.

Large-scale rehab facilities offer one solution to help meet these challenges. By getting patients out of acute setting earlier, and putting them in an environment where they are more likely to achieve higher functional  outcomes and require less care downstream, the entire health system can benefit from savings, improved flow and better patient outcomes.  We know that most patients who remain in acute setting too long or go direct to nursing homes tend to immobilise and not return to full independence at home. We want to change that – and offer a cost-effective alternative which will produce better outcomes.

We are looking forward to bringing this vision to life as the planning for Birmingham ramps up. Any suggestions or feedback are more than welcomed!

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