We must do more to ensure no-one misses out on rehab

Professor Karen Middleton is Chief Executive of the Chartered Society of Physiotherapy. Karen is a Fellow of the Society of Orthopaedic Medicine, and, in that capacity, has taught physiotherapists and GPs on a national and international basis. Here she discusses the report Recovering after a hip fracture:
helping people understand physiotherapy in the NHS.

It’s the overwhelming feelings of regret and loss that get me. Every time. Whenever I hear a family member say they ‘can only wonder what might have been’ or a patient talking about what they can no longer do.

Whenever I see our Rehab Matters film I know that the fictional story it depicts is playing out in real life, behind closed doors, in homes across the country. It cuts deeply, as a physiotherapist, to hear these stories of how a lack of access to rehabilitation has changed a life.

It makes me burn at the injustice of so many people missing out. Because I know how access to high-quality rehabilitation can change a life for the better – how it can return a person to the things they love, and to the things they do with the people they love. How it can restore independence and a sense of self-worth. How it can restore a life; how it can save a life. The frustrating thing is that there is little new here – we’ve known for decades about the benefits of rehab, but also about the variations in how much and for how long patients can access it. We know, also, the economic case for rehabilitation in terms of reducing demand on health and social care services and supporting independent, active lives. It just doesn’t receive the attention it deserves on a national level or, in many cases, in local decision-making. It was a desire to address this disparity that drove the Chartered Society of Physiotherapy to commission the Royal College of Physicians to conduct the largest ever audit of hip fracture rehabilitation services in England and Wales.

The Hip Sprint started last May, capturing the experience of patients over a 120-day period after a hip fracture. It tracked their rehab in hospital, their return to a community setting and to their own home. By the end of the project, the CSP members in England and Wales had collected data on almost 6,000 patients’ experiences. In all, 580 physios took part and the data covered patients in 131 hospitals. The data represents 80 per cent of all hip fracture patients in England and Wales. So when we discuss the results of the audit, we are giving a comprehensive, authoritative picture of what is available to patients.

Firstly, it’s important to highlight the outstanding rehabilitation that is being delivered in many parts of the country. These are services providing intensive rehab that continues seamlessly post-discharge and gets people back to where they were before their accident, or as close as can be. These services are showing how it’s done. Elsewhere, the picture was stark.

Just one in five services (20.5 per cent) successfully maintained the continuity of their patients’ rehabilitation, which we know is crucial for their recovery. The average wait to see a physiotherapist after being discharged from hospital was 15 days, but for some patients it was up to 80 days. The amount of rehabilitation patients received varied greatly, with some patients getting less than one hour a week. There were worrying variations before discharge too. NICE guidelines state after surgery, hip fracture patients should be offered rehabilitation at least once a day. The audit revealed four out of ten (43 per cent) missed a day’s therapy due to no physios being available.

We are now working with patient groups and other professions to draw up best practice guidance for the rehabilitation of people with hip fracture in the UK. However, I’m anxious that we don’t just draw up yet another guideline that leads to yet another strategy that decision-makers are invited to implement at some unspecified time in the future. We need to set out exactly what people should expect to get after surgery. What they should demand to receive. We need to specify what this entails, how it will be accessed, where it will be delivered and by whom it will be delivered. We then need to go to the people power and demand implementation. We need to stop taking no for an answer and refuse to go away until we are sure that people will be getting the rehabilitation they deserve. For themselves, for the system and for the country. Too many people are missing out and righting this wrong is one of the pressing issues of our time.

It’s in our gift to turn things around and the hip sprint audit is an important landmark in that mission. But it will be a judgement on us all if in 10-20 years’ time, someone else is writing about families wondering ‘what might have been’.

Download the report Recovering after a hip fracture: helping people understand physiotherapy in the NHS.

One thought on “We must do more to ensure no-one misses out on rehab

  1. This is also occurring after a Total Hip Replacement. My father who is now 85 had a hip replacement in a large hospital in the South of England. They proposed to send him home after 3 days. He lives alone, there was no pre assessment done for his house and they expected him to cope. His condition was poor in hospital and they eventually diagnosed him with vascular dementia, which he showed no sign of before the op. I refused to let them discharge him as I knew he would be straight back in, as by now he was non compliant with using his crutches. So in retaliation all physio was stopped. He remained in hospital as they told me as a “bed Blocker” until he could be properly assessed. With the help of a hospital social worker we had him referred to a mental health rehab facility where he stayed for 7 weeks as it was over Christmas. He returned home with reablement, and has now been there for 2 years with care going in, with no problems. Without this rehab I have no doubt my father would have fallen at home and probably have died by now. Complaints by me to the hospital were answered but were unsatisfactory.

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