Coronavirus – Impact on Rehabilitation
How can international businesses with interests in the UK economy can emerge from the coronavirus crisis?
Impact on Rehabilitation
A briefing from our UK rehabilitation experts
We look at how rehabilitation service providers have had to adapt to new ways of working
The coronavirus crisis, and associated lockdown measures, has severely limited the amount of face-to-face contact that rehabilitation service providers can have with their clients.
As a result, service providers have had to innovate and make major adjustments to their working practices to make sure those needing support still receive it. So how have they done it? How have they continued to work alongside their partner organisations? And which of the changes do they hope to retain post-lockdown?
We brought together experts from across rehabilitation services both in the statutory and the private sector to share their experiences of how the pandemic has affected the provision of their services, and what they think the long-term impact will be.
The panel discussed:
- Virtual assessments for clients and service users
- The NHS response
- The future.
personal injury partner, Irwin Mitchell
- Jackie Dean, clinical director, N-Able Services Ltd
- Toby Carlsson, owner, Pace Rehabilitation Ltd
- Sarah Ambe, complex care manager, Newcross Healthcare
- Susan Pattison, clinical lead and director, SP Therapy Services
- Angela Kerr, managing director, AKA Case Management, Chair of BABICM & Chair of IRCM
- Nicola Irwin, managing director, Harrison Associates
- Lisa Brown, director, Coastal Case Management
- Matthew Hughes, managing director, Dorset Orthopaedics
- Dr Ganesh Bavikatte, consultant and clinical lead in rehabilitation medicine, The Walton Centre.
- Dr Vinay Parambil, speciality trainee (ST4) northwest deanery, The Floyd Unit, Rochdale
- Lauren Walker, professional adviser, Royal College of Occupational Therapists
- Amy Dooley, care & rehabilitation expert witness/case manager.
Representing Irwin Mitchell
- Hilary Wetherell,
- Mathieu Culverhouse, public law partner
- Claire Howard, personal injury partner.
What's UK Powerhouse?
UK Powerhouse is our quarterly economic briefing looking at regional growth around the United Kingdom. Published in partnership with economic think tank Cebr, it's built around a city tracker ranking that helps you spot investment opportunities, or scout new areas for expansion.
Each briefing centres around a specific sector or theme. Our latest edition delves into the effects of coronavirus on different industry sectors, and how different UK regions are coping.
This whitepaper forms part of a series of roundtable events in response to our UK Powerhouse findings. The series covers the following sectors:
- Supply chain and logistics (including manufacturing and consumer)
Find out more about UK Powerhouse
We pick out the pieces of information you need to know
Panel experts were asked to complete a short survey before the roundtable to provide an overview on how coronavirus has affected their industry.
Here's the results:
How the switch to remote working has impacted rehabilitation services for clients and service users
Virtual Assessments of Clients and Service Users
In the UK, the internet is used by 90% of adults and 99% of 16 – 34-year-olds, according to ONS figures for 2018.
Knowing so many people were able to chat online and use technology allowed rehabilitation services to offer virtual sessions within weeks of lockdown starting. This has created some incredible success stories and valuable learning experiences along the way.
Software and applications have been used for a wide range of assessments, meetings and therapy sessions. Learning to use new software and apps can form the basis of SMART rehabilitation goals for clients who were not previously familiar with them. Using software designed with accessibility in mind has meant that clients have been able to participate in discussions and contribute to goal setting meetings as well as receive direct therapy intervention.
Benefits for clients
With the knowledge of how much their everyday lives have been affected by lockdown measures, clients have been largely receptive to changes but care has had to be taken not to assume that virtual provision will be positively received.
Young, tech-savvy clients have shown considerable enthusiasm for and interest in virtual sessions. This is the generation that has been 'brought up' online.
Clients and providers who live and work in rural areas have welcomed this new way of providing services. Communication has increased as a reduction in travel time frees up capacity of service providers – leaving clients feeling more connected.
This has also been welcomed by clients and their families who don’t wish to travel or who find having people in their own home difficult to manage. This group has felt more relaxed and been able to engage in remote therapy as a result.
For some clients, online sessions can work very very well. They tend to be the ones who embrace technology – particularly some of the younger brain-injured patients can respond well to this kind of treatment.
Managing Director, Harrison Associates.
Businesses across all sectors and industries have been forced to reconsider how they work and how they communicate internally and externally. As predicted there’s been a move towards using web tools – with tech giant Microsoft reporting an increase of 12 million users in a single week early on in lockdown.
Providing physical rehabilitation services presents challenges under lockdown conditions. Delivering services either in the client’s house, in a rehabilitation care unit or hospital presents opportunities for the virus to spread – whether on surfaces or through contact between patients and therapists. As a result, many have either adopted virtual assessments or had to substantially change how they deliver services.
Our capacity to see patients on site has reduced as we have to make sure rooms are cleaned down and there’s no overlap of patients. We have to consider the number of staff on site to allow for social distancing.
managing director, Dorset Orthopaedics
Carrying out virtual assessments and sessions saves on travel time for therapists. This time is then being put to better use by carrying out more assessments and engaging with more patients.
It’s also made service providers think more holistically about how they work. Virtual assessment and discussions allow more time to be spent getting a thorough understanding of client requirements. Rather than a single therapist completing a standalone assessment, specialists from other disciplines or organisations are being brought into the virtual discussion much earlier so that all issues are identified at an early stage. Provision of service can therefore commence sooner than otherwise might be the case.
Providers have also looked at how their rehabilitation sessions are delivered. Shorter online sessions have received positive feedback from patients. Case manager Angel Kerr said that running 10, 20 or 30 minute long sessions, ‘bitesize pieces’ can overcome some of the cognitive drain seen in hour-long sessions for someone recovering from brain injury.
“Being behind a screen and being able to step away has empowered patients and support workers to step up and take more ownership.” Susan Pattison, clinical lead and director, SP Therapy Services.
Despite a number of positive experiences, virtual assessments and rehabilitation sessions aren’t right for everyone, and haven’t become the only delivery method. Some providers still have commitments to physical assessments, and sometimes physical intervention is needed.
“There's no escaping the fact you need to be hands on with people to see what their body can do, what prosthetics they have, and how they’re using them.” Matthew Hughes, managing director, Dorset Orthopaedics.
One panel member shared a story of a patient who wasn’t able to get out of bed. After a home visit from an occupational therapist, she was sitting in her conservatory. This wouldn’t have been possible through remote means, so consideration must always be given to what is appropriate for that individual client. The focus on person centred services must be maintained.
Some patients are also reluctant or nervous about using technology. Very careful consideration has to be given to using technology to deliver services to any client who is particularly vulnerable. Capacity of clients to consent to exchange of information and delivery of service via remote means must also be considered. Care must be taken to ensure that there's no assumption made about a client’s willingness to engage with technology.
Another key benefit of the traditional face-to-face service, noted by our expert panel, is that it’s easier to identify potential safeguarding issues and vulnerabilities. Spider senses don't tingle in quite the same way over a virtual platform. Without being able to go into the client’s home, there's a risk that key issues or influences may be missed and wellbeing taken quite literally at face value.
Clients may paint a good picture, but you can’t see what’s being hidden when you’re not there. Sometimes you feel that things aren’t ringing true. You’ll not get that feeling if you’re not in the environment.
managing director, AKA Case Management, chair of BABICM & chair of IRCM
The Response from Statutory Services
How have services reacted?
The Response from Statutory Services
Perhaps the biggest change for all providers has been the way in which statutory providers and the NHS have stepped up and embraced technology and virtual platforms. They're both delivering services using these methods, but also communicating with each other and outside agencies. Multi-disciplinary teams (MDT's) are taking place promptly and decision making and follow up is easier to track via virtual calls and updates.
The NHS has adapted well to adopting technology and has made a big leap which would have otherwise taken significantly longer. Technology is here to stay but we now need to work out the best way to use it for the optimal benefits of patient care.
Dr Ganesh Bavikatte
consultant and clinical lead in rehabilitation medicine, The Walton Centre
The historically poor levels of interagency working and communications have been seen to improve, although this hasn’t been the case across all areas of the country. However new technologies have been adopted promptly to enable services to continue. Statutory teams have been keen to learn from and work with their private counterparts to ensure a person centred approach.
There's been some experience of early discharge before patients have reached their full potential – this was inevitable in view of the need to free up beds in hospitals. It's essential that those early discharges are tracked and contact with them is maintained to ensure that they can continue to receive their rehabilitation. There are many reported incidents of those with life changing injuries or conditions being discharged to care homes where there's been little or no focus on rehabilitation. The duty of care owed by those in statutory services hasn't changed during lockdown.
“It’s always – even at the best of times – been hard for clients to access social care due to the pressure on resources for the last ten years. It doesn’t seem likely that there’ll be a huge change.” Mathieu Culverhouse, partner, Irwin Mitchell.
Within the major trauma centres, The Rehab Prescription should be able to be completed fully and given more prominence in the patient’s onward rehabilitation journey. This will be even more valuable if all members of an MDT can contribute to it promptly via remote means. This remains a valuable tool for patients and families as well as service providers outside the statutory sector. But use of it varies widely across the country.
“We've championed early intervention of rehab services for our clients for many years. It's been brilliant to see and hear how the providers of those services have adapted and innovated during the last few difficult months to ensure that those who need this crucial support can still access it. There've been numerous success stories of effective collaboration and teamwork, and we really hope that the benefits of these changes will persist for years to come. Rehab services need to be bespoke, client centred and holistic; care must be taken not to undervalue the input required simply because it can be delivered via remote means”. Hilary Wetherell, partner, Irwin Mitchell.
How the industry is using e-learning
A good portion of training and learning was already being provided online prior to the pandemic, but all of our panel members have seen a significant increase in available e-learning since late March. A wide variety of platforms and applications have been used as well as webinars, podcasts and YouTube videos.
“Virtual collaboration is really valuable. We now have referrers and specialists in the room with us at the drop of a hat rather than in three weeks when the diaries could work out. The training opportunities and webinars are so accessible and are very good.” Toby Carlsson, owner, Pace Rehabilitation Ltd.
With therapists being home based, rather than out on the road, it’s easier to bring them together. One panel member talked about how they’d obtained consent to video a specific type of specialist care being provided to a client, and using this as part of distanced training. This has the added benefit that it can be paused and discussed if queries are raised and kept for future training. It also serves as a valuable record to monitor changes if needed.
But not all panel members have found it easy to deliver training sessions remotely. There's sometimes no substitute for being physically present and everyone misses the social and networking aspects of face-to-face training sessions.
There's no doubt however, that there's a growing and extremely valuable bank of online training material available for everyone to access. As communication channels have developed, it’s become easier to work with external training providers.
Newcross very quickly moved to training online, even Basic Life Support is done via an app, although things like MAPA/Positive Behaviour Management is more challenging whilst not being able to run face-to-face training.
complex care manager, Newcross Healthcare
The pandemic has raised extremely challenging issues but also created positive opportunities for change
With all of the changes being introduced during lockdown, it will be interesting to see what becomes part of the ‘new normal’ and what changes are moved back to more traditional ways of working.
“Whilst virtual assessments have clear benefits for both clients and therapists, the importance that face-to-face contact has on rehabilitation can't be replaced. Assessing someone online is like assessing through a keyhole, you only get to see a small section of what's going on, you can’t see the individual in their wider environment which may be essential. A concern is that virtual assessments will be seen as a cheaper more efficient alternative, but face-to-face is essential and the client should always be given a choice.” Claire Howard, partner, Irwin Mitchell.
With more of us working from home than ever before, it’s likely that remote working will become part of a normal way of working.
Many businesses are seeing opportunities to save money on office space and bases. In May 2020 the BBC reported that businessman Sir Martin Sorrell had said that he’d prefer to invest the £35 million he spends on offices on people.
Within the care sector, where the aim isn’t necessarily to save money but to circumvent concerns about transmission of coronavirus, a new hybrid model of delivery could be introduced. This would see patients receive remote support unless they require a physical assessment.
“It will be interesting moving forwards to see if the success rate of remote working during lockdown sustains, and how it fits into the real world. That will be the real question for me.” Susan Pattison, clinical lead and director, SP Therapy Services.
The concern for the social care sector is how they can manage their spaces and the spaces they visit to make sure everyone is safe. Where protocols have been brought in to mitigate the possibility of transmission there’s been an impact on capacity.
Private rehabilitation providers all shared a note of caution about the absence of social contact for their employees and the social benefits of being office based. As employers, they were all concerned about the risks of isolation, particularly for those who were new to their role.
The big concern is that we don’t see the future clearly yet. For independent businesses like Pace, it's been a big disruption commercially and we have yet to see the full fallout. Thankfully, I do believe that even in six months, we'll have adjusted to the new normal and look back at this period (which is now hopefully nearing the end) and it will feel like a weird and distant dream.
owner, Pace Rehabilitation Ltd
Delivering sessions remotely and being able to reduce or completely abandon travel expenses could lead to insurers pushing remote therapy as a way to cut costs in litigated cases. It has to be right for the client and the decision cannot and should not be influenced by whether the client is involved in litigation or not.
“I'm concerned about therapy being described as cheaper. Remote therapy has become a method of improving the service we already provide.” Susan Pattison, clinical lead and director, SP Therapy Services.
There’s been a lot more family education taking place under lockdown, aiming to get family members involved in the care of the patient. While this has been positive given the restrictions on people’s movement, it’s not clear what's going to happen when these people return to work. It's crucially important that this isn’t used as a reason to withdraw professional care and support or as justification for denying access to professional input in the future. It’s also important to bear in mind the impact that this involvement can have on relationships and roles within a family.
“The current crisis is having a profound impact on children and adults with complex health and social care needs. Many will be reliant on carers and support workers, who may have to self-isolate. Some children and adults with complex health needs will be classed as vulnerable to COVID-19 meaning that they must stay at home for at least 12 weeks, avoiding all non-essential face-to-face contact.
These individuals may wish to change their care provision in order to minimise the number of carers coming in and out of their home, if this is possible. As a solution to these challenges is for ‘direct payments’ to be used to allow family members to be paid to provide care. This has been a welcomed change to families in this position.”
Lisa Brown, director, Coastal Case Management.
Although our ability to travel has been restricted, modern technologies allow us to communicate with more or less anyone in the world in an instant.
Lockdown has forced us to think about how we communicate with our colleagues, partners and clients, and the use of these technologies has been central to overcoming challenges. But we’ve only just started to explore their capabilities and we mustn’t see technology as the 'easy option' for delivery of person centred care and therapy.
But is technology all that it should be - just because we can do something digitally, should we be doing it? Or should more research be completed as to the outcomes?
Technology could be greater used to learn what organisations in other countries are doing, particularly in the United States.
“We need to link with our international partners, and learn from them, especially with America. There's a great opportunity to say show us what you're doing. It's making rehabilitation more universal across the world which is quite exciting.” Angela Kerr, managing director, AKA Case Management, chair of BABICM & chair of IRCM.
“COVID and the chaos it has caused has to go! We don't want to choose between saving lives and providing quality of life. The collaborative work between sectors and services, and using technology alongside what we had in the best interest of patient care can stay.” Dr Ganesh Bavikatte, consultant and clinical lead in rehabilitation medicine, The Walton Centre.
We need to make sure there's evidence around the outcomes especially for digital rehabilitation. Royal College of Occupational Therapist members are looking at evidence around this and are learning from other countries.
professional adviser, Royal College of Occupational Therapists
Mental Health and Being Kind
With isolation and anxiety pressures surrounding the crisis, we look at the importance of mental health
Mental Health and
Throughout our debate, we returned to the theme of the mental health impact of lockdown. Everyone acknowledged that it's been a huge challenge, both personally and professionally. People have been surprised by their own reactions to the situation. The need to look out for each other as professionals as well as for our clients, patients and their families has added to the burden of an isolated working life. Having to balance homeschooling, other caring responsibilities and family life has made for an incredibly difficult few months.
There was universal acknowledgement of the need for the kindness, patience and tolerance shown to each other to continue.
“I hope that the kindness continues. I think this collaboration and the support that we’re offering each other will continue. We don’t need Covid to be going through a rough time or to be struggling and we need to be thinking of that.” Amy Dooley, care & rehabilitation expert witness/case manager.
Supporting You Through COVID-19
We share the latest legal updates to help you and your business in these unprecedented times
Supporting You Through COVID-19
We’re keeping up-to-date with the changes the UK government is making and how they could affect you.
From employment concerns to family law matters, get all the latest updates on our coronavirus hub or sign up to one of our webinars.
Visit the hub
What Else Can We Help You With?
Find out about our other services for you and your business
What Else Can We Help You With?
Whether it’s business or personal we understand that everyone’s situation is different.
If you need legal advice or support with financial planning, we’re here to offer an expert hand with a human touch, so you’re able to focus on what really matters.
We’re here to help you with:
* Financial planning and wealth management services are provided by IM Asset Management Limited which is authorised and regulated by the Financial Conduct Authority. Its Financial Services Register Firm Reference Number is 402770.