Let's get you home: Why we need a new approach to rehabilitation and recovery in our community hospitals

We want to improve the rehabilitation and recovery of people in our community hospitals, supporting them to regain their independence and live healthier lives for longer.

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Community rehab and recovery illustration

What we want to achieve

We want to improve our community hospital rehabilitation to make sure people can retain their independence and live healthier lives, for longer.

If people do need to go into hospital for treatment they should be empowered to get home faster and be able to reach their goals with less intervention.

If we get this right, we will have centres of excellence for rehabilitation, providing seven-day therapy which consistently delivers better outcomes and experience for the people we care for, rewarding careers for colleagues and a sustainable model for the future.

Why do we need to talk about this now?

The population of Kent is changing. We need to evolve and adapt our services so we can meet people’s needs both now and in the long term.

We know:

there are 1.6 million people living in Kent at the moment, but this number is expected to rise by a quarter by 2031
the number of people living with multiple and complex health conditions will rise by around 16 per cent by 2027
the number of people living with frailty* will increase by around 16 per cent by 2027.

What is frailty?

NHS England defines frailty as the group of older people who are at the highest risk of falls, disability, admission to hospital, or the need for long-term care. Frailty is linked to the ageing process and how our bodies gradually lose their in-built reserves, leaving us vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection, a change in medication or environment, or a fall.

Increasing numbers of people with frailty is putting a strain on NHS and social care resources.

Why are we talking rehabilitation, recovery and reablement?

When people go into hospital, we know too many of them stay there too long, which impacts their ability to regain their independence.

We also know that while many of the people we care for say they have a great experience in our hospitals, there is more we can do to maximise their recovery and achieve what's important to them.

We want to design a new way of delivering rehabilitation and reablement and we need your help to decide what that looks like.

What do we mean by recovery, rehabilitation and reablement?

Everyone who comes into our hospitals should be asked, 'what matters to you?'. This helps us tailor the care we give them to reach their goals. The infographic shows what can be covered by the terms recovery, rehabilitation and reablement, but in reality many of these activities will overlap with each other.

The important thing is that what matters most to people is placed at the heart of their care.

If we get that right, everything else will follow.

Finding out ‘what matters to you’

Putting the people we care for first means finding out what really matters to them and helping them to achieve it. What matters to one person, for example, being able to get out to see their local football team play, may not be important to someone else. Everyone will have different goals. The important thing is we have the conversation with the patient, their carers or loved ones and anyone else who is important to them. The more we involve family or carers the better the outcomes will be for patients.

I really want to be able to watch my football team again. I don’t care if I have to go in a wheelchair. I just want to get home so I can see them play this weekend."

I want to be able to get home and have a normal life. To go to my club again, see my friends. That’s what I want to do."

My family are keen to see progress and often visit more at weekends. They would be happy to take part and help me with my therapy sessions."

Which services are included in our plans?

Community rehab and recovery illustration

We have nine community or ‘cottage’ hospitals in Kent. Patients are admitted to our wards in the hospitals from all over Kent, the majority coming from larger acute hospitals

The wards provide care for people who need support to recover from illness or injury. They provide:

general rehabilitation, often for people who are frail and elderly
specialist rehabilitation, for example for people who have had a stroke or broken hips.

All of our hospitals offer other services as outpatient clinics, or act as bases for our community nursing or therapy teams. These services are not included in this review.

End-of-life care is also not part of this review.

Why do we think things need to change?

At any one time, three in 10 people in our community hospital beds are fit and well enough to go home, if the right care and support was available for them – or if we could maximise their independence to reduce the care they need at home.

People receive different care and outcomes across our hospitals, for example:

The average length of stay varies; the lowest is 23 days and the highest is 36 days.
Not all our hospitals offer seven-day therapy
The percentage of patients who are still in hospital despite being well enough to go home also varies between 10 per cent and 37 per cent.
The people we care for do not always have consistent access to the full range of specialist services, which can slow down their recovery. Some sites have on-site therapy teams, others have visiting community therapy teams.
Some of our buildings are outdated and do not always help us to offer effective rehabilitation, for example, ward gyms or day rooms are cramped and under used.

The most up-to-date research says people should play a more active role in their recovery. The way we deliver rehabilitation now in our community hospitals is not based on emerging best practice, so people do not recover as quickly as they could.

Many people stay too long in a hospital bed, losing muscle and strength, when they would recover better at home
Teams across health and social care need to work better together so we don’t duplicate and slow down access to the care people need.

Providing more rewarding careers

Community rehab and recovery illustration

There are national workforce shortages and we often struggle to recruit qualified staff. Ten per cent of nursing and support staff will reach retirement age in the next five years.

We are growing our own workforce, but this takes time and we want to offer our colleagues the opportunity to progress into more senior or specialist clinical roles.

Our vision is nurses, pharmacists, physiotherapists, occupational therapists, speech and language therapists, dietitians and doctors working together in a seamless way to provide the best possible care

Our ambition

for people we care for…
better outcomes and experience in centres of excellence for rehabilitation, recovery and reablement, which support them to return home, no matter where they live in Kent.

for colleagues…
rewarding careers and development, delivering evidenced-based care and the best patient outcomes.

for the future…
a sustainable rehabilitation, recovery and reablement service for the NHS and social care to support communities in the future.

What the experts say

“Recovery shouldn’t mean being tucked up in bed”

KCHFT Chief Nurse Dr Mercia Spare

“We know too often people end up in a hospital bed when they don’t need to be – or stay there too long – which can impact their ability to regain their independence.

“Our community hospitals do an amazing job of caring for people, but we need to modernise our approach, focus on what really matters to our patients and make sure everybody has the same chance to live an independent life.

“People shouldn’t think about recovering tucked up in bed. You will recover much quicker if you are up, dressed and moving about and also, much quicker if you are at home, in a familiar environment – which is where we know people want to be.”

“More joined-up working is vital”

Barbara Rickman, Assistant Director for Enablement and Support Services at Kent County Council

“More joined-up working between health and social care is vital. Social care is there to support people to stay out of hospital, but also if they’ve been in hospital we can support them to go home safely by assessing their long-term plans and care needs.

“The voluntary sector is also vitally important, along with our developing micro enterprises, which can support people with shopping, hobbies or just meeting people and staying connected within their communities when they get home from hospital. All of these contribute to keeping people active and independent for as long as possible."

“We want to help people get their independence back”

Rachel Dalton, KCHFT’s new Chief Allied Health Professions Officer

“We need to develop centres of excellence for rehabilitation that consistently help people get their independence back as well as providing rewarding careers that attract and retain colleagues as a sustainable model for the future.

“By testing this approach first, we will be able to see if it truly works for patients and carers, improves the flow through our acute and community hospitals, and gets people back home sooner, feeling more confident and needing less support to get back to their living their life.”

Your experience can help us

Have you or someone you care for had care in our community hospitals in the past two years? We’re looking for people to be part of our patient experience group, which will help us to better understand how we can support effective rehabilitation and recovery in on our community hospitals. Please email kentchft.engagement@nhs.net to express your interest and find out more.

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