Delivery of rehabilitation services — an integrated hospital-community model

Abstract

The present models of delivery of rehabilitation services in the United Kingdom do not take into account the recent reorganization of the National Health Service (NHS) into purchaser and provider units, or the Community Care Act. Furthermore, these models are based almost entirely on hospital practice with minimal emphasis on long-term community support for the disabled.

An alternative model, which takes into account the recent changes in planning and resource allocation in the NHS, and the new role of local government in community care provision for people with disabilities, is proposed in this paper. The model also attempts to bridge the gap between hospital and community rehabilitation services. It is based on a philosophy of multidisciplinary team work, clients' autonomy and recognition of the contribution and needs of informal carers. It emphasises the importance of creating a partnership with local authorities and voluntary bodies which care for the disabled.

To ensure the continuity of rehabilitation care provision in the community, the model adopts a system of follow-up which is based on three levels of assessment of the needs of disabled clients living in the community. It is suggested that disabled clients with high care needs, e.g. disabled school leavers, are reviewed routinely by the rehabilitation physician. Subjects with mild or stable disability and adequate social support may only need to be reviewed on ad hoc basis, whilst those with intermediate needs could be monitored by a therapist by telephone or home visits.