Healthwatch Norfolk has made a series of recommendations following a review of the Norfolk Community Health and Care Trust’s (NCH&C) inpatient general rehabilitation service.
Inpatient rehabilitation provides a tailored environment in which patients can rebuild strength and mobility following a stay in hospital. Patients are often transferred from acute hospitals following falls, orthopaedic procedures, or a medical condition. They will commonly be experiencing reduced mobility, balance difficulties, or declining strength. Rehabilitation units act as a bridge between acute hospital care and the home when returning home is not immediately possible, helping patients regain their mobility and enable ongoing recovery.
NCH&C requested a review of this service and detailed insight into the experiences of rehabilitation, discharge, and post-discharge care.
As part of the project, Healthwatch Norfolk explored the full rehabilitation journey, from admission to discharge, with a focus on four key areas: acute hospital communication about the rehabilitation journey, the ward environment, the quality of care and therapy and discharge and post-discharge care.
What did we find?
One of the key findings revealed that communication in acute hospital settings about rehabilitation care was often limited, with stress, pain, or fatigue sometimes hindering patient understanding. With staff trying to balance patient-centred care with workplace pressures, the process was often seen as unclear or inflexible, potentially leading to anxiety for patients or unrealistic expectations of their recovery journey.
When it came to the ward environment, opinions were generally positive and staff were praised for their warmth, attentiveness, and professionalism. Many remarked that the wards were clean and comfortable, with plenty of equipment to support their needs. Most patients also felt their personal care was good, noting that staff respected their privacy and dignity and encouraged them to do what they could for themselves to increase independence.
However, staff support was sometimes considered inconsistent, with areas like the regularity of therapy sessions, responses to call bells and help at meal times not meeting expectations. This points to a deeper issue regarding workforce pressures, which pose challenges to the staff’s ability to sustain care levels, despite that support being highly valued by patients.
Experiences of the discharge process varied widely, with some patients receiving notice of their discharge plan early and others only receiving guidance shortly before returning home. Physical and emotional readiness to leave the unit was also mixed, with some feeling confident and improved enough to make the move back home and others feeling less prepared due to ongoing health and mobility challenges.
Recommendations
On the basis of our findings we have made a number of recommendations to NCH&C, including:
- Enhance communication about rehabilitation to support meaningful patient understanding and manage expectations
- Improve patient awareness of rehabilitation activities to encourage engagement and better support therapy delivery
- Strengthen patient-centred care through workforce capacity, training and support
- Improve discharge planning and day-of-discharge experiences
NCH&C response
In response to our findings, NCH&C said: “Thank you for submitting the Healthwatch Norfolk ‘Experiences of Inpatient General Rehabilitation’ report, we acknowledge and agree the findings and recommendations of the report.
“The report has been shared with the Intermediate Care Leadership team and, working with the ward managers, they have created an action plan to address the report’s recommendations.”
Some of the key initiatives from the action plan include improved collaboration with acute hospital colleagues to support consistent communication with patients and families, development of ward-based activities that enhance traditional therapy sessions and a review of nurse and therapy staffing levels as part of annual establishment reviews.
Read the full report and NCH&C action plan here.