Community Rehabilitation Alliance
The Community Rehabilitation Alliance (CRA) was founded in December 2019 to campaign for better community rehabilitation services, especially during the UK general election. The Chartered Society of Physiotherapy hosted it on its website, and I think it must have funded it. I first wrote about it on June 5th, 2021. From a standing start, it has become quite influential, and in December 2022, it published the Rehab on Track. Community Rehabilitation Best Practice Standards. The CRA is fascinating because, as far as I can see, it has no official status, constitution, dedicated funding or website. It is a tribute to trust and collaboration between over 50 organisations aiming to improve rehabilitation. My first page was replaced by a new page outlining the position on 31st May 2023, when there are four alliances, one for each UK country. This is a further update; it seems to have stopped new work.
Table of Contents
Introduction.
At the October 2019 joint meeting of the Society for Research in Rehabilitation and the British Society for Rehabilitation Medicine (BSRM), posters and flyers advertised the Community Rehabilitation Alliance as a pressure group to improve community services. Only a short time later, it was launched as the Community Rehab Alliance.
It has been hosted by the Chartered Society of Physiotherapy, which provides administrative support and webpages. The Alliance in England has over 50 organisations covering professional organisations, patients and care organisations, and bodies covering research and specific diseases or disabilities.
Community Rehabilitation.
The first publication, on 26 February 2020, was Community Rehabilitation: Live Well for Longer, and the document can be downloaded.
The page also links to the broader Chartered Society of Physiotherapy’s (CSP) drive to increase community rehabilitation resources with a page linking to other campaigns, coalitions, and CSP resources, including the directive, ‘collaborate, don’t compete’.
Community Rehabilitation Data
In 2020, the CRA set up several task-and-finish groups, including one on the data that community rehabilitation services should collect. The output, Making Community Rehabilitation Data Count, was published in November 2022. The report can be downloaded.
The first main finding was, “Community rehabilitation organisations want service level data for multiple purposes including clinical delivery, research, quality improvement, benchmarking, showcasing best practice, making business cases and workforce planning.” I wonder if they wanted it; they may have agreed it could help, but I suspect no one had a burning desire for the data.
The other six main findings were:
- The lack of data means no one can judge the effectiveness of services;
- Data collection, storage, and analysis are inconsistent;
- Data collection processes are inefficient;
- Many organisations, services, and clinicians do not receive the results of analysis of data submitted;
- There was broad agreement on items to collect for an ideal core dataset. (I rather doubt this is the case.)
- Most people wanted to improve data content, collection, and use.
Community Rehabilitation Standards.
A second Task-and-Finish group, chaired by Professor Diane Playford, achieved universal agreement and support for a revolutionary document setting standards for localities to achieve. The document, Rehab on Track: Community Rehabilitation Best Practice Standards, was published in December 2022 and is supported by suggested audit data for the Director of Locality Rehabilitation, patients, and clinicians to collect.
They are aimed at the new Integrated Care Systems (ICS) and their associated Boards (ICBs).
The standards cover seven fundamental principles:
- Referral processes should be explicit, easy, efficient, and equitable
- Rehabilitation interventions should be timely, co-ordinated and prevent avoidable disability
- Rehabilitation interventions should meet patient needs and be delivered in an appropriate format
- Rehabilitation pathways should meet needs and be provided locally with access to specialist services
- Rehabilitation programmes should enable patient optimisation, self-management and review
- Rehabilitation services should be well-led, adequately resourced and networked to other services
- Rehabilitation services should involve families.
While I would have a slightly different set of principles, these are reasonable. I am delighted they do not refer to disease-specific services or specialist services. The focus is on community services.
They also imply there will be a rehabilitation network that should:
- Share good practice
- Audit findings across the network
- Work with patients, carers, and local communities
- Link with other networks (i.e. form a larger-scale network)
The Community Rehabilitation Alliance have not taken the suggestions any further, but I have written two blog posts about rehabilitation networks, here and here.
Right to Rehabilitation
A third group in the Community Rehabilitation Alliance developed a Right to Rehab position statement, published in May 2023. It covers many concerns, such as service fragmentation, lack of staff, and the need for more rehabilitation training.
The Alliance makes the case for a right to rehabilitation under four imperatives:
- ethical,
- quality of life,
- economic, and
- functional benefits.
They set out five issues:
- Services are patchy and vary significantly between localities with areas of deprivation, which have the highest need, being least well served,
- The fragmentation of services, a problem I have repeatedly mentioned (e.g. here),
- Long waits,
- A lack of any valuable data because healthcare systems are only interested in diseases, not disabilities,
- More people, equipment, and other resources are needed. The lack of data partially hides this.
They also highlight the considerable demand arising from Long Covid, which has reduced the rehabilitation for other people as there has been no increase in rehabilitation resources.
Discussion on the Community Rehabilitation Alliance
In June 2021, I was initially concerned by the absence of any usual organisational features, such as rules and processes, a structure, a website, etc. When I updated this page in May 2023, it was functioning well, and I was unaware of any problems. The Chartered Society of Physiotherapy supported it because the Community Rehabilitation Alliance furthered its charitable objectives.
It was also successful because the CRA was entirely composed of organisations with no individual members. People attending had less to lose and more to gain from collaboration and being trusting and supportive.
Now, in August 2024, I again have some concerns. The first is the difficulty in finding output. The website pages are scattered and not linked into a group. There is no differentiation between Community Rehab Alliance work and Chartered Society of Physiotherapy work. The concern is not about ownership—the CSP is paying for everything. It is just a matter of clarity about authorship and responsibility.
My other concern is that activity has stopped. There are no further initiatives. The work produced sensible recommendations that should benefit all patients, but I have not seen any follow-up.
An opportunity to revitalise?
The Community Rehabilitation Alliance rapidly produced good, helpful documents and ideas. However, its initial purpose was to highlight community rehabilitation during an election, and everyone was enthusiastic and committed. I am sure most work was undertaken outside regular working hours.
It is no surprise that people have moved on. A longer-term organisation or body was needed to maintain and develop its work.
A long-lasting Society or Alliance must advocate for all rehabilitation everywhere to progress. The community rehabilitation standards document made four crucial recommendations in December 2022; who is now monitoring whether Integrated Care Boards:
- Designate a director at executive level with direct responsibility for rehabilitation services, if this is not the Director of Therapy automatically?
- Establish a local provider rehabilitation network with a regional footprint that includes primary, secondary, and tertiary health care, mental health, social care, and independent and third-sector providers.
- Review existing rehabilitation services to remove silos of care and duplication of services?
- Publish an annual report on rehabilitation?
A broad, representative Rehabilitation Society could:
- Monitor the standards of community rehabilitation
- Develop the capabilities and competencies needed to judge whether a rehabilitation service is safe and effective
- Develop and validate capabilities applicable to all professionals who wish to acquire rehabilitation expertise in addition to their professional expertise.
- Represent rehabilitation on Regional and national committees and working parties.
- Develop and accredit courses and credentials for rehabilitation knowledge and skills.
- Represent the UK internationally in rehabilitation forums.
The 50 organisations that formed or still are the Community Rehabilitation Alliance could create an independent Alliance with a constitution and purpose.
Conclusion.
The Community Rehabilitation Alliance was conceived and born in 2019, and its first document was produced in February 2020. It produced several documents, the most important of which was in December 2022. It has reduced or even stopped its activities. However, the alliance’s model was very successful. I am suggesting it transform from an informal coalition into a formal organisation representing rehabilitation, just as the many members of the alliance represent a profession or other group involved in rehabilitation.
