Optimisation of function and mobility at North Cambridgeshire Hospital

The main challenge has been achieving and sustaining staff engagement in the rehabilitation model. Training staff, keeping them motivated, and ensuring rehabilitation remains a consistent priority across the ward has been difficult over time.

Many patients admitted to the unit have experienced long stays in acute hospitals and often present as deconditioned, with low confidence in their physical abilities, multiple comorbidities, and are typically aged 80 years or older. This leads to functional decline and challenges in achieving timely discharges.

A high proportion of patients are discharged with double-up care through Intermediate Care Teams (ICT) and Reablement, with further delays linked to care package arrangements and home environment suitability.

Aim of the rehabilitation model

The aim is to create a rehabilitation model that focuses on patient engagement and empowerment, ensuring that patients take an active role in their own recovery and progress towards independence every day.

Goal setting and baseline assessment

On admission, therapists complete a range of baseline assessments to inform goal setting. These include:

• Barthel Index
• mobility score
• confidence score
• manual muscle power scale
• range of motion of upper and lower limbs
• Tenneti assessment, if required.

Based on these results, therapists work collaboratively with the patient to create personalised goals that support safe and sustainable discharge home.

Rehabilitation folder and resources

Each patient receives a rehabilitation goals folder, designed to encourage daily engagement in their recovery.

The folder contains:

• information leaflets on pressure area care and prevention, falls risk, PJ Paralysis, and the Eat, Drink, Dress, Move (EDDM) campaign
• a personalised goals sheet completed on admission, identifying what the patient must achieve to return home safely. This is reviewed weekly or when progress changes
• individualised care plans addressing pressure areas, falls, nutrition, and continence
• a Rehabilitation Activities Record (RAR) form, which can be completed by any staff member (nurses, therapists, HCAs). This form logs daily activities such as:
  • chair-based group exercises
  • atrength and balance sessions
  • bed transfers, sit-to-stand, and toilet transfers
  • walking (recorded in meters)
  • bedside cycling, self-directed bed exercises, standing stations
  • 1:1 therapy sessions with physiotherapists or occupational therapists.

Daily engagement tools

To promote active participation, each bedside table includes a rehabilitation placemat with:

• One side: End PJ Paralysis information
• The other: four reflective questions for patients to engage with staff:
  • Do I know what is wrong with me and why I am here?
  • What am I going to be doing today?
  • What do I need to achieve to leave hospital?
  • When can I expect to leave hospital?

Patients are encouraged to discuss their goals and daily activities with staff using these prompts, creating a culture of shared responsibility for progress.

Training and workforce development

Healthcare Assistants (HCAs) are being trained in chair-based exercises and strength and balance programmes to build foundational rehabilitation skills and confidence. This empowers HCAs to support therapy-led activities and take an active role in group sessions.
Rehabilitation is designed to be a whole-team approach, involving all staff regardless of grade or discipline. Every team member is accountable for patient engagement and progress. This prevents reliance on a small group of staff and promotes sustainability.

Patient and system challenges

Many patients are admitted functionally deconditioned due to prolonged acute hospital stays.

Common barriers include reduced mobility, frailty, and low motivation, as well as complex social and environmental factors affecting discharge.

Delayed discharges are often linked to availability of community care packages and double-up care requirements.

Staff engagement and workload challenges

Workload remains a significant issue. Initially, staff tended to do everything for the patient rather than encouraging independence or rehabilitation. When patients declined participation, staff often accepted this without further discussion or escalation.

This behaviour affected both patient outcomes and staff time, delaying morning routines (washing, dressing, mobilising) and reducing opportunities for rehabilitation.
Registered Nurses were sometimes less focused on rehabilitation, perceiving it as the responsibility of HCAs, therapy support workers, or therapists. This limited multi-disciplinary coordination and engagement.

Leadership efforts have focused on changing this culture, emphasising that rehabilitation is everyone’s responsibility.

Training challenges

The initial City & Guilds training for chair-based and strength/balance exercises was too community-focused and not well suited to inpatient needs.

This was reviewed, and the training content has since been aligned to the needs of the inpatient population. Feedback from the first cohort of trained staff has been positive.

Process and engagement barriers

• staff not consistently completing RAR forms
• activities sometimes selected that did not support patient goals
• patients occasionally disengaged, becoming passive in their care
• staff not always ensuring that patients had daily access to their folders; some folders were placed out of reach.

• Therapists now highlight priority activities on the RAR form so staff can easily identify which actions are most important for patient progress.
• Training has been reviewed and adapted to focus on inpatient rehabilitation.
• The Ward Manager and Band 6 lead on reinforcing expectations, checking patient access to folders, and encouraging discussion of goals during daily rounds.
• Progress and engagement are discussed in ward meetings, ensuring that all staff understand the purpose of rehabilitation and are invested in promoting independence.

Resources required

• training courses and materials
• ongoing workforce review to ensure sufficient staff capacity for active rehabilitation delivery.

Timeframe

Development of this rehabilitation model has been ongoing for approximately one year.

Future progress:

• staff will discuss the RAR form daily with patients, identifying reasons for non-participation and recording these for review.
• barriers to engagement will be discussed during weekly MDTs and daily handovers.
• a workforce review will ensure staffing levels support the model’s focus on rehabilitation rather than only providing routine care.

Outcome

Formal review of all RAR forms is ongoing. Early patient feedback indicates that the goals folders are informative and helpful in understanding progress and recovery.

• PJ Paralysis
• Last 1000 Days
• Eat, Drink, Dress, Move (EDDM)

Sandra Dade

Email: [email protected]