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R EHABI L I TATION


Based on these principles, Prof. Greenhalgh explained that a four-tier services programme has been proposed. The first tier looks at self-management – tapping into existing resources. The second tier is primary care support with community-based rehabilitation.


The third tier is specialist assessment and rehabilitation, particularly for patients who have ongoing breathlessness, severe fatigue, and severe interference with daily living. Finally, the fourth tier focuses on the care of those with very rare, but very serious complications. “From our interviews with people suffering from Long COVID, there is a desperate and urgent need for a rehabilitation service which operates at various levels, has proper referral pathways, is accessible to patients and where the patient doesn’t have to fight their way in,” Prof. Greenhalgh concluded. With a background in military rehabilitation, Dr. Etherington CBE joined the debate advocating the development of a COVID rehabilitation programme and summarised the wide ranging and complex impact of Long COVID on areas including pulmonary, respiratory and neurological health, and mental health. “We have no culture of rehabilitation


From our interviews with people suffering from Long COVID, there is a desperate and urgent need for a rehabilitation service which operates at various levels, has proper referral pathways, is accessible to patients and where the patient doesn’t have to fight their way in. Professor Greenhalgh, University of Oxford.


in the UK, as far as I’m concerned,” Dr. Etherington stated. “To put it in context, in England, we have 950 specialist commissioned beds for rehabilitation and about 20% of those are set aside for trauma. In addition to that, there’s a lack of capacity in the system. “We have a commissioning structure that arbitrarily separates specialised commissioning from community services and non-specialised services and, that’s for the same patient on the same pathway. In that context, where we’re not used to rehabilitation to then say: ‘well we may have 40,000 – 100,00 people who are requiring rehabilitation for a disease we don’t really understand’, is not getting a lot of traction,


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JANUARY 2021 I would argue, in the NHS. “If you look at other countries, such as


Germany, there is a better acceptance of rehabilitation being needed for all types of illness and injury. Indeed, there are COVID rehabilitation pathways in Germany which are commissioned through the German health and work insurance, which are being used. I’m not sure we’re in that particular position.” When exploring what is being done to provide for these patients, particularly in England, Dr. Etherington raised the point that £10 million has been allocated for post-COVID syndrome assessment clinics. However, he highlighted that it is only for signposting purposes rather than supporting with rehabilitation capacity.


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