Experiences of inpatient general rehabilitation

Healthwatch Norfolk aimed to engage patients, their relatives, and staff to gather insights into the inpatient general rehabilitation service provided by Norfolk Community Health and Care NHS Trust (NCHC). Using interviews and a survey, the study explored the full patient rehabilitation journey - from transfer from acute care, through inpatient rehabilitation unit stay, to post-discharge experiences - identifying strengths and areas for improvement.

Patients were commonly transferred from acute hospitals following falls, orthopaedic procedures, or a medical condition, often with reduced mobility, balance difficulties, or declining strength. Rehabilitation units provided a structured environment to support recovery, regain daily function, and meet care needs when returning home was not immediately possible. Communication from acute settings about rehabilitation was often limited. Stress, pain, or fatigue sometimes hindered patient understanding. Placement decisions were frequently influenced by bed availability rather than patient preference. While staff tried to balance patient-centred care with operational pressures, the process was often perceived as unclear or inflexible. Clearer and more timely communication could improve patient understanding, engagement, and satisfaction.

First impressions of rehabilitation wards were generally positive. Staff were praised for warmth, attentiveness, and professionalism, helping to reduce admission anxiety. The physical environment was clean, comfortable, and supportive of therapeutic needs, with adequate safety or assistive equipment. Noise was generally manageable, though call bells and disturbances from other patients disrupted rest. Mealtimes were the area of lowest satisfaction. While patients were generally satisfied with the food, consistent staff support was needed to help patients access communal dining areas and assist those requiring meal adaptations or help to eat or drink. This underscores the importance of adequate staffing to ensure patients’ safety, comfort, and wellbeing during mealtimes. 

Emotional wellbeing was influenced by anxiety about recovery and discharge, fatigue, and periods of isolation. Social interaction and recreational activities supported mental health, providing cognitive stimulation, companionship, and routine. Staff support, alongside visits from family and friends, was highly valued. Opportunities for leisure were sometimes limited by low awareness, insufficient encouragement or assistance, and cognitive or physical constraints. While structured communal or volunteer-led activities were appreciated, patients often relied on self-directed activities, personal devices, or television. Low-pressure, socially oriented, and adaptable activities could enhance engagement, emotional resilience, and overall wellbeing.

Experiences of clinical care were largely positive. Attentive nursing, professional competence, and empathetic communication fostered trust in clinical decision making. However, workload pressures, standardised ward norms and routines, and occasional gaps in communication or follow-up limited responsiveness, continuity, and personalisation. Rare safety incidents and systemic pressures highlighted the need for sufficient staffing, greater flexibility to accommodate individual preferences, and a sustained focus on communication and coordination. 

Therapy experiences were mixed. Supervised sessions were generally skilled and patient-centred, promoting functional independence and gradual progression. However, many patients expected more frequent and intensive therapy than they received, leading to disappointment with perceived progress. 

Self-directed exercises were valuable, but effectiveness depended on clear guidance, staff support, and patients’ ability to manage fatigue and pain. Opportunities for everyday mobilisation varied, often limited by staffing pressures or uncertainty over whose role it was to assist. 

Communication about rehabilitation goals, plans, and progress was sometimes reactive, unclear or fragmented, leaving patients and families uncertain about outcomes and timelines. Improving experiences requires a better understanding between patients and clinicians of each other’s expectations, adequate staffing to support therapy and mobilisation, and proactive, transparent communication that fosters partnership with patients and families. 

Personal care was generally reported positively, respecting privacy, dignity, and independence. Staff maintained privacy with physical barriers and encouraged patients to do what they could for themselves. Empathetic interactions and reassurance during vulnerable moments were widely appreciated. Challenges included delayed responses to call bells, particularly for toileting needs, resulting in discomfort, embarrassment, and increased reliance on continence products. These issues were more evident during night shifts, when staffing levels were lower or care was delivered by temporary staff who may have been less aware of individual needs. Inconsistent hygiene routines and occasional lapses in communication, particularly for patients with cognitive difficulties, also affected dignity. Adequate staffing, responsive care, and effective supervision are key to upholding consistently high standards.

Experiences of discharge planning varied widely. Some patients met discharge coordinators early, while others only received guidance shortly before returning home. Explanations of the discharge planning process were often limited, and understanding was influenced by intermittent contact with staff, stress, fatigue, illness and cognitive impairment. Communication and shared decision-making primarily focused on home adaptations and equipment, while decisions about discharge timing or care packages were often presented as predetermined. Family involvement ranged from minimal to active, with some families experiencing directive communication and pressure to take on additional caregiving responsibilities. 

Clear, timely, coordinated communication, along with practical support for carers are central to improving understanding and satisfaction with discharge decisions. On discharge, many patients felt ready, safe, and supported to return home, reflecting improved mobility, growing confidence, or trust in staff judgement. Others felt less prepared due to ongoing health and mobility challenges, or perceived organisational pressures. 

Discharge timing often depended on equipment delivery and care package finalisation. While most patients received sufficient notice, last-minute notifications occasionally caused upset. Verbal instructions and discharge summaries were valued, though many patients received paperwork without staff talking them through it, leading to variable understanding. Confusion about medication and transport delays were common issues. Returning home was emotionally charged for patients. 

These findings emphasise the need for more thorough assessment of readiness, clear and proactive communication about discharge day plans and paperwork, safe handover of medications and supplies, and emotional support to ensure a smooth return home. Following discharge, patients accessed a range of community health and social care services, including equipment and home adaptations with follow-up occupational therapy, community physiotherapy, consultant care and district nursing, short-term reablement or ongoing domiciliary support, social services input, voluntary sector assistance, and specialist services such as emergency response and falls prevention programmes. Experiences of these services were mixed. For some, effective interagency working – with clear communication, proactive coordination and timely follow-up - supported safe transitions home and recovery. However, perceived communications gaps, bureaucratic inefficiencies and unclear responsibilities sometimes caused stress, delays in care provision or declines in functional ability. Improved communication and coordination across health and care services, and a single point of contact to guide patients and relatives could enhance the navigation of post-discharge services.

The Guide for Unpaid Carers – Hospital Stays was valued for helping Carers understand what to expect during hospital stays and discharge, and to advocate for the person they care for. Its professional appearance and logical structure enhanced engagement, though small font size, dense layout, complex language, and reliance on hyperlinks or QR codes limited accessibility. Recommendations include simplifying language, clearer section breaks, adding practical checklists, and consolidating key contacts on a single page. Implementing these changes will enable Carers to support patients effectively while reducing stress and confusion.