Critique of a Rehabilitation Unit
By Andy Berry
At the end of 1996, I moved one rehabilitation unit in the UK
to another prior to returning home after a lengthy stay in
I wrote the original version of this document as I felt
appalled that a service like that it described could still
operate in the late 1990's. To misquote a popular saying:
- "Nice building, shame about the service!"
From the first moment I arrived, when nobody greeted me or
explained anything about the service, I formed the impression
- The unit was dominated by the nursing staff, some of whom
seemed to feel that they could do just about anything to
make their lives easier.
- Amongst the nursing staff, there was an atmosphere of
"just coping" and no sense of professionals
doing a job they enjoy. Only a few of the staff appeared
to have been trained. There are times when the unit
seemed understaffed and others when staff seemed to have
little to do and were visibly bored.
- The unit was run following out-of-date and inflexible
principles. It reminded me of horror stories of hospital
wards in the 1950's. There were rigidly enforced visiting
hours and a complete ban on visitors during mealtimes.
- Few, if any, of the users were happy.
- There was no empowerment of the users. There seemed to be
an on-going power struggle between staff and users.
Rehabilitation could mean several different things, but the
service had no clear policy on what they were trying to achieve.
- There seemed to be no structure to the withdrawal of
support - I was continually having to remind some nurses
that I could walk with a frame. Not once did anyone
suggest that I tried something new. I was moved back from
a single room (where I was just about ready to sleep with
the door closed - I had been in hospital an awfully long
time) to a ward just before going home.
- Apart from physiotherapy, no effort was ever made to
increase my functional ability. Occupational Therapy
input was limited to ordering equipment.
- I received no input to help me in my daily life. Indeed,
few people expressed any interest in what I want or need
to do during a typical day. We had to ask for training on
using the aids that I being issued with - even through
some, such as the seat raisers, are dangerous if used
- No-one explained what I might hope to achieve or offered
Were The Service Users Ill?
There was a perception amongst staff at the service that the
users were all 'ill' and therefore the emphasis throughout the
service is that nursing and medical intervention are paramount.
- That the auxiliary nurses be renamed "enablers"
and wear normal day clothes.
- That they be retrained with the best of practise in
community care so that users can get familiar with the
sort of care they will be receiving in the community.
- That these enablers take the views of the users into
account. It should be mandatory to do as the user
requests unless there is a good reason not to.
Nothing too radical there, you might think!
Respecting the Users
I saw others subjected to, and experienced myself, some
appalling breaches of reasonable behaviour towards users.
- People being ignored after having made reasonable
- People being given medication by wholly inappropriate
means. I saw that one user's pills were mixed with their
food without their consent.
- People being made to wait in the corridor in sheets
because there is no shower available. This happened
nearly every day and is the thing that sticks in my mind
most vividly. Remember, this was 1996 - not 1896.
Re-integrating the Users
The service was quite well placed, next to a shopping street
in a major English city, to allow users to prepare to move back
into the community - to do things like shopping and enjoy a quiet
pint in the pub.
- There was no attempt to use the local facilities. It
would have been quite possible for a user to return to
the community having just had a single home visit - quite
unprepared and running the risk of a very low of quality
- The equipment was all standard hospital issue rather than
being of the type that would used at home.
- That visitors should be encouraged to take users out and
that the service provide the necessary assistance.
- That one or two rooms should have furniture and equipment
like that found at home and that a normal-sized bath
should be installed.
I concluded that I had not enjoyed my time at the service. A
typically British understatement!
To get some action, I sent the report to the Chief Executive
of the body responsible for the service. Do you know what
happened then? Yes - a nice letter blaming a change of staff and
No action, no changes, zilch!
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