Prehabilitation: reducing length of stay in hospital and increasing elective uptake

What is prehabilitation?

Prehabilitation focuses on a continuum of health. A patient can be in rehabilitation after something happens but there is also preventative rehabilitation, where someone gets healthier while they wait for treatment. The entire approach of prehabilitation is about patients engaging with their care in a very different way to how they have in the past with multidisciplinary teams assisting patients to help them prepare for the care they are going to receive next. This has been shown to lead to improved patient experience and also improved patient outcomes.

One of the key elements of prehabilitation is the multidisciplinary approach, which means different teams engage with the patients while they are waiting for treatment. This is seen, for example, in some of the approaches taken before surgery where there’s nutritionists, dieticians, psychologists, therapists and occupational therapists supporting the patient to prepare in body and in mind for treatment.

Prehabilitation success stories

There are already some pockets of excellence across the country where prehabilitation is being utilised. In Greater Manchester there is an example within the cancer services called Prehab4Cancer. The initial programme focused on a colorectal cancer patient cohort with multidisciplinary teams getting together to interact and engage with the patients in advance of their surgery. As a result, by being in a better state to receive surgical intervention. the patients were on average in bed for one and half days less after they had their treatment that those who didn’t receive prehabilitation. So, for the 1,000 patients that were involved in the programme that cumulatively released 179 days of available capacity for other patients to access the care pathway who wouldn’t have otherwise been able to.

Due to the success, Prehab4Cancer has now been rolled out across Greater Manchester and is being rolled out in Mid and East Cheshire. This is an example of what can happen when you get the right people together and do the right thing for patients. This model should be a universal ICS priority; prehabilitation links with all of the local ICS priorities and it supports a sustainable service by improving the care being delivered and reducing the patient’s length of stay, so more patients can be seen and more funding is available to deliver care.

What next?

Although we are starting to see other parts of the country developing prehabilitation teams and commissioning these services, it is still fairly sporadic. There is a challenge for the NHS in making prehabilitation a more universal model of care and this is where there is an opportunity for industry to collaborate. To increase clinical adoption, we need more evidence and we need to build on the great work that is already happening. There is a now an opportunity to create a data base of evidence around prehabilitation and its benefits so it can become a universal approach within our healthcare system and to create a really strong case for NHS England to then lead on the implementation of this from the top down.

It's an initiative that is really at the cutting edge of how population health management becomes the norm. By building more partnerships and creating more evidence there’s an opportunity for the entire population to have access to prehabilitation. This is a whole new way of supporting patients and managing care and it’s really interesting and exciting.

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