Community Rehabilitation Service

Definition/Description

The Hull and East Riding Community Rehab service provides Physiotherapy and Occupational Therapy assessment and treatment of patients who have a rehabilitation need due to a physical or neurological condition. The service accepts referrals for people aged 18 and over, who have either a Hull or East Riding GP (except Pocklington) . Patients are seen in either a clinic or in their own home.

This service works with people who have long term conditions, illness or injury, and aims to optimise people’s function and independence, and to prevent deterioration where possible. Clinicians carry out a holistic assessment, and treatment options include encouragement of self-management, building knowledge skills and confidence and providing rehab programmes to achieve patient centred goals. The overall aim is for people to be able to regain and maintain their function or independence, in order to be able to participate in everyday life. The team also works with family/carers to achieve patient goals.

This is not an urgent service.

The service is a generic rehabilitation service, therefore does not provide specialist/complex or intensive rehab for any client group.

Examples of referrals:

Referrals to Physio for assessment of mobility or for walking aids.

Referrals to Physio/OT for a holistic assessment of a person with a neurological/physical condition who’s mobility or function has deteriorated (assessment may include functional, environmental, support or equipment required, education/knowledge required to self-manage, effect on carer, liaison with other agencies etc)

Referral to OT for cognitive assessment, impact on function, and rehabilitation where appropriate.

Referral for a patient with a physical/neurological condition who is having difficulty managing everyday activities ( mobility around the home, transfers, personal care, food prep etc.)

Red Flag Symptoms

Community Rehabilitation is not an urgent service. If a patient is in crisis and requires a rapid response to prevent a hospital admission, please refer to Intermediate Care

Exclude Red Flag Sympyoms

Community Rehabilitation is not an urgent service. If a patient is in crisis and requires a rapid response to prevent a hospital admission, please refer to Intermediate Care.

Guidelines on Management

If a patient requires a hospital bed, commode or pressure relief items, please refer to Nursing.

If a patient requires a simple piece of equipment only (such as a perching stool/roma trolley, please refer to Local Authority OT team ( For Hull refer via 01482 300300,  For East Riding refer via 01482 393939)

If a patient requires a splint/orthosis, please refer to Orthotics.

If a patient requires a Moving and Handling assessment only, please refer to Local Authority OT service  ( For Hull refer via 01482 300300, and for East Riding, refer via 01482 393939). If the patient requires a Moving and Handling assessment and they live in a care home, the care home would be expected to provide this assessment in the first instance.

Referral Criteria/Information

Do Not Refer

  • For equipment only ( ie: commode, hospital bed, pressure relief items ) refer to Local Authority OT department . However, the Community Rehabilitation service does accept referrals for walking aids.
  • Moving and handling assessments – refer to Local Authority OT
  • MSK if patient is not housebound (refer to MSK service – CHCP MSK in East Riding and Health Share for Hull) .
  • Amputee rehab.
  • If presenting problem is due to a stroke, refer to stroke service.
  • If presenting problem is due to a learning disability, refer to learning disability services.
  • Falls, refer to Falls service.

Referral Criteria

  • Patients must be registered with a Hull or East Riding GP (except Pocklington).
  • Over the age of 18.
  • Patient has a physical/neurological condition, and a rehabilitation need.

Referrals

Self Referrals are accepted.

Referrals by Health and Social Care professionals are accepted.

Additional Resources & Reference

FOR PATIENTS REQUIRING: REFERRAL OPTIONS FOR APPROPRIATE PATIENT MANAGEMENT
Patients requiring MSK input who are able to access a clinic.

MSK for East Riding patients  ,CHCP NHS Service

https://www.chcpcic.org.uk/chcp-services/physiomsk

Tel:01482 247111

MSK for Hull patients

https://www.healthsharehull.org.uk/

Tel:01482 300003
Patients requiring provision of Occupational Therapy equipment only ( eg: roma trolley, perching stool) or a moving and handling assessment

Hull patients:

https://www.hull.gov.uk/disabled-adults/occupational-therapy

Tel: 01482 300300

East Riding patients:

https://www.eastriding.gov.uk/living/help-for-people-with-disabilities/general-help-and-advice/
Patients requiring a rapid response in order to prevent a hospital admission /facilitate a discharge.

CHCP NHS Service

https://www.chcpcic.org.uk/chcp-services/intermediate-care-services

Tel:01482 247111
Patients who’s presenting difficulties are due to stroke

CHCP NHS Service

https://www.chcpcic.org.uk/chcp-services/community-stroke-team

Tel:01482 247111

Respiratory/CVS conditions eg Asthma, COPD, CCF

CHCP NHS Service

https://www.chcpcic.org.uk/chcp-services/pulmonary-rehabilitation-east-riding

01482247111

Falls associated with fragility and falls through poor mobility 

CHCP NHS Service

https://www.chcpcic.org.uk/chcp-services/hull-east-riding-falls-service

Chronic Fatigue Syndrome as primary diagnosis

Humber NHS Service

https://www.humber.nhs.uk/Services/chronic-fatigue-syndrome-service-cfs.htm

or

Yorkshire Fatigue ME/CFS Service & Yorkshire Fatigue Clinic

https://www.chcpcic.org.uk/chcp-services/yorkshire-fatigue-me-cfs-service

Amputees of lower or upper limb

HUTH NHS Service

https://www.hey.nhs.uk/limbunit/

Medically unstable patients or patients with suspicion of Red Flag/Sinister features on referral Appropriate medical management
Provision of orthotic devices, splinting or orthopaedic supports

For East Riding patients: ABH Steeper

hnyicb-ery.alfredbeanorthotics@nhs.net

Lakeland Orthotics

hnyicb-ery.lakelandorthoticsclinic@nhs.net

For Hull patients, refer to Orthotics at HUTHT

 

Associated Policies

There are no associated policies.

Specialties

There are no associated specialties.

Places covered by

  • east-riding
  • hull

Hospital Trusts

Author:
Date created: 14/08/2025, 07:59
Last modified: 14/08/2025, 07:59
Date of review: 14-08-2025