The review has identified that there is a significant shortage of rehabilitation services in Tasmania. Further, as the population ages over the next decade, the need for rehabilitation will significantly increase. Key findings in relation to the need for rehabilitation include: § Relative to national standards, Tasmania is under-supplied with rehabilitation beds with the current shortfall estimated at around 50-60 beds. § Medical and allied health staffing levels fall well short of recommended standards. § With only 47-49 designated rehabilitation beds in Tasmanian public hospitals, at least 70 other beds are being used by patients formally classified as undergoing rehabilitation. Further, it is estimated that up to 195 beds, including up to 100 acute beds, are being used by patients requiring rehabilitation or restorative care. § The lack of ambulatory rehabilitation services in the North and North West regions limits alternative options to provide rehabilitation to those who require it. § The projected 45% increase in the population aged 70+ from 2003 to 2018 has major implications for rehabilitation and other sub-acute care needs. § Demand for inpatient rehabilitation services in Tasmanian public hospitals is projected to more than double between 2004-05 and 2016, with around 150 beds being needed at that time if current patterns of use are maintained. § Current outcome data suggest that shortages of allied health staff and alternative rehabilitation service options may be having a negative impact on outcomes and/or length of stay. The review has identified a range of issues that need to be addressed as part of the development of a network of rehabilitation services that will meet the needs of Tasmanians over the next decade. These are set out in Section 4 and are briefly discussed below. Perhaps the most important issue to be addressed is the status of rehabilitation within Tasmania’s health system. Consultations have highlighted the relatively poor status accorded rehabilitation relative to acute care services in Tasmania, in spite of the needs arising from population ageing Page 2 Tasmanian Rehabilitation Review and Plan and increasing frailty. The need for strong clinical leadership to raise the profile of rehabilitation services and drive service development is evident. There is, at present, a lack of clarity around the rehabilitation role. There are apparent overlaps and some blurring of service roles between rehabilitation services and other services including stroke, geriatric management, restorative care and maintenance therapy. In spite of some changes that have been made in recent years, the formal organisational structure presents some barriers to the development and delivery of an effective system of rehabilitation services. Not least is the separate management of hospital and primary health sectors, which runs counter to the integrated model of delivery required to support an effective rehabilitation service. In this context, ongoing planning and cooperation between the Acute Health Services Group and the Community Health Services Group of the Department will be critical. This review has highlighted a need to strengthen overall clinical direction for rehabilitation services, both Statewide and at Regional level, with the capacity for program planning and management across both hospital and community settings. A range of specific issues has also been identified. These include clinical staffing levels, referral and assessment protocols, admission, discharge and case management, specialist rehabilitation needs, orthotic and prosthetic services and outcomes measurement. Finally, the review has highlighted three main infrastructure issues. These relate to improved facilities, equipment and transport and are summarised in Section 4.11 (page 24).