What was the issue you were addressing or working on?
The vision for Reablement Services across Glasgow was to:
- Have an approach that changes the culture of homecare from ‘task and time’ to better outcomes.
- To ‘do with’ service users rather than to ‘do to’ or ‘do for’.
- Maximise service users long-term independence and quality of life.
- Appropriately minimise ongoing support required and thereby, minimise the whole life-cost of care, targeting a 30% reduction.
- Have service users making the most of their lives.
What you did?
The Reablement teams are made up of Occupational Therapists, Reablement Coordinators and Reablement Home Carers. An important element of the partnership arrangement is the role of NHS Rehabilitation Services in leading on Reablement assessment and goal setting, in partnership with service users and Cordia staff. While Reablement was initially aimed at supporting individuals on discharge from hospital it has now been extended, where relevant, to community homecare referrals in most areas.
Due to the scale of the service and change strategy, a phased roll out was felt to be the most manageable way of introducing Reablement to the city. It started in the North East sector in October 2011 and roll out will be concluded by December 2013.
In order to plan for this, Cordia needed to identify, recruit and train homecare staff from the existing homecare workforce. Cordia implemented advice from the Joint Improvement Team to build a capacity model for the Reablement Homecare Service, taking account of hours of care required based on number of discharges and average hours of homecare care plans. The above formula was then applied to the South (March 2012) and North West (August 2012) sectors of the city. The rationale for Cordia’s role in Reablement Homecare service delivery in Glasgow was due to it being wholly owned by Glasgow City Council and it being a lead partner in homecare service delivery for 13 years. Due to Cordia’s staffing infrastructure, they can provide homecare services 24 hours a day and provide homecare support to all 15 Acute Hospitals in Glasgow, with a minimum notice period of 4 hours.
The Reshaping Care policy directive and Change Fund financial contribution has been a major catalyst in achieving this whole system service development across Social Work Services, NHS Glasgow & Clyde and Cordia. Change Fund monies were used to assist in the development of the initial workforce, training and communication plans.
What were the outcomes – benefits or otherwise?
- Analysis has demonstrated that Reablement Service delivery has achieved and exceeded the target reduction in ongoing homecare hrs provision where service users have fully completed Reablement; the target reduction was 30% and analysis indicates that a 51.5% reduction was achieved (this data is based on 181 service users who fully completed Reablement over period 4,5,6, 2012).
- 799 clients have fully or partially completed a Reablement programme of support this year to date. 45% of service users who complete Reablement require no homecare further service.
- Survey findings demonstrated that service user feedback has been very positive, both in relation to satisfaction levels and self reported independence levels.
- The Reshaping Care policy directive and Change Fund financial contribution has been a major catalyst in achieving this whole system service development across Social Work Services, NHS Glasgow & Clyde and Cordia.
- The support of Social Care Direct services in recording hospital discharge homecare referral information from ward staff, and ensuring seamless transfer to Cordia, SWS and Rehabilitation Services, has greatly assisted the discharge pathway and appropriate care provision, often at a few hours notice.
- A higher than anticipated number of service users (45%) have not progressed via Reablement following initial assessment, due to service users level of dependency and ill health (see table 1, page 4). However it is noteworthy that most receive a comprehensive service by Occupational Therapy staff, who identify the need for any additional support before transferring to mainstream homecare. The number/percentage of service users not progressing via Reablement has had a negative impact on the full utilisation of the Cordia Reablement workforce, due to a lower than anticipated number of service users and hours, which has also impacted negatively on related efficiencies in homecare spend. In response, the service pathway has been changed (July 13) to ensure better information is available to inform the need for Reablement intervention. In addition, a para-professional role has been introduced (Cordia Assistant Manager) to support non complex assessment and review, in order to optimise access to Reablement where relevant for all clients on discharge from hospital, or referral for homecare.
- Reablement Service delivery has assisted with ensuring the timely provision of supports to enable and sustain discharge e.g. assistive equipment, adaptations, telecare.
- The key benefits of complementing Rehabilitation Service delivery with Reablement Homecare has been widely demonstrated in North East and South Glasgow. Rehabilitation complemented by Reablement Homecare works as it allows the complex needs of the service user i.e. nursing, pharmacy, physiotherapy, to be met effectively through the interdisciplinary team. It also ensures the follow-on of rehabilitation goals by Reablement carers under the supervision of the OT. However, Reablement has resulted in pressure on Rehabilitation Services workload, due to the higher than anticipated number of service users supported via Rehabilitation Services following discharge, and the additional processes involved in the Reablement pathway. Additional OT staff have been required to meet this demand.
- Development of performance information to routinely measure the impact of Reablement intervention on patterns of homecare provision has proven difficult to achieve due the complex nature of capturing the Homecare Care Plan. Following the recent introduction of Carefirst 6, a new Reablement performance report has been developed using a Homecare/Reablement Eform, which should facilitate meaningful and systematic performance information in the near future. This will assist in assessing the strategic benefits and impact of Reablement Services.
Contacts – to find out more
Stephen Fitzpatrick, stephenNBH.firstname.lastname@example.org 0141 276 5596
Additional contact for further information:
Fiona Brown, Service Manager, Social Work Services, North East Glasgow