Caroline Glendinning Emeritus Professor of Social Policy Social Policy Research Unit University of York College of Occupational Therapists/Skills for Care 22 nd July 2014

 Background and early evidence  Major studies  SPRU (York)/PSSRU (Kent)  Perth (W Australia)  Concluding remarks

 England 2000 onwards: development home care re-ablement services in most councils  Scotland 2013: Joint Improvement Team survey  25/30 councils had home care re-ablement services  17 of these planning to expand  From selective to inclusive services  Australia, New Zealand – growing provider interest

 High proportions receiving re-ablement needed no further, or less, home care on discharge than those who received standard home care  63% needed no further home care on discharge  26% needed less home care than comparison group  But would they have recovered anyway?  … and how long do the effects last?

Aimed to investigate longer-term impacts of home care re-ablement services, including:  Compare home care re-ablement vs standard home care  Assess user outcomes and use of NHS and social care services for up to 12 months  Estimate unit costs home care re-ablement services  Assess cost-effectiveness home care re-ablement  Describe organisation and content of home care re- ablement services  Examine user and carer experiences

 5 re-ablement councils, 5 conventional home care councils  Users recruited on referral – baseline interviews  Re-interviewed after 9-12 months  Data collected on:  Users’ health, quality of life, social care outcomes at baseline and follow-up, using standardised measures  Social care and NHS etc services used by both groups  Costs of re-ablement services (staff, overheads etc)  How re-ablement services organised and delivered  Experiences of users and carers

 Re-ablement had positive impacts on health-related quality of life and social care outcomes  Compared with conventional home care service use  Typical re-ablement episode (39 days) cost £2,088  More expensive than conventional home care  But 60% less use of social care services subsequently  Over full year, total social care services used by re- ablement group cost £380 less than conventional home care  Re-ablement group – higher health service use and costs  Effects of recent hospital discharge?

CE = compare improvements in outcomes against costs  NICE threshold £20-30K for each outcome gain  Re-ablement was cost-effective in relation to health-related quality of life outcomes  Re-ablement may be cost-effective in relation to social care outcomes  Depends on £ threshold  Higher healthcare costs of re-ablement group  Probability of cost-effectiveness only

 Poor initial understanding of re-ablement  Previous experiences of standard home care  Context of referral - crisis, hospital discharge  Value of repeated information  Appreciated frequent visits, monitoring  Quality of relationships crucial  Reported greater independence  improved confidence, relearned self-care skills  People discharged from hospital/recovering from accident/illness reported greater gains than those with long-term/progressive conditions  Felt shortcomings  More help with mobility/activities outside the home  Anxiety about end of re-ablement  Potential for greater carer involvement?

Assessed impact of ‘restorative’ home care on subsequent service use for 2 years  750 older people randomised  Restorative home care  Standard home care  Service use records  Home care  A+E attendance  Hospital admissions - number and duration  Calculated costs of all services used

Compared to standard home care, restorative home care group:  Less likely to use on-going personal care services  Used fewer hours of home and (especially) personal care services  Less likely to be assessed as needing residential care  30% less likely to have attended A+E  31% less likely to have unplanned hospital admission  Had lower total (health + social care) service costs (average £ £2380 less)

Growing body of evidence that re-ablement reduces service use and costs in short and longer terms. But outcomes and cost-effectiveness depend on:  How services are organised  Specialist service vs generic/extended assessment  Delays in onward referral  Who receives re-ablement  Inclusive vs selective services  Eligibility thresholds  What’s included in re-ablement interventions  Home care only vs wider range of skills/inputs  Rapid access equipment/AT  How long intervention lasts

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