Islington - Joint Services Reablement Team Mary Jamal Head of Disability and Intermediate Care

Before Reablement… Background Contracts with eight external providers An in house home care service specialising in users with dementia A small rapid response and enabling service delivered by an external agency (in operation since 2004) Monitoring All the contracts monitored with the exception of the home care team activity Based on a small sample size activity from the rapid response agency, there was evidence of 56% of clients had their home care hours reduced and 78% of clients discharged had no on going home care or a reduced package Budget spend Home Care budget was around 17% of the budget for Islington Adult Social Services Home care spend increased by 7% from the financial years 2005/6 (from 11.9 million to 12.7 million) Was predicted to increase by 4% 2006/7 (from 12.7 million to 13.2 million)

Why set up a Reablement service? Fit with government policy The four key objectives of the White Paper ‘Our Health, Our Care, Our Say’: better prevention with earlier intervention more choice tackle inequality & improved access to community services people with long-term conditions supported to manage their conditions The National Service Framework for Older People: Standard 3 Intermediate Care: “prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living” Standard 8 The promotion of healthy and active life in older age. 2 out of 3 English Councils only deliver to users with ‘critical’ and ‘substantial’ needs - Islington continues to also see users with ‘moderate’ needs

How Reablement was launched… In line with DoH recommendations for adult social care, based on evidence from other councils, the key triggers to establishing a Reablement service were: Demand for home care had increased and was continuing to increase People over 85 was predicted to increase by 12% by 2012 and 45% by 2022 People traditionally employed in the care industry are getting older – making it harder to recruit care workers needed There was commitment from SMT to implement the DoH recommendations, and the following steps occurred: Reablement Project Team and Home Care Board established Business Case prepared and approved (includes service model) Home Care Project Board approves business case Reablement implementation project commenced 4

What is the Re-ablement Service? The Re-ablement Service is an ‘intake’ service – the ‘Gateway’ to home care services in Islington Anyone you determine needs home care will go to the Re-ablement Service first The aim of a re-ablement service is to work with users and carers, intensely and for a short period of time, to enable them to live more independently in their own homes The service ill be delivered mainly by Enablers and will last for up to six weeks If service users have ongoing home care needs at the end of that period, they will be referred to the brokerage service, which will place hem with a home care provider

What does this mean for service users? If you have an existing home care package – no change arising from the Re-ablement Service Only new referrals to home care services will be directed to the Re- ablement Service Re-ablement is intermediate care and therefore free of charge for the first six weeks Vast majority of users will receive less than six weeks of re- ablement.

How will it work? - Overview The Re-ablement Service is an ‘intake’ service. Anyone you determine needs home care should go to the Re-ablement Service, unless they meet the exclusion criteria: the user has mental health or learning difficulty needs that would prevent them from participating in the Reablement process is not suitable because of particular care needs (e.g. terminal illness) is not old enough (i.e. less than 18 years old) is currently wearing a plaster of Paris cast and is unable to complete any day to day activities . Throughout re-ablement service, user receives regular (at least weekly) reviews.At end of re-ablement period, IF ongoing home care is needed, user referred to brokerage service

Re-ablement service – organisation structure Director of Adult Social Services Director of Joint Services Head of Disability & Intermediate Care Re-ablement Manager (PO6) Administrators (Scale 5) x 3 FTE Occupational Therapists x 2.0 FTE Deputy Re-ablement Manager (PO3) Senior Enabler (PO1) Senior Enabler (PO1) Senior Enabler (PO1) Senior Enabler (PO1) Senior Enabler (PO1) Enabler (scale 3 or 4) x 7 Enabler (scale 3 or 4) x 7 Enabler (scale 3 or 4) x 7 Enabler (scale 3 or 4) x 7 Enabler (scale 3 or 4) x 7

Re-ablement service – number of staff Post FTE Re-ablement Manager 1 Deputy Re-ablement Manager Administrator 3 Occupational Therapist 2 Senior Enabler 5 Enablers 35

Re-ablement service – roles Key tasks Reports to Re-ablement Manager Service management Staff management Financial management Performance management Head of Disability and Intermediate Care Deputy Re-ablement Manager Deputises for Re-ablement Manager Supports the Re-ablement Manager above Line manages Senior Enablers Senior Enabler As Team Leader, lead team of Enablers (8) Receives assessment and care plan from Care Coordinator Risk assessment Re-ablement goal-setting, with input from OTs sets predicted discharge date Assess for and issue basic equipment (all Senior Enablers are Trusted Assessors) Continuous re-assessment reviews Discharge users from re-ablement service Care Coordinator liaison. Re-ablement Manager & Deputy Line managed by Deputy Re-ablement Manager

Re-ablement service – roles Key tasks Reports to Enabler Work with service user in day to day re-ablement activities Carry out home care tasks where user is unable Update Re-ablement Action Plan Discuss progress with users and carers. Senior Enabler CCA s .Input into multidisciplinary team meetings and final review if ongoing support is needed. Detailed knowledge of FACS Criteria. Supporting and advising Senior Enablers. Liaison with social services teams. Input into the development of Individual Budgets pathway for Reablement Services. 2 Support Advisors that are professionally supervised by social work team

Re-ablement service – roles Key tasks Reports to Occupational Therapist Develop and deliver induction and training to Enablers and Senior Enablers Conduct regular audits of each team’s cases with the Senior Enabler and Enablers in the team Set re-ablement goals and carry out re-ablement reviews with Senior Enablers Support Re-ablement Manager in managing and monitoring the service’s strategic objectives. Report to Re-ablement Manager when working in the service. Line managed outside re-ablement Service Administrator Maintain Webroster Support Senior Enablers in producing work programmes Assign referrals to Senior Enablers Produce and update team schedules/ work programmes Support the Re-ablement Service in all administrative tasks. Re-ablement Manager and Deputy

Re-ablement service – referral to discharge process…

Care Manager Re-able.Mgr/ Deputy Senior Enabler Service User OT Enabler 1.Overview assessment, care plan & predicted re-ablement outcomes 4.Receive & check referral 8. Conduct risk assessment 10. Review outcomes, agree goals & produce action plan and agree predicted discharge date 11. Agree goals & action plan and predicted discharge date 9. Review outcomes, agree goals & produce action plan and set predicted discharge date 5.Determine if rapid response 2. Home care? 6. Enter into SWIFT & Webroster 12. Assess for basic equipment & issue Act as consultant to Enablers & Senior Enablers Y 3. Refer to Re-Ab Service 7. Allocate Senior Enabler 13. Hand over folder & plan to user. Allocate Enabler(s) 14. Carry out tasks in plan 15. Carry out tasks in plan 17. Discuss progress 16. Discuss progress 18. Discuss progress 20.Check progress (min. weekly) 20. Inform Care manager 19. Update action plan 21. Re-ablement goal review (min. weekly) 22. Re-ablement goal review Week before last 24. Final tasks, inform user, hand over questionnaire to user 29.Complete questionnaire & post 23. Goal review & discharge planning 28.Statutory review & refer to other services 25. Other services? Y N 26.Statutory Review & discharge 27.Statutory Review & discharge

Details of current Reablement Service When did the service become operational? April 2008 What are the current annual volumes? 2008/ 2009 Admissions = 401 2009 / 2010 Admissions Quarters (1 – 3) = 434 Intake & assessment / Hospital discharge model? Yes Selection / Deselection model? De - selection - The service has a minimum exclusion criteria Entry subject to FACS? Yes - Islington responds to moderate level of need. Service subject to charge? No the service is free of charge In house / outsourced model? In House Performance 2009 / 2010 data Quarters 1- 3 No further homecare package required at end of reablement phase 64% Reduced homecare package required at end of reablement phase 11% Assessed homecare package at start maintained at end of reablement phase 2.% Assessed homecare package at start increased at end of reablement phase 17% User did not complete reablement phase 5% 15

Activity % of episodes exiting Reablement service type

Activity – People exiting Reablement with home care need comparison with potential hours

Activity – AVLOS days

Activity - Total difference in weekly home care hours needed following Reablement

Learnings What worked well: What didn’t work well: Integration within the Intermediate Care Pathway Client consultation and feedback Enabling model leading to reduction in long term home care packages. Facilitation of hospital discharges reducing acute delayed transfers of care. Accurate monitoring of performance and mechanisms for auditing In House team benefitting from training packages investment into the process Reducing the no of home care Embedding the enabling philosophy with members of staff who were used to a ‘home care’ philosophy Home Care and Reablement sharing same office accommodation 20

Future aspirations Reablement plans to further integration within Intermediate care services to support the work related to: Poly systems Urgent Care Centre Prevention of admission Health Promotion Increase access to services by targeting hard to reach communities Individual budgets and the personalisation agenda 21