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

2. 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)

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Re-ablement service – referral to discharge process…

14. 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

15. 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

16. Activity % of episodes exiting Reablement service type

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

18. Activity – AVLOS days

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

20. 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

21. 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