Community re-ablement consultation
What we consulted on? - Please note this consultation is now closed
People living in Haringey were invited to have their say on proposals to develop a Community Re-ablement Service.
The objectives of the proposal were to:
- Promote independent living, especially after hospital discharge
- Deliver an excellent customer-focused, cost-effective reablement service
- Encourage lifetime well being at home
Haringey Council’s plans included:
- Closure of the current in-house home care service by March 2012 at the latest.
- Establishment of a new, smaller and more flexible re-ablement service, dealing with service users for a maximum of six weeks
- All long-term home care packages to be provided by our independent sector partners
When did we consult?
The consultation ran from 1-31 August 2011
Who did we consult?
We welcomed local people’s views on our proposal which helped us shape the service to ensure that it meets the needs of people in the borough.
Reason for recommendation
The new re-ablement service will benefit service users in a number of ways.
The service received will be more flexible than the current home care model, where the service is currently delivered in time designated and time limited slots. During the free six week re-ablement period, the amount of time delivered will be varied to reflect the level of dependency – as the person regains independence, the level of support can be reduced to reflect that. In addition, there are potential financial benefits for service users in that, where a financial assessment is required for a long term service, the amount the service user has to pay will be reduced to a minimum. The new service should also deliver considerable savings to the Council in a time of financial austerity.
- To work with people who have been discharged from hospital/A& E to help them regain and then maintain their independence
- To encourage and motivate those discharged by providing appropriate - but reducing - levels of support that increase their ability to cope and helps them regain their confidence
- To effectively assess people and create individual Re-ablement Plans; accessing occupational therapists for more complex assessments
- To quickly supply equipment to service users when they need it
- To deliver home visits that are flexible in terms of timing, duration and content
- To refer users needing long-term care to external agencies after the initial 6 week period, with the possible exception of individual complex cases where there are safeguarding concerns
- To have teams that are involved, well motivated, organised, deployed and rostered to work with service users in flexible ways that enable swift responses to the changing needs of service users and their increasing capacity over time following the initial inputs
- To have close working arrangements at the front-line with Whittington Health community health based services such as Physiotherapists and Community Nurses
At the time of consultation
The service in place at the time of the consultation was a good service but not capable of delivering what we need to meet our re-ablement objectives which is why we are developed a new service and way of doing things.
How it will work in future
There are two re-ablement areas, East and West with boundaries equivalent to those in the former home care service.
Front-line staff will communicate between themselves and the central office, using service-supplied mobile phones. In the future, these may also be used to ‘touch in’ and ‘touch out’ of the homes of service users to monitor time spent with individual service users and generate performance data for the service generally, for example, contact time/client. This model will enable people who receive the service to adjust the input they receive, according to their wishes on that particular day and will give much increased flexibility to the service provided on a daily basis, for example, getting up times, meal times, times for rehabilitation/re-ablement activities and the time devoted to such activities.
The service will not be charging for the re-ablement phase. A financial assessment will be carried out at the end of that time on the reduced package, if necessary. Ceasing charges will therefore enable the current time “slots” to be abolished and for a much more flexible and fluid system of visits to people to be put in place, front loaded to maximise input immediately after discharge and reducing further the service the user gets from that date. Priority tasks such as personal care can be done at peak times, and the workers can then return to carry out re-ablement training with service users when they are less busy.
Creating and supporting an effective re-ablement team
The skills mix required to operate in the new environment and deliver better outcomes for people will be found within a wider range of people than current home care workers. All roles in the team will have the potential to cross professional boundaries and post-holders can have backgrounds as occupational therapists, physiotherapists, social workers as well as home carers. It will be the accountabilities of the role and the competencies required (skills/knowledge and behaviours) which will be critical.
These re-ablement workers will receive specialist training to enable them to work with clients to increase their independence, rather than do things for them in a way that makes them dependant.
Proposed changes to the staffing structure
The structure and numbers of staff involved have been calculated on current numbers of discharges from local hospitals about 400 per year, and based on 70% contact time/30% non-contact time. Non contact time in this context includes travel time, annual leave, sickness absence and training.
The size of the proposed new in-house Re-ablement Service will be some 25% of the current home care service due to the fact that it will not be providing personal care to long-term clients as currently. It will be dealing with circa 400 hospital discharges per year, for a strict six-week period, following which the cases in question will be passed on to external contracted providers in the independent sector. Achieving a high standard of service and throughput is critical. We need to sustain our “excellent” performance indicator on delayed discharges from hospital.
The approach will be to frequently review and reduce levels of support to the minimum necessary as the capacities and abilities of the person increases (the ideal will be that the person will no longer need the service after six weeks, if not before, and not need any form of ongoing personal care/support service).
The budget for the current home care service is £1.7 million, following the first phase of the Haringey Efficiency Savings Programme. It is now proposed to design and establish a new re-ablement service and close the current in-house home care service, rather than reorganise it, in order to increase efficiency and flexibility of delivery and thus release a further tranche of savings (£500k).
This process will be carried out in the wider context of readily accessible guidance, based on best practice as set out by the Department of Health, via the Care Services Efficiency Delivery (CSED) work stream. Please note that we worked with a Department of Health colleague on our business re-engineering model and business case during 2010.
In essence, there will a number of necessary change areas in order to establish the new service and therefore generate the efficiencies from a current service which, though providing care of good quality, has old-fashioned somewhat rigid systems and processes, centrally driven by managers, which have a tendency to increase inefficiency of delivery, by default.
More efficient use of our resources
It is clear from a range of sources, most recently the Audit Commission “Improving Value for Money in Adult Social Care” (June 2011) that a well-run re-ablement service is capable of generating direct efficiencies and that other local authorities (21%) have already begun or completed the process of outsourcing the home care services and are converting the remainder to providing a re-ablement approach. 54% of all Councils have made efficiencies by using re-ablement and other intermediate care schemes. 81 Councils have cited re-ablement in their 2009/10 efficiency statements (See Appendix 1 - What is a successful Re-ablement Service? please see table below).
Update 3 Nov 2011: Haringey’s New Joint Community Reablement Service
The decision to create the New Joint Community Reablement Service and close the in-house homecare service was agreed at Cabinet Member signing on 17 October 2011. The internal Homecare service will close by 1 April 2012 and the new will commence by 1 April 2012.
Further details about the new service are at Getting Back Your Independence - Reablement. This information is for users of the service and their relatives and carers, staff, NHS and voluntary sector colleagues and others explaining the workings of the new service in more detail.
Formal consultation was included in the Council's Consultation Calendar.
For more information please:
Let us know if you need information in alternative formats or languages.
Tel: 020 8489 1400
Attached files section
In the table below are various files that will ensure you are provided with all the relevant information around the proposed consultation.
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