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Alison Petch, Gerry Graham and Sam McLean

Joint Improvement Team How Effective is Home Care Re-ablement? Performance Information and Outcomes Explored. Alison Petch, Gerry Graham and Sam McLean. Purpose. To consider research about Home Care Re-ablement

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Alison Petch, Gerry Graham and Sam McLean

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  1. Joint Improvement Team How Effective is Home Care Re-ablement?Performance Information and Outcomes Explored Alison Petch, Gerry Graham and Sam McLean

  2. Purpose • To consider research about Home Care Re-ablement • To engage with relevant stakeholders to understand how performance for Home Care Re-ablement is being undertaken across Scotland • To consider the importance of taking action in order that we know how well we are doing with: • Outcomes for service users • Delivering the service • Tracking and recycling financial benefits

  3. Programme • Review of the research – Professor Alison Petch • Headline findings from survey of Home Care Re-ablement in Scotland – Gerry Graham • What is happening locally with outcomes and delivery measurement? – Discussion • Key Action Question – Discussion • Summary of Issues Arising – Sam McLean

  4. Review of the Research – Professor Alison Petch

  5. Key aspirations for reablement • Maximising long-term independence, confidence and quality of life • Reducing unnecessary levels of ongoing support and therefore avoiding unnecessary costs

  6. Evidence base • Early studies eg Leicestershire (Kent et al, 2000) • Four schemes in England for CSED (Newbronner et al, 2007) • Evaluation of Edinburgh initiative (McLeod and Mair, 2009) • SPRU – short-term outcomes and costs (Jones et al, 2009) • SPRU/PSSRU – longer term outcomes (Glendinning et al, 2011)

  7. Short-term outcomes • Typically a period of reablement is in the order of six weeks • Studies show improvements over the short term in respect of perceived health, quality of life and social care outcomes eg – Edinburgh: 92% greater confidence; care at home hours decreased by 41%

  8. Longer-term outcomes SPRU/PSSRU study prospective study in five la areas, reablement v conventional home care • Improvements in users’ health-related quality of life and social-care quality of life • Users and carers were positive about the impact of reablement on their independence and confidence; some would have liked more help with mobility and activities outside the home • 60% reduction in need for social care following reablement

  9. Cost effectiveness • Findings related to cost vary; in general initial costs of reablement are higher but the reduction in service use longer term implies cost reduction • The SPRU/PSSRU study found no net cost savings to health and social care in the first year of reablement but considered reablement was cost effective on the basis of the improved outcomes for individuals

  10. Key factors • Type of scheme ie selective (eg hospital discharge) versus inclusive (eg intake) • Eligibility criteria eg age • Professional mix – important role of OT skills • Flexibility of reablement period and package, signposting to other services • Culture of independent providers • Training for home care support workers • Specific service or culture across the organisation

  11. Headline findings from survey of re-ablement in Scotland – gerry graham

  12. Response • Telephone Survey • Carried out by Gerry Graham and Alex Davidson • February through to May 2012 • 31 out of 32 authorities engaged

  13. Geographical Spread • 19 authorities had 100% spread across their geographical area • 3 authorities had between 50% and 75% spread across their geographical area • 4 authorities had between 10% and 45% spread across their geographical area

  14. Summary • 25 Authorities have Home Care Re-ablement Service and 5 Authorities in the development stage (months away) • Most common model was Stand Alone Home Care Re-ablement Service (25 Authorities) • High number of referrals from hospital and community 84% • Authorities still testing information and significant numbers had difficulty accessing information on • Staffing numbers • Number of service users • Care hours of service users per week • Before and after care hours • Unit Cost • Outcome Measures suggest at least 10 different models • Finally….Authorities stated that Change Fund used to resource Home Care Re-ablement ranged from £25k to £2m

  15. What is happening locally with outcomes and delivery measurement? - Discussion

  16. What is happening locally? • Measuring Outcomes for service users • Measuring effectiveness of delivery including operation • Measuring financial efficiencies

  17. Outcomes for Service Users • How do you measure effectiveness? • Could comparative data help? • Should we be looking to a core data set?

  18. Delivering the Service • Do different models of service configuration deliver different results? Notwithstanding this……. • Should we be looking to understand the components that deliver better outcomes?

  19. Tracking Financial Benefits • Do you track financial benefits? • In what way? • Do you use these for efficiency savings or do you recycle them?

  20. Summary • Accessing recording of presentation • Thanks to participants

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