1. Reablement and Occupational Therapy in Gloucestershire Margot Mason Professional Team Lead, Occupational Therapy, Stroud & Gloucester Locality.

2. Presentation outline Integrated Adult Health & Social Care. Overview. Our Journey. Challenges & benefits.

3. Measuring Outcomes April 2013-March 2014: number of people entering Reablement: 557 86.6% of these were over 65 years old 43.8% of these did not need ongoing care We are to gather more detail: % partially reabled % needing less/same/more ongoing care reasons for not completing

4. Quality Outcomes Right levels of care: Indicative budget calculation before & after reablement used as a measure of the outcome/ benefit. Initial results showed a 48% reduction in indicative budget following reablement (although it should be noted that the sample size was very small). Canadian Occupational Performance Measure: Occupational Therapists use the COPM, showing significant improvement in Service User satisfaction and performance of their identified Occupational Performance Issues. Experience: Countywide Service User Reablement satisfaction survey rolled out. Positive results.

5. Identifying Reablement cases Countywide telephone ‘Helpdesk’. Local referral centre: New referrals screened by an Occupational Therapist, Physiotherapist and Reablement co-ordinator. Initial assessment by Therapist or Senior Reablement Worker. Use of robust Goal Planning. Regular Evaluation.

6. Added Value of Occupational Therapy The COT Position Statement discusses our use of evidence informed practice, person centred working, thorough assessment and outcome measurement. Literature review & Benchmarking. We use the Canadian Model of Occupational Performance & outcome measure. Work within Integrated Community Teams for the benefit of Service Users.

7. Occupational Therapy skills New Integrated Community Teams (ICTs) in place. Social Care, Intermediate Care & Community Hospital backgrounds. All extending core skills. Supervision, CPD sessions, work-shadowing. Use of delegation to Reablement staff.

8. Our journey Literature review completed to inform practice. Competency framework for Reablement staff developed. Range of training developed. Reablement goal plan re-designed. Team working & Communication. Need for countywide model of Reablement.

9. Assessment High-quality assessment before re-ablement started was said to be essential in helping re-ablement teams to set up appropriate support arrangements. Ongoing assessment during the period of re- ablement was also important to enable the team to identify new targets as people’s abilities improved. Rabiee & Glendinning 2011

10. Communication Regular communication is extremely important and key to the whole process; So, understanding each others roles; Discussion with the service user & family to monitor progress and timescales; And liaison between Reablement workers, Nurses, Therapists & Co-ordinators to regularly review and progress goals with the service user.

11. Work completed to date Development and implementation of a comprehensive Reablement competency framework. Delivery of an extensive training programme to support the framework. Development of Team Working Workshop and Workbook. Development of Therapy screening and first assessment. Development of outcome based performance measures as part of the scorecard.

12. Barriers & Challenges Reablement staff change of role, hours & rotas. Widening role of Occupational Therapy staff. Service demands. New referral screening & assessment-By whom? Need to increase Assessment skills and Clinical support of Senior Reablement Workers. Need to further embed Team working, Vision and true Integrated working.

13. Leadership South West Clinical Network Benchmarking Leadership Group, Work streams identified: Development of alternative reablement pathway and pilot. Workforce Development. Development of outcome measures. Increasing contact time. Review domiciliary care in lieu of reablement.

14. Summary Reablement is embedded in the Integrated Community Teams. Continue to develop Occupational Therapy at the forefront of Reablement. Positive impact on External Care budget spend. Any Questions?

15. References Boniface et al. 2013. The effectiveness of local authority social services’ occupational therapy for older people in Great Britain: a critical literature review. British Journal of Occupational Therapy. 76(12) 538-547 COT Position statement 2010 Reablement: The added value of occupational therapists. www.cot.org.ukwww.cot.org.uk Rabiee P. and Glendinning C. (2011) ‘Organisation and delivery of home care re-ablement: what makes a difference?’, Health and Social Care in the Community, vol 19, no 5, pp 495–503.

16. Contact details Margot Mason Professional Team Lead, Occupational Therapy. Stroud & Gloucester Locality margot.mason@glos-care.nhs.uk 01452 427661