Presentation on theme: "Caroline Glendinning Emeritus Professor of Social Policy Social Policy Research Unit University of York College of Occupational Therapists/Skills for Care."— Presentation transcript:
Caroline Glendinning Emeritus Professor of Social Policy Social Policy Research Unit University of York College of Occupational Therapists/Skills for Care 22 nd July 2014
Background and early evidence Major studies SPRU (York)/PSSRU (Kent) 2008-10 Perth (W Australia) 2005-07 Concluding remarks
England 2000 onwards: development home care re-ablement services in most councils Scotland 2013: Joint Improvement Team survey 25/30 councils had home care re-ablement services 17 of these planning to expand From selective to inclusive services Australia, New Zealand – growing provider interest
High proportions receiving re-ablement needed no further, or less, home care on discharge than those who received standard home care 63% needed no further home care on discharge 26% needed less home care than comparison group But would they have recovered anyway? … and how long do the effects last?
Aimed to investigate longer-term impacts of home care re-ablement services, including: Compare home care re-ablement vs standard home care Assess user outcomes and use of NHS and social care services for up to 12 months Estimate unit costs home care re-ablement services Assess cost-effectiveness home care re-ablement Describe organisation and content of home care re- ablement services Examine user and carer experiences
5 re-ablement councils, 5 conventional home care councils Users recruited on referral – baseline interviews Re-interviewed after 9-12 months Data collected on: Users’ health, quality of life, social care outcomes at baseline and follow-up, using standardised measures Social care and NHS etc services used by both groups Costs of re-ablement services (staff, overheads etc) How re-ablement services organised and delivered Experiences of users and carers
Re-ablement had positive impacts on health-related quality of life and social care outcomes Compared with conventional home care service use Typical re-ablement episode (39 days) cost £2,088 More expensive than conventional home care But 60% less use of social care services subsequently Over full year, total social care services used by re- ablement group cost £380 less than conventional home care Re-ablement group – higher health service use and costs Effects of recent hospital discharge?
CE = compare improvements in outcomes against costs NICE threshold £20-30K for each outcome gain Re-ablement was cost-effective in relation to health-related quality of life outcomes Re-ablement may be cost-effective in relation to social care outcomes Depends on £ threshold Higher healthcare costs of re-ablement group Probability of cost-effectiveness only
Poor initial understanding of re-ablement Previous experiences of standard home care Context of referral - crisis, hospital discharge Value of repeated information Appreciated frequent visits, monitoring Quality of relationships crucial Reported greater independence improved confidence, relearned self-care skills People discharged from hospital/recovering from accident/illness reported greater gains than those with long-term/progressive conditions Felt shortcomings More help with mobility/activities outside the home Anxiety about end of re-ablement Potential for greater carer involvement?
Assessed impact of ‘restorative’ home care on subsequent service use for 2 years 750 older people randomised Restorative home care Standard home care Service use records Home care A+E attendance Hospital admissions - number and duration Calculated costs of all services used
Compared to standard home care, restorative home care group: Less likely to use on-going personal care services Used fewer hours of home and (especially) personal care services Less likely to be assessed as needing residential care 30% less likely to have attended A+E 31% less likely to have unplanned hospital admission Had lower total (health + social care) service costs (average £1574 - £2380 less)
Growing body of evidence that re-ablement reduces service use and costs in short and longer terms. But outcomes and cost-effectiveness depend on: How services are organised Specialist service vs generic/extended assessment Delays in onward referral Who receives re-ablement Inclusive vs selective services Eligibility thresholds What’s included in re-ablement interventions Home care only vs wider range of skills/inputs Rapid access equipment/AT How long intervention lasts