Adults Health & Care Integrated Reablement Service Stephen Cameron Head of Reablement January 2017

What is reablement? Reablement is the active process of an individual regaining the skills, confidence and independence to enable them to do things for themselves, rather than having things done for them. It helps people learn or re-learn the skills necessary for daily living, also known as Activities of Daily Living (ADL). These skills may have been lost through deterioration in health and / or through a change in circumstances.

What is the integrated reablement service in HCC? A bringing together of four distinct service functions, each of which support reablement Occupational Therapy Community Response Teams (CRT) Sensory Services Equipment Services

Why integrate? Background context: National austerity measures & subsequent Central Government funding reductions. Local Authority services need to change to meet these challenges. A sustainable service is needed that is able to respond to the ever-changing challenges that the sector faces, including delivering cost-effective services within the resources available. Continue to be focused on outcomes for service users; this means that we have to support service users & staff in positive risk taking. Strength Based Approach

Strength Based Approach Current model Deficit Based Approach Future model Strengths Based Approach

Service principles The principle behind the delivery of service is to establish an OT governed framework, using established therapy techniques and access to a qualified practitioner when appropriate, as identified as best practice in national research. The operational integration of services offers rapid access to professional practitioners through effective triage of workflow to better manage demand & improve support planning & service user outcomes built around strength based methodologies.

HCC Care Offer Tiered Approach What services and resources can I access to assist people to meet their care and support outcomes and enable them to live as well as possible? TIER 7 | Residential Services Residential/ Nursing services e.g. registered placements. . TIER 6 | Care in the Home Care provided in your home e.g. domiciliary care TIER 5 | Maintaining Independence A solution to assist the individual to live well e.g. Extra Care Day care, support worker TIER 4 | Resources to regain independence A solution to assist the individual to regain their independence e.g. OT, sensory support TIER 3 | Signposted Support Sign posted specific support to meet eligible need e.g. fire safety and Meals on Wheels. TIER 2 | Community Support Wider support within the community that is focused on outcomes, which promotes community access to live well e.g. faith groups and lunch clubs To assist practitioners the resources and services have been grouped by type in a menu which will be held by Adult services teams. The menu starts with low-level universal services and works up through to short-term council funded ‘enabling’ services and finally to fully-funded council services. In the contact centre we will not operate in all of the tiers, the ability to move through the tiers depends on the level of assessment carried out on the individual to asses their eligibility. It is important that you always work up through the tiers. The tiered menu of resources has been developed to support you to use a strengths based approach It will provide an approach to support and guide practitioners in building creative solutions for Care Packages This document should be used as a guide on how to best adopt the resources available through the Care Offer, tailoring each case to the person’s individual strengths Facilitator to ask ‘How might the contact centre work with these? In the contact centre Tier 1 will operate in the first 3 tiers of the tiered model Tier 2 will operate in the first 5 tiers of the tiered model These tiers will be discussed again in a later training session when we look at the wellbeing check and subsequent adjustments to care that can be made as a result. The ability to make these changes will depend on the tier. TIER 1 | Universal Support Support that is available within a person’s own social and community network and is widely available to all members of public e.g. Health, District  Council, libraries

Reablement & Strength Based Approach Training, technique, coaching The fundamental delivery element of reablement, supporting individuals to relearn or regain the skills associated with the activities of daily living requires teams to support service users through direct face-to-face training, technique & coaching. Equipment Appropriate equipment can reduce the need for direct care support whilst assisting an individual to maintain their levels of independence. Signposting service users to, or suitable provision of, equipment through a clearly defined prescription pathway is fundamental to the reablement pathway & is included at all stages from front door to discharge. Services Signposted Support (a specific referral to a service to meet an eligible need) Telecare, Argenti, Apetito, Red Cross, SAAFA, Local Grants and Schemes

Reablement – short-term, long term or both? Short term model This element of reablement service forms part of Hampshire County Council’s non-chargeable care offer and is based on The Care and Support (Charging and Assessment of Resources) Regulations 2014, which includes Up to 6–week reablement services under intermediate care funding support people to use prescribed equipment or adaptations support for safe moving and handling transfers to achieve social care outcomes OT / Sensory Due to different legislation and guidance there are specific responsibilities that are carried out by Occupational Therapists and Sensory Officers due to their specific skill/qualification set, that fall outside of the short term 6 week model and charging policy but will still be considered as reablement.

Getting from A to B! Multiple teams Multiple localities Multiple referrals Different functions Different ways of working Different ways of thinking

Getting from A to B! Seek solutions from operations Involve those doing the do from the outset Where were the overlaps? Common functions Where was the duplication? Same or similar being delivered by many Where was the skill base/gaps? Who could do what? What knowledge did we need?

Better Care Fund/Health Education Wessex Workforce development Underpin transformation in the workforce across health & social care through the Better Care Fund OT Leadership and governance, Moving and handling competencies, dementia pathway and tools, standardised equipment pathway and competencies, Development of long term condition social care competencies and development of occupational therapy mobilising skills.

Benefits? Single service approach Timely & effective decisions Capacity & demand management Acknowledge & appreciate multi-disciplines Person centred, strength based principles Reduce, delay or avoid need for funded long term support Home first

Forward plan Year 1:- Year 2 – 3:- Consolidation of new integrated structure Building new pathways with operating model Continued development of governance structure Consolidation of T17 savings and efficiencies Identification of future reablement efficiencies and contributions Continued development of BCF goals and health integration Year 2 – 3:- Escalation of reablement connection to health integration and BCF goals Development of therapeutic and 3R integration Enhancement of reablement connection in HCC long term care model

Future integration- intermediate care

Questions?