Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog Caroline Glendinning Professor of Social Policy University of York Presentation to SSRG Scotland Conference 28 October 2013

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Context – growing interest in re-ablement  Home care re-ablement – evidence on impacts and cost-effectiveness  Success factors – circumstances optimising effectiveness of re-ablement?  Effectiveness in social care - wider reflections on the evidence base

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Most English councils now have home care re- ablement services  From selective to inclusive/intake services  Interest in Australia, New Zealand (particularly providers)  New NHS funding for England to invest in re- ablement  Autumn £70m  2011/12 - £150m  £300m p.a.

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  High proportions receiving re-ablement needed no further, or less, home care  63% needed no further services  26% needed less home care  But would they have recovered anyway?  … and how long do the effects last?  York/Kent study aimed to  Provide evidence on longer-term impacts of home care re- ablement  compared outcomes of re-ablement vs. conventional home care services  … up to 12 months later

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Comparative study  5 re-ablement councils, 5 ‘standard’ home care councils  Users recruited on referral  Baseline interviews  Re-interviewed after 9-12 months  Standardised outcome measures  Health  Quality of life  Social care outcomes  Costs of re-ablement, other social care and NHS services used  Organisation and delivery of re-ablement services  Focus groups  Observations  Experiences of users and carers

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Re-ablement had positive impacts on health-related quality of life and social care outcomes  Compared with conventional home care services  Typical re-ablement episode (39 days) cost £2,088  Higher 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 costs  Effects of recent hospital discharge?

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Compare improvements in outcomes against costs  NICE threshold £20-30K for each outcome gain  Re-ablement is 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

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Established services not pilot schemes  Small samples after 12 months – couldn’t examine:  Differences within groups  Hospital discharge vs all community referrals  Higher vs lower needs for assistance  Differences between sites, service models (especially OT or NHS involvement)  Standardised outcome measures – but not sensitive enough?

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Service organisation  Thorough initial assessment, regular reassessment  User-focused care plans  Flexibility  Rapid access to OT expertise/equipment  Access to other specialist skills  Physio; mental health; sensory impairment; dementia  Communication and continuity  Small teams  Clear recording systems  Regular discussions  Training and supervision  On-going reinforcement re-ablement ‘ethos’

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  User characteristics  Expectations and motivation  Dementia?  Carer involvement  Wider environment  Strong/shared vision of service  Within adult social care  External stakeholders, especially NHS referrals  Direct referral for on-going home care  Capacity within long-term home care services  Approach of long-term home care services

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Across the boundaries – from acute ward to return home  Selection  Continuity  Skillmix  Impacts on NHS service use (esp. readmission)  Roles and impacts on carers  In-house vs outsourced services  Costs, commissioning, quality  Beyond re-ablement – sustaining improvement

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  NIHR SSCR workshops and survey  No standard definition, approaches to evaluation  Most popular ‘preventive’ services  Re-ablement  Telecare/telehealth/other technology-based interventions  Information and advice

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog  Causality, ‘soft’ outcomes’, pilot vs ‘bedded in’, diversity of QoL, cognitive/communication issues  Logic model – link interventions > intermediate outputs > outcomes  Outcome measures might include:  ASCOT, others standardised outcome measures  Personal outcomes achieved, QoL domains  Falls-related admissions  Set against costs  Labour-intensive  Budget silos  Short vs long-term costs

Twitter: SPRUYork alerts: bit.ly/ Spru Blog: bit.ly/Sprublog SPRU/PSSRU evaluation of home care reablement services: bit.ly/hcreablebit.ly/hcreable NIHR School for Social Care Research: especially:  RF9 – Allen and Millar - prevention  MR6 – Netten - outcomes measurement