Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Wirral Home Assessment and Reablement Teams - the way forward Presentation for Reablement Seminar 10/1/08 Tate Gallery Liverpool Anne Bailey Principal Manager Homecare Reablement Melanie Jones Professional Lead for Occupational Therapy

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Population 312,000 (2001 census) Comparator authorities include Sefton, North Tyneside and South Tyneside, Darlington, Bolton 10 year difference in life expectancy between wards

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Background Wirral Enablement Discharge Service established 2004 as a partnership between Home Care and Wirral Hospital Trust Team included 3 Home Care Organisers, 1 Senior Carer, 16 PT Home Care Enablers, 2.63 WTE Occupational therapists + OT Assistants.

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Background cont.. July 2006 management agreement to extend the role of the WEDS team to include an assessment function based upon Leicester model of an intake assessment service August 2006 WEDS chosen as a case study site by CSED as part of its Reablement work stream. Evidence from other CSSR’s supported the business case for the re- engineering proposal

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Background cont.. June 2007 WED service chosen by CSED as a site to take part in a retrospective study of the effectiveness of reablement to be carried out by SPRU (University of York) Wirral Home Assessment and Re-ablement Teams established August 2007 (WED Service integrated)

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Wirral Home Assessment and Reablement Teams The name has been changed to reflect the assessment function and the eventual wider inclusion of community referrals. OT referrals have clear reablement goals identified Care Manager referrals identify needs that can be met by care in the home. Role of Wirral HART is in promoting independence and assessing the correct level of provision

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Objectives of Wirral HART To maximise users long term independence, choice and quality of life To appropriately minimise ongoing support required and, thereby, minimise the whole-life cost of care Helping people ‘to do’ rather than ‘doing to or for people’

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Objectives cont.. To ensure that the provision of ongoing care packages are more accurately assessed and not purely defined by a one off assessment but by skilled observation over a longer period in the home environment To be outcome focused with a defined maximum duration of input

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Phase 1 - Hospital Discharges Hospital patients who meet the old WEDS criteria. (OT referrals) Hospital patients with no previous homecare support who now require support as identified by MDT/Ward/Care manager. Hospital patients requiring an increase to an existing package of care. Hospital patients whose length of stay has exceeded the timescale for automatic reinstatement of their previous package (currently > 2 weeks.)

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Phase 1 cont.. As part of the discharge plan for hospital patients who have been identified for elective episodes To integrate more fully with pathways of other intermediate care services to facilitate faster discharge into individual’s own home To integrate with the telecare pathway

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Phase 2 – Community referrals To accept 70% of community domiciliary care referrals currently going through brokerage To link to Community Therapy Service (CTS) To link to community matrons and long term conditions agenda To offer step up intermediate care Potential involvement in locality pilot project Support assessment of direct payments and support care management reviews

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Structure December Trained Home Care Enablers (55.2 WTE) 4.63 Whole time equivalent OT’s and OT assistants provided by Wirral Acute Trust Home Care Organisers and Senior Care staff are running Wirral HART alongside the traditional service

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Challenges The initial plan was for OT staff to be involved in the screening of all cases taken onto the service 80% of referrals coming via care management are benefiting from OT input It was anticipated that OT’s would be primarily involved in provision of equipment. It quickly became evident that OT’s skills were more widely required

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Initial service data 6/8/07 – 14/12/07 Number of referrals to date 550 No of referrals proceeding to service 485 Referrals not actioned 65 Turned down service 22 Inappropriate 43 Average number of cases live at any one time 102

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Service data cont.. No of care management referrals 279 No of OT referrals 229 No of OT referrals to WEDS April – July

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Service data cont.. Number of people went from HART service into HospitalH45 (9%) Number of people that went from HART into Residential RespiteR7 (1.4%) Number of people who went into Nursing RespiteN3 (0.6%) Number of people who went from HART into Intermediate Care Residential I4 (0.6%) Number of people who went into Intermediate care nursing (Grove House)G0 Number of people who died while in receipt of HART serviceD7 (1.4%) Total number of unplanned outcomes 40

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Service data cont.. Outcomes Number of people on completing HART intervention required no ongoing service (Excludes Live, non actioned, ongoing and unplanned). 111 (29%)

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Finance and efficiency Saving impact on Commissioning Budget 562,482 Cost of HART Delivery to date 177,485 Total Net Efficiency achieved to date 384,997 Number of Wirral HART hrs delivered to date (Including live cases). 7,881.4

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Monitoring Sustainability of outcomes Within the process service users requiring on going care will be transferred to independent sector providers Care planning and intervention outcome information is transferred with the service user

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Why improvement might not be sustained? Deterioration in service user’s functional ability &/or confidence Alteration to informal care support structures Family anxieties and expectations in conflict with professional views Conflict of philosophy between independent sector care providers and re ablement service (Care for v encourage)

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Maintaining outcomes Close working relationships with care management Offering review through reablement service when appropriate Closer working with contracts dept to improve QA Closer working relationships with independent sector providers to encourage a culture change through closer working and good feedback mechanisms Promoting the culture change with family and informal carers to reduce anxieties around risk issues

Department of Adult Social Services Wirral University Teaching Hospital NHS Foundation Trust NHS Any Questions?