East Midlands Region 21 st July 2009

1. East Midlands Region21st July 2009

2. HOMECARE RE-ABLEMENT Gerald Pilkington Care Services Efficiency Delivery

3. HOMECARE RE-ABLEMENT: Objectives of this Presentation To provide: • a summary of CSED’s role and programmes • a summary of CSED Homecare Re-ablement documents • monitoring operational performance • an update of the national ‘picture’ • an outline of current and future work areas Questions

4. HOMECARE RE-ABLEMENT: CSED’s role • To support CSSRs to achieve their efficiency targets within adult social care in England • Working through a number of programmes • Transforming Community Equipment • Homecare Re-ablement • Crisis Response • Integrated Care and Support Pathway Planning • Support Related Housing and Technology • Assistive Technology • Better Buying • Demand Forecasting and Planning (POPPI, PANSI) • PSSEX1, Engaged with CSSRs through programme leads and regional teams

5. HOMECARE RE-ABLEMENT: CSED Documents As a result of its work with CSSRs, CSED has produced a body of evidence which is available via its website: Executive Summary and Discussion Document:published January 2007 containing information from 5 case studies and 13 additional information sites, supporting documents: evaluations, evidence of benefits, example documents. Assessment tools and satisfaction surveys: published August 2007 7 examples of functional assessment tools used within CSSRs Summary of outcome measures / standardised assessment tools 8 examples of satisfaction survey tools Retrospective Longitudinal Study: published November 2007 working with four CSSRs, tracks 2,441 people that underwent a phase of homecare re-ablement for 24 months and quantifies the duration of benefit CSSR Status Directory Update: published March 2009 provides an update on 137 CSSRs Benefits for people at different levels of need: published January 2009 provides data outcome on 14 services across 13 CSSRs, of which 10 are at substantial or critical

6. HOMECARE RE-ABLEMENT: Monitoring Operational Performance How effective is the service ? compare to local baseline data compare to previous period data compare to local targets / business case compare ‘area’ data compare to other services

7. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (1) Data from 14 services across 13 CSSRs

8. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (2) The 13 CSSRs • account for 14.5% of the total population of England • account for 16.0% of the total over 65 population, and 16.2% of the total over 75 population in England • by population they range from the 1st to the 130th largest across England Although not representative, they provide examples based on a broad spread of councils and add to the evidence base

9. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (3) Non-completers ranged from 10% to 35% in established services (non-pilot) Need to monitor % and reasons

10. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (4) No Homecare Package Required Post Re-ablement • although the range of benefits for those operating at substantial and above is lower and more variable than for those at moderate and above, or even at critical, the more established services see similar levels of outcome benefit. • those at critical and above have relatively high results when compared with all other FACS groups.

11. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (5) Reduced Homecare Packages • across all three levels of need, significant proportions of people benefit from greater independence even though they still require a subsequently reduced homecare package. Maintained and Increased Homecare Packages • although most results are an improvement on what appears to be the situation without re-ablement, the group with the widest divergence is that where the start package was not altered by the re-ablement phase

12. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (6)

13. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (7) Duration of Homecare Re-ablement Phase • the average duration for the vast majority of people is 3.1 to 6.4 weeks. • there is a significant consistency between services operating at substantial and above in that, with few exceptions, each maintained its relative position in shortest to longest durations for each of the user groups e.g. site with the shortest overall duration was shortest for every user group (no package required, package reduced, package maintained, package increased) (see section 2.3.5)

14. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (9)

15. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (10)

16. HOMECARE RE-ABLEMENT: Benefits for people at different levels of need (11) Thus, based on these additional examples, it would appear that Homecare Re-ablement does have significant benefits for people at substantial and even critical levels of need. What is also clear is that CSSRs need to • continually monitor operational performance • identify fluctuations • investigate reasons • and amend practice if they are to ensure that clients gain maximum benefit

17. HOMECARE RE-ABLEMENT: A regional approach Regional approach to identify possible areas to assist Councils to make a step improvement in implementation / operation of the service

18. HOMECARE RE-ABLEMENT: National Map of Coverage – July 2009 • information available from 146 (97%) CSSRs • 23 (15%) CSSRs have a scheme • 123 (82%) of CSSRs are in the process of either establishing a scheme, or enhancing or extending an existing scheme

19. HOMECARE RE-ABLEMENT: National Coverage – June 2009

20. HOMECARE RE-ABLEMENT: Outline of Direction for 2008/09 + Focusing on 4 projects • Continued roll-out of the Homecare Re-ablement model • CSSR Homecare Re-ablement Scheme directory – completed May 2008 but updating Feb 2009 • Benefits of homecare re-ablement – completed Jan 2009 • Outsourced services • Clients with mental health, physical, sensory and learning disability needs • Prospective Longitudinal Study – underway Working with nine CSSRs • to identify the features of an effective and cost efficient service • to maximise both outcome and duration of benefits and reduce variability between services • to understand and reduce the demands on other formal care, including • other social care services e.g. delay or prevent admission to residential care • other council services • delay or reduce demands on health • Homecare Re-ablement for those on ‘maintenance’ packages - underway • seek to provide evidence through case studies and supporting information of the benefits of homecare re-ablement for those who have been in receipt of a maintenance homecare package. • Post initial phase homecare re-ablement – underway • seek to provide evidence through case studies and supporting information of the benefits of additional phases of homecare re-ablement for those whose needs increase at subsequent reviews following an initial phase of homecare re-ablement

21. HOMECARE RE-ABLEMENT: Contact with CSED Gerald K Pilkington CSED Lead Homecare Re-ablement gerald.pilkington@dh.gsi.gov.uk www.csed.org.uk Telephone: 020 7972 4161