HOMECARE RE-ABLEMENT CSSR Scheme Directory Update April 2012

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1 HOMECARE RE-ABLEMENT CSSR Scheme Directory Update April

2 The original Discussion Document published by the Care Services Efficiency Delivery (CSED) programme and launched at its workshop held in January 2007 contained a summary of information provided by Councils with Social Services Responsibility (CSSRs) on their Homecare Re-ablement schemes. This was compiled as part of their work during 2006 and updates to this section were published in September 2007, May 2008, March 2009 and then again in November 2010 Many CSSRs continue to implement schemes or are making significant changes to existing schemes and so, given the level of interest in this information, and in response to numerous enquiries, we invited CSSRs to update and return an outline for their council.. Throughout this document, a self assessment colour code has been used to provide a quick visual identification of the current stage of development for each CSSR. The colour code used is as follows: Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a Service (various stages commonly operating a pilot) No scheme in place but wish to develop (various stages commonly planning a service No plans to introduce service No information known Colour coding has not been used where we have no information on a service. In addition, where a scheme exists, but for which we have limited knowledge, it has been assumed that the service is not undergoing any enhancement and so is coloured yellow. We would like to thank all those CSSRs that have provided an update of the status of their scheme. We continue to work with councils to help them enhance their re-ablement services, as well as other service areas. Further updates or requests for information should be sent to Gerald Pilkington, whose contact details are as follows: Website: gerald@geraldpilkingtonassociates.com Mobile:

3 SUMMARY OF HOMECARE RE-ABLEMENT SCHEMES as at April 2012 Table of contents Executive Summary... 7 CSSR Homecare Re-ablement Status National Map of Coverage... 8 Intake and Assessment or Hospital Discharge Support Model of service: Selective or De-selective Funding of the Homecare Re-ablement service Delivery of the Homecare Re-ablement Services CSSR Scheme FACS Level and Application CSSR Scheme Service subject to charge EAST MIDLANDS REGION Derby City Council (UA) Derbyshire County Council Leicester City Council Leicestershire County Council Lincolnshire County Council Northamptonshire County Council Nottingham City Council (UA) Nottinghamshire County Council Rutland Council (UA) EASTERN REGION Bedford Borough Council (UA) Cambridgeshire County Council Central Bedfordshire Council (UA) Essex County Council Hertfordshire County Council Luton Borough Council (UA) Norfolk County Council Peterborough City Council (UA) Southend on Sea Borough Council (UA) Suffolk County Council Thurrock Council (UA) LONDON REGION Barking and Dagenham (London Borough of) Barnet (London Borough of) Bexley Borough Council (London Borough of) Brent Council (London Borough of) Bromley Council (London Borough of) Camden Council (London Borough of) City of London Council Croydon Council (London Borough of) Ealing Council (London Borough of) Enfield Council (London Borough of) Greenwich Council (London Borough of) Hackney Council (London Borough of) Hammersmith and Fulham Council (London Borough of)

4 Haringey Council (London Borough of) Harrow Council (London Borough of) Havering Council (London Borough of) Hillingdon Council (London Borough of) Hounslow Council (London Borough of) Islington Council (London Borough of) Kensington & Chelsea Council (Royal Borough of) Kingston Council (Royal Borough of) Lambeth Council (London Borough of) Lewisham Council (London Borough of) Merton Council (London Borough of) Newham Council (London Borough of) Redbridge Council (London Borough of) Richmond Council (London Borough of) Southwark Council (London Borough of) Sutton Council (London Borough of) Tower Hamlets Council (London Borough of) Waltham Forest Council (London Borough of) Wandsworth Council (London Borough of) Westminster City Council NORTHERN REGION Darlington Borough Council (UA) Durham County Council Gateshead Council (Metropolitan) Hartlepool Council (UA) Middlesbrough Council (UA) Newcastle City Council (Metropolitan) North Tyneside Council (Metropolitan) Northumberland Council (UA) Redcar & Cleveland Borough Council (UA) South Tyneside Council (Metropolitan) Stockton-on-Tees Borough Council ( UA) Sunderland City Council (Metropolitan) NORTH WESTERN REGION Blackburn with Darwen Borough Council (UA) Blackpool Borough Council (UA) Bolton Borough Council (Metropolitan) Bury Borough Council (Metropolitan ) Cheshire East Cheshire West and Chester Cumbria County Council Halton Borough Council (UA) Knowsley Borough Council (Metropolitan) Lancashire County Council Liverpool City Council (Metropolitan) Manchester City Council (Metropolitan) Oldham Council (Metropolitan) Rochdale Borough Council (Metropolitan) Salford City Council (Metropolitan) Sefton Borough Council (Metropolitan)

5 St. Helens Council (Metropolitan) Stockport Borough Council (Metropolitan) Tameside Borough Council (Metropolitan) Trafford Council (Metropolitan) Warrington Borough Council (UA) Wigan Borough Council (Metropolitan) Wirral Borough Council (Metropolitan) SOUTH EASTERN REGION Bracknell-Forest Borough Council (UA) Brighton & Hove City Council (UA) Buckinghamshire County Council East Sussex County Council Hampshire County Council Isle Of Wight Council (UA) Kent County Council Medway Council (UA) Milton Keynes Council (UA) Oxfordshire County Council Portsmouth City Council (UA) Reading Borough Council (UA) Royal Borough of Windsor and Maidenhead (UA) Slough Borough Council (UA) Southampton City Council (UA) Surrey County Council West Berkshire Council (UA) West Sussex County Council Wokingham Borough Council (UA) SOUTH WESTERN REGION Bath and North East Somerset Council (UA) Bournemouth Borough Council (UA) Bristol City Council (UA) Cornwall County Council Devon County Council Dorset County Council) Gloucestershire County Council Isle of Scilly North Somerset Council (UA) Plymouth City Council (UA) Poole Council (Borough of ) (UA) Somerset County Council South Gloucestershire Council (UA) Swindon Borough Council (UA) Torbay Council (UA) Wiltshire County Council WEST MIDLANDS REGION Birmingham City Council (Metropolitan) Coventry City Council (Metropolitan) Dudley Borough Council (Metropolitan) Herefordshire County Council Sandwell Borough Council (Metropolitan)

6 Shropshire County Council Solihull Borough Council (Metropolitan) Staffordshire County Council Stoke on Trent City Council (UA) Telford & Wrekin Council (UA) Walsall Council (Metropolitan) Warwickshire County Council Wolverhampton City Council (Metropolitan) Worcestershire County Council YORKSHIRE AND HUMBERSIDE REGION Barnsley Borough Council (Metropolitan) Bradford Council (Metropolitan) Calderdale Council (Metropolitan) Doncaster Council (Metropolitan) East Riding of Yorkshire Council (UA) Hull City Council (UA) Kirklees Council (Metropolitan) Leeds City Council (UA) North East Lincolnshire Council (UA) North Lincolnshire Council (UA) North Yorkshire County Council Rotherham Borough Council (Metropolitan) Sheffield City Council (Metropolitan) Wakefield Council (Metroplitan) City of York Council (UA) APPENDIX 1 INTAKE AND ASSESSMENT or HOSPITAL DISCHARGE ONLY APPENDIX 2 SELECTIVE or DE-SELECTIVE MODEL APPENDIX 3 FUNDING OF HOMECARE RE-ABLEMENT SERVICE APPENDIX 4 DELIVERY OF HOMECARE RE-ABLEMENT APPENDIX 5 - APPLICATION OF FACS ELIGIBILITY CRITERIA The Table of Contents above provides shortcut links to each of the regional or council sets of information. By resting the cursor on a specific regional or council name, holding down the Ctrl key and clicking the left key on your mouse, it will take you immediately to the start of the regional section or individual council section. CSSRs are in alphabetical order within each regional group. Within the tables that follow, any narrative in red indicates, for established services, that this information has not been made available by the CSSR. For CSSRs that are at an early stage of planning (colour code), these decisions may not yet have been made

7 Executive Summary This is the fifth update since publication of the original CSSR Homecare Re-ablement Scheme Directory, and it reflects the latest known position as shared by councils with social services responsibility (CSSRs) across England. The previous update was in November 2010, since when a few notable changes have occurred. Some of these have been a continuation of previous trends whilst others appear to be a reversal. It is too early to know if these are temporary or the start of a new direction. The main features and changes are 17% of reported services only support people from hospital whilst the vast majority support referrals from the community and hospital 67% of reported services operate on a de-selective basis. Between March 2009 and November 2010 there was a slight shift with some de-selective services changing to a selective model. However, since the there has been a small shift back with a few selective models changing to a de-selective model. As experience grows, some deselective services are refining their criteria so that, for instance, people with large packages of care and double staffing are under closer scrutiny to consider whether re-ablement truly can improve independence. 71% of reporting services are funded solely by the council with the rest being funded by the council and health partners. In some cases the health funding takes the form of providing OT input rather than hard cash. Interestingly, despite the heightened drive to encourage integration between social care and health, none of the services reporting their funding source have indicated a newly created funding arrangement with health. A few have, however, referred to use of the additional funding that has been made available via PCTs for use by social care. Unsurprisingly, the biggest change has been in the number of services outsourced. Of the reporting services, 110 are operated in-house, 24 are now outsourced in a variety of ways and a further 5 have a mix of in-house and outsourced services. In addition, within those currently operated in-house, one is known to have sought expressions of interest from external providers whilst another is understood to be close to creating a local authority trading company (LATC). The number and rate of change appears to be increasing as some councils consider the costs of operating even effective services. 1 69% of reporting services use FACS as an eligibility criteria for entry to their service. However, since the last update in November 2010, four of the services that previously applied FACS on entry to their re-ablement service now only apply it afterwards if ongoing support is required. Many councils are still trying to improve both the volume of activity and performance of their service as they address funding levels, whilst others are preparing for outsourcing. These continue to be areas where GPA is working with councils and other providers. 1 The Outsourcing of Homecare Re-ablement Services, Aug 2011, Gerald Pilkington Associates - 7 -

8 CSSR Homecare Re-ablement Status National Map of Coverage The following map provides a pictorial view of the national position as known to us and uses the same colour scheme as applied within the tables that follow. Since January 2007, 115 of 152 CSSRs have changed their status in terms of progressing their implementation plans. Of the remaining councils that have not reported any change to their status, 12 are established with no plans to change, 19 are established but seeking to extend, and 3 remain in pilot status. Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a Service (various stages (commonly operating a pilot) No scheme in place but wish to develop (commonly planning) No plans to introduce a service No information available to CSED - 8 -

9 A regional summary is as follows: Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a Service (various stages) No scheme in place but wish to develop No plans to introduce a service No information held North West North East (Northern) Yorkshire & Humberside East Midlands West Midlands South Western Eastern South Eastern London TOTAL (152) TOTAL reported in Update Nov 2010 (152) TOTAL reported in Update Mar 2009 (150) TOTAL reported in Update May 2008 (150) TOTAL reported in Update Sept (150) TOTAL reported in Discussion Document (150) In addition to information now being available from a larger number of CSSRs (98%, previously 91%, 87% and 65%), progress has been made by a number of councils as they implement their plans. A total of 122 (80 %) of CSSRs are in the process of either establishing a scheme, or enhancing or extending an existing scheme

10 Intake and Assessment or Hospital Discharge Support Within earlier work councils were categorised services into one of two groups, namely, those that form part of the intake and assessment function and so take referrals from the community, hospital discharges, etc. or those that only or primarily support people on discharge from hospital. The nature, prime focus, characteristics and volumes of both types of service differ. For instance, intake and assessment services, as their name implies, means that the vast majority of people referred for homecare support will pass through and so it becomes the default pathway. Often they work on a deselection basis i.e. people referred for a potential homecare package will undergo a phase of homecare re-ablement unless it is agreed that the service is not appropriate. (i.e. unless deselected). In comparison, hospital discharge services tend to work on a selective basis i.e. people are selected to participate on the basis that they will benefit from participation. Others not selected are immediately offered a maintenance homecare package. See the separate analysis on selective / de-selective services below. In recent years we have seen some of the hospital discharge support services broaden their role and evolve into intake and assessment services, thereby multiplying the number of people they support and diluting their overall performance percentage but increasing the actual number of people being returned to full independence. Also, in recent years we have seen some CSSRs establish a new service by first establishing a hospital discharge service and then, in accordance with their plans, develop it into an intake and assessment service. Thus, in some cases, hospital discharge support services have become a stepping stone to introducing a full service. Based on the responses included within this document, a summary of the known position is as follows INTAKE AND ASSESSMENT SERVICE HOSPITAL DISCHARGE SUPPORT (solely or primarily) Further details with names of specific CSSRs can be found in Appendix 1 Model of service: Selective or De-selective As outlined in the section above, in our earlier work most but not all intake and assessment services operated on a de-selective basis. However, as a result of our recent work with councils it has become clear that a number operate a selective model within their intake and assessment service. Selection or de-selection differs from the application of FACS criteria (see below) and reflects a fundamental principle about who is likely to benefit. A de-selection approach assumes that most people will benefit from a phase of homecare re-ablement unless there

11 are specific issues that mean that this is highly unlikely. Thus, these services have declared de-selection criteria, which often include the following not an adult and so will not pass through adult services primary need is for end stage life support and the person does not feel it to be appropriate high mental health or learning difficulty needs to the extent that they are unable to identify and work towards goals over a 6 to 8 week period In addition, some services deselect people with lower limb fractures in plaster because they are not able to participate, and so entry is delayed until after removal. Also, we have seen a few examples where councils consider the size of the original package. For instance, some consider that if the package is over, say, 25 hours and includes two carers at the same time, then they have determined that there is little likelihood of benefiting and so the person does not enter the re-ablement service. A selection approach assumes that only a specific group of people / conditions will benefit and so unless these criteria are met, the person will pass to routine support whether that be provided or commissioned care, or a direct payment, etc. This approach also assumes that an assessment tool and process is used that can readily identify people that meet the selection criteria. Unsurprisingly this approach will result in lower numbers passing through than is the case with a de-selection based service. We are not aware of any widely used and consistent assessment tool in use across services. A couple of services use the Canadian Occupational Performance Measure (COPM) and we are aware that at least one is trialling a tool from Australia. Work within one of the English regions in recent years sought to develop a consistent assessment tool. Two initial pilot sites were involved in the development work but after a matter of months it was apparent that they had both customised it to their own needs. The absence of at least a common framework is an indication of the variety in services operating and highlights an area of potential development that would benefit many services. Comments received during a workshop with OTs from virtually every council in one region indicated that some people passing through their local service had been seen to benefit from the phase, but it was the view of the OTs concerned that they would not have been selected if a formal assessment of ability to benefit had been applied. Almost as a reversal of what was seen when the scheme directory was last updated in November 2010, since then we have seen a small number of intake and assessment services change from a selection approach to one of de-selection. Based on the responses included within this document, a summary of the known position is as follows SELECTIVE DE-SELECTIVE Intake and Assessment service Hospital Discharge Support (solely or primarily) 10 5 Further details with names of specific CSSRs can be found in Appendix

12 Funding of the Homecare Re-ablement service A common differentiating characteristic remains the source of funding for the service with the most common being funded only by the council or jointly with health. Whilst a number of services are operated and funded jointly with health (whether that be through pooled budgets or by agreement), other services are funded solely by the council, albeit they may have speedy access to therapists and other health colleagues. Some councils appear to still have problems with attracting the interest of health colleagues whilst others are concerned that health seek to impose a medical model rather than a social care model of support. Linkages to intermediate care services are also variable. In most services, homecare reablement differs in its approach, focus and purpose, location of service, skill mix of staff and numbers of people supported. Homecare re-ablement complements rather than replaces intermediate care and tends to support a much larger proportion of people referred, albeit that some people will require the support of both at different stages of their progression towards independence following a crisis in their lives. In our work with CSSRs we encourage them to consider homecare re-ablement within the full range of support services operated by them and health, rather than in a silo. This includes intermediate care but also includes other services. Since the previous update in November 2010, there has been an increase in the number of schemes reporting their funding source, and so the number of unknowns has reduced. However, so far despite encouragement by the Department of Health to see a joining up of health and social care services, none have reported a shift in the funding of their service from council to council with health. Based on the responses included within this document, a summary of the known position is as follows FUNDED BY THE COUNCIL FUNDED WITH HEALTH Further details with names of specific CSSRs can be found in Appendix 3 Delivery of the Homecare Re-ablement Services Back in 2007 few homecare re-ablement services were outsourced and of those some had arisen after the outsourcing of homecare. Since then, most services developed have been with in-house staff who, with appropriate training, have evolved from the homecare service. Whilst this is still predominantly the case, a number CSSRs have adopted a different approach and in recent years there has been a growing number of outsourced services and an even greater number considering the option.. For instance, both Essex and Sefton Council decided to outsource all of their in-house provision by transferring it to wholly owned trading subsidiaries of the council and there are

13 2 others who have followed this route. Another is understood to be considering this change shortly. In other CSSRs, where they do not have an existing in-house homecare team to refocus on the new service, some have started to engage the external provider market. For instance, Hertfordshire County Council and the London Borough of Richmond have adopted this route, whilst Kent County Council and Brighton Council have added to the capacity of their own in-house service by engaging with external providers to provide homecare re-ablement. One of the main inhibitors to engaging external providers appears to arise from the desire to ensure that there is no conflict of interests for a provider because they may pick up any subsequent ongoing homecare package requirement. CSSRs would also appear to be concerned about how they can ensure that the maximum level of independence was achieved as a result of the homecare re-ablement phase. In view of the importance and reliance by care managers on the input and advice of the homecare re-ablement service, many have, historically, decided that this would best be served by an in-house service. However, that situation is changing and we are likely to see an increase over the next year or so in both the number of outsourced services and the rate at which they arise. 2 Based on the responses included within this document, a summary of the known position is as follows IN-HOUSE OUTSOURCED (in part or whole) (of which 4 are LA trading companies and 2 provide in-house OT support for an outsourced service) In addition, 5 CSSRs have a mix of both in-house and outsourced provision. Further details with names of specific CSSRs can be found in Appendix 4 CSSR Scheme FACS Level and Application For a number of years it has been apparent that there is some diversity in the application of FACS levels in terms of when as well as how they are applied. This has been a regular source of enquiry by those CSSRs seeking to establish or implement significant changes to their services because they wish to understand the interplay between an authority s FACS level, if applied at entry to the service, and the order of benefit likely to arise for participants. Services that work with health partners do not tend to apply FACS as an eligibility criteria, not least of all because health do not recognise or use FACS themselves. However, even within services that are operated only by the council, there appears to be a difference in how FACS is applied. For instance, some apply it as a rigid approach on the day of the 2 The Outsourcing of Homecare Re-ablement Services, Aug 2011, Gerald Pilkington Associates

14 assessment for need whilst others consider the level of need likely to arise shortly if support were not to be offered at the time of the assessment. Since the last update in November 2010 four of the services that previously applied FACS as an eligibility criteria for entry to their re-ablement service now apply it only if ongoing support is required. Based on the responses included within this document, a summary of the known position is as follows: FACS LEVEL FACS APPLIED AT FACS APPLIED ON TOTAL ENTRY TO SERVICE EXIT FROM SERVICE Low and above Moderate and above Substantial and above Critical and above TOTAL Further details with names of specific CSSRs can be found in Appendix 5. In response to requests from CSSRs we have brought together further examples of the benefits of homecare re-ablement, and particularly within those councils that support people with needs at substantial and above, or critical. The results from 14 services across 13 CSSRs have been published and the document 3 is available via the CSED website. In summary, the examples show that Homecare Reablement 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. The CSED Homecare Re-ablement Implementation Toolkit provides some valuable guidance and examples 4 CSSR Scheme Service subject to charge The legal definition for intermediate care, as set out in the Community Care (Delayed Discharges) Act 2003, is as follows: "Intermediate care" means a qualifying service which consists of a structured programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live in his home." 3 CSED Benefits of Homecare Re-ablement for people with different levels of need. (January 2009) 4 CSED Homecare Re-ablement Implementation Toolkit

15 Local Authority Circular (DH)(2010)6 states, "Regulation 4(2) of the 2003 Regulations requires that intermediate care is provided free of charge for the first six weeks. Accordingly, re-ablement services are likely to fall within the definition of intermediate care services and should not be charged for the first six weeks". i5 5 LAC (DH) (2010) 6: The Personal Care at Home Act 2010 and charging for re-ablement: Local Authority Circular

16 Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a service (various stages commonly operating a pilot) No service in place but wish to develop commonly planning a service No plans to introduce a service EAST MIDLANDS REGION CSSR Current Service Next Steps Derby City Council (UA) (updated Jun 2010) Intake and Assessment Service (see note 1 below) Model: de-selective Funding: by the Council (see note 4 below) FACS: Moderate and above and applied on entry to and exit from the re-ablement service 1. Initially implemented a hospital discharge support service but developed this and from Jan 2009 it became an intake and assessment service taking virtually all new referrals with the exception of people with LD needs 2. Service supports people over 18 yrs for up to 6 weeks 3. The service is council wide and operates 7 days a week from 7am to 10.30pm 4. Service is delivered by former homecare staff with access to therapists for training and specialist support. 5. Ongoing homecare support is commonly provided by external providers 6. Currently undertaking a review of the service to improve and bed down good practice 7. Considering future expansion for clients with MH and LD needs Derbyshire County Council (updated Jun 2010) Intake and Assessment Service Model: de-selective Funding: by the Council FACS: Low and above applied on entry but moderate on exit from the service (see note 3 below)

17 Leicester City Council (updated Jun 2010) See Volume 2: Additional Information of CSED Discussion Document 1. Service in the south of the authority became operational in June 2009 and in the north from October Service initially operated on a selective basis but now operates on a de-selective basis. 3. Entry to the service is subject to meeting the Low level of need. However, if an ongoing package us required the level is moderate and above. 4. The service supports people for up to 6 weeks and is not subject to charge 5. Service supports approx. 1,500 people per annum with approx. 47% not requiring subsequent homecare packages 6. It is open to all client groups and operates between 6am and 10pm 7 days a week 7. Seeking to implement a 24hr service Hospital Discharge support service (see notes 2 and 7 below) Model: selective (see note 3 below) Funding: by the Council and Health (see note 4 below) FACS: Substantial and above and applied at entry to and exit from re-ablement service. (see note 3 below) 1. Initial implementation phase ended March The service supports hospital discharges from 1 of 3 hospitals and saw 188 service users in first 6 mths. 3. Service users are screened into the service and service users must meet local FACS criteria 4. Service funded by the council with funding from health for therapist input 5. The service is currently open to all discharges from Leicester General Hospital, but these are mainly older adults. 6. The service operates from 7am to 1pm and then 5 pm to 10pm 7 days a week Hoping to extend service to all (intake and assessment) with an increase in hours

18 Leicestershire County Council (updated Jan 2012) See Volume 2: Case Studies section of CSED Discussion Document See CSED Assessment Tools and Satisfaction Surveys Document See CSED Retrospective Longitudinal Study Document See CSED Benefits of Homecare Re-ablement Document Lincolnshire County Council (updated Jan 2012) Intake and Assessment Service Model: de-selective Funding: by the Council FACS: Substantial and above and applied at exit from re-ablement service. 1. Intake and Assessment scheme operated since early Evaluated by De Montfort University 2. Approx 3,600 users pa in 20119/12 3. Focusing on a service for up to 6 weeks 4. Service supports all client groups, the majority of users are older adults 5. The approach is now also applied to people with dementia but the time scale is extended to up to 12 weeks 6. Sits at beginning of SDS Customer care pathway and assesses for eligibility 7. Seniors are trusted assessors 8. The services operates from 7am to 10.30pm, 7 days per week. Intake and Assessment Service (see note 4 below) Model: de-selective (see note 4 below) Funding: by the Council (see notes 6 and 7 below) FACS: Substantial and above and applied on entry to and exit from the service. 1. Service specification, care pathway, documentation, outcome measures in place. Service is now fully established across county. Forms part of mainstream care pathway and is available to all new service users requiring an immediate domiciliary care service (crisis and short-term support) Service is provided by Inhouse teams (3,500 hours per week) who are also withdrawing from being a long term community

19 Northamptonshire County Council ( Feb 2012) Kerry Tio 2. Service is called LARS (Lincolnshire Assessment and Reablement Service) and combines assessment and case management with reshaped in-house home care service. Current planned capacity is for service to support up to 78 new entrants each week.. 3. Discharge from service, for people needing ongoing social care support, is now via individual budget and support planning arrangements. 4. Service is offered to all new cases, and existing service users if a practitioner believes they would benefit from a phase. Current activity is around 50 new entrants a week and around 450 people are being supported in LARS at any one time. 5. The service has a target of up to 6 weeks. Current average length of stay is 47 days. It operates from 7am to 10pm 7 days a week Hospital Discharge service (see note 2 below) Model: selective Funding: by the Council FACS: Substantial and above. but only applied on leaving the service. service provider. 7. Current developments this year: Direct referrals from Customer Service centre. Testing provision by independent sector home care providers. Joint working on reablement pathways with health Integrating within an `intake` assessment and care management service, including OTs

20 Nottingham City Council (UA) (updated Jan 2012) 1. Currently reconfiguring our START service which started in 2003 and which was reorgainsed in Jan Adding Telecare from Apl The service seeks to work with hospital discharges, mainly older people, as the priority and some admission avoidance. 3. Service sees approx. 40% not requiring any ongoing care package. 4. Service operates from 7am to 11pm 7 days a week. In addition, an overnight service is available 5. All staff have NVQ2 and 50% have NVQ3 6. Considering join with ICT and extend to include pharmacy technician and access to equipmentconsidering change to LATC Apl 2012 Intake and Assessment Service (see note 1 below) Model: selective (see note 1 below) Funding: by the Council FACS: Moderate and above and applied at entry to and exit from re-ablement service. 1. The.service receives 40% of clients from hospital and 60% from the community and people entering are assessed to be able to benefit 2. Currently the service sees approx. 900 people a year 3. The service is open to all adults but the majority (90%+) are older adults. Average durations are between 6 and 8 weeks but some extend to 13 weeks. 4. The service operates from 7am to 10.45pm 7 days a week. A review is completed at 4 weeks and then again on transfer at 6 or 8 weeks. 5. Now putting people through to transfer on personal budgets. 6. Have a full time O.T who works closely with care workers at the persons initial entry into intake re-ablement 7. Staff and O.T have worked to develop a weekly monitor of peoples progress which is currently being piloted Considering the inclusion of OTs in the service. 9. New service to be developed looking blending the o.t.telecare s/w team and reablement so that all services come under the umbrella of reablement with key worker seeing the process through for the citizen to brokerage as appropriate but using same care/support plan. New project will also involve work with the community

21 and developing the preventative agenda Nottinghamshire County Council (updated Jul 2010) Intake and Assessment Service Model: de-selective Funding: by the Council FACS: Moderate and above and will apply at exit from re-ablement service. (see note 2 below) 1. The START service is now operational across the whole County. 2. The service is positioned between the Customer Service Centre or hospital ( light touch referral sources) and ongoing service with the Self Directed Support Assessment being completed towards the end of the re-ablement period for those who will need ongoing service 3. Following a review of Occupational Therapy services a number of OTs are being gradually moved into START. 4. Roles and responsibilities of re-ablement and intermediate care are being carefully considered to enable maximisation of resources 5. Service users are predominantly older adults with some under 65 yrs with non-severe dementia and some with MH needs. LD services are considering their own service. Rutland Council (UA) (update Jun 2010) Intake and Assessment Service (see note 1 below) Model: de-selective Funding: by the Council (see note 1 below) FACS: Moderate and above and applied on entry to and exit from the service

22 1. REACH Service was fully operational from July 2009 and supports all adult client groups across the authority from the community and hospital discharges. 2. The service supports people for up to 6 weeks 3. The service operates from 7am to 10pm 7 days a week

23 Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a service (various stages commonly operating a pilot) No service in place but wish to develop commonly planning a service No plans to introduce a service EASTERN REGION CSSR Current Service Next Steps Bedford Borough Council (UA) (Jun 2010) Intake and Assessment Service Model: selective (see note 2 below) Funding: by the Council FACS: Substantial and above and applied on entry to and exit from re-ablement service. Cambridgeshire County Council (Apl 2009) 1. The service was established in 2008 and underwent a review following the split of Bedfordshire into two unitaries wef Apl 2009 Intake and Assessment Service OR Hospital Discharge Support (solely or primarily) Model: selective / de-selective Funding: by the Council with health (see note 1 below) Provision outsourced service (see note 1 below) FACS: Substantial and above. 2. Proposing to develop into a deselection services by Mar 2011 and increase activity levels 1. Service has been outsourced to PCT 2. Central Bedfordshire Council (UA) Intake and Assessment Service (see note 2) Model: de-selective Funding: by the Council

24 (Feb 2012) FACS: Substantial and above and applied on exit from the re-ablement service. 1. The service was established in 2008 and underwent a review following the split of Bedfordshire into two unitaries wef Apl It operates as an intake and assessment model with adeselective approach. 3. The service is co-located with the ITC service, affording easy access to therapy input when required. Essex County Council (updated Feb 2012) See CSED Benefits of Homecare Re-ablement Document See CSED Assessment Tools and Satisfaction Surveys Document Hertfordshire County Council (updated Feb 2012) Intake and Assessment Service (see note 1 below) Model: selective / de-selective Funding: with health (see note 2 below) Provision: out sourced service (see notes 3 and 5 below) FACS: Substantial and above and applied at entry to and exit from re-ablement service. 1. The initial hospital discharge service was expanded to an intake and assessment service wef Oct 2008., although the majority of referrals are currently from hospital. 2. The service is funded with health. 3. The re-ablement team is a Local Authority Trading Company called EssexCares. They were an in-house service that has now been established as a private company. Other subsidiaries of Essex Cares provide other services. 4. The service currently receives approx. 3,100 referrals a year 5. Essex County Council confirmed its decision on the reprocurement of reablement services on 31 st Jan They are currently reviewing their contract and have invited expressions of interest from a range of providers. Intake and Assessment Service (see note 4 below) Model: de-selective (see note 4 below) Funding: by the Council (see note 3 below) Provision: outsourced (see note 4 below) FACS: Substantial and above and applied at entry to and exit from re-ablement service. 1. Historically the service was delivered through two different

25 Luton Borough Council (UA) (updated Feb 2012) Norfolk County Council (updated Jul 2010) See CSED Benefits of Homecare Re-ablement Document models. The first through contracts with external providers and the second through intermediate care services provided by health. 2. Both models took referrals from community but the majority were hospital discharges and both are selective 3. The homecare model was funded by health whilst that operated with health is funded by both 4. The service was awarded to Goldsbrough Healthcare and went live in August A staged roll-out across the county followed. Intake and Assessment Service (see note 2 below) Model: selective Funding: by the Council FACS: Substantial and above and applied at entry to and exit from re-ablement service. 1. Scheme in operation for two years, providing support for up to 6 weeks 2. Referrals taken from hospital and community 3. Phase 1 from Nov 2008 took older adults > 65yrs 4. Re-ablement Service currently being reorganised to expand to under 65yrs Intake and Assessment Service (see note 4 below) Model: de-selection Funding: by the Council (see note 1) (see note 1 below) FACS: Substantial and above and applied at entry to and exit from re-ablement service (see note 8 below). 1. Norfolk County Council Adult Social Services remodelled its home care services and commenced our assessment and re-ablement service in February

26 2. To date 37% of service users have not required an ongoing service. 3. Hours transferred to the independent sector show a reduction of 69% from the total number of hours delivered in the first week of Norfolk First Support. 4. Norfolk First support receives referrals from the acute hospitals, community hospitals, transitional beds and community services, where they meet the criteria. 5. To date we have provided the service to 4,375 people. 6. Norfolk First support service is a six week service of intensive input to optimise service users independence, following which any ongoing homecare needs are supported by external providers. 7. The County has 21 Block Contracts with 10 Independent Home Care Providers 8. The service is subject to FACS assessment at entry to service. 9. Norfolk first support has trained 250 staff who work in the service in assessment and re-ablement skills. The service works closely with our Occupational Therapy teams. Peterborough City Council (UA) (updated Jan 2010) Intake and Assessment Service OR Hospital Discharge Support (solely or primarily) Model: selective / de-selective Funding: by the Council OR with health Provision: outsourced service (see note 2 below) FACS: Moderate and above and applied at entry to and exit from re-ablement service. 1. Currently, the service is quite diverse. 2. Delivery undertaken by the provider services through the PCT. 3. Currently reviewing services to introduce a reablement service across the council

27 Southend on Sea Borough Council (UA) (Jul 2010) Suffolk County Council (updated Jan 2008) See CSED Benefits of Homecare Re-ablement Document Intake and Assessment Service Model: de-selective Funding: with health (see note 4 below) FACS: Substantial and above and applied on exit from re-ablement service. 1. The Collaborative Care Team provide intensive rehabilitation at home to promote optimum independence, with the outcome to enable people to remain in their own homes and prevent long term admission to residential care. It has also provided a re-ablement service since April Team supported by an occupational therapist and a physiotherapist with nursing input from a community matron and assessment nurse. The nursing input is in the process of being increased due to the complexities of some of the patient groups. 3. Working closely with the intermediate care teams and the Cumberlege Intermediate Care Centre (residential), the team have enabled a reduction in home care packages that would have been provided by the independent sector. 4. Funding is predominantly by the council with some from health 5. A business case for an enlarged service has been approved and work has commenced on this project. Intake and Assessment Service Model: selective / de-selective Funding: by the Council FACS: Substantial and above and applied at entry to and exit from re-ablement service 1. The in-house Home First scheme was first started in Sept 2006, initially offering a 12 weeks re-ablement service. The 4. Wish to undertake an evaluation

28 Thurrock Council (UA) (updated Jun 2010) service changed in October 2008 and now provides a reablement and assessment service for up to 6 weeks for people being discharged from hospital or at a point of crisis. 2. Any remaining need the customer has for long-term home care is commissioned from private sector providers. 3. Scheme has been successful in terms of helping people to reach and maximise their potential, support the assessment process and reduce hospital delays in transfers of care. Intake and Assessment Service Model: selective / de-selective Funding: by the Council with health FACS: Substantial and above. 1. Establishing an intake and assessment service that supports people for up to 6 weeks. 2. Service will be operated with health in-house and not be subject to charge 3. Clients to be supported will be all adult groups other than older clients with mental health needs

29 Service in place with no declared intention to extend / expand / amend Service in place but seeking to extend / expand / amend Establishing a service (various stages commonly operating a pilot) No service in place but wish to develop commonly planning a service No plans to introduce a service LONDON REGION CSSR Current Service Next Steps Barking and Dagenham (London Borough of) (updated Jun 2010) Intake and Assessment Service Model: de-selective Funding: by the Council FACS: Substantial and above and applied at entry to and exit from re-ablement service. (see note 2 below) 1. Service is called First Response. Initially it was focused on hospital discharges but then expanded, as planned, into an intake and assessment service Work to refocus the in-house homecare service started in Sept 2008 and the new service commenced Jan Service formerly launched in May 2009 following training of all teams. Subsequent work to increase focus of seniors on clients by establishing support roles to undertake rostering. 3. In-house staff numbers reduced and some former homecare staff now support in-house specialist dementia team and four extra care facilities. 4. Referrals will initially come following FACS, though we may review this for the re-ablement element if we feel people are being denied access who would benefit. 5. We have scoped the size of the service by looking at previous referral data (which is subject to FACS). 6. Adult Social Services operate an apprentice scheme to train Focusing on level of noncompleters mainly as a result of inappropriate referrals

30 Barnet (London Borough of) (updated Jun 2010) Bexley Borough Council (London Borough of) (updated Jan 2012) young people across the organisation including the reablement service. This has been a positive step to create skilled workers with relevant experience. Intake and Assessment Service Model: De-selective Funding: by the Council Provision: outsourced service FACS: Substantial and above and applied at entry and exit to re-ablement service. 1. The enablement service is still technically a pilot although in terms of timescales the pilot of 6 months was extended for another 6 months ( it is available to all adult groups and across whole area ) 2. Service is outsourced to a single provider 3. Plans to increase the volume of activity Intake and Assessment Service (see note 2 below) Model: De-selective Funding: by the Council and health (see notes 3 and 4 below) Provision: outsourced service (see notes 3 and 4 below) FACS: Substantial and above and applied at entry to and exit from re-ablement service. 1. Reablement service started in full in August In addition to intake and hospital referrals, re-ablement is also used after yearly reviews and to people with learning disabilities. 3. The re-ablement provision is outsourced to a number of care provider agencies but the service is monitored by an inhouse service of OT s and Rehabilitation Assistants. 4. Health monies enabled the temporary recruitment of a Social Work Assistant and a Physiotherapist (seconded from health). 5. Telecare just introduced to complement re-ablement 6. 82% of new referrals for care packages go through re

31 Brent Council (London Borough of) (updated Jul 2010) Bromley Council (London Borough of) (updated Jan 2012) ablement 7. 48% of clients ended without a care package a. 52% with a care package of which 20% ended with the same care package as at start of reablement, 13.5% with an increase and 66.5% with a decrease Intake and Assessment Service, (see note 1 below) Model: de-selective Funding: by the Council Provision: out-sourced (but see note 2 below) FACS: Substantial and above and applied on entry to and exit from re-ablement service. 1. A new intake and assessment re-ablement service was launched on the 19 th April 2010 and is being phased in to March The service will also include people on long term review and discharges from hospital. 2. The main re-ablement service has been outsourced to a range of providers whilst OT support is provided in-house, and physiotherapy support provided from Health. Intake and Assessment Service Model: de-selective Funding: Jointly with health (see note 5 below) (see note 6 below) FACS: Substantial and above and applied at entry to homecare re-ablement. 3. Planning to extend authority wide by Mar Numbers are being phased in so by March % of referrals will go through re-ablement service 1. Have an intermediate care service with 60 beds and 2 Community and Assessment Rehabilitation Teams with domiciliary care staff. This service is not charged. 2. Started planning and mobilisation in Aug Hospital discharge pilot started Jan Now standard service for new referrals as per plan. 4. Refining selection criteria in light of experience Most funding from LBB but some of the reablement funding that went to the PCT was used to increase the speed of roll-out 6. We are considering market testing for all our in-house services and