Adrian Scaife from Tunstall Advisory Service (TAS) asks if you can have quality and quantity in reablement services…
One of the five mandatory metrics for the Better Care Fund is:
The rationale is that improving the effectiveness of these services is a good measure of delaying dependency, and the inclusion of this measure supports health and social care services working together to reduce avoidable admissions. This is an important point as reablement is not ‘just’ about maximising independent living skills but also ensuring a preventative approach to reduce the probability of further hospital admissions.
As a final point, there is reference to ensuring that the rate at which these services are offered is maintained or increased to support this goal.
My key point is that quality and quantity should receive equal attention. For example, which is better: 1% of people discharged from hospital going into reablement and 95% still at home after 91 days or 5% using reablement and 90% still at home after 91 days?
In the last three months of 2012, in England, 1.34 million people aged 65 and over were discharged from hospital and of these 43,000 or 3.2% were supported with a reablement service and 81.4% were still at home after 91 days.
The Reablement Effectiveness graph below illustrates the Better Care Fund baseline position. Each axis shows the England average for both percentage of people going into reablement and the percentage still at home after 91 days. Each blue dot represents a council with adult social care responsibility.
So what can we learn?
As always seems to be the case a large variation exists between authorities. When you look at the data on a regional basis, London authorities use reablement for people being discharged from hospital more than twice as often as those in Yorkshire and Humber and have the best regional success rate in supporting people to remain at home.
To conclude, can you have quality and quantity in reablement services?
The answer appears to be ‘yes’, at least in the London region.
One final thought, is reablement effectiveness associated with better community support services, and in turn does this support more people to remain at home for longer, delaying admission to residential and nursing home care?
Adrian Scaife is a member of the Business Intelligence Team in Tunstall Advisory Service (TAS).