Integrating reablement and intermediate care for improved outcomes

Kat Macann, a Manager at Attain, outlines the benefits of greater integration of Reablement and Intermediate Care services to improve outcomes and efficiencies.

Introduction

ReablementCCGs, local authorities and providers around the country are facing huge challenges as they work towards developing system-wide leadership and ambitious plans for strategic change, captured in local Sustainability & Transformation Plans.

Reablement and Intermediate Care services are a critical part of the health and social care system. Social care reablement services have proven to be effective in reducing reliance on long term services by helping people stay healthy and independent for longer, and intermediate care is an essential part of hospital discharge pathways – supporting people to recover in a non-acute setting. However, the traditional split between health and social care commissioning and provision means that too often people are unable to access the right services to meet their needs, and their experience of care is disjointed.

Integration between health and social care has been high on the national agenda in recent years but can be difficult to make a reality. Reablement and Intermediate Care as service areas offer an ideal starting point for health and social care leaders to work together for two practical reasons:

  • There is significant overlap between Reablement and Intermediate Care services in terms of their aims, how they operate, and who they are for – people using these services more often than not have a combination of health and social care needs
  • Reablement services commissioned or provided by local authorities are not usually subject to the same eligibility criteria and financial mean-testing as long term care, taking out of the equation one of the major practical challenges to integration.

If leaders are able to develop effective joint working in this area of the system, this can be used as a platform for further integration.

What are Reablement and Intermediate Care?

The National Audit of Intermediate Care (NAIC) uses ‘Intermediate Care’ as an umbrella term to describe a tier of services, including reablement, that offer short term support between primary and acute or long term care. Other terms used include ‘transitional care’, or ‘step up’ and ‘step down’ services.

‘Reablement’ originated as an alternative approach to standard domiciliary care that is based around supporting people to learn or re-learn skills necessary for daily living – usually short term and goal-based. Reablement services are either directly provided by local authorities or commissioned from independent providers. According to the NAIC in 2015, the average annual investment in Reablement services per 100,000 population was £0.6 million, with an average cost of £1,484 per service user.

‘Intermediate Care’ is used in the health sector to describe a range of home or bed-based services that provide short term multi-disciplinary support – crisis response where people have escalating health and care needs that can be managed in a non-acute setting or supported discharge and rehabilitation to support people to regain function and independence following an episode of ill health or injury. The total average investment in crisis response, home based and bed-based intermediate care in 2015 was £2 million per 100,000 population.

Priorities for improving and integrating Intermediate Care

System leadership – health and social care commissioners and providers

  • Establish a shared vision, outcomes and priorities
  • Share the challenges and develop solutions together – for example tackling delayed transfers of care as a whole system with joint working groups and shared action plans, rather than passing the problem around
  • Set the tone and build a culture of respect – empower and encourage staff at all levels to work collaboratively

Commissioners

  • Map capacity and demand across services and identify pressure points or underutilised resources
  • Develop a shared language and methodologies for tracking benefits across health and social care
  • Commission for outcomes, not units of activity, with incentives for providers to enhance quality and improve access
  • Prioritise investment in intermediate care (and other preventative services such as telecare) and commissioning these jointly or as part of an aligned approach

Providers

  • Where there are multiple services, develop a single pathway in with simple criteria and assessments
  • Build multidisciplinary staff teams – this can be done in phases with simple co-location as a starting point where there are different providers involved, working towards more formal integration and the development of trans-disciplinary roles in the longer term. There is evidence that having multiple staff from different disciplines involved in someone’s care contributes to improved outcomes for that individual.
  • Build partnerships with third sector and other providers to deliver a holistic support offer that includes assistive technology, telecare and low level services such as home from hospital and befriending.

What will be the outcomes if we get it right?

Front line staff are empowered to deliver person-centred coordinated care with fewer hand-offs and assessments. Patients and carers only have to tell their story once.
A smooth, clear pathway from hospital to home – health, social care and the third sector working in partnership to tackle delayed discharges and maximise use of resources such as step down beds.

Our offer

With expertise drawn from health and social care; commissioners and providers, Attain can support individual organisations and systems to improve people’s wellbeing and care, through the development, design and implementation of sustainable, outcome-focused and integrated models of care.

Case study

We recently worked with a Clinical Commissioning Group in the north of England and one of its partner local authorities to develop elements of their Better Care Fund plan, which included a focus on identifying opportunities to improve the performance and efficiency of reablement and intermediate care services. This involved:

  • Mapping and review of all services on the ‘step up / step down’ services pathway, including proposals for new initiatives
  • Detailed analysis of home-based intermediate care and reablement services – cost, activity and performance; benchmarked against national and local comparators
  • A desktop review of case studies and examples of good practice in relevant services and outcomes-based commissioning approaches
  • Co-design workshops with commissioner and provider operational leads, including third sector partners
  • Iterative design of a new care model and outcomes framework, with extensive input from front line service leads
  • Managing alignment with other relevant areas of work, including short term action planning to reduce delayed transfers of care

The support provided by Attain contributed to improved understanding and partnership working between health and social care commissioners; and between providers. Key products developed for commissioners to take forward with providers were:

  • A new model of care and service specification for the intermediate care tier of services, with buy-in from key health and social care partners
  • A new person-centred outcomes framework covering health and social care requirements, matched with baseline data for existing services.

For more information, please contact John Ryan.