Agenda item

To consider information from the Stockton-on-Tees Borough Council (SBC) Adults, Health and Wellbeing directorate in relation to this scrutiny topic.

Following the Committee’s approval of the scope and plan for the Reablement Service review at the last meeting in September 2024, this first evidence-gathering session involved an initial submission from the Stockton-on-Tees Borough Council (SBC) Adults, Health and Wellbeing directorate.

Led by the SBC Integrated Interim Care Team Lead (CQC), and supported by the SBC Strategic Development Manager (Adults & Health) and the SBC Service Manager – Integrated Early Intervention and Prevention, a presentation was given which covered the following:

·       What is reablement?

·       Why (provide the service)?

·       Who can access the service?

·       How we deliver the service?

·       Activity and Performance

·       Feedback about our staff

·       Client feedback

·       Future

·       Powering Our Future

Coming under the wider umbrella of ‘intermediate care’, reablement was one of several short-term support offers involving NHS and social care services.  Providing assistance within a person’s own home, this assessment and support service helped an individual to do tasks (e.g. washing, getting dressed) for themselves rather than relying on others, with support workers working alongside the person while they regained skills and confidence.  The aim was to maximise independence (doing tasks ‘with’ them, not ‘for’ them), and the service could be used to support discharge from hospital, prevent re-admission, or enable an individual to remain living at home.

From a legislative perspective, the Council had a duty to prevent, reduce or delay needs for care and support (Care Act 2014 s2) for all adults (18 years-old or over), including carers.  In practice, this meant early intervention to prevent deterioration and reduce dependency on support from others, and reablement was one of the ways the Council could fulfil this duty.  The Care Act regulations required the Council to provide reablement support free-of-charge for a period of up to six weeks – this was for all adults, irrespective of whether they had eligible needs for ongoing care and support.

The service may be accessible if an individual had a temporary illness / accident, a crisis, a change in their (or their carers’) circumstance, or to avoid unnecessary admission to hospital.  Where a ‘need’ (not a ‘want’) had been identified, individuals would be referred following an assessment via a health or social care professional.  Any subsequent support could be tailored to the individual, and its duration was dependent upon their progress (i.e. this free service could be less than the maximum six-week period).

In terms of service delivery, the SBC Reablement Team consisted of a Manager, a Deputy Manager, four Co-ordinators, an Assistant Co-ordinator, three Senior Support Workers, and 37 Support Workers (courtesy of a recent expansion in October 2024) who were all dedicated and worked alongside individuals to promote independence.  The workforce had a mix of experience, and the service benefitted from good staff retention, with those in post for a number of years able and willing to share their knowledge and expertise with newer recruits.

With a focus on making every contact count, visits to service-users occurred 1-4 times per day, with Senior Support Workers holding regular weekly reviews with individuals to ensure they were on track to achieve their goals and adjust their support plan accordingly (they were also able to assess and order low level equipment to aid independence).  Discharge plans and end dates were agreed with individuals, and throughout the duration of their assistance, staff could signpost to other services such as welfare rights, community groups and befriending initiatives so an individual had a support network to help them remain at home and not feel isolated when leaving the reablement offer.  Help was also provided with applications for entitled benefits.

The SBC Reablement Service was last inspected by the Care Quality Commission (CQC) in May 2021 where it was subsequently given an overall rating of ‘Good’.  591 individuals were supported between April 2023 and March 2024, with just over 75% of this number independent on leaving the service (those who needed further care required less intensive support due to the work undertaken by staff).  Local performance was consistently better than the regional and national averages over the past four years, with the 2023-2024 data ranking Stockton-on-Tees eighth in the country (top in the region).  In addition, the service had been shortlisted for the regional (North East and Scotland) Great British Care Awards in the categories of ‘Team Award’, ‘Newcomer to Care’, ‘Co-ordinator’, and ‘Care Manager’.

Two key areas were identified regarding considerations around the future service offer.  The first concerned the issue of ‘demographics’, with population projections up to 2030 showing that there was an expectation for a consistent increase in the number of people aged 55 and over in the Borough (particularly in the 65 to 69 and 80 to 84 age-brackets).  Related to this, a system developed by the Institute for Public Care indicated that ‘projected service demand’ for both the Borough’s residential and nursing care population was expected to grow by 10% over the next five years.  Whilst SBCs local market assessment for residential provision anticipated that this growth would be significantly lower, acuity, length of stay, and use of short-term assessment beds to support hospital discharge would

impact on the Council’s ability to support people to independence.

The presentation concluded with a summary of the reablement review being undertaken via the Council’s Powering Our Future (POF) initiative, the project proposal of which was signed off by the POF Board in June 2024.  As part of the first phase of this work, the commissioned Discharge 2 Assess (D2A) provision was brought in-house earlier in October 2024, and a pilot assessment of activity monitoring technology would begin (the results of which were due to be reported in December 2024).  Phase two of the review was looking to establish revised models of reablement to accommodate support for people in the community and greater numbers of people being discharged from hospital, as well as those with a mental health need, autism or learning disability.

Commending officers for the performance of the Reablement Service, the Committee drew attention to the previously considered agenda item involving an update on care and health winter planning, and asked if they concurred with the statement that there was enough capacity within the service to cope with anticipated demand.  In response, Members heard that existing structures were sufficient to deal with the Council’s projections on the numbers requiring support, but issues would inevitably follow should these projections be exceeded, as would staff absences as a result of sickness / COVID.  Resilience was built into plans to counter potential surges in demand, though much was fundamentally down to having enough staff available.

With reference to the first phase of the ongoing SBC Powering Our Future review of reablement, the Committee enquired about what sort of technology was being considered as part of the intended pilot.  Officers spoke of the use of sensors (subject to an individual’s consent) which fed into a dashboard to give a picture of how a person was managing within their own home – this could help understand patterns of behaviour which could then identify risks (including changes in normal routines which may indicate a problem) and any associated support needs.

Members asked if the service had any dealings with the North Tees and Hartlepool NHS Foundation Trust (NTHFT) Frailty Ward and, if it did, was this relationship working well.  Officers stated that referrals were received from the Frailty Ward and that the service worked alongside colleagues within that NHS function which carried out more healthcare-related tasks and offered overnight provision (something the Reablement Service did not).  Most of those receiving reablement support were aged over 65 years old.

Reflecting on the number of staff employed within reablement and the number of individuals supported during 2023-2024, the Committee praised the hard work and dedication of those providing the service.  It was subsequently highlighted that there were only 28 support staff during the 2023-2024 year, a total which had since risen.  It was also noted that a robust training offer was in place to support / strengthen the workforce.

Member questions finished with a comment on last week’s (17 October 2024) Cabinet meeting which included a Powering Our Future report stating that, in light of the Council’s financial position, there was a need for some people to pay more for their care.  To this end, the Committee requested further details on the way the Reablement Service was funded and the costs it incurred, as well as future projections around budgets / expenditure for this type of care.

AGREED that the information presented by the SBC Adults, Health and Wellbeing directorate be noted and further details be provided in relation to Reablement Service funding / costs.