Agenda item

To consider feedback from the Stockton-on-Tees Borough Council (SBC) delivery partner, Peopletoo in relation to the findings of its review of local reablement provision as part of the ongoing SBC Powering Our Future-related work.

The fourth evidence-gathering session for the Committee’s ongoing review of Reablement Service focused on feedback from the Stockton-on-Tees Borough Council (SBC) delivery partner, Peopletoo in relation to the findings of its review of local reablement provision as part of the ongoing SBC Powering Our Future-related work.  In addition, consideration was given to tabled documents outlining service budgets / costs for the 2023-2024 and 2024-2025 (up to 31 December 2024) periods, and proposed survey questions for existing staff.

PEOPLETOO

The SBC Powering Our Future initiative involved a range of transformation reviews, one of which focused on supporting people to live independently.  As part of this work, the Council was exploring what reablement services needed to provide to support a broader range of people from local communities.

In 2024, SBC commissioned Peopletoo to assist the Council in assessing the impact of current ways of working and analyse the best model for continuing to support people to maximise their independence.  Peopletoo had recently completed its work and, further to a Committee request, had submitted a presentation summarising the following:

·       Project Scope – Reablement / Enablement / Rehabilitation: With a background in working alongside Local Authorities and a view to looking at ‘the art of the possible’, Peopletoo’s focus areas for its project in Stockton-on-Tees included reablement expansion, covering both people being discharged from hospital and people in the community.  To get from where the service was now to where it needed to be, key lines of enquiry included:

o   Who / what was the optimum population the reablement service could expanded to in order to accommodate more hospital discharge / community support (return on investment / impact on people's lives)?

o   What was the most efficient model to deliver the new service (not just more staff, but technology, good practice, etc.)?

o   What size / type of reablement service would be needed to make a positive impact on people with a learning disability / autism / mental health needs through a reablement offer?

o   What would be the most effective method of delivering the service to people with a learning disability / autism / mental health needs?

·       Peopletoo Review Activity: A range of interactions were undertaken which involved visits and shadowing teams, case reviews with professionals within Stockton-on-Tees, conversations with senior and regional leaders, and the analysis / benchmarking of data.  Peopletoo encountered no barriers when conducting its work and found a positive culture across the Borough which reflected the openness and honesty of professionals.

·       Overview of key findings from Reablement: Peopletoo was currently working with SBC to validate data – once the full report was finalised, representatives were happy to report back to the Committee if required.  Prior to this, some headline findings were relayed in relation to improved independence outcomes, increasing referrals, challenges with declined referrals, staff and workforce development, digital and technological integration, benchmarking and performance, and cost and resource efficiency.

·       Overview of key findings from Hospital Discharge: Headline findings regarding reablement uptake, delays in hospital discharge, over-prescription and risk aversion, strain on Rosedale Centre, and Integrated Single Point of Access (ISPA) and multi-disciplinary gaps were noted.

·       Overview of Overall Opportunities: Identified activity for the short-term included an enablement pathway pilot, enhancement of frontline training, and the streamlining in the way data was collected.  Over the medium-term, reablement-based services could be enhanced, utilisation of resources optimised, and interdepartmental co-ordination improved.  Longer-term, actions were proposed to embed reablement as core practice, sustain financial savings, and evaluate and scale successful models.

·       How this could be implemented (Reablement): Key steps were outlined focusing on the themes of developing clear criteria and educating on the reablement offer, generating reablement capacity, the community referral process, and outcome monitoring and reporting.

·       How this could be implemented (Hospital Discharge): Actions were identified within the themes of delaying root cause analysis and solution generation, a pathway decision-making workshop, positive risk enablement training and strength-based practice, and data collection, visibility and reporting.  It was re-iterated that these proposals were high-level steps which were subject to existing workstreams and feedback on the final report.

Thanking the Peopletoo representatives for the information provided and their attendance at this meeting, the Committee sought clarity on when the final report was likely to be published.  Members were informed that data was due to be reviewed this week, with a discussion to then be held with senior Council officers.  In terms of timings, there was an attempt to align reporting with both the Powering Our Future and Committee reviews.

With reference to the proposed future opportunities (and how these could be implemented) for local reablement provision within the presentation, the Committee queried if these were likely to be replicated in Peopletoo’s final report.  It was confirmed that a paper was being produced (with costings) for each option – this would be presented to the Powering Our Future Board.

Regarding engagement with professionals, the Committee asked if Peopletoo spoke to the local Falls Service – it was subsequently confirmed that this team was indeed included within the case review workshop.  Peopletoo noted that it was working with 15 Councils across the UK (details of one such example, Durham, was incorporated within the covering report for this agenda item), and also drew attention to the fact that its work in Stockton-on-Tees coincided with the inspection of SBC adult social care provision – it would therefore be interesting to see how far the regulator’s findings (once published) echoed what was encountered by Peopletoo.

Turning to the key findings, Members wondered if the increasing rate of referrals into reablement provision (up 85% in October 2024 compared to October 2023) was reflective of any increase in the total number of people discharged from hospital over the same period.  In terms of delays in hospital discharge, the Committee expressed surprise in the quoted ‘812 days delayed reported within a 5-month period (June-November)’ – this was concerning given that local performance had frequently been heralded and held up as an example to others across the UK.  SBC officers suggested that the data could likely be attributed to the period around the transitioning of the previously commissioned Discharge 2 Assess (D2A) provision into reablement, and also provided assurance on additional capacity (Comfort Call) that had been brought in to bolster the offer.  There was no current waiting list to access the service.

To create and maintain robust oversight of current and potential future demand within the Borough, the Committee suggested that there may be merit in a single database which relevant organisations could securely access.  Members were informed of the existing social care system which recorded reablement-related activity, and that this provided a link between the Council and local hospitals.  In addition, a recent decision had been made to introduce the Great North Care Record as a further way of sharing patient information – a dataset had been agreed and would include an opt-out system for individuals.  The Committee expressed caution around the well-established challenges associated in making personal data / information accessible.

Concluding its questions, the Committee asked if Peopletoo were involved with any other Council departments (e.g. Children’s Services).  Representatives noted some work which was previously undertaken around transitions in Stockton-on-Tees, though that was not as detailed as this reablement-related project.

SERVICE BUDGET / COSTS

Following a previous request from the Committee, budget and expenditure statistics for the local Reablement Service were shared – this covered the complete 2023-2024 year, and the current 2024-2025 (up to 31 December 2024) period.

The Committee queried if the potential impact on costs of the proposed future service models identified through the work undertaken by Peopletoo would be factored into financial planning.  SBC officers stated that 2025-2026 funding requirements were already being considered.

STAFF SURVEY

Proposed questions for inclusion in a survey which would be issued to all existing staff within the Reablement Service were shared and subsequently agreed.

AGREED that the information presented by Peopletoo, and the additional documents on Reablement Service budgets / costs and the proposed survey questions for existing staff, be noted.