department of adult social services wirral university teaching hospital nhs foundation trust nhs...

Department of Adult Social Services

Wirral University Teaching Hospital NHS

Foundation Trust

NHS

Wirral Home Assessment and Reablement Teams - the way

forwardPresentation for Reablement Seminar 10/1/08

Tate Gallery LiverpoolAnne Bailey Principal Manager Homecare Reablement

Melanie Jones Professional Lead for Occupational Therapy



Foundation Trust

NHS

Population 312,000 (2001 census)

Comparator authorities include Sefton, North Tyneside and South Tyneside, Darlington, Bolton

10 year difference in life expectancy between wards

Wirral



Foundation Trust

NHS

Background

• Wirral Enablement Discharge Service established 2004 as a partnership between Home Care and Wirral Hospital Trust

• Team included 3 Home Care Organisers, 1 Senior Carer, 16 PT Home Care Enablers, 2.63 WTE Occupational therapists + OT Assistants.



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Background cont..

• July 2006 management agreement to extend the role of the WEDS team to include an assessment function based upon Leicester model of an intake assessment service

• August 2006 WEDS chosen as a case study site by CSED as part of its Reablement work stream. Evidence from other CSSR’s supported the business case for the re-engineering proposal



Foundation Trust

NHS

Background cont..

• June 2007 WED service chosen by CSED as a site to take part in a retrospective study of the effectiveness of reablement to be carried out by SPRU (University of York)

• Wirral Home Assessment and Re-ablement Teams established August 2007 (WED Service integrated)



Foundation Trust

NHS

Wirral Home Assessment and Reablement Teams

• The name has been changed to reflect the assessment function and the eventual wider inclusion of community referrals.

• OT referrals have clear reablement goals identified

• Care Manager referrals identify needs that can be met by care in the home. Role of Wirral HART is in promoting independence and assessing the correct level of provision



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Objectives of Wirral HART• To maximise users long term

independence, choice and quality of life• To appropriately minimise ongoing

support required and, thereby, minimise the whole-life cost of care

• Helping people ‘to do’ rather than ‘doing to or for people’



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Objectives cont..

• To ensure that the provision of ongoing care packages are more accurately assessed and not purely defined by a one off assessment but by skilled observation over a longer period in the home environment

• To be outcome focused with a defined maximum duration of input



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Phase 1 - Hospital Discharges• Hospital patients who meet the old WEDS

criteria. (OT referrals)• Hospital patients with no previous homecare

support who now require support as identified by MDT/Ward/Care manager.

• Hospital patients requiring an increase to an existing package of care.

• Hospital patients whose length of stay has exceeded the timescale for automatic reinstatement of their previous package (currently > 2 weeks.)



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Phase 1 cont..

• As part of the discharge plan for hospital patients who have been identified for elective episodes

• To integrate more fully with pathways of other intermediate care services to facilitate faster discharge into individual’s own home

• To integrate with the telecare pathway



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Phase 2 – Community referrals

• To accept 70% of community domiciliary care referrals currently going through brokerage

• To link to Community Therapy Service (CTS)• To link to community matrons and long term

conditions agenda• To offer step up intermediate care• Potential involvement in locality pilot project• Support assessment of direct payments and

support care management reviews



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NHS

Structure December 2007

• 92 Trained Home Care Enablers (55.2 WTE) 4.63 Whole time equivalent OT’s and OT assistants provided by Wirral Acute Trust

• Home Care Organisers and Senior Care staff are running Wirral HART alongside the traditional service



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NHS

Challenges

• The initial plan was for OT staff to be involved in the screening of all cases taken onto the service

• 80% of referrals coming via care management are benefiting from OT input

• It was anticipated that OT’s would be primarily involved in provision of equipment. It quickly became evident that OT’s skills were more widely required



Foundation Trust

NHS

Initial service data 6/8/07 – 14/12/07• Number of referrals to date 550• No of referrals proceeding to service 485• Referrals not actioned 65

Turned down service 22Inappropriate 43

• Average number of cases live at any one time 102



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Service data cont..

• No of care management referrals 279

• No of OT referrals 229

• No of OT referrals to WEDS April – July 2007

118



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Service data cont..Number of people went from HART service into Hospital H 45 (9%)

Number of people that went from HART into Residential Respite R 7 (1.4%)

Number of people who went into Nursing Respite N 3 (0.6%)

Number of people who went from HART into Intermediate Care Residential

I 4 (0.6%)

Number of people who went into Intermediate care nursing (Grove House) G 0

Number of people who died while in receipt of HART service D 7 (1.4%)

Total number of unplanned outcomes 40



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Service data cont..Outcomes

Number of people on completing HART intervention required no ongoing service (Excludes Live, non actioned, ongoing and unplanned).

111(29%)



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Finance and efficiencySaving impact on Commissioning Budget 562,482

Cost of HART Delivery to date 177,485

Total Net Efficiency achieved to date 384,997

Number of Wirral HART hrs delivered to date (Including live cases). 7,881.4



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Monitoring Sustainability of outcomes

Within the process service users requiring on going care will be transferred to independent sector providers

Care planning and intervention outcome information is transferred with the service user



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NHS

Why improvement might not be sustained?

• Deterioration in service user’s functional ability &/or confidence

• Alteration to informal care support structures• Family anxieties and expectations in conflict

with professional views• Conflict of philosophy between independent

sector care providers and re ablement service (Care for v encourage)



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Maintaining outcomes• Close working relationships with care management• Offering review through reablement service when

appropriate• Closer working with contracts dept to improve QA• Closer working relationships with independent sector

providers to encourage a culture change through closer working and good feedback mechanisms

• Promoting the culture change with family and informal carers to reduce anxieties around risk issues



Foundation Trust

NHS

Any Questions?

department of adult social services wirral university teaching hospital nhs foundation trust nhs...

Documents

home care organisers

wirral hospital trust

home environmentto

pt home care enablers

assessment function

existing package of

ot referralshospital

intermediate care services