Immediate Discharge Service – Reablement, Perth & Kinross (Update)

What was the issue you were addressing or working on?

The number of people aged over 65 living in Perth and Kinross is expected to increase by 74% by 2031.  The Reablement Service launched in Perth City on Monday 4 October, 2010.  The service is aimed to help people regain skills that will allow them to live as independently as possible in their own homes.  The Reablement service is also key in ensuring the Council can meet the challenges that lie ahead for service provision.

The full Immediate Discharge Service – Reablement, Perth & Kinrooss Example of Practice (Update) is available here.  It is an update of the original Example of Practice published in 2013, which can be accessed here 


What you did?

The Immediate Discharge Service was established in 2011 and comprises a Reablement Co-ordinator, 12 Reablement Assistants (RAs), an OT support assistant and a clerical officer.  The team assists people throughout Perth and Kinross who are in hospital and require reablement support to return home.  The team has:

  • Introduced direct access to reablement by health workers which has reduced waiting for assessments
  • Provided direct phone access to the service through dedicated clerical support which has improved communication
  • Improved coordination and communication between existing services which has led to improved joint working.
  • Reviewed and redesigned the discharge pathway which has led to reduced duplication and increased efficiency.

What were the outcomes - benefits or otherwise?

As at September 2014:

  • Contribution to the 4876 bed days saved to date
  • Evaluation has shown that after receiving support from the service:
  • ⅓ of people require no further going support and return to their previous level of independence
  • Of this ⅓, 65% require further reablement for up to 6 weeks
  • Of this 65%, 60% require no further support, 40% require a care package
  • Ward based OTs have completed 806 direct access assessment since April 2012
  • Capacity in social work has been created to manage a 20% increase in demand for assessment
  • Unit cost of outcomes focussed assessment is calculated at £158. On this basis it has been calculated that direct access has saved £127,348 in social worker assessment capacity to date, approx £54,576 pa
  • Average delay for social work assessment has reduced from 8 to 4 days

Contacts - to find out more

Shona MacLean, Senior Practitioner OT