Reablement and developing the Community Equipment Service

What was the issue you were addressing or working on?

This project ensures the continued provision of the Reablement pilot (phase 1) and strengthening of the integrated Community Equipment Service to ensure  responsive and integrated delivery of timely interventions whilst developing phase 2 of Reablement in partnership with Care at Home Services in the Western Isles.

It seeks to maximise existing resources, reducing unnecessary dependency, giving practical support to people to live safely, confidently and independently with some short term, intensive, practical support from a dedicated, well trained team.

  • Reablement is services for people with poor physical or mental health to help them accommodate their illness by learning or re-learning the skills necessary for daily living.
  • Reablement seeks to support people, maximise independence and reduce the whole life cost of care
  • Timely provision of equipment to support to reduce the risk of falls, enhance independence and support reablement programmes.

What you did?

  • Building capacity to offer rehabilitation/reablement interventions by a dedicated Rehabilitation OT and Rehabilitation assistant in Lewis and Harris over the last 18 months.
  • Extended this to recruit 4 staff to the Community Equipment Service (September 2013) and invite support from JIT for the review of the model of equipment service provision in the Western Isles
  • Very close working with the Rehabilitation Physiotherapist who offers a dedicated Physiotherapy falls service 1 day per week, Ambulance service, Community Alarm Service, Emergency department, Discharge Coordinator and others – this strengthened the falls prevention work already supported by AHPs by enabling a more responsive service.
  • Exploring involvement in anticipatory care plans and evaluation of the impact with a local GP Practice. Developing a local resource of staff across agencies who can deliver.
  • Falls prevention including increased capacity within the community (Sport centre, Care Homes, Community Groups and Third Sector Agencies) to deliver evidence based small group exercise options to prevent falls, injuries and improve cognition amongst older people.
  • A second CES vehicle for Lewis and Harris has been ordered and should be delivered by the end of September 2013. This will increase the CES capacity to respond to emergency requests e.g. palliative care, prevention of admission to hospital
  • The servicing of health equipment has been incorporated in the Social Work contract for repair and maintenance of SW funded equipment for the period of 2013 – 2015. This means for example that if a community bed or mattress breaks down, that the patient and carers have the reassurance that it will be repaired within 24 hours.

What were the outcomes - benefits or otherwise?

In the 18 months to September 2013, over 360 people seen by the service.  Outcomes that have been achieved are:

  • Improving quality of life
  • Reducing risk of falls
  • Enabling independence
  • Reducing carer stress and risk to carers
  • Sign posting to other relevant services
  • Preventing admission to hospital
  • Supporting fast track discharge from hospital
  • Responsive provision of equipment to support reablement, prevent admission to hospital, facilitate timely hospital discharges and support independent living

The Rehab team developed a comprehensive multi-disciplinary falls screening tool, which has been embedded in clinical practice since June 2012 and has been rolled out to the wider OT and Physiotherapy service.  The referral pathway from A&E and Ambulance service has been formalised.  When someone is admitted to A&E with a fall a rehabilitation referral is e-mailed to the Rehab Team.  The Ambulance service notifies the Rehab team of people in the community who required their support following a fall and any identified concerns.

In September 2013 the project has expanded to include the development of the Community Equipment Service.

A snapshot of 20 cases (between 23 February till 6 June 2012) where hospital admissions were prevented through the Rehab interventions demonstrated the following savings:
Reablement & Community Equipment Service table
The above snapshot analysis resulted in the Reablement Project securing the support from the Analytical Services Division and Information Services Division to undertake a ROI (Return on Investment) exercise.  This exercise will also link with data gathered from SocialCare where possible.

The Canadian Occupational Performance Measure as a patient reported outcome measure was used with 10 of the clients in the last quarter demonstrated the following outcomes:

Clients score their performance and satisfaction with every day activities prior to intervention and at completion of intervention.

  • On average, scores prior to intervention for Performance are 2/10 and following completion of intervention, scores are on average 7.5/10.
  • Satisfaction scores prior to intervention is on average 2/10 and following intervention Satisfaction scores are on average 8/10

Contacts - to find out more

Sonja Smit, Sonja.smit1@nhs.net  01851 708286