Reablement as part of whole service reconfiguration

1
Reablement as part of whole service
reconfiguration

• Bruce McLernon
• Carmarthenshire County Council

2
Context

• Carmarthenshire County Council is on a
  journey.
• Two years ago we had the worst delayed discharge
  figures in Wales.
• We spend more than the Welsh average proportion
  of our budget on older people, and less than most
  on procurement compared to residential and
  domiciliary services.
• We have increasing pressures on our budget.
• These pressures will not go away our older and
  disabled population is projected to grow.
• We also had the challenge of the Joint Review.
• Therefore we need to both improve outcomes
  for older people and the value for money of the
  investment in our services
• .

3
Population and Geography
Population Tywi, Teifi, Taf 64,765
65 13,096 Aman Gwendraeth 57,674 65
11,364 Llanelli 56,533
65 11,348
4
Developing a strategy for older people

• We have worked with SSIA over the last year to
  pull together a number of strands of work.
• Joint Commissioning Strategy
• Domiciliary care commissioning strategy
• Accommodation Strategy
• ..and we are re-structuring
• to deliver these

5
Joint Commissioning Strategy

• Covers all community, social and supported
  housing services for older people.
• Is based on developing better, more cost
  effective services that improve outcomes for
  older people.
• Key planks are domiciliary services, intermediate
  care and
• accommodation

6
Intermediate Care Services

• Canllaw Community Intermediate Care Teams
• Transition Beds in Local Authority Homes
• Units in sheltered accommodation
• Acute Response Team
• Chronic Disease Management Team
• Day Hospitals
• Social Day Care and Clubs
• Community Nursing Services
• Community Hospital and Rehabilitation Services in
  three localities.
• Home Care reablement

7
Domiciliary Care Strategy Development a Process
of Engagement

• Worked with commissioners in the context of the
  drivers and challenges reablement became obvious
• Worked with Home Care they had been keen to
  integrate with Canllaw and were largely managing
  our information, activity and thus budgets and so
  are ready to go
• Worked with care managers they are key to
  informing expectations as well as assessment and
  care planning and are key drivers or inhibitors
• Work with politicians scrutiny/ all
• Engagement with trade unions

8
Development activities

• Auditing care management files need, risk,
  reablement and independent living, DPs,
  application of eligiblity
• Reviewing existing packages
• Re-design the allocation process
• Finalise unit costs
• Agree the model of domiciliary care
• Agree the financial and activity models
• Agree the staffing structure to go with the model
• Undertake change management support for home
  care, care management and commissioning staff
• Review contracts and develop tendering processes
• Review the contracts monitoring process

9
Domiciliary Care Model
10
Implementing the strategy e.g. of work with
commissioners and care managers
Commissioning the components
Working together to keep people at home

• What are the key types of care that need to be
  commissioned?
• What do they look like?
• How can we do this and when?
• Actions to implement the revised allocations
  process

• What services need to be in place across the
  system?
• How do we develop them together?
• Pick one and set out the actions to make it happen

Re-ablement
Assessment models and practice

• What are the options for our teams if everyone
  goes through the rapid response/ assessment/
  reablement and brokerage process?
• How do we make assessment focus on supporting
  peoples strengths and abilities rather than
  deficits?
• What training/ coaching/ monitoring is needed?

• How do we need to change our practise to make a
  reablement approach reality?
• What would a county wide reablement service look
  like if everyone went through it for 2 6 weeks?
• How do we make it happen?

11
Implementing the strategy e.g. of work with
providers

• How do we do our bit to implement the strategy?
• What are the building blocks we need in the
  Business Plan?
• What are the key things that need to happen?
• How do we do it over three years?

12
A structure to deliver

• Integrated strategic head of older peoples
  services
• Engaged around 100 managers and staff in
  identifying issues and options
• Integrated commissioning and contracting unit
• Re-balancing area and county wide functions
  local accountability
• Introducing strategic and operational
  commissioning, brokerage and business support
• Introducing rapid response, assessment and
  reablement