Neath Port Talbot€¦ · referrals age profile to give rate of access per 1,000 population by age band: February 2010 Whole System Partnership 16 Age band 08/09 referrals 2010 pop

Neath Port Talbot

Reablement capacity planning

Final feedback – February 2010

Objectives

To feedback outputs form the generic model having adopted assumptions developed at the first workshop on the 7th January;

To consider the future aspiration for reablement services as an integral part of an intermediate tier and consider expected throughput of such a service to inform the local business case development process.

February 2010 Whole System Partnership 2

Neath Port Talbot – reablement planning sessions

Insights from the generic model and application to local circumstances

Local policy and service context

The reablement function is currently undertaken in NPT as part of both:

The Homecare Enablement and Assessment Team (HEAT), which has been in existence since January 2009 and provides an enabling approach to people assessed as eligible for support as being in critical or substantial need;

The Community Integrated Intermediate care Service (CIIS), put in place during the autumn of 2009 as an integration of homecare reablement and intermediate care crisis response services – both of which have been in place since the early 2000’s and include an element of residential reablement.


Use of generic model

A set of assumptions that could be applied to the generic model were identified by the working group and subsequently applied;

Three scenarios were generated:

Baseline – do nothing scenario but with demographic impact;

Adopting the local assumptions as identified on the 7th January;

Applying three ‘stretch’ targets for improvement in key assumptions.


Stretch targetsStretch targets applied where there was a local expectation of improved performance or where national averages suggested potential for improved performance:


Assumption National default

Local currentassumption

Target or aspiration

% of direct staff time spent with clients 70% 60% 75%

Outcomes from reablement

No further support 60% 30% 50%

Lower levels of support 25% 33% 25%

Same level of support 12% 30% 20%

Higher level of support 3% 7% 5%

Note: updated information from the HEAT service suggests that between April and December 2009 38/79 (48%) of clients went on to receive no ongoing support.

Generic model – NPT scenarios

In the following outputs the graph lines refer to:1 = do nothing & no demographic impact

2 = do nothing with demographic impact

3 = assumptions based on current services

4 = possible stretch targets (see previous slide)


Change in total annual equivalent cost


Total number of people receiving ongoing packages of home care


Other outputs from the generic model

An optimised reablement component for local services (using stretch targets) might consist of: A caseload at any one point of time of between 50 and

60 people;

Dedicated reablement staff delivering care at home of 14-18 in year 2, the equivalent of c.600hrs per wk;

A saving of c.£1.1M pa by year 3 (with cost pressures after this reducing the level of savings due to demographic change).


Neath Port Talbot – reablement planning sessions

Local issue identification and high level analysis

Local challenges

During the working session on the 7th January the following local challenges emerged:

The need to explore the impact of integrating the current services;

There was a recurrent theme of travel time and therefore the efficiency of the current services;

The service at present was not able to address the needs of people with dementia;

There was an aspiration to reflect early intervention and prevention measures into the service.


Overarching service modelTransforming Older People’s Services programme sets the context for future redesign:

Reablement seen in the context of (and as a critical component of) an emphasis on maintaining independence through targeted interventions that are cost effective, high quality and sustainable;

The service model is premised on delaying the point at which people require long term support and reducing the period over which this support is needed;

Capacity and impact modelling need to dovetail with wider policy agenda.


Key issue for reablement modelling

What capacity would be required and outcomes achieved from reablement functions within a fully integrated intermediate

tier of services with the following characteristics:

1. A single point of access and further integration of the HEAT/CIIS services including delivery of services on a locality basis wherever possible.

2. Where there were minimal exclusions (e.g. mental health needs) apart from the willingness and potential to achieve a specific improved outcome for the client.

3. Where eligibility for ongoing support was determined after appropriate input (i.e. reablement an option for low – moderate needs).

4. Where there were opportunities for early intervention and prevention as well as ongoing support and review for people re-enabled to receive no formal package of care.


Key local data to inform potential modelling

Obtained and reviewed:

Demographic projections by age band between 2010 and 2020 – modifying the expected impact of demographic change downward;

Locality populations as proxies for breakdown of needs;

Detailed referral information about Reablement element of current CIIS service;

Information about first year of HEAT;

ERS activity since inception.


Initial scaling of fully integrated service – demographic impact

Demographic impact – use of 08/09 reablement referrals age profile to give rate of access per 1,000 population by age band:


Age band 08/09 referrals

2010 pop Rate/ 1000 pop

2015 pop Expectedreferrals

<65 87 90

65-74 89 13,679 6.5 15,689 102

75-84 227 8,660 26.2 8,744 229

85+ 154 3,588 42.9 3,667 157

TOTAL 557 25,927 28,100 579

Locality population breakdown: West 45,817 (34%); East 49,079 (36%); Central 39,572 (30%).

Initial scaling of fully integrated service – baseline admissions

Reablement team admissions pre-CIIS service:

Increasing from 498 in 06/07 to 557 in 08/09 (6% then 5% increase year on year);

In 08/09 63% of referrals from hospital, 16% from social services, 11% from other community services, 6% from early response and 4% from residential rehab.

HEAT – estimated annual equivalent referrals of c.250, assumed not to duplicate the above.


Reablement team (pre-CIIS) & HEAT referrals (annual equivalent)


Screening

16%

114

557

Assess & support

23%

104

433

Community with support242 (74%)

Community ‘advice’52 (15%)

Residential rehab35 (11%)

Reablement:

HEAT (based on April-Aug 09):

Screening

23%

58

250

Assess & support

23%

44

192

No ongoing support50 (34%)

Ongoing support, but with 6.3hrs instead of 8.9 (-30%)

98 (66%)

Summary activity levels and development of services


Emergency Response Service

Home care reablement

HEAT (since Jan ’09)

CIIS(since Sept

‘09)

Future – fully integrated

service

Historic level of referrals: 133 pcm (62/1,000>65/pa)

Historic level of referrals: 36 pcm

Annual equivalent number of referrals = 192 (16 pcm)

The service model


Single point

Hospital (adm. avoidance &

step-down care)

Social care access points

Community health

services

Initial screening & identification of

potential outcomes

Including (for example):• New referrals to social care• People with increasing levels of need but who could benefit• People at risk of admission to long term care• People with a long term condition at points of crisis or particular need

Including (for example):• People attending A&E at risk of admission but with no clinical need• People initially considered suitable for care home admission• People requiring any form of reablement or rehabilitation but not needing to stay in hospital

Minimal exclusions

NPT West

NPT Central

NPT East

Assessment & care mgt incl.

specialists Residential reablement

Emergency response and

targeted rehab

Eligibility determined for ongoing care –

critical & substantial

Common assessment tool

Intensive home

support

Day centre

Recalibrating the model

Key changes: Revised demographic baseline with dampened impact due

to significant increase being accounted for in 65-74’s;

Improved outcomes and efficiency of service (previously identified stretch targets);

Increase in reablement activity as part of prevention and early intervention approach – increasing numbers accessing the intake element of the service;

Reduced level of ‘return to service’ following reablement to no support to reflect lower level of needs amongst prevention and early intervention cohort;

Resultant workforce ‘allocated’ to localities.


Making the case – the ‘logic’Current ERS pathway to Home care reablement function remains;

Current HEAT service extends/increases intake by (50%) to simulate extension to earlier intervention, i.e. not restricted to only critical and substantial levels of need;

Combined reablement episodes are integrated and localised and therefore achieve improved efficiency levels of 75%;

Outcomes for reablement to no ongoing support increase to stretch target to reflect broader band of people included in reablement service.


Model timescales

Existing model timescales retained with initial state (time=0) being without reablement;

At Month 12 of simulation reablement function is introduced and is now calibrated to the initial assumptions and analysis underlying the ERS, reablement team and HEAT referral data and outcomes;

At month 48 the various additional assumptions identified in previous slide are turned on.


Scenarios in following outputs

In the following outputs the graph lines refer to:1 = do nothing & no demographic impact

2 = do nothing with demographic impact

3 = revised assumptions without future integration

4 = future impact of integration and related changes (see previous slide)


Change in total cost


Hours of reablement capacity


Reablement case load


Receiving low level support at home (telecare as proxy)


Locality potential

Revised reablement capacity after integration would be c.1,200 hours pw across NPT, equates to:

408 hours pw for West;

432 hours pw for East;

360 hours pw for Central.

Using a flexible workforce based on 20hrs pw per staff member this enables local teams to respond flexibly and efficiently.


Summary of modelling outputs

Extending reablement to reflect an earlier intervention strategy coupled with an integration of existing reablement functions to deliver better efficiency results in:

A marginal but possibly not significant cost benefit over existing arrangements which already achieve significant reductions in ongoing costs of home care packages;

Sufficient reablement capacity to enable locality needs to be reflected and improved efficiency of delivery;

Significant increases in the numbers known to services at a low level and therefore likely to be supported by telecare or similar preventative measures.


Neath Port Talbot€¦ · referrals age profile to give rate of access per 1,000 population by age band: February 2010 Whole System Partnership 16 Age band 08/09 referrals 2010 pop

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