Agenda item

This report provides an update to the Committee on the new Intermediate Care and Reablement Service with examples of learning from the first six months of the contract’s operation.

The report also details some potential developments which are being explored as a result of that learning to streamline and improve the service people receive when they are ready to leave hospital and return home.

Discussion

The Director of Children and Adults Services informed the Committee that the update provided was in relation to the importance of Home First and how it had been embedded in intermediate care and reablement services. This was part of the broader strategy of increasing the range of options for care outside hospital on the basis that a person’s own home was the best setting.

The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund and the Director of Planned and Urgent Care at Medway Community Healthcare introduced the report. A report had previously been presented to the Committee in November 2016. This had provided feedback on the Home First pilot project that ran between April and October 2016. It had been agreed that a further report would be presented to the Committee once the first six months of operational data was available.

Depending on their needs, reablement of patients either took place in their own home or in an intermediated care bed. These beds were provided in two locations, Britannia Court and Platters Farm. There was a two hour target for patients to be assessed following notification being received that they were ready to be discharged from hospital.

The Committee was advised that some figures contained in the report were incorrect. The report stated that the Home First service had a capacity of 150 referrals per week with an average number of patients received of 96 per week. These figures should have been 150 and 96 per month.

Since commencement of the service, a total of 801 patients had received reablement at home while 203 received it in a community based bed. The average length of stay in a bed was 21 days. 73% of service users had improved their independence with 27% showing little improvement. 98% of patients had their service in place within 24 hours while 84% of patients referred to the service were discharged within six weeks. Where the service was not in place within 24 hours, this was due to patient choice.

It had been determined that more in depth assessment of some patients needed to be performed outside hospital. It was envisaged that this would take place in a discharge hub. Work was being undertaken with partners to determine how the discharge hub would operate and which patients it would help.

Every patient accessing the Home First service received a personalised plan. Patients who showed little improvement would be referred on for long term care via long term care teams. Patient surveys had been undertaken with 39 completed questionnaires representing a 92.1% response rate. 66.67% would recommend the service to others. 79% were more confident in undertaking personal tasks as a result of the service provided while 87% had achieved their personal goals.

Questions and points raised by the Committee were responded to as follows:

Benchmarking: In response to a Member who asked what the statistics in relation to users of the reablement service were being compared to, the Committee was advised that as the service was new there was no data to enable direct comparisons to be made. The number of people requiring the service was driven by the number of hospital admissions. Data would be tracked to determine how hospital stays could be reduced and reablement flows improved.

Patient assessments: A Committee Member questioned how it could be evidenced that initial assessments were taking place within the two hour target. The Committee was informed that mobile devices were used to record assessment time and to log assessment staff visits to the patient’s home. In some cases staff reached a patient home before the patient due to patient transport delays. An evening cut off time was in operation, whereby referrals would not be made after a certain time. During the discharge process, ongoing contact was maintained between the hospital ward, the Integrated Discharge Team and ambulance services. It was requested that future reports to the Committee provide figures for the number of service users being seen within the two hour target.

Patient outcomes: Full data was not immediately available to show how many patients required the service for a full six weeks, although it was known that there were currently 17 people that had been accessing the services for longer than this. Further data would be circulated to the Committee. 

Contract monitoring: The contract with Medway Community Healthcare (MCH) for the reablement service was for five years. Regular contract monitoring was undertaken with MCH. The Key Performance Indicators (KPIs) used were outcome based, acknowledging that demand would fluctuate from day to day and week to week. KPIs included response time to a reablement request and handover time. The personals goals of patients were set in consultation with patients and families, with the aim being that a significant proportion of patients would achieve their personal goals.

Personal Care: A Member asked how it was ensured that patients newly discharged from hospital were helped to ensure that they had, for example, enough food in their home or help with laundry. The report presenters advised that as a person passed through the reablement process they would be assessed to determine what the new ‘normal’ would be for them. Long term plans were not normally made until this had been determined and the patient had reached this point. Other support services were utilised as appropriate, some of which would continue after the main reablement programme had concluded.

Patient Satisfaction: In response to a question that asked whether the 66% of patients surveyed who would recommend the service were broadly the same as the 73% of patients who showed improvement, it was confirmed that this was likely, but it was not possible to say for definite.

Intermediate bed provision: The Committee was informed that the difference between the two reablement facilities at Brittania Court and Platters Farm was that the former provided high dependency nursing while Platters Farm was a residential setting without 24 hour nursing.

Decision

The Committee noted the progress detailed in the report and requested that data in relation to patients accessing the service for longer than six weeks be circulated to the Committee.