neath port talbot€¦ · referrals age profile to give rate of access per 1,000 population by age...
TRANSCRIPT
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.
February 2010 Whole System Partnership 4
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.
February 2010 Whole System Partnership 5
Stretch targetsStretch targets applied where there was a local expectation of improved performance or where national averages suggested potential for improved performance:
February 2010 Whole System Partnership 6
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)
February 2010 Whole System Partnership 7
Change in total annual equivalent cost
February 2010 Whole System Partnership 8
Total number of people receiving ongoing packages of home care
February 2010 Whole System Partnership 9
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).
February 2010 Whole System Partnership 10
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.
February 2010 Whole System Partnership 12
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.
February 2010 Whole System Partnership 13
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.
February 2010 Whole System Partnership 14
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.
February 2010 Whole System Partnership 15
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:
February 2010 Whole System Partnership 16
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.
February 2010 Whole System Partnership 17
Reablement team (pre-CIIS) & HEAT referrals (annual equivalent)
February 2010 Whole System Partnership 18
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
February 2010 Whole System Partnership 19
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
February 2010 Whole System Partnership 20
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.
February 2010 Whole System Partnership 21
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.
February 2010 Whole System Partnership 22
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.
February 2010 Whole System Partnership 23
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)
February 2010 Whole System Partnership 24
Change in total cost
February 2010 Whole System Partnership 25
Hours of reablement capacity
February 2010 Whole System Partnership 26
Reablement case load
February 2010 Whole System Partnership 27
Receiving low level support at home (telecare as proxy)
February 2010 Whole System Partnership 28
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.
February 2010 Whole System Partnership 29
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.
February 2010 Whole System Partnership 30