Improving outcomes through reablement at Swindon Borough Council and Great Western Hospital Foundation Trust
The Swindon reablement project came from practitioners reviewing a sample of cases for patients discharged from an acute setting over a 6-month period and asking: “was the best outcome for the person achieved?”.
Results showed that in 45% of cases where someone was discharged to a residential care setting, they would have achieved a better outcome had they been supported to return home (either directly with domiciliary reablement, or via intermediate residential reablement). The challenge we faced was that neither of these services had the capacity or capability to take the required additional volume of patients
The project has progressed through 3 phases: design, implementation and extension.
Design Phase
Six health and social care practitioners came together to design, pilot and iterate new ways of working. They identified and solved key blockers:
• Co-locating domiciliary and residential reablement services to deliver a seamless ‘hospital to home’ service for patients
• Aligning staff rotas with service demand over weekendswhich released a 63% increase in service capacity.
• Improving the function of MDT meetings through improved dashboards and case prioritisation - unlocking a further 52% of capacity.
• Communicating what reablement is and when it is suitable through revised patient letters. Theseemphasised the benefits, setting the expectation that achieving the outcomes required engagement and commitment from them.
The service throughput increased from 28 patients per week up to 38, providing the confidence needed to move on to implementation.
Implementation Phase
We implemented the new ways of working across the whole team over a further two months.
This was achieved - but not without challenges along the way, for example persuading staff who had not been involved in the design of the new processes of their merit. One solution to this was fortnightly ‘temperature check’ surveys
The answers to these allowed a more scientific approach to implementation. For example, when the survey showed staff were not confident in how achievable the changes were, we organised a lunch talk by the pilot group to share their experience of how they reached a point ofsustained improvement.
Extension Phase
Having demonstrated that every £1 spent on reablement services saved three times that amount
across health and care services, we extended the team size to support 920 patients per year with £220K of funding from the CCG.
Results
• 163% increase of patients receiving reablement services
• Annual saving of over £1.9m to the health and social care economy
• Reduction in social care DTOC days from 516 to 132 between May and November 2017
• 10% readmission rate to acute (vs. 20-26% for other patients aged 75+)
During a recent review, the LGA’s Care and Health Improvement Advisor commented: “this is the best reablement model I’ve seen anywhere in the country”. He is using it as a case study as he works with other authorities across the country to maximise knowledge sharing, both of the model itself and also how to deliver the change.
Further information please contact Sue Wald , Corporate Director Adult Social Services
[email protected]