Establishing Reablement at Merton LBC
Establishing the In-House Reablement Service
At Merton LBC (December 2013)
The brief was to establish a new in house reablement service out of the existing MILES (Merton Independent Living and Engagement Service). This included designing how it is organised, defining how it operates, calculating its costs and the forecasting the results it should achieve. All this with a view to identifying savings of around £800K for 2014 – 15, from a combination of lower running costs and reduced packages for service users after support by the reablement team. In particular Merton Council wanted an option appraisal including an evidence based business case leading to the maximum feasible level of savings.
The review took place during October 2013 and provided:
• An assessment of the current service.
• A financial assessment.
• An options appraisal.
What we did:
Working closely with Merton’s staff Alder combined evidence from the following:
• A desk top review of research and literature on reablement services.
• A review of local activity and financial data.
• An analysis of practice involving a review of a selection of case files and direct observation of practice. 10 of these were the most recent reablement cases and 12 the most recent hospital discharges requiring packages of care.
• Stakeholder meetings e.g. with senior strategic and operational managers,team managers, organisers, senior reablement carers, reablement carers, Independent sector domiciliary care providers and NHS managers.
The following options were considered:
- Do nothing: This option is not consistent with the authority’s financial strategy. Current arrangements were unaffordable. Therefore it was rejected
- Reduce reablement carer hours: This option would meet the authority’s financial strategy if the budget for reablement carers was reduced by 51%. This would have significant consequences in terms of service viability. This option does not address the structural and organisational inefficiencies identified nor improve the outcomes for service users, therefore it was rejected.
- Outsource the totality of the service: This option requires detailed planning, negotiation, consultation and implementation. This would be hard to achieve within 2014-15 and there are significant accountability and governance risks. Interviews with independent providers found they would want to undertake specific recruitment processes rather than TUPE existing staff i.e. this option would have a profound impact upon existing staff , incur redundancy costs and be resisted by stakeholders therefore it was rejected on feasibility grounds.
- Total integration with NHS services: This was consistent with central and local strategies for the integration of health and adult social care services, but since the service is used as a one stop open access home care service for hospital discharge by the NHS it was not the right time for integration. Actioning this option now would maintain the status quo of a hospital discharge service with a reduced ability to influence and direct change. This option was therefore rejected for now, but it could be reconsidered as part of the Integration Project in Merton.
- An occupational therapy led in-house MILES reablement service: This option addresses the financial requirements and the structural and organisational inefficiencies identified. Recommended for further evaluation.
Merton accepted our recommendation that an occupational therapy led in-house MILES reablement assessment and care management service with the direct service outsourced to the independent sector be fully evaluated because of the potentially higher level of savings it would release.