Waiting times for reablement services have doubled over the past two years, finds an annual audit of intermediate care provision released today.
People waited 8.7 days on average between referral and assessment for a reablement service in 2015, up from 5.3 days in 2014 and just 4.2 days in 2013.
The hike, revealed by the National Audit of Intermediate Care 2015, came as investment in reablement fell from 2014-15. In 2015, clinical commissioning groups and local authorities invested £0.6m per 100,000 weighted population (a figure that adjusts for different levels of need between areas), down from £0.7m in each of 2013 and 2014. Referrals for reablement also fell, from 583 to 497 per 100,000 weighted population.
The audit, published by the NHS Benchmarking Network, was based on responses from 61 of the 211 clinical commissioning groups in England and 46 local authorities.
Waiting times also rose for people waiting to receive home-based – as opposed to hospital-based intermediate care – from 4.6 days in 2013 and 6.1 days in 2014 to 6.3 days this year. The audit found that one third of those waiting for home-based intermediate care or reablement were waiting in an acute hospital bed.
Poor patient experience
“The delays represent not only a lost opportunity to reduce average length of stay but also may create a poor patient experience and impact on the effectiveness of rehabilitation,” said the audit report.
This comment chimes with findings in last year’s report. The audit also found that staffing levels and levels of contact hours per service user fell in reablement services. Whole-time staffing levels stood at 3.95 per 100 service users in 2015, down from 4.64 in 2014; contact hours per service user fell from 35.6 to 25.6. However, the report said that these differences could reflect a change in the composition of the sample from 2014-15.
Reablement services provide personal care and daily living support, usually for up to six weeks, in a bid to boost service users’ confidence and skills to live independently. They are often jointly commissioned by CCGs and councils. The services offer ‘step up’ support to prevent a person going into hospital and ‘step down’ support for people admitted to hospital to facilitate their discharge and prevent readmission.
There was a fall this year in the proportion of step-down provision, from 43% to 35%, within reablement, with the majority of services geared towards preventing admissions.
Lack of capacity
The 2012 audit concluded that intermediate care capacity needed to double to meet need, but capacity has remained relatively static ever since according to successive audits.
“It is likely that intermediate care capacity nationally is continuing to fall behind potential demand and an opportunity to reduce the pressure on secondary and social care may be being missed,” concluded the 2015 report.
The audit was produced in partnership with organisations including the Association of Directors of Adult Social Services, the British Geriatrics Society and the College of Occupational Therapists.