Reablement blighted by long waiting times and lack of integration with health, finds study

Audit of intermediate care also finds capacity remains half of what is required to prevent hospital admissions and support discharge

Reablement services are preventing most clients from needing ongoing home care but are being blighted by long waiting times and a lack of integration with health, an audit has found.

On average, 85% of service users completed their programme of reablement and 61% of these did not need ongoing home care subsequently, found the National Audit of Intermediate Care 2013.

However, the proportions who did not need ongoing home care varied significantly between the 49 services studied, while clients faced an average waiting time of 4.2 days from referral to assessment.

The report of the audit – commissioned by health and social care leaders – warned that waits of this length were too high as “evidence suggests there is a short window for rehabilitation to be effective”.

This was the second annual audit but the first to cover reablement. This reflects the similarities between reablement and home-based intermediate care, in so far as both seek to help people regain independence and skills, often following a hospital episode.

Lack of integration

However, the audit identified a lack of integration with health among reablement services, with 43% delivered by separate teams to intermediate care services.

“There is evidence that [reablement] services are running in parallel with ‘health’ intermediate care,” said NHS England’s national clincial director for integration and frail elderly, Professor John Young, in a foreword to the report.

Though the other 57% of services were integrated within intermediate care, the audit found two-thirds of reablement staff were social care support workers and just 2.4% were occupational therapists, 0.9% physiotherapists and 0.6% registered nurses.

Also, just 34% of reablement services had access to specialist geriatricians – compared with 45% of home-based intermediate care services. With over half of reablement services saying that they provided rehabilitation for complex disabling conditions, the audit report raised concerns whether the medical needs of service users were being adequately met.

Last year’s audit concluded that the capacity of intermediate care needed to be doubled to meet potential demand from people coming out of hospital and from those who require support to avoid a hospital admission.

However, this year’s study concluded that capacity remained half of what was required. Excluding two NHS commissioners that increased their intermediate care budgets (excluding reablement) by 48% and 62% respectively, budgets increased by 3% on average from 2011-12 to 2012-13. The study also found that reablement spending fell by 8% in areas that reported figures for both years.

Clinical commissioning groups and councils are going to have to provide seven-day health and social care services to people requiring discharge from hospital or at risk of an admission to access a £3.8bn pooled budget for integrated care that will be launched in 2015-16.

However, the audit found that not all intermediate care services were currently open every day; for instance, this applied to 85% of reablement services.

Little mental health input

The audit also found a lack of mental health input and dementia care training in intermediate care services.

Despite the prevalence of people with dementia among the potential client group, the proportions of staff trained in mental health and dementia care was just 51% in home-based intermediate care services, rising to only to 60% in crisis response services, 65% in bed-based services and 72% in reablement.

Mental health staff accounted for just 2% of workers in crisis teams, 0.5% of staff in home-based services, 0.3% of workers in bed-based provision and none in reablement teams.

At a strategic level, the audit found a greater level of joint working between the NHS and local authorities than in 2012, with 74% of services jointly commissioned (up from 58%) and 32% using pooled budgets (up from 21%).

But Young said the findings as a whole showed that the “integration agenda has yet to be addressed”.

About the audit

The audit was produced by organisations including NHS England, the Association of Directors of Adult Social Services and the British Geriatrics Society, which represents specialist older people’s doctors. It received data from 107 CCGs, 19 local authorities and 410 intermediate care services. It also received survey responses from several thousand patients and service users.

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