The Home Cure

This project explores a gap that exists in reablement services for people returning home after treatment in hospital. Under the current system, health care and social care workers link up to make the transition from hospital back to everyday life a smooth one for NHS patients who have seen their ability to live independently diminished after medical treatment. Such an approach should lead to greater wellbeing for individuals as they return to health as well as preventing bed-blocking in hospitals by allowing people to be discharged sooner.

However, social housing providers are largely marginalised in this process. This project aims to explore how social housing providers might be included in the reablement agenda through the use of existing housing support services. This could lead to greater cost savings and better outcomes for those using reablement services to recover their independence.

Background

The Coalition Government has adopted the reablement agenda with zeal – honouring Labour's original commitment to invest £70m in reablement services in 2011-12 and adding to it – with £300m allocated to reablement by 2014-15, and a further £162m announced for immediate use in 2011, generated by central NHS cost savings.

The Government has also introduced a 30-day duty of care on hospitals – whereby hospitals are responsible for those people it discharges for 30 days after discharge, and penalised if they are readmitted to hospital or require emergency treatment. This was warmly welcomed by those in the social care sector, seeing it as the first recognition by a government that the responsibility for those leaving hospital is a shared one between social care and health services. 

In spite of this welcome new investment and policy reform, there remains a critical omission in current reablement services – housing support. Reablement is perceived very much as a short term social-care based intervention, led by social care workers and sometimes an occupational therapist, to rehabilitate people to living independently at home. Whilst home adaptations and telecare often form part of this intervention, the wider role a person’s home can play in mental and physical recovery after hospital discharge, and in regaining independence, is usually overlooked. As such, key opportunities to improve outcomes through non specialist home-based support and improvements are missed, and important stakeholders – from housing associations (which provide homes for 5 million people), to extra care, supported housing and retirement village providers – are often left out of commissioning decisions and critical conversations between health and social care services when it comes to discharging someone from hospital and putting in place reablement and rehabilitative support. It also means those with more complex needs – whose reablement may require more than therapy and adaption, but actually re-location to a more suitable home – are often under-supported and vulnerable to readmission to hospital.

The project

With all this in mind, Demos will re-examine the current model of reablement, and in particular, focus on the opportunities for improved outcomes and lower costs by addressing a clear weakness in its current delivery – the omission of housing-related support.

This project will challenge the concept of reablement as a  “social care intervention” and explore how better outcomes can be achieved, potentially at a lower cost, through a more integrated approach – one which brings together health, social care and housing support following hospital discharge.

The project has the following aims:

• To review reablement services at local level and identify weaknesses in current delivery, particularly regarding its integration with housing support and the impact this has on service users
• To quantify the potential inefficiencies of this approach and the cost efficiencies associated with improved outcomes that might be achieved through a more integrated approach to reablement
• To identify the barriers to bringing housing support into reablement services and how these might be overcome – including looking at the potential opportunities that the establishment of GP Commissioning Consortia and Health and Wellbeing Boards may create.

To achieve these aims we will employ the following methodology:

• Scoping of current reablement practice, to identify weaknesses in current delivery and instances of good practice. Two thirds of local authorities already have some form of reablement scheme in place – it is likely that some PCTs and councils will be better at engaging with housing providers and considering housing as part of their reablement commissioning than others. These cases will be identified to establish whether other local authorities may learn from them.
• Interviews with a) Housing development managers/senior site staff and b) local authority commissioners, PCTs and reablement teams and Health and Wellbeing Board and clinical consortia early adopters identified through the scoping stage, to explore their perceptions of the role of housing in reablement and the barriers they perceive in greater joint working
• Mapping interviews with Midland Heart residents who have experience of reablement or support following hospital discharge. These will be used to form service journeys to identify disjoints in service provision, negative outcomes and potential inefficiencies. This evidence would be used to quantify the potential inefficiencies of the current reablement strategy and potential savings made through a more integrated approach.
• A solutions workshop held in a half-day session, hosted and facilitated by Demos, in London or Birmingham/West Bromwich. This would bring together housing experts/academics, PCTs and representatives of GP Consortia, local authority commissioners, and others to discuss the findings of stages 1-3 and potential policy solutions based on their on-the-ground knowledge.

The project is supported by Midland Heart housing and regeneration group.