Wigan Council

Reablement

Introducing the Service

Reablement support people to remain independent or learn new skills after a period of illness / change in circumstances

Looking at areas of daily living / assesses for living aids

Reduce hospital admissions/reduce dependency on formal support/ provide care

Free 6 week service, operating 7 days a week 7.30 am until 10pm

82 staff– Leads, Managers, Officers, Support workers, co-ordinators

April 2018-March 2019 - 2224 referrals via the acute trust, OOB hospitals, Step Down, Community social and therapy teams

72.78% independent following Reablement intervention

Pathway/Process/Roles Assessment complete by Occupational Therapist/Physio/Social

worker/Primary Assessor/ Reablement officers/ Community health teams

Co-ordinator receives completed referral, screens and processes (Within 48 hours usually same day)

Reablement Officer completes initial visit

Support workers visit to progress goals/outcomes, monitoring and reviewing for up to 6 weeks – All trusted assessors

Outcomes met service user independent or reduced needs

No further action or Package of Care arranged

Case closed – audit/ review

Managers operationally manage teams

Our Model

Integrated with Council OTs

Skilled workforce to ensure team is autonomous i.e. can progress change and develop programmes, request adapts, equipment, AT

Embedded in Integrated Discharge Team

Embedded in Integrated Community Services as key partner: admission avoidance, supported discharge, Reduction in care packages, undertaking programmes written by Physio, OT, District nurses, SALT, Mental Health , Public Health

Flexible approach – Reablement/Care : Take people who have been deemed to require care package

Asset based approach (The Deal): programmes to increase community involvement/QOL

Stand alone programmes.

All support workers have laptops, phones and access to social care IT system, email etc

Accessing my home

Preparing Lunch

Off to the shops

Confidence Building

Off to bed

Supporting with Medication

Reablement completions (Overall %) - April 2018- March 2019 72.78% of all referrals do not require commissioned POC following Reablement intervention

72.78

27.22

Completed cases (%) commissioned POC not required

Completed cases (%) commissioned POC required

Reablement Request by source

78

115

89 89

67

80 76

91

83

95

87 90

1 4 4 3

6 5 5 5 1 2 1

4

28 25

22

29 25

18 19 23 23

26

20

28 32

39

31 28

37

32 28 28

30

41

32 34

9 12

5 7

9

3

9 11

6 7 6 5

0 1 4

2 1 3 4 4 5

2 5 4

0 1 0 0 4 4 3

0 0 0 2

0

9 7

10 9 9 6 7

15

7 6 8

11

5 3 3

11

1

6 2 3

6 7 7 3

15 15 12

8

16 13

10 12

9

14

2

17

1 4 5

1 1 2 2 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0 0 1

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

0

20

40

60

80

100

120

140 Wigan Infirmary

ACST - Wigan Infirmary

OOB Discharge

Alexandra Court

Richmond House

Temporary Step Down Bed

Temporary Step Up Bed

Hospital at Home

Community Therapy

Early Intervention

Mental Health

Hospice

Other

Outstanding CQC rating

Highly skilled, committed team with Wigan Behaviours, using The Deal approach, going the extra mile

Value based recruitment

Striving to improve, develop, be innovative, “Can-do”

Scaled up capacity delivering and widening of eligibility with £1.5m of additional investment per annum

Contributing to DTOC performance

Mosaic: worked with company to design own IT unit within social care system

DRS – worked with company to designed own rota system

Celebrating Reablement

In 2016 we were the first Reablement team in

the country to be rated ‘OUTSTANDING’

In 2019 Wigan Reablement team retained our CQC ‘OUTSTANDING’ rating

SAFE

Without exception, people using the service told the inspectors

they felt extremely safe and well supported. Comments

included,

• "Safe, oh very. Every one of the staff has been nice"

• "Yes, I feel very safe and in their presence.“

• “I’m very happy, very happy with how this is managed”

How? Focus on safety of staff, service users via rigorous recording processes,

competences, training, joint working with OTs/DN etc, Peer support feedback

meetings twice a week

EFFECTIVE

People the inspectors spoke with were positive about the Reablement process. Comments included,

• "They discussed things with me, sought my consent, excellent, can't fault them"

• "They went through the assessment with me to see what I expected.

• “The staff were exceedingly helpful.“

How? : Skilled staff with easy access to OTs, equipment, adaptations, AT. standardised measures, confident to adapt and develop programmes, Focus on induction, audits, observations, relevant, asset based programmes, learning, audits, feedback, competency

CARING

Service user comments:

• 'Thank-you so much for your visits, it was like having friends stopping by’

• 'Thank you for your kindness and help, you have been wonderful’

• 'Every one of you is brilliant, caring and very good at what you do.“

How?: Wigan behaviours, value based recruitment, observation of staff, encouraging service user feedback

RESPONSIVE

Responsive to need: Inspectors noted they saw and were told about numerous examples where the service had been responsive to people’s needs.

One person had been referred specifically for support with personal care and

meal preparation following a fall. During conversation with support workers, they identified an interest in working on their mobility, with a goal of being able to go into town. This was added to the support plan and the person was supported to mobilise indoors, and then into town using the bus, with support gradually withdrawn until they were able to make the trip independently.

Responsive Timescales: We provide same day discharge for referrals before 4pm

WELL LED

Inspectors stated each member of staff they spoke with was clear about who their immediate line manager was, but said they were both able and felt comfortable going to any of the senior staff. Comments included

• "I feel this is the most supported job I have ever been in“

• "All of them [senior staff] are very approachable and make time for you"

• "Management are very approachable, you never feel you are on your own here. Definitely an open-door policy in place.“

How? Wigan management behaviours, Strategic managers (OT and Experienced reablement lead) Team leaders: all with same vision and approach

Why are we Outstanding?

https://drive.google.com/open?id=1x0NO6zmVcBwKt3qYVhtDVBjNuS96pwEA