Maximising the potential of reablement
Since 2010 the government has supported reablement through specific funding streams. The funding has been directed via health to encourage integrated planning between local authorities and health. Local authority commissioners need to work with their colleagues in CCGs to negotiate use of these monies to support the ongoing development of reablement. Online resources are available to help inform the development and/or ongoing monitoring of reablement services and a selection of these can be found in the Further resources below.
National policy context
The importance of investment in preventive services has long been recognised and has cross-party support. At the Fifth International Carers Conference in 2010, the then Secretary of State for Health, Andrew Lansley, placed renewed emphasis on maintaining independence:
We must place renewed emphasis on keeping people as independent as possible for as long as they feel able, not least by providing earlier support. People need to feel help is there as soon as problems occur. We have to maximise the potential of reablement, telecare and other innovations, which can dramatically improve people’s lives while also being highly efficient. Some local authorities have picked up this challenge, others have not. We need to accelerate this change so that these services and this approach is the norm.
Reablement has since received policy support as one means of prolonging or regaining independence and to facilitate its wider roll-out, the Department of Health (DH) invested £70 million in reablement in 2010 . The government spending review and 2011/12 NHS operating framework provided further funding to the then primary care trusts (PCTs) for the financial years 2011/12 and 2012/13 to develop local reablement services, in partnership with councils, in the context of post-discharge support plans .
Subsequently, the ‘Care and Support’ White Paper  announced that £859 million would be transferred to local authorities by the NHS Commissioning Board during 2013/14. This funding is often known locally as the ‘256 monies’, because the payments are to be made via an agreement under Section 256 of the 2006 NHS Act .
Although the payments are not ring-fenced for reablement the DH stipulates that they must be used to support adult social care services, which also have a health benefit. It is therefore clear that the investment is intended to support services like reablement and other means of improving the hospital/care and support interface. One of the main conditions of the transfer is that local authorities can demonstrate how it will make a positive difference to social care services and outcomes for services users compared to service plans in the absence of the 256 monies. It is clear that the emphasis is on ensuring the funding is used cost-effectively, which requires local authorities to measure the costs of the services they invest in and the outcomes achieved as a result.
Local implementation of reablement
The majority of reablement services are funded by local authorities (71 per cent in 2012) although, increasingly, some are being co-funded with health. A central tenet of government funding for reablement has always been that investment in adult social care benefits health services and improves overall health gain. As this argument gains recognition, the balance between jointly funded and solely funded schemes may shift.
- Local authority commissioners should be working with their CCG counterparts to negotiate use of the 256 monies. Health and wellbeing boards are the logical place for discussions to take place between the NHS Commissioning Board, CCGs and local authorities about use of the monies.
The allocation of funding to local authorities is a recognition of the upfront investment needed to provide this more intensive support. Reablement is more costly to deliver than conventional home care and, unlike home care, it is not a chargeable service. This is in accordance with Section 15 of the Community Care (Delayed Discharges etc.) Act and the Community Care (Delayed Discharges etc.) Act (Qualifying Services) (England) Regulations 2003 (2003/1196) (the ‘2003 Regulations’).
Almost all reablement services were started in-house (often developed from existing in-house domiciliary services) although, as the market matures, consideration is being given to outsourcing reablement. In 2012 24 local authorities reported to have outsourced reablement in various ways (compared with 110 still operating in-house). In addition, several were in the early planning stages of outsourcing, testing the market and so on.
- The following tips may be helpful in setting up and monitoring a reablement service:
- Commissioners will be helped, when establishing a reablement service, by identifying the baseline performance of current provision. For example, the existing in-house home care service. The Care Services Efficiency Delivery (CSED) programme provides some useful benchmarking formats and advice.
- When setting up or reviewing a reablement service, use a standard framework such as the toolkit published by CSED. This is based on local authorities who piloted the use of reablement across England. The toolkit is set out in eight sections describing the project steps that help lead to a successful reablement service.
- The connection with other community-based services, such as intermediate care, needs to be reviewed, especially if they have been developed on a needs basis rather than planned. Bury NHS and Adult Care Services has an integrated model with the connections between many community services identified in its document on reablement.
The full text of Andrew Lansley’s speech to the Fifth International Carers Conference can be accessed via the DH online archives.
- The ‘Care and Support’ White Paper.
- The local authority circular outlining investment in reablement via NHS support for social care (2010/11–2012/13).
- The local authority circular setting out arrangements for the funding transfer from the NHS to social care in 2013/14, including arrangements for the 256 monies.
- The local authority circular explaining the position on charging for reablement.
- The CSED toolkit for reablement archive.
- A discussion paper about outsourcing reablement, by Gerald Pilkington Associates.
- The Bury NHS and Adult Care Services’ business case for reablement.