Agenda item

For the Community and Wellbeing Scrutiny Committee to receive information detailing Brent’s new reablement service.

which updated the Committee on the reablement service which went live in February 2024. In introducing the report, he highlighted the commissioning process that took place and new operational arrangements. He emphasised the importance of having a dedicated reablement service to enable as many people as possible, upon leaving hospital, to maximise their independence and avoid institutional support.

In adding to the introduction, Andrew Davies (Head of Commissioning, Contracting and Market Management, Brent Council) highlighted that the report described the process that the Council went through in order to arrive at the service that was now available with the three providers and the ambitions the Council had for that service for the duration of the next 5 years. He advised the Committee that the service went live 2 months ago therefore it would be premature to draw conclusions about the success of the service but would be happy to provide an interim update in the future.

Sarah Richards (Head of Intermediate Care and Principal Occupational Therapist, Brent Council) added that the work she was doing aligned with the reablement service, focusing on the right areas for assessment teams. Her team was ensuring that there was a therapy led service, in line with the NHS framework, and that the right numbers of staff were appointed to be able to assess residents as they came through the door. Having that reablement focus ensured the team was reducing, preventing and delaying the need for formal care.

The Chair thanked presenters for their introduction and invited comments and questions from those present. The following points were raised:

The Committee noted that there were now 3 providers with 3 patches and asked whether each provider covered the same level of workload. Andrew Davies confirmed that was the case, which was the basis on which the contracts were designed. He highlighted that the contracts were based on a fixed hourly rate of care at £21 per hour as of 1 April 2024, and the Council had given an indicative number of hours when it tendered the service of around 800 hours of reablement care per week spread across the 3 patches. That hourly rate would increase through the life of the contract at 50p per hour per year. In response to whether there were any risks to that approach, Andrew Davies highlighted that there was a risk to the provider that the number of hours of care per week that the Council tendered for either fell short or was exceeded. However, the Council had mitigated that by looking at the average number of hours of care delivered over a period of time to get to a figure that was felt to be realistic. In terms of the hourly uplift, this mirrored what had been done on the homecare contract. The Council expected providers to pay London Living Wage (LLW) which the 50p uplift per hour per year would contribute towards, and whilst it was recognised that LLW had increased more than that recently it was expected to come in line with inflation over the next few years and therefore officers felt 50p was prudent. From the Council’s perspective, the contract arrangements allowed the Council to know its financial commitments year on year and be confident that the amount being paid to providers was fair and enabled them to plan and manage cost.

The Committee heard that reablement was an important part of the hospital discharge process and the Council had ambitions for it to become a larger part of the approach taken in delivering Adult Social Care. This would mean if someone requested or was recommended an uplift in the number of care hours they received the Council would look to try a reablement approach first, where appropriate, to avoid that ongoing and permanent uplift in care. In doing that, officers felt that the Council would be making good use of the reablement service and providers would be delivering more hours of care in line with the hours that were tendered for to help the Council both enable people to live as independently as possible and deliver on its financial savings.

The Committee noted the details in the report regarding the need for bespoke training for providers and asked whether a skills gap had been identified. Members highlighted that those delivering reablement care needed different skills than those delivering homecare. Andrew Davies explained that the aim of the contract was to appoint three providers who would specialise in reablement and be bespoke reablement providers, which was a move away from the larger number of providers who were more generic homecare providers. He advised that, inevitably, those providers would also work in homecare and other sectors as well, so there had been a need to attract providers with an interest in the reablement line of work. The Council monitored these contracts through quality assurance processes and were working with providers and their in-house trainers to ensure that their enablers were kept up to date and trained in the most appropriate reablement techniques which required a bespoke training programme with those providers so that they worked in the way the Council wanted.

Regarding section 3.2.9 of the report, the Committee highlighted there were no figures, although the report did state that there would be a reduction in spend on care for the Council. They asked how much savings were being made as a result of the contract. Andrew Davies confirmed there was a savings target against this which could be shared with the Committee.

The Committee noted that one of the aims of the service was to reduce rates of hospital readmission, but felt that there may be circumstances where reablement was not the appropriate treatment and an individual may need to be readmitted to hospital. Andrew Davies acknowledged that there were many factors influencing hospital readmission and that, in some cases, good reablement delivered really well could still only delay readmission. From an Adult Social Care perspective, even a delay in ongoing permanent care was better for both the person and the Council.

The Committee asked how the service supported those placed outside of Brent for care. Officers confirmed that Brent did make placements outside of the borough. When that happened, Adult Social Care spoke with the host borough and then worked with local commissioners to quality assure the provision of care. An annual statutory placement review would also take place with service users.

In terms of capacity, the Committee asked whether all those assessed as needing reablement received that support. Members were advised that there were no capacity issues with providers so if someone was assessed as needing reablement services then the providers would be able to deliver that. In terms of assessment, a patient would initially be seen at home once they were discharged from hospital or the need for reablement had been identified. That person then needed to meet the criteria for reablement and if they were eligible then they would agree their rehabilitation goals and receive that service. 

As no further points were raised, the Chair drew the item to a close. In terms of recommendations, the following was RESOLVED:

i)              To request an update in 6 months’ time to review how the service was doing which included more figures.