Challenge 4: Focusing on rehabilitation, recovery and reablement
What is the challenge?
To support the development of a culture of rehabilitation, recovery and reablement across the care sector in Gloucestershire.
The right support at the right time and in the right place
Over the course of a 12-month period from July 2022 to July 2023, there was a net increase of 120 older people receiving packages of care funded by Gloucestershire County Council. During this same period, 705 care packages increased in cost, adding around £12m to our external social care budget.
Over the course of the same period from July 2022 to July 2023 the number of health funded packages for Adults increased by approximately 200, at a cost of £11m.
A study of data from 20 home care providers showed that over the course of a year, 1 in 10 of those providers were able to achieve reductions of 20% or more in size of the care packages they delivered. On the other hand, some providers saw their packages increase in size by over 20%. This initial study was limited and the reasons for increases and decreases are always many and complex. But it shows that there could be potential for more providers to stabilise or achieve reductions in care packages.
People are often most at risk of losing their independence when a transition in their life occurs. By supporting people to take a more pro-active approach to transition, we can potentially enable them to avoid deterioration or dependence as a result. Some examples of these points of transition are:
- A person with a disability moving from children’s to adult social care services
- Adjusting to changes after an accident or trauma
- Fluctuations in mental health
- The process of ageing
- A person approaching the end of their life
We acknowledge that it is also sometimes appropriate for a package of time limited support at these points which can help reduce the risk of deterioration or a loss of independence.
Supporting unpaid carers through times of crisis and transition
Carers UK[1] recommend the following areas of focus “to ensure that the challenges that carers face are reduced, particularly if they are providing more intense, impactful or longer-term care”:
- Raise awareness of caring and make it central to public policy
- Support carers’ health and wellbeing
- Ensure the sustainability of key social care support
- Ensure that carers can balance work and care
- Ensure carers do not experience financial hardship
Our data shows that 20% of people referred to us initially by an unpaid carer go on to need a package of care, whereas only 10% of people referring themselves do.
This suggests that carers could be seeking support when they’ve reached a crisis point, therefore we need to ensure that they are supported beforehand.
How are we planning on addressing this challenge?
We have a proud history of supporting unpaid carers in Gloucestershire and we work with providers to support carers from all communities in the county. The Gloucestershire Carers Hub have increased the number of unpaid carers they support from 2,000 when they took over the contract five years ago to over 12,000 now. We understand that a generic offer might not suit everybody so we also commission smaller voluntary organisations to support specific groups.
To further recognise the importance of unpaid carers and the impact that the Covid-19 pandemic had, we plan to work with them and other representative groups to build on our existing Carer’s Action Plan by developing a new Carer’s Strategy to co-ordinate a system wide approach. It is anticipated that this will include an in-depth study of crisis / emergency response for unpaid carers and the development of a new approach to services in this area.
We will also extend the carer's action plan to include:
- Timely support for carers
- Support during crises (emergency response and out of hours care)
- Support through transitions
- Training for unpaid carers
- Day opportunities, short-breaks and respite
This work will be led by Integrated Commissioning and will involve the Carers Partnership Board, the Gloucestershire Carer’s Hub, as well as other groups to ensure a co-produced strategy is developed which we will aim to publish in spring 2025.
We have a proud history of supporting unpaid carers in Gloucestershire and we work with providers to support carers from all communities in the county. The Gloucestershire Carers Hub have increased the number of unpaid carers they support from 2,000 when they took over the contract five years ago to over 12,000 now. We understand that a generic offer might not suit everybody so we also commission smaller voluntary organisations to support specific groups.
To further recognise the importance of unpaid carers and the impact that the Covid-19 pandemic had, we plan to work with them and other representative groups to build on our existing Carer’s Action Plan by developing a new Carer’s Strategy to co-ordinate a system wide approach. It is anticipated that this will include an in-depth study of crisis / emergency response for unpaid carers and the development of a new approach to services in this area.
We will also extend the carer's action plan to include:
- Timely support for carers
- Support during crises (emergency response and out of hours care)
- Support through transitions
- Training for unpaid carers
- Day opportunities, short-breaks and respite
This work will be led by Integrated Commissioning and will involve the Carers Partnership Board, the Gloucestershire Carer’s Hub, as well as other groups to ensure a co-produced strategy is developed which we will aim to publish in spring 2025.
Intermediate care
Our intermediate care programme provides a range of short-term services to support people during times of crisis in their lives, including:
- Same day hospital discharge into home first (including an assessment in the first 48 hours)
- Timely assessment for individuals stepping up and down into reablement services
- Support with emergencies, either short term, at night or as support for an unpaid carer who might require treatment themselves
- Urgent step-up and assessment from the community
Over 100-125 people per week need to flow into home first with 50% likely to then flow into reablement. With specialist reablement supporting step up, we will need this service to manage 60-70 cases per week.
We want to ensure that everyone receiving care services is supported to live well and to maintain or increase their independence. We want to take an 'outcome-based' commissioning approach and expect to give an increasing focus to reablement in every context. We want to work with innovative providers to understand and develop models of best practice and promote these across the market.
This work will be led by Integrated Commissioning working with Adult Social Care providers and the wider system.
Intermediate care
Our intermediate care programme provides a range of short-term services to support people during times of crisis in their lives, including:
- Same day hospital discharge into home first (including an assessment in the first 48 hours)
- Timely assessment for individuals stepping up and down into reablement services
- Support with emergencies, either short term, at night or as support for an unpaid carer who might require treatment themselves
- Urgent step-up and assessment from the community
Over 100-125 people per week need to flow into home first with 50% likely to then flow into reablement. With specialist reablement supporting step up, we will need this service to manage 60-70 cases per week.
We want to ensure that everyone receiving care services is supported to live well and to maintain or increase their independence. We want to take an 'outcome-based' commissioning approach and expect to give an increasing focus to reablement in every context. We want to work with innovative providers to understand and develop models of best practice and promote these across the market.
This work will be led by Integrated Commissioning working with Adult Social Care providers and the wider system.
- Support a culture change by working with us on a clearly defined prevention approach involving the pro-active identification of need and appropriate care in response
- Providers can continue to signpost unpaid carers to the support and advice available
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