Adults, Health & Community Wellbeing
Policy Document
Putting People First
Reablement Policy
Lead Director:
Policy approved by:
Date Policy
approved:
Implementation Date:
Review Date:
Status:
Liz Chidgey, Deputy Executive Director
Adults, Health & Community Wellbeing Management Team
17th July 2008
1 April 2008
September 2008
Final
Version no: 4.0
Adults, Health & Community Wellbeing
Document Control Sheet
Title of Policy:
Putting People First: Reablement Policy
Purpose of Policy:
To implement reablement support for service users
of adult social care in Essex.
Operational policy
Type of Policy:
Target Audience:
Adult Social Care Practitioners and Managers, especially those
involved in assessment, care management or management or
delivery of the reablement service.
1 April 2008
Implementation
Date:
Action required:
Adoption of this policy as the framework for provision of the
reablement service.
n/a
This policy supersedes:
This policy should be
read alongside:
SDS Strategic Policy
Lead Director:
Liz Chidgey, Deputy Executive Director, Adults, Health &
Community Wellbeing
Policy Lead / Author:
David Williams / Ethan Tucker
Project Team:
Karen Wright, Jonathan Matthews, Amanda Julian, Anna
Casbolt, Ron Hiller, Valerie Russell, Helen Terry
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Putting People First
Reablement Policy
Policy statement
1. Reablement focuses on maximising people’s long-term independence, choice and
quality of life, while at the same time attempting to minimise the requirement for
ongoing support. Through achieving these goals, the policy seeks to reduce the wholelife cost of support, by applying resources at the early stages of a service user’s
recovery process in an attempt to support independent living and delay or reduce the
need for ongoing support.
2. The aim of this policy document is to implement a short term community reablement
scheme in Essex. The scheme will provide services for people with declining physical
and/or mental health to foster wellbeing by helping them to accommodate their
condition by learning or re-learning the skills necessary for all the activities of daily
living and by regaining the confidence to perform these skills.
3. The objectives of this policy are to improve outcomes for service users, to promote
service users’ independence and to increase the potential for regaining and sustaining
skills.
4. The reablement scheme is a part of the Putting People First approach towards social
care provision, and comes within the overarching policy on self-directed support (SDS),
sharing the same goal of promoting the independence, health and wellbeing of service
users, while improving the choice and control of support offered to service users.
Definition
5. The Department of Health’s definition of reablement is:1
‘the use of timely and focused intensive therapy and care in a person’s home to improve
their choice and quality of life, so that people can maximise their long term independence
by enabling them to remain or return to live in their own homes within the community. This
approach focuses on reabling people within their homes … so they achieve their optimum
stable level of independence with the lowest appropriate level of ongoing support care’.
6. Reablement is also defined as one of three partially overlapping forms of social care
(see over):2
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PREVENTION
Services for people with
declining physical or mental
health to help them avoid
unplanned or unnecessary
admissions to hospital or
residential care. This can
include short-term emergency
interventions as well as longer
term low-level support.
REHABILITATION
Services to people with
declining physical or mental
health to help them achieve
optimum independence.
REABLEMENT
Services for people with
declining physical or mental
health to help them self
manage their condition by
learning or re-learning the skills
necessary for daily living.
Scope and exclusions
7. The reablement team will work with all adult service users who are residing in Essex
and eligible for support in line with current Essex County Council eligibility criteria
for Fair Access to Care Services. The reablement scheme will include those people
where it is clear from the outset that short term, reablement focused services would be
beneficial. The scheme will also include service users with no fixed abode provided
they are deemed eligible.3 The majority of reablement scheme participants will likely
be the adults leaving hospital or emergency interventions to prevent admission but
adults meeting the criteria, who are as yet unknown to Adult Social Care will also be
included.
8. All of the individuals included within the above groups will be assessed for suitability for
the reablement scheme and, if appropriate, will be included within the reablement
programme for a period of up to six weeks.
Regulatory and policy context
9. The regulatory and policy framework governing adult social care in Essex is in a period
of transition. National and local governments are in the process of moving towards a
new model of care provision with a greater level of personal control for service users in
most cases. Parliament makes the statutory framework, while the Department of
Health generates its guidance, policy and secondary legislation.
10. At the national level the Government, through the Department of Health, sets the
strategic direction of adult social care in England and provides the legal and policy
framework and funding to local authorities to enable them to assess individuals who
are eligible for social care support.
11. The Government has released a number of key policy documents setting the strategic
direction of adult social care. Community reablement supports principles expressed in
the white paper, Our Health, Our Care, Our Say,4 by facilitating delivery of care closer
to home, and improved rehabilitation.
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12. In July 2006 Councillor Candy, the Cabinet member with responsibility for adult social
care, took a key decision to:
‘…create a unified home support service, retaining some specialist provision … for a
temporary ‘intake service’ with enablement objectives. This service aims to minimise the
care requirement over a maximum of six weeks, which will then be transferred to the
independent sector. This will create both greater efficiencies and service user
independence in line with the recent white paper, ‘Independence, Wellbeing and Choice’,
and Essex County Council’s ‘Age of Opportunity [for Older People]’.
13. In December 2007 the Government, local councils, health partners, professional bodies
and voluntary organisations agreed on a strategy called Putting People First to
personalise care services.5 This says we should offer people the highest standards of
professional expertise, care, dignity, control and the chance to make decisions for
themselves. Reablement is one key aspect of implementing this strategy.
14. At the sub-national level, local authorities have direct responsibility for delivering social
care services. Essex County Council is responsible for meeting local adult social care
needs through the commissioning of public, private and voluntary sector providers to
deliver services. Essex has a broad policy of continuous improvement of its services
for people with physical and sensory impairment (the ‘Equal Lives’ five year plan, 200611).6
15. In keeping with this policy, in December 2007 the Essex County Council Cabinet
considered the reablement scheme in an overview paper on the SDS project.7 The
paper observed that:
‘Some people will benefit from intensive short term reablement programmes which help
people to learn or relearn basic skills necessary for daily living. Such reablement
programmes may be particularly applicable in the context of discharge from hospital but are
also applicable under other circumstances. As well as being of great benefit to the
individual, experience in other local authorities suggests that effective reablement
programmes can significantly reduce the level of ongoing social care support required for
many people. The County Council is currently engaged in three pilot projects with three of
the five PCTs in Essex to develop an integrated approach covering rehabilitation and
reablement and it is anticipated that reablement will in due course be jointly commissioned
with the PCTs’
16. A decision was made at the council managerial level to implement a reablement
scheme in Essex. In December 2007 the Senior Management Team agreed that a
reablement model should be included in a provider transformation business case, and
that Essex should ‘aim to start [a] reablement service [provided by the Essex County
Council Domiciliary Support Staff] as soon as possible’.
17. In January 2008 the discussion document Putting Essex People First,8 the council
highlighted reablement in the following statement:
‘This intensive, short-term package of support can reduce people’s ongoing social care
needs. Essex County Council wants to help people live at home by giving them greater
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choice and control over services. We also want to make sure our services keep improving
and guarantee value for money for taxpayers’
18. There are a number of key documents with direct relevance to the development of the
reablement scheme in Essex listed in Appendix B.
Policy background
Why is reablement being implemented?
19. Reablement has been shown to help people remain in their own homes for longer
when they have been affected by declining physical and/or mental health. As an
example, in 2005/6 1836 people received reablement services in Leicestershire. Of
these, 49.7 percent required no further homecare support, and 28.5 percent ended up
with a 30 percent reduction in ongoing support needs.9
20. It is also one way in which councils can manage ever-increasing demand for
domiciliary support services. There has been a steady growth in the number of
domiciliary support contact hours funded by councils. At the same time the number of
people supported has reduced since 1992, reflecting a shift towards supporting those
with more intense needs:
YEAR
1992
2001
2005
UK DOMICILIARY SUPPORT CONTACT
HOURS (MILLIONS / WEEK)
1.6
2.9
3.6
21. This increase is predicted to continue, with ongoing population increases, particularly in
the older age brackets. This has been predicted to lead to a 10 percent growth in high
dependency cases in the five years to 2012 and a 33 percent increase in the 15 years
to 2022. Increased demand for domiciliary support services has led councils to focus
on those with greatest needs, and this has led to a narrowing of the criteria for
accessing care services in some areas of the UK. This is likely to result in people
being denied care and presenting with a higher level of need at a later stage.
Reablement will attempt to prevent this occurring.
22. There are also concerns about the demographic shift that may, over time, reduce the
proportion of the population that have tended to provide care and support.
Guiding principles
23. The key principle underpinning the establishment of the reablement policy is the
adoption of a process of early intervention and short term help with the aim of
preventing the development of complex support needs at a later stage in a service
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user’s life. The policy is in keeping with the emphasis of the Adults, Health and
Community Wellbeing Directorate Plan 2007-2010, which indicates that preventative
methods should be a prominent theme of adult social care.
24. Other guiding principles informing the policy are set out below:
Increased choice and control for people eligible for social care services






Person-centredness: Service users should have more control and choice over their
support.
The role of adult social care is to help people to maintain or regain their
independence, regardless of age, impairment, ethnicity or personal circumstances.
Service users should have more responsibility for assessing their needs and for
planning and managing their support.
The role of adult social care professionals is to support service users to achieve the
desired outcomes that have been identified in the support plan.
Service users should have access to a full range of information, advice and services
to empower them to address their social care needs themselves.
Not all service users want to or are able to plan for and achieve the outcomes
identified in their support plans, so they must receive assistance to do so, when
necessary.
Improve the quality of services


Service users should be able to access a choice of high quality services and
providers to enable them to benefit from tailored, high quality and good value
support.
Eligible service users should be provided with information, advice, assessments
and appropriate support in a timely manner.
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Make best use of resources

Prioritising prevention, early intervention and promoting greater wellbeing and
independence can in many cases reduce the need for ongoing support, thus saving
public money in the longer term.
Policy requirements
How will it operate?
25. In Essex reablement will provide intensive support to people leaving hospital to
minimise the chances of re-admission, and to those new to the service who meet the
eligibility criteria. The aim of this support is to increase users’ levels of independence
and providing greater choice and improving their quality of life, while at the same time
seeking to reduce the need for ongoing support. This is seen as an intermediate care
service and therefore will not attract a charge for the period of the reablement
programme, which will be up to six weeks in duration. It is for this reason that
reablement is not intended to operate beyond the six week period.
26. Reablement services will be delivered by domiciliary support services, supported by
reablement occupational therapists (OTs). Reablement services have been piloted in
South East Essex, and implemented across Essex from 1 April 2008. The
implementation has begun with the hospital discharge teams for those adults leaving
hospital, and then rolling out to encompass the use of interim (IP) beds for
rehabilitation purposes, and then opening up to other eligible adults new to the service.
27. The Council aims to work closely with Primary Care Trusts to develop a coordinated
approach to maximise the potential benefits of reablement through alignment of PCT
Intermediate Care / Rehabilitation Services with the Council Reablement Team. Joint
commissioning of reablement is a long term goal.
Assessment & selection
28. A process map for the reablement process is attached as Appendix A. The key stages
of the process are:








Referral accepted from Essex County Council or PCT
Reablement assessment to be completed10
Reablement objectives and programme signed off by OT
Reablement worker tasks defined; Telecare assessment completed
Weekly team meetings to review service user progress
At 3rd week (or earlier if appropriate) the discharge date is identified
Final assessment to be completed within the final week of reablement.
Review summary sent to case coordinator (an appropriately skilled worker) with a
discharge recommendation
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
Service user discharged, and transferred to other ongoing support or offered a
personal budget if required.
29. Self-funders will be as eligible for reablement as those who will be seeking financial
support from the Council.
30. Once a service user is assessed as being suitable for a reablement programme, an
appropriately skilled worker will assign complete a reablement assessment by
assigning the potential reablement service user case to one of three categories: either
simple, moderate or complex in nature.

Simple: one or two everyday tasks have been lost and support or guidance will be
required to increase confidence and enable them to undertake ADLs independently.

Moderate: two or more everyday tasks have been lost, and preventative work is
needed to reduce the risk of deterioration in their condition and/or to reduce the
likelihood of admission to a hospital or care home.

Complex: a significant impairment, or where deterioration in the condition has been
experienced and/or where complex physical need requires support to regain or
improve their independence.
31. The reablement assessment will determine the level of service users’ functional ability
to undertake a range of independent activities, including general mobility, transfers
(e.g. toilet, chair and bed), personal care and other domestic tasks. In each of these
areas service users will be assessed as either ‘independent’, independent with
supervision’, independent but needing assistance’ ‘independent with difficulty’ or
‘unable to do at all’.
32. If after the initial assessment the service user is not found to be an appropriate
candidate for reablement the service user’s case will be referred on to the local
community team for completion of the assessment.
33. A reablement plan is agreed with the service user based on the reablement
assessment. Each service user will have agreed individual outcomes to enhance their
daily living skills, and reduce or eliminate the need for support packages.
34. Domiciliary Support Services will work with service users during the day assisting them
to complete tasks for themselves. The emphasis will be on allowing and encouraging
the individual to do the tasks themselves where appropriate, rather than having the
tasks completed for them.
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Appendix A – Reablement programme pathway
Referral Accepted
via emailed COM5 from HSW and SPT
Care element identified for DSS by HSW and COM5
Reablement assessment completed by Facilitator/OT
Reablement assessment score sheet and
objectives/outcomes completed
Reablement objectives/outcomes and programme signed
off by OT
Reablement programme translated into reablement
worker tasks.
Telecare assessment completed
Weekly team meeting to review service user progress
with facilitators, reablement workers and OTs.
At latest at 3 week review discharge date identified - SW
SPT informed
Reablement programme completed, scored and reviewed
Review summary sent to SW with discharge
recommendation
SU discharged from Reablement service.
SU not engaging/progress
completed
DSS to present to CPB for external
package/personal budgets **
Self-caring
Discharge
COM5 from SW for
external provision to CPB
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Appendix B – Key policy documents
Legislation
National Assistance Act 1948
Health Services and Public Health Act 1968 (subject to LAC (93) 10)
Chronically Sick and Disabled Persons Act 1970
Race Relations Act 1976
National Health Service Act 1977
Health and Social Services and Social Security Adjudications Act 1983
Mental Health Act 1983
Disabled Persons (Services Consultation and Representation) Act 1986
National Health Service and Community Care Act 1990
Carers (Recognition and Services) Act 1995
Data Protection Act 1998
Human Rights Act 1998
Health Act 1999
Freedom of Information Act 2000
Race Relations Amendment Act 2000
Local Government Act 2000
Care Standards Act 2000
Health and Social Care Act 2001
Local Government Act 2003
Community Care (Delayed Discharges etc.) Act 2003
Carers (Equal Opportunity) Act 2004
Mental Capacity Act 2005
Disability Discrimination Act 1995 as amended by the Disability Discrimination Act 2005
Equalities Act 2006
Safeguarding Vulnerable Groups Act 2006
Mental Health Act 2007
Policy and Guidance
The New Performance Framework for Local Authority and Local Authority Partnerships
(2007)
Building on Progress Public Services (2007)
Putting People First (2007)
Strong and Prosperous Communities: Local Government White Paper (2006)
Our Health, Our Care, Our Say: a new direction for community services (2006)
Independence, Well-being and Choice (2005)
Improving the Life of Disabled People (2005)
Fairer Access to Care Guidance (2002)
Valuing People (2001)
National Service Framework for Older People
A Stronger Local Voice
National Carers Strategy
Independent Living Strategy
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Independent Living (1983) Fund
Code of Practice for the Mental Capacity Act 2005
Local Authority Circulars
LAC (2008) 1 Transforming Social Care
LAC (2004) 24 Community Care Assessment Directions
LAC (2003) 14 Changes to Local Authorities Charging Regime for community equipment
and intermediate care services
LAC (2001) 32 Fairer Charging Policies for Home Care and Other non-residential Social
Services – Guidance for Councils with Social Care Responsibilities
LAC (2001) 6 Better Care Higher Standards
LAC (93) 7 Ordinary Residence
LAC (93) 10
LAC (92) 15 Social Care for Adults with Learning Disabilities
Notes
1
Source: Essex County Council social worker information pack for the reablement service.
Modified from document at www.csed.csip.org.uk/silo/files/hradiscdocfinalhh.pdf
3 s.47 of the National Health Service and Community Care Act 1990 sets out the duty for a local authority to
assess a person in their area who may be in need of services. The services are under s.29 of the National
Assistance Act 1948 or s.2 of the Chronically Sick and Disabled Persons Act 1970, while older people can
be given services under Schedule 8 of the National Health Service Act 1977.
4 www.dh.gov.uk/en/Healthcare/Ourhealthourcareoursay/index.htm
5www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118?IdcS
ervice=GET_FILE&dID=156660&Rendition=Web
6 www.essexcc.gov.uk/vip8/ecc/ECCWebsite/content/binaries/documents/equal_live_consultation.pdf
7 http://comad.essexcc.gov.uk/ComadDocuments/Decision/3755/Self%20Directed%20Support.pdf
8 www.essexcc.gov.uk/vip8/ecc/ECCWebsite/content/binaries/documents/SocialCareConsultation.pdf
9 www.csed.csip.org.uk/silo/files/csed-workshop-leics-modelppt.ppt (slide 21)
10 Complex assessments will be made by OTs; simple and moderate assessments will be made by trained
supervisors with OT support.
2
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