Derbyshire County Council
Equality Impact Assessment Record Form 2008
Department
Adult Social services
Service Area Responsible
Older peoples services
Chair of Assessment Group
Vicky Worthington
Title of Policy/ Service/
Function
Home care Re-ablement
Stage 1. Prioritising what to impact assess
1.1
Why has this policy, service or function been chosen?
Home care re-ablement provides support to people in their own homes to
enable them to learn or re-learn skills necessary for daily living. This is
achieved through the use of short term intensive support packages that:


Maximise independence, choice and quality of life
Minimise ongoing support required.
The approach focuses on re-abling people so that they optimise their potential
in terms of a stable level of independence with the lowest appropriate level of
ongoing support.
The home care re-ablement service in Derbyshire has been established over
the last several years and operates as separate and discreet teams that are
managed within the umbrella of the mainstream home care service.
The re-ablement service represents a relatively small proportion of the
County’s in-house home care provision. The service has traditionally operated
selection criteria whereby only those individuals identified as likely to benefit
from re-ablement have been able to access the service. This has meant that
only relatively small numbers of new service users have had the opportunity
to receive a period of intensive support prior to arranging ongoing care. In
addition, certain groups of people have been largely excluded from the
service including people with dementia, and those with a learning disability.
As part of Derbyshire’s Making Care Personal: Your Choice; your Life
Programme the size of the existing homecare re-ablement teams are being
expanded to enable the provision of a short term assessment and reablement ‘intake’ service for all new referrals for home based support. This
approach is based upon the underlying assumption that everyone has the
potential to benefit from support to improve their independence.
The service will also be available to people who are already receiving support
arranged via Adult Care (typically, in the future in the form of a Personal
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Budget and Support Plan), but whose needs have changed significantly, and
where assessment identifies re-ablement would be beneficial.
The development of a universal home care re-ablement service is a key
component of the ‘Putting People First’ approach to adult social care provision
in Derbyshire and comes within the overarching policy on self directed
support, sharing the same goal of promoting independence health and
wellbeing, while improving service users’ choice and control over the care and
support they receive.
This equality impact assessment (EIA) will help identify any possible adverse
impacts of the service on different equality groups and ensure that effective
action is taken to address these.
1.2
Why does the policy, service or function exist/ what is its
purpose? Who should benefit?
The white paper Our Health Our Care Our Say (DH 2006) mandates
investment in services which promote independence, wellbeing and choice for
all adults. The focus is on services which promote care closer to home, and
the prevention of avoidable admissions into long term care.
The cross Government Putting People First Concordat (2007) builds upon the
white paper and sets the direction of social care for the next decade and
beyond. Key themes include prevention, early intervention, re-ablement and
personalised services.
These changes are also being driven by the need to develop ways of working
that reduces pressure on long term services due to demographic changes
these include:
 Demand for homecare will increase significantly over the next two
decades. Projections for Derbyshire indicate that the population of
those over 65 years is predicted to grow 55% by 2028. Within this the
number of aged over 85 years is predicted to grow 28% by 2018 and
82% by 2028.
 The proportion of people within the age bands that historically have
provided care will reduce considerably over the next decade. This will
have serious implications the capacity of care agencies to maintain
sufficient workforce to meet demand.
 Changes to Eligibility criteria: This cannot provide a long term solution
on its own as many people who do not fulfil the current criteria are
likely to deteriorate and may present with a higher level of need at a
later stage. As highlighted by CSED (2007) simply raising the bar is
unlikely to make economic sense within a prevention agenda.
To address these key challenges home care re-ablement is now firmly on the
social care agenda, and there is a growing body of national evidence
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indicating that the approach can increase peoples independence, and
significantly reduce the subsequent use of homecare services, and that the
benefits can be sustained in the longer term (Newbronner et al 2007).
The development of a universal re-ablement service in Derbyshire has been
shaped largely in response to consultation with service users and other key
stakeholders who have consistently told us that they want services to enable
them to live more independently with dignity and respect.
The service model will ensure that all adult citizens assessed as needing and
being eligible for personal/practical assistance to maintain them at home will
have access to the service which aims to:



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Maximise each individuals independence
Prevent/delay the need for domiciliary care
Reduce the level of domiciliary care required by those service users
who need ongoing support
Reduce the number of admissions to hospital/care homes
Facilitate timely hospital discharge
Provide a rapid response to those in crisis.
Service users will be actively supported to participate as fully as possible in
the design and delivery of their re-ablement service. This will be achieved by
identifying and working towards outcomes that are important to each
individual. Outcomes could include for example, improving self care, building
confidence and self esteem, establishing/maintaining social activities and
networks.
The service will be flexible and responsive to individual needs with reablement packages personalised to take account of each service user’s
lifestyle, preferences and choices.
Importantly the role of family members and informal carers will be respected
and their valuable contribution to re-ablement fully recognised.
The service will initially be available from 6am-10pm seven days a week.
However, detailed modelling is currently underway to assess the nature and
level of demand for support after 10pm to enable the provision of a
comprehensive 24 hour service.
The service will be established across the County by the end of September
2009.
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Stage 2.
Pulling an assessment team together
Name
Area of expertise/ role
(Chair)
Vicky Worthington
Project Manager Service re-design
Jane Parke
Project Manager Homecare
Alice Sanghera
Project Manager Commissioning
Steve Philips
Project Manager Quality Assurance
Rachel Knox
Re-ablement Service Manager
Carla Jervis
Re-ablement Domiciliary Service Organiser
Stage 3.
Scoping of the assessment / identifying likely issues
The equality impact assessment will review the way the service is delivered
including:





Identifying who the service will impact on e.g. general public or specific
groups
Identify differential or negative impacts on sections of the community
and people identified as belonging to equality groups
Provide recommendations to address resolve these within the action
plan including appropriate timescales.
Identify information gaps
Provide details of monitoring arrangements that will be implemented to
ensure recommendations are effective.
Stage 4: Pulling together all the information
Name of source
Reason for using
2001Census
Joint Strategic Needs Assessment
(JSNA)
Local Area Agreements (LAA)
Information on ReGARDS (Religion,
Gender, Age, Race Disability,
Sexuality and Gender identity)
communities. Demographic trends
and projections of future service
demands.
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Best Value review of home Based
services
Management information
Satisfaction surveys
(Perspective 34)
Individual service users
Literature review
Race equality Scheme 2008-2010
Stage 5.
5.1
Review of performance against
national and local targets
Information on stakeholder views and
recommendations for service
improvements
Data on current activity relating Data
on current activity relating to the
provision of homecare
Information on levels of service user
satisfaction with home care in
Derbyshire
Consultation on individuals
experience of home based services
Research relating to the
implementation of universal reablement services nationally
Updated information on profile of
Derbyshire Black and Minority Ethnic
(BME) Communities
Assessing the impact or effects
What does customer feedback, complaints, and discussions with
stakeholder groups tell you about your service, policy and
function, including which aspects are seen as negative,
inaccessible, unhelpful, difficult to use etc?
Nationally the majority of people (some 80%) wish to live independently within
their own homes for as long as possible (DH 2006).
In addition, people will no longer accept being the passive recipients of care
and rightly expect that they will be actively involved in selecting and shaping
the services they receive. Whatever their age people consistently tell us that
they want to have practical and personal assistance that:




Offers choice and control
Promotes independence
Treats them with respect
Preserves their dignity
(CSCI 2006)
Nationally surveys of service users’ views usually demonstrate high levels of
satisfaction with home care. This is reflected in the overall results of
Derbyshire’s recent consultation exercise undertaken by the performance
review team that identified 93% of respondents were extremely, very, or fairly
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satisfied with the home care service they receive. Some specific examples are
as follows:






Over 90% agreed their care worker (s) always or nearly always did the
things they wanted done
Almost 85% of respondents said their workers always or usually came
at suitable times
Over 95% stated that their carer stayed as long as expected
97% stated that they got up and went to be at times that suited them
97% stated they felt their workers were excellent at their job
98% felt that their workers treated them with respect and dignity and
were obliging.
Although satisfaction ratings from standard surveys are generally high recent
research found that more detailed interviews and group discussions tend to
elicit more critical feedback.
A study carried out by CSCI in 2006 paints a mixed picture of the quality of
home based support with many service users finding the task based approach
inflexible and insensitive to their needs.
Importantly, some of the responses in Derbyshire’s survey found that the
appreciation expressed towards individual workers is tempered by concerns
that carers do not always have enough time to work in ways that support
independence.
“They are wonderful ..... but how much better life would be if they
had more time.”
“Often they seem time pressed and I feel obliged to rush.”
Whilst the in-house home care service is highly valued by Derbyshire citizens
and achieves many positive outcomes for service users, the traditional model
of provision does impose constraints on service innovation and the
development of better personalised services. This is reflected in the Council’s
Best Value review which identified the need for a number of service
improvements particularly in relation to more inclusive and effective
approaches to re-ablement.
Those service users and stakeholders consulted about the development of a
universal re-ablement service felt that this could help achieve more positive
outcomes for people in terms of improved independence and wellbeing.
However, some concerns were raised that any gains may be lost if longer
term mainstream and independent providers fail to work to a re-ablement
ethos.
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5.2
What does your information tell you about the effects of the
policy, service or function on the lives of different groups or
communities? Is any of this negative or unwanted?
Groups
Effects identified from data/ information
All ReGARDS
The traditional re-ablement service has focussed
very much upon a task orientated approach to
functional Independence.
The universal re-ablement service is designed to
provide a broad enabling role taking account of
much wider social issues, personal aspirations and
goals.
It is recognised there may be issues relating to how
effective the service will be in delivering more
personalised support packages that promote not
only functional independence but also support and
enhance opportunities for inclusion and equality.
All ReGARDS
Failure to develop a whole systems approach will
result in mainstream and independent providers of
ongoing home care being unable to ensure the gains
from re-ablement are sustained.
All ReGARDS
Service user satisfaction with home care services
has been analysed globally, and not broken down
into type of service or equality groups. It is therefore
not possible from existing data to establish any
negative impacts or identify potential patterns of
discrimination.
Older people represent the vast majority of service
users who receive home care. Derbyshire’s overall
population of older people will rise gradually but the
increase will be most marked for those over 85
years. Therefore the service has been predominantly
designed to meet the needs of high numbers of
older People. There may be an issue as to how
effective the service will be in meeting the needs of
young adults of working age.
Age
Disability
With a strong focus upon re-ablement and
independence the service supports
the social model of disability which recognises the
social, environmental and attitudinal barriers faced
by people with disabilities and the impact of these
barriers.
A strengthened focus on re-ablement should
therefore extend opportunities for independent living.
However, the current emphasis on physical reablement within the service limits potential benefits
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and opportunities for working with people who have
a learning disability or who are experiencing mental
ill health
People with Dementia People with dementia have historically been
excluded from the re-ablement service. Again, as
above there may be an issue with how effective the
universal model will be in meeting the needs of
those with dementia.
Ethnicity
Religion/belief
Take up of Adult social services including
existing domiciliary/re-ablement services is
services is significantly lower (0.93%) than the
size of these communities (4.3%) would
suggest.
Outcome focussed and person centred
approaches have been developed to include the
religion and cultural context of the person
requiring support. However, further work is
required to promote access to services to people
from BME communities (see above).
Gender
The overwhelming majority of home care staff is
female. This may compromise the ability of the
service to respond to individuals who request carers
of a specific gender to assist with personal care
tasks (see also above).
Sexuality and Gender
Identity
Person centred and Outcome focussed approaches
seek to ensure the service is responsive to the
needs of individuals regardless of sexual orientation
or Gender identity. However information from
Derbyshire friend suggests awareness of the support
available through Adult social services is low within
Lesbian, Gay Bisexual and Transgender (LGBT)
communities.
The authority does not currently monitor the sexual
orientation of service users receiving a home care
service.
Gypsy and Traveller
communities
Despite significant health and social care needs
these communities have traditionally experienced
low levels of access to adult social care support
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Stage 6. Ways of reducing or removing unwanted effects
What small steps could be taken to achieve improvements? Please
outline the main things that need to be altered to reduce any illegal,
negative and unwanted impact.
1) In addition to the existing core training home care staff working as part
of the re-ablement service (including DSO’s) will undertake a specially
commissioned training programme focussing upon goal setting and reablement approaches with different service user groups.
2) A set of specific competencies for re-ablement staff will also be
developed to reflect the national work being undertaken by Skills For
Care, and the Care Services Efficiency Delivery Programme.
Re-ablement training and skill based competencies will be designed to
incorporate issues relating to equality and diversity.
3) To help develop whole systems approach re-ablement training will also
be rolled out to the mainstream service and independent providers of
home care.
4) Comprehensive performance and monitoring arrangements will be put
in place to measure the effectiveness of the service. This will include
take up of the service and outcomes for individuals broken down by
equality groups to identify any potential patterns of discrimination.
5) Future service user consultation and satisfaction surveys will include
specific questions to capture equalities information for example, the
views of service users receiving support from re-ablement workers of
opposite gender, and whether they were given a choice.
Stage 7.
Finding out whether your assessment has identified
what people think needs changing.
This assessment has been signed off by the assessment team. Further
consultations will take place as an ongoing process through
events/consultation exercises which will ensure the actions remain relevant
and on track
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Stages 8 and 9 Action planning, target setting and monitoring
TARGETS / SUCCESS CRITERIA
LEAD
RESP
ACTION
1. Establish a universal home care reablement service in all areas of the County
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VW
PARTNERS
Integrated
care
pathways
have been
agreed with
health
partners to
ensure that
service
delivery fits
with existing
intermediate
care
provision
RESOURCES
PERFORMANCE
INDICATORS/
MILESTONES
The service will By end of
be established September 2009
using
approximately
25% of the
overall inhouse
capacity. This
assumes the
provision of
approximately
5,500 hours of
support per
week at a cost
of
approximately
£9million
QUALITY
ASSURANCE
Of those who
access reablement
20% will cease to
receive a care
package
30% will receive a
reduced care
package.
(Based on a
comparison of the
level of support at
the
commencement of
the service to the
level of support at
the end of the
intervention
LEAD
RESP
ACTION
2. Re-ablement training to be provided for all
re-ablement staff.
This will be designed to include re-ablement
approaches with different service user groups,
and issues relating to equality and diversity
VW
PARTNERS
Skills for
Care
3. Specific skills based competencies to be
developed for re-ablement staff
4.Re-ablement training to be rolled out across
the standard mainstream service and
independent sector providers of home care
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Skills for care
Independent
Providers
RESOURCES
PERFORMANCE
INDICATORS/
MILESTONES
QUALITY
ASSURANCE
To be delivered By end of
by the staff
September 2009
development
team within the
existing
training budget
Feedback from
trainers and staff.
Operational
managers to
monitor impact on
service delivery
and quality
outcomes.
Consultation with
service users.
Quality
audits/inspection
To be
supported by
staff
development
Feedback from
operational staff
and managers re
impact upon
developing best
practice.
Consultation with
service users
By end
September 2009
To be delivered By end of 2010
through
existing staff
development
Feedback from
trainers, staff and
operational
LEAD
RESP
ACTION
PARTNERS
RESOURCES
PERFORMANCE
INDICATORS/
MILESTONES
budget
5. Performance and monitoring arrangements
to be put in place. To include take up of
service and outcomes for individuals broken
down by equality groups
VW
CSED
ReGARDS
Performance
Review Team
Management
information
QUALITY
ASSURANCE
managers
Consultation with
service users
Quality
audits/inspection
By end of
September 2009
Centrally collected
information to be
compared to data
collected by
responsibility
centre managers
Consultation with
specific groups:
ReGARDS, BME
forums,
partnership
boards, DCIL etc.
6. Future service user consultation and
satisfaction surveys to include questions to
capture equalities information.
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VW
ReGARDS
To be
developed by
the
Performance
Review Team
By January 2010
Consultation with
specific groups:
ReGARDS, BME
forums,
partnership
LEAD
RESP
ACTION
PARTNERS
RESOURCES
PERFORMANCE
INDICATORS/
MILESTONES
QUALITY
ASSURANCE
boards, DCIL etc.
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Step 10. Have your main actions been added to the relevant
business or service plan(s)?
Please indicate below which actions to which plans
Action planned
Actions 1-6
Business /
Service Plan
Business case
and project plan
How will performance be
tracked and reported?
The chair of the
assessment group will
produce regular highlight
reports for scrutiny by the
service re-design board.
Overall scrutiny will be
provided through the
making Care personal
Programme Board
Step 11. Publishing your assessment
Please indicate below:Your assessment has been signed off for publishing by
Adult Social services Senior Management team (SMT)
Your assessment was published on
Medium/ location
Date
Signed
Date
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