Reablement programme, Somerset
Last updated: 15 October 2012
The journey
The Reablement programme helps patients or their carers to be experts in their own care and maintain independence for as long as possible. By giving tailored solutions that don’t foster dependence and supporting people to remain in their own homes, it ultimately aims to reduce health inequalities and build a cost-effective service that meets demand.
The programme takes a systems approach. This has meant taking a long hard look at the way that services are delivered and has led to fundamental changes in service provision, rather than simply ‘doing the wrong things righter’, as one programme manager put it.
Listening to patients and collaborating across professional and organisational boundaries are both central to what makes the Reablement programme work. In Somerset, the PCT and the county council jointly reviewed all their services that might be termed ‘reablement’. They worked in partnership with private and voluntary sector organisations and the new CCG to deliver better, more coordinated services.
Outcomes
In Somerset, the Reablement programme has led to an increase in collaboration across the healthcare sector and made significant changes in how patients are assessed and what services are provided. An example is a patient with a history of sciatic pain who had a fall. Previously, he would have been hospitalised, but his GP contacted the Reablement team, who quickly established that he would prefer to be at home. The team devised a personal support package that enabled him to gradually increase his mobility without being admitted to hospital.
Ultimately, the programme has delivered a number of real gains in service quality, patient outcomes, productivity and staff motivation. This includes significant reductions in hospital readmissions and the cost of social care.
Patient setting
| In-patient X | Out-patient X | Community based X |
| Mental health | Chronic illness X | Cross-systems X |
Clinical area
| Staying healthy | Maternity and newborn | Children and young people | Acute care X |
| Planned care | Mental health | Long-term conditions X | End of life X |
Information, tools and techniques used
The programme used Vanguard Consulting’s change methodology for systems thinking.
Geography
The programme was first piloted in the Taunton federation and is being rolled out more widely across the county.
Timescale
The Somerset Reablement programme started in spring 2010 with a pilot in Taunton. From January 2012 Reablement was mainstreamed in Taunton and rolled out in another large federation in Somerset.
Contact details
Ann Anderson ann.anderson@somersetccg.nhs.uk and Sue Glanfield Susan.glanfield@somerset.nhs.uk were both members of the project team.