Having had things done for me in hospital I did wonder how I was gonna get coping with meals or
just making pot of tea. Margaret who's 85 came out of hospital six weeks ago after suffering a
slight stroke. Really my legs weren't at all my legs, but they were. The retired physiotherapist
lives in the London borough of Sutton and was referred to the START programme pioneered by
the local authority. START stands for short-term assessment and reablement team. And that's exactly
what we are, we provide a service up to six weeks or more depending on the individual for people
who are coming out of hospital or to prevent them going into hospital following injury or illness,
or people that have got long-term disabilities in the community that you have decreased mobility
and struggling to cope. It's not the same as rehabilitation. It's not that you can necessarily
get better with the condition that you have but there's some real dignity and respect issues that
come through reablement. At some levels reablement is a philosophy. It's about not trying
to do things for people but helping people to do things themselves. And there's
an argument perhaps that in the past home care services for example tend to come in they tend
to do things for people, they get them dressed, they prepare food for them and you know it meets
their immediate needs. But that's different from reablement where reablement is there to help
people to regain those those life skills. So that is I would say the key distinction between a
reablement home care service and a conventional home care service. Can you open that? I see you open it.
Sometimes they're a bit stiff aren't they? Reablement in Sutton is seen as an opportunity to assess a person's social care
needs and also as an effective way of preventing injury or deterioration in a medical or physical
condition. When Margaret was referred to START, carers were told she needed help with personal
care and with taking her medication. She was assessed by Lyn Locke. I first came to Margaret's
when she just came out of hospital and I needed to assess her needs for equipment and how many
calls that she needed it may and that needed an extra call being put in at lunchtime because she
wasn't able to do her meals at lunchtime. And now she's really really coping very well and the way
we got to that stage was we verbally encouraged her to do her own personal care and gave her that
encouragement that she was lacking when she was in hospital thinking that she wasn't going to be able
to come home and do all this. You keep dropping these sticks. That's why this is so useful, you can't drop the trolley. Key features of an
effective reablement scheme are the provision of specialist equipment and the requirement
that assessments are done in a person's home environment. It's a help to have something like
the trolley to me. And you've got your bath master haven't you and your perch installed you
can sit on and now wash independently and. Amazing. You don't have to think now what am I to do. She's a very
different person now full of more life, not down in the dumps like when I first saw Margaret.
And she seems to be wanting her life back to where she was before. To me it's essential to
have my own home, that's the great thing. To be able to be independent when you have always been.
Yeah. It's expected that Margaret's condition will improve to a point where she requires few if any
commissioned care hours after reablement. This outcome isn't unusual. From an outcome perspective
we know that 30% of the people coming through the service don't require any ongoing care at
all so their hours are cut off at the end of the six weeks and then another 30% have ongoing care
so we've developed a support plan with the person to meet their own very needs. And there's something
like 42 percent of that ongoing care is on a reduced level to what it was in the beginning.
Can't say I could stand on my head or my heels but I mean it is such a help to feel independent. Good.
And get about. Good. Sutton's reablement scheme is known as an intake model. In other words it's
inclusive and anyone in need of social care will be assessed. For us reablement isn't just
about moving everybody out the system and being self-supporting and only focusing on
people that have had a fracture or a break, and are potentially going to get better. It's
about everybody has some degree of reablement potential. Sutton's START service means that
some people get support who wouldn't qualify under a different type of reablement scheme.
People like Rob and Ann. What they do they come and get her up in the morning, take her to the bathroom,
toilet her, wash her, dress her
and bring her down here and then I give her her breakfast. And in the evening, they come along and they do the reverse. In themselves they might sound like two very simple
tasks which they probably are but when it's on top of everything else that you're doing
during the day, they sometimes become like a major obstacle. Rob's wife Ann has dementia. For several
years he's cared for her without any social care support. But the responsibility has worn
him down. I'm normally a pretty happy-go-lucky chap. And as this thing has progressed I found and
this is a dreadful thing to say I was beginning to resent what I was having to do. Show me how you
brush your hair. How do you have it? Down or back? I have said to my closest friends you must notice
that I'm being really miserable at the moment, and that's not like me. Two weeks into reablement, Rob has
realised that he was doing too much for Ann. What the carers have been doing, they get her
to do some of the things because they've probably got a little bit more time and a little bit more
patience than I've been showing. But they have certainly helped her to try and do some of the
things for herself. With this intervention the need for Ann to go into residential care may be delayed
and the decline in Rob's mental health is being reversed. I can honestly say, after the first 24 hours
I felt totally different because I hadn't had to do those two jobs that day. Now that they've been
coming to us for a fortnight, people have said to me you're back to your normal self.
Sutton's experience of reablement echoes the findings of a national report which compared this
type of scheme with more conventional services. What we found was that people using reablement had
better outcomes so reablement was no more expensive but it produced better outcomes and on that basis
we found it was a cost-effective or it had very high chance of being cost-effective. Sutton Council
has evaluated its START scheme to identify cost benefits and personal outcomes. Results show that
reablement has proved to be good value for money. In total for that first two years operation,
the cumulative savings should be 2 million pounds. In terms of people, 400 additional people have been
diverted out of the social care system altogether so they've achieved full independence compared to
the proportion that we would have expected from our control group. So it's a real significant
difference for people. In November last year, the government announced that it's making 1
billion pounds available to local authorities to set up reablement schemes. It believes that
such projects provide positive outcomes for people as well as saving money in the long term.