Ed Bridges argues the case for measures to reduce the hospital churn amongst older people in Wales
Last year, 15,281 over-75s in Wales were readmitted to hospital within 30 days of discharge. It’s a figure which has been growing steadily since 2007. We need to be smarter about how we help older people if we’re to end the cycle of people yo-yoing to and from hospital.
With that in mind, WRVS set out to examine the state of so-called ‘reablement’ services in Wales, to see what help was given to older people by health boards and local authorities so they could adapt back to life at home after a prolonged stay in hospital. Services coming under the banner of reablement might include physical rehabilitation, home adaptations or social support such as befriending schemes.
In a research report released today, WRVS found some encouraging signs but also some challenges in the responses we received from health boards and local authorities to our Freedom Of Information requests.
First, the good news. Although health board budgets for reablement varied significantly across Wales, funding was moving in a positive direction. All health boards were either maintaining or increasing reablement budgets, despite the challenging financial climate. Furthermore, there was evidence of good local authority partnership working (particularly in north Wales), and evidence of common aspirations to increase referrals, and for interventions to be targeted towards those who needed them most. These are significant steps in the right direction.
Less encouraging was the fundamental problem that health boards and local authorities are still operating to different understandings of what is meant by the term ‘reablement’. There is no standard Welsh definition. This is leading to confusion and different interpretations. So when we asked councils about their reablement budgets, it appeared that, for example, Torfaen was spending ten times as much on reablement as Conwy. However, in reality, this was because of different readings of the term ‘reablement’. Until a standard definition is developed for Wales, we cannot hope to have a level playing field where we can compare like with like.
Elsewhere, there was also a disproportionate focus on physical support. Reablement necessarily involves a whole-person approach – so physical rehabilitation must be matched by social and emotional support to help a person regain confidence. Recent research from America has shown an inextricable link between social isolation and increased risk of mortality. Stopping people becoming lonely really does save lives. This is particularly important after what might be a debilitating illness which could leave someone housebound for a period.
Reablement works. Agencies delivering front line reablement services in Wales have seen the benefits it brings to service users. The Social Services Improvement Agency has shown that it delivers better outcomes. Research from Demos has pointed to the significant savings it delivers to the public purse. It really is a win-win for Wales.
Our hope is that today’s report will help highlight the areas which the Welsh Government will need to prioritise if we are to have a first-class reablement service. We recommend:
- The development of a reablement framework for Wales, outlining what exactly is meant by reablement and what features public bodies should seek to include in services.
- The establishment of a mechanism to measure wellbeing which looks at not only physical health, but also emotional and social wellbeing, both crucial to a person’s quality of life.
- The creation of a central source of funding for reablement services, to pump-prime investment into first-class reablement and share best practice.
- The involvement of the voluntary sector to ensure a multi-sector approach to providing social support services.
If we can start to pick up on some of these areas, then we really can help older people in Wales to get back on their feet.
This is a very interesting and important article raising an important issue. However, I just don’t understand the relevance of the title to the subject matter of the article. “Bed Blocking” refers to people who have completed their treatment in hospital but are still there because there is no room for them in a community hospital or with a care service. They are then taking up a hospital bed that should have been available to a new patient and so become a “bed blocker” or cases of “Delayed Transfer of Care” which is the official term in the NHS. This problem has been with us for decades and will become even worse with the current Health Board reorganisations which are proposing reductions in hospital beds and closures of some community hospitals. Health Boards must be made to prove that they are going to be able to tackle bed-blocking before they undertake any reorganisations.
This article raises the issue of “Reablement” which is a different but equallly important issue which, if tacked successfully, will ensure that fewer elderly people will return to hospital. WRVS are to be congratulated on their work which highlights the inconsitencies in definition of the problem and a lack of a coordinated approach to recording and measuring the problem. It highlights again one of the first principles of good management, “if you don’t measure it, you can’t manage it”.
Bed Blocking has been around for a long time. I have worked on a project to assist with that since 2003.
Awareness of it however is pretty low. The Bed Bureau is a Database of UK care homes where they post any vacancies they have, this allows them to be easily found by anyone.
It was originally commissioned by the Welsh Government back in 2002. Interestingly it was originally the North Wales Bed Bureau – they seem to be addressing the problem more there. It was expanded to cover the whole of the UK.
The problem was take up and awareness, I am currently trying to get more knowledge of this system to the social services staff, as well as the care homes. Technology has jumped forward dramatically in the last few years, and there is no reason we can’t make the problem a lot more manageable, through the use of the internet.
If you are a care home owner, or bed blocking staff you may want to check out bedbureau.org