A ward in the Queen Elizabeth hospital, Birmingham. The reablement policy aims to reduce demand for beds. Photograph: David Sillitoe for the Guardian
Ministers have been warned not to expect significant savings from a new care policy aimed at keeping elderly people out of hospital and residential care.
An official evaluation of the “reablement” policy has found that, while it is effective and popular, its costs are relatively high and wipe out most of the savings it makes in traditional health and social care services.
Reablement is a short-term, intensive programme of support for people who have had a spell in hospital. The aim is to help them relearn daily living skills so they do not need long-term support or to go back into hospital.
Amid rising concern among doctors about hospital beds being occupied by elderly people ready for discharge, as highlighted last week by a survey for the Guardian, reablement is seen as a way to free up blockages in the system.
The government has allocated £70m for reablement services in England in 2011-12, rising to £300m by 2014-15, and last week released a further £162m of central savings for immediate spending on reablement and related initiatives.
The evaluation, carried out for the Department of Health by a team led by the social policy research unit at the University of York, endorses the approach, but finds that it yields no overall savings at a time of acute strain on the NHS and local councils.
A course of reablement was found to cost an average £2,088. Although it led typically to a 60% reduction in need for traditional social care services over the following year, the net saving was not big enough to be judged statistically significant.
Similarly, there was no significant saving in healthcare costs over a year, and people who had undergone reablement were no less likely to be readmitted to hospital.
Caroline Glendinning, who led the research, said reablement was worthwhile because it improved people’s quality of life. It was most effective among people recovering from an accident or illness, rather than suffering a long-term condition.
“There are substantial savings, but that’s offset by the higher costs of reablement,” Glendinning said. “I think the Department of Health would have liked to have seen a greater reduction in overall social care costs and I think that’s going to be a crucial issue for local authorities.”
A separate report today from the Care Quality Commission, the government’s care regulator, finds that support in the community for people who have had a stroke is too patchy across England.
Stroke is the biggest cause of disability in adults, but early access to intense rehabilitation services can promote recovery. The commission found that only two in three NHS primary care trusts were commissioning specialist stroke physiotherapy, while barely one in three was providing good access to psychological therapy or counselling.
Cynthia Bower, the commission’s chief executive, said improvements had been made, but much more needed to be done.
Sources : Guardian-Health