Enablement service update

Cllr Paulette Hamilton, cabinet member for health and social care, talks about why improvements to the enablement service are needed:

The enablement service helps people recover skills and confidence to live at home after a spell of illness or hospital stay; allowing them to live independent lives, with minimal support. We are committed to delivering a first-class enablement service and for this to be delivered by Birmingham City Council staff.

Sadly, that’s not what we have now. 80% of service users are failing to get what they need, because we don’t have staff available when they are needed. Service users are seeing up to 15 different staff a week; this isn’t right for people receiving very personal care.

Care and health services are under intense pressure at the moment and the enablement service should perform a vital role in lifting some of that pressure by helping people back into independence, while relying less on expensive care. That is why our NHS partners support our improvement plans. I firmly believe this service – carried out in-house – can be the jewel in the crown of the wider support we offer to vulnerable citizens.

The proposals we have been consulting on for some time will improve outcomes for elderly and vulnerable citizens, giving them the support they need and deserve. We have made many changes to our proposals to give a good deal to staff, and there are other roles in adult social care staff can move into if they don’t want to come with us on the improvement journey.

The importance of these changes can be shown in this story of two women:

Barbara, 85 and Charlotte, 90: both independent women living an active life and part of their community before they suffered falls.

After an operation on her broken hip, Barbara received physiotherapy in hospital to regain mobility. She was medically fit for discharge before this was completed so needed enablement at home, but the service did not have the capacity.

This meant a temporary residential home while she recovered, but after 6 months a review found she needed to stay there permanently.

Barbara can now only move a few steps at a time with a wheeled frame, and is socially isolated because of complex needs of other residents, spending most of her time in her room.

Charlotte also needed intensive therapy after 2 operations. The enablement team therapist visited her in hospital to agree goals, outcome and intervention plan which included exploring support from the community, friends and voluntary sectors.

This included falls rehabilitations, mobility, balance, self-confidence, and sensory compensatory measures at home. The enablement therapist worked with Charlotte’s church to adapt the environment to ensure it was safe to continue with her church activities.

Charlotte is back at home and after a 21 day review, enablement was no longer needed due to increased independence.

Charlotte’s story doesn’t happen often enough because of the system our teams work in; we must change so that her story is the norm, not Barbara’s.

We have dedicated staff working in the enablement service who work hard to improve the lives of our vulnerable citizens. At its best, as well as improving people’s lives, enablement reduces the use of more expensive health care such as lengthy hospital stays, so it provides long- term savings to the public purse.

This is a difficult time for this service, but we must all put serving the needs of our citizens first, while doing all we can to minimise any losses to staff.

Throughout the 18 months of the consultation we have set out a number of proposals that we believe will improve the service we provide citizens and will provide benefits to our staff above the other proposals put forward. Now the only way we can move forward is by directly seeking the views from staff on what they want to do individually within the final offer.

Key service changes which will benefit our citizens:

Now – only 20% of service users leave enabled

Future – 80% will be enabled

Now – evening and weekend shifts do not have adequate staff cover to meet service users’ needs

Future – there will be consistent staffing cover across the working week

Now – there is no capacity to support hospital discharge and referrals from hospital are being turned down

Future – enablement will be a key service for older adults with a focus on hospital discharge

Now – service users report seeing up to 15 different carers a week

Future – service users will recognise their enablement team and key enablement assistant

Mitigation measures proposed include:

1. The increase to a Grade 3 role (between £0.36 and £1.17 extra per hour);
2. A payment based on hours lost and length of service, described as ‘redundancy for hours lost’. This will tend to average the equivalent of 3 – 6 months’ pay;
3. Access to other full-time roles within Adult Social Care or the wider Council via the Lateral Movers Programme which involves staff indicating a preference but without risk to their existing job. At present, up to 30 vacancies are being held at Grade 2 for this purpose;
4. Access to other full-time roles within Adult Social Care or the wider Council via the Priority Movers Programme which involves staff at risk of redundancy being placed in a pool against BCC vacancies (after the close of consultation);
5. Access to the Flexible Retirement Scheme which allow workers over 55 years of age to reduce their hours and access pension benefits. Of the 198 workers, 87 are 54 years of age or older and there is likely to be considerable interest;
6. Redundancy payments to those staff who determine the available rota does not provide a suitable alternative employment option;

All staff will also be offered a comprehensive package of support to secure alternative employment:

• Career transitions skills workshops
• Personal Assistant training to support transition into direct payment roles
• Access to priority mover vacancies, including roles covered by agency
• Application skills, CV clinics, Interview skills, Job search, self-employment
• Time off to seek alternative employment
• Jobs fair with internal and external employment opportunities available
• Support from the Jobcentre Plus to secure alternative employment

There are 44 Vacancies in ASCH (at 4 January) – we can offer these as potential alternative employment opportunities to enablement staff at NO RISK to their current job

The 22 January cabinet report can be found on our committee papers website.