The second research question considered the approach taken to enablement in LA. Like most other local authorities in Scotland, LA has taken its lead from the JIT in relation to the development and implementation of its enablement service. The model that was initially adopted sought to use the expertise of the therapy services and that would appear to have been justified in terms of start-up and training commitments. However, over time the provision of these services has diminished for a variety of reasons (funding streams, realignment of priorities) essentially leaving the enablement service as a stand-alone service with no direct engagement with therapy services. In this context, therefore, it is argued that there are two related issues that need to be considered within this question. First, the issue of enablement sitting within social care is a moot point because the definition of enablement is not clear within the literature (Becker, 1994; Young, 1996; Bowman, 1999, Brophy, 2008) and consequently it finds itself positioned between health and social care. What is clear, however, is the process that individuals are required to work through to achieve specific goals or outcomes through a short-term, focussed period of activity thus seeking to optimise levels of functionality that prevent further demand on service provision (Pilkington, 2008; Rabiee, 2009). To achieve this, however, two factors emerge that are critical: (i) Wade (2004) argues, good outcomes for individuals and organisations may be difficult to achieve unless there is a culture within the organisation that is focussed on an enablement ethos and utilises all of the skills of all of the players, and (ii) Francis et al (2011) suggest that for enablement to work effectively there is a need to ensure that the appropriate skillset, knowledge and expertise is available to fulfil objectives. As Seddon (2008) contends, the failure to have the right person, doing the right job at the right point it is needed will, invariably, lead to demand failure thereby creating additional work.
It can be argued that neither of these factors has helped LA achieve their goals for the following reasons. First, the assessment for enablement continues to be based on a procedural model which, importantly, is tied to an eligibility criterion that only allows those with the highest needs to access the service. Consequently, those individuals progressing through the system following assessment are those at the upper end of the needs scale who potentially have the least potential to be enabled. Second, the demand to move people out of hospital and back to the community at the earliest opportunity places great pressure on those staff with the responsibility to assess need. As an intake team, LA’s enablement team receives 71% of referrals from hospital settings. Within the hospital, however, there is an expectation that discharge will not be unnecessarily delayed (Scottish Government, 2012). Consequently, there is a need to keep the discharge rates at a level that maintain a level of throughput. The concern now is that the pressure exerted on the assessment services to maintain that expected level of throughput results in mechanistic assessments which are form-led and have a checklist approach (Francis et al, 2011) This is contrary to the ethos of enablement that is focussed on describing the outcomes and detailing the activity schedule to meet those objectives (Francis et al, 2011).
It might be argued that, if enablement is defined within the spectrum of rehabilitation, then the assessment for service needs that seeks to optimise independence through a restorative process requires the skillset to develop the goals and outcomes that will be beneficial to individuals. Consequently, the issue of assessment is critical within this debate. The lead for preventative, restorative service should be with the services steeped in therapy and it should be the qualified professionals in this field who drive forward this agenda.