Factors that are impacting (positively or negatively) on LA’s ability to deliver enablement services.
In relation to the fourth research question, in addition to the demographics, the lack of engagement with therapy services and enablement’s ability to prevent increased demands, the evidence suggests that two other issues impact on LA’s ability to deliver. These relate: (i) to time and timing, and; (ii) policy implementation.
Time and timing
Time exists on an operational and strategic level. At the operational level the biggest challenge for the enablement service is that the time needed to properly construct and deliver an enablement package has diminished in comparison to previous years. As the demand for services has grown over the years and the pressures have been applied from elsewhere (delayed discharge pressure), the time described by Francis et al (2011) as being essential to satisfying outcomes has been compromised. There is a concern that the dedicated enablement teams are no longer specialist teams but are extensions to the mainstream services and that the focus on enablement has been lost because more individuals can be attended to using the time and task model. Consequently, it might be argued that the time allocated for enablement needs has to be ring-fenced to allow this activity to occur effectively. The intake model adopted by LA does not let that happen because its primary focus is to deal with volume to the detriment of enablement outcomes. This has clear implications for policy objectives if the principle, preventative model is not working as envisaged.
On a strategic level, the timing of the establishment of enablement services is vital in this debate. It is argued that in the case of LA the establishment of enablement teams in 2009/10 was too late as there were already too many people in the system in receipt of traditional services. For these people, no change to their existing service commitments is expected. Therefore, they will continue to draw from existing resources for the foreseeable future. Despite enablement services being promoted as a principle measure in the management of demand it has been overwhelmed by the volume of people now in the system.
Policies and initiatives are vital to develop the strategic position. Despite the policies being well intentioned, the length of time required to implement and reap the benefits can be prohibitive. Organisations that are rooted in management structures based on consensus management practices means that change takes time. Second, an expectation that a consultative process that seeks to engage with wide stakeholder groups through meaningful dialogue and discussion also means that a change process will take time to implement. Third, to change services that have been entrenched through time requires a shift in culture within communities and an acceptance that the statutory agencies cannot supply the level of services necessary in the future (Christie Commission, 2011). This coupled with the slow pace of change in the public sector would suggest that little or no impact will be evidenced from change proposals for some time to come (ADSW, 2013).