{"id":147,"date":"2014-02-07T09:17:34","date_gmt":"2014-02-07T09:17:34","guid":{"rendered":"http:\/\/www.researchunbound.org.uk\/aging\/?page_id=147"},"modified":"2019-04-10T16:02:35","modified_gmt":"2019-04-10T15:02:35","slug":"4-2-enablement","status":"publish","type":"page","link":"https:\/\/www.researchunbound.org.uk\/aging\/4-2-enablement\/","title":{"rendered":"4.2 Enablement"},"content":{"rendered":"
The following section discusses the second finding of the empirical analysis. Specifically, it considers enablement first from a historical perspective and then identifies how that has impacted on the arrangements that exist currently.<\/p>\n
Analysis of LA committee papers and findings from the interviews confirm that in 2009\/10, LA established an enablement service based on a model of operation prevalent throughout Scotland at that time. The teams were introduced to deliver the principles and expectations of enablement across the geographic boundaries and LA was able to establish dedicated enablement by restructured services and re-configuring a hospital discharge team and a crisis care team. As part of the original set up arrangements, therapy services were assigned to the team and played a critical role in determining goal and attainments for individuals. LA\u2019s Occupational Therapists were involved in the establishment and delivery of training events for the social care staff transferring into the new service thereby ensuring that the ethos of enablement was firmly embedded. The close engagement with colleagues from the therapy services at that time was essential in the start-up phase, as well as providing the support and training for front line staff. As one SCO 2 commented in an interview:<\/p>\n
Without the help from our colleagues (in the therapy services) we would have been struggling to get off the ground. It wasn\u2019t that we didn\u2019t know what we were doing but they were brilliant at keeping us right without being too overpowering. Their expertise was invaluable as we developed care plans around the service users\u2019 functioning. XX helped me initially to make sure that I was doing what I was supposed to do.<\/p><\/blockquote>\n
The interviews describe how an eligibility criteria was set against which individuals were selected or de-selected depending on their suitability for an enablement intervention. This criteria was developed to target specific individuals who would benefit from an intensive period of enablement thus leading to better outcomes.<\/p>\n
However, a change to the eligibility criteria was effected in 2011 and, as a result of that decision; the enablement service no longer operates on a target specific basis but operates as an initial intake team [The intake approach suggests that all referrals should progress through the enablement team] for the home care service. \u00a0Consequently, all individuals referred to the LA (except those in the end stages of an illness or with significant cognitive difficulties) are expected to have a period of enablement to optimise their level of functioning and independence. This approach is widely adopted across Scotland (JIT, 2013) on the premise that everyone can benefit from a period of enablement thereby maximising independence and lessening the dependence on services. The decision to switch to an intake model has not been universally welcomed and as one SCO 6 put it:<\/p>\n
the intake model creates difficulties<\/p><\/blockquote>\n
The interviews suggested that the need to change the eligibility criteria was the result of pressures felt across the health and social care sector in 2010\/11. At that time, it was reported that there were significant increases in delayed discharges from hospital for individuals in LA (ISD, 2013). From the interviews and from anecdotal information, the general perception was that the length of time taken to undertake an assessment, as part of the discharge protocol, was taking too long. Consequently, key targets measuring the performance of health services were not being met. Therefore, a decision was taken in 2011 to relax the eligibility criteria to the enablement service which had a resultant effect on the Delayed Discharges in LA hospitals. Figure 8 evidences the trend in delayed discharges from 2009 \u2013 2012.<\/p>\n
Figure 8 Delayed Discharge (Aggregated) 2009 \u2013 2012.<\/strong> Source: ISD Delayed Discharge<\/p>\n
<\/a><\/p>\n
The figure clearly demonstrates that there are now fewer individuals who are delayed in hospitals in LA and that a peak was reached in 2011. By resolving this problem, however, the failure to recognise the cause and effect20 implications have simply shifted the problem across to another part of the system (in this case the enablement teams) but the consequences here are potentially far more reaching. The impact that these decisions have had on the current enablement service are described in the following section. 20 The relation between an event and a second event where it is acknowledged that the first event has caused the second to occur.<\/p>\n
Current arrangements<\/h3>\n
Although the decision to decrease the delayed discharges from hospital increased the number of individuals requiring social care services in LA, no changes were implemented to the staffing levels or the management arrangements of the enablement service to accommodate the change in approach. Alternatively, team capacity that existed at that time was used to absorb the influx of service users. Operationally, the impact on the service has been quite marked and, in particular, the time set aside within the service to develop, implement and monitor enablement programmes of activity has been lost. As SCO 2 remarked:<\/p>\n
We have become so inundated with service users who shouldn\u2019t be on our service, we no longer have the time or capacity to deal with enablement<\/p><\/blockquote>\n
This was further emphasised by SCO4 who suggested that:<\/p>\n
The enablement teams are simply chocked up with people\u2026too many people. Previously, we wouldn\u2019t be dealing with many of these people as they would have been deselected<\/p><\/blockquote>\n
Perhaps the most telling remark was from SCO6:<\/p>\n
Enablement no longer works. I\u2019m dealing with people who are in the end stages of their lives and the potential to enable does not exist. The staff has no time any longer to spend with people<\/p><\/blockquote>\n
These comments in isolation tell part of the story. However, when they are added to the quantitative data, the full impact of the operational shift in approach becomes more apparent. Figure 9 provides a graph of the outcomes for individuals in LA in 2013 following a period of enablement intervention. This graph illustrates three emerging consequences: (i) the number of individuals needing no further (or decreased) service post enablement; (ii) the length of time spent with enablement, and; (iii) individuals returning to hospital during enablement. A further factor was identified by the interviewees in relation to the assessment of enablement users. These are discussed in more detail in the following pages.<\/p>\n