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Meeting of the Parliament 09 November 2011

09 Nov 2011 · S4 · Meeting of the Parliament

Item of business

Rehabilitation and Enablement

Chisholm, Malcolm Lab Edinburgh Northern and Leith Watch on SPTV

I am always fascinated by the continuity in health and community care policy from the Administration that governed until 2007 to the current Scottish Government. That is certainly true in the debate’s themes. Members might have seen the Scottish Parliament information centre’s material for debates document, which mentions the rehabilitation framework from 2007 and “Healthy Working Lives” from 2004, and which might well have mentioned the David Kerr report, whose central theme was shifting the balance of care into the community.

The current Scottish Government has produced “Health Works”, which picks up on “Healthy Working Lives”, “Improving the Health and Wellbeing of People with Long Term Conditions in Scotland” and “Reshaping Care for Older People”. The themes and messages of those reports are consistent with the earlier reports that I mentioned.

I am sure that we were all struck by the demographic information that the minister gave. We are all familiar with it in general, but I was struck by the 144 per cent increase in over-85s by 2031 that he cited.

I was also struck by a statement by Dr Roger Gibbins at the Health and Sport Committee a couple of weeks ago, in which he tied demographics in with funding issues. Dr Gibbins, a former NHS Highland chief executive, said:

“Broadly speaking, the number of older people in Highland was increasing at about 5 per cent a year. As older people consume about 50 per cent of the health budget, that meant an immediate pressure of 2.5 per cent on the health budget that had to be addressed just to stand still.”—[Official Report, Health and Sport Committee, 25 October 2011; c 376.]

As the minister said, that is completely unsustainable.

Services must be redesigned for financial reasons, but that must be done in a desirable way, as the minister reminded us. That is always a challenge for us in looking at new models of care. We can perhaps see the benefits for the service, but can we see the benefits for individual service users? We must be able to see both if we are to approve redesigned services.

I took the word “reablement” to be a specific reference to a form of rehabilitation that has existed in England for a few years and which was pioneered in Scotland by the City of Edinburgh Council in 2008. When reablement started in Edinburgh, it was quite controversial and people had many concerns about it.

The theory of reablement is that work is done with people to make them as independent as possible, doing things with them rather than to them. Under the Edinburgh model, which follows the model that was used extensively in England, work is done with people for six weeks, either when they come out of hospital or when they are referred to the service from the community. Intensive work is done with them for six weeks. They are then, the theory goes, able to look after themselves to a far greater extent.

Obviously, there were concerns that reablement would just be a cover for cuts, but the Scottish Government commissioned an evaluation in 2009 that indicated a 41 per cent reduction in hours of care resulting from the six weeks of reablement. It also said, perhaps reassuringly, that most of the reabled clients had a positive view of the service that they received. The evaluation was of a fairly small number of people, so there is perhaps more room for qualitative research. However, most people were reassured by what they learned from that report and from what they heard from people who had used the service.

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Meeting of the Parliament 09 November 2011

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