Social Rehab Reviews: Towards the next generation of services. Dylan Cross Category Manager Social Rehabilitation

Transcription

1 Social Rehab Reviews: Towards the next generation of services Dylan Cross Category Manager Social Rehabilitation

2 Acknowledgements Gill Hall, Manager Rehabilitation Programmes, ACC Nic Johnson, Category Advisor, Social Rehabilitation, ACC Jane Kelley, Head of Insurance Risk Management, ACC Kim Allen and Sarah Carne, Senior Research Advisors, ACC Alice Kan and Karen Connell, UMR Corrine de Bonnaire and Jane Falloon, Research NZ Jo Fadyl, AUT Dr. Maree Dyson, Dyson Consulting Group

3 Social Rehabilitation The aim of ACC s social rehab services is to: Provide support that allows a client to maximise their independence / participation Continuously improve the quality of service and outcomes for clients with sustainable growth in liabilities. Services worth nearly $300 million per annum: Home and community support services Inpatient non-acute rehabilitation Residential Support Social rehabilitation assessments

4 Non Acute Rehabilitation (NAR) Fast Stream rehab 20 district health boards and 4 trust hospitals Predominantly older people (50% over 85) Mostly post-fall injuries (fractures, soft tissue, reconditioning) ~ 4,000 clients per annum

5 Residential Support (RSS) Slow stream rehab and home for life Most commonly have a traumatic brain injury Wide mix of ages 106 suppliers ~700 clients

6 Social Rehab Assessments (SRA) Identify client needs and develop options to support rehab 8 main assessment types, 57 suppliers Mix of ages and injury types ~ 10,000 clients per annum

7 Research Questions For these services: What is the local and international context? Who are our clients, when and why? What service gaps exist? What is the state of the provider market? What are international trends? How are they performing for clients, staff, providers and other stakeholders? What is working well? What is not working so well?

8 The Reviews Literature reviews & qualitative research: Clients (54 case studies) and their support people/whanau; ACC staff (23 in individual or mini group settings, 10 focus groups) Providers (44 individual, 5 focus groups) Other stakeholders (12 individuals). Client selection structured to achieve a range of perspectives Interviews transcribed and thematically analysed

9 Themes Positive client feedback about providers and ACC staff Regional Variation Services working well where relationships well cultivated Single points of contact Consistency of staff Collegial relationship Integration and flexibility of services a challenge ACC s contracting model built around services, not clients Injury (ACC) / illness (Ministry of Health) funding streams Processes administratively heavy for staff and providers

10 Non Acute Rehabilitation Strengths Communication skills of providers excellent Providers generally seen as knowledgeable and honest Clients individual needs and priorities often recognised Positive relationships in some regions led to: Effective rehab planning Timely decisions Efficient process Smooth transitions

11 Non Acute Rehabilitation Opportunities for Improvement Resourcing / workforce pressures Group or self-directed therapy Easier administration (especially for complex clients) Availability of services for under 65s Build of trust and understanding between ACC and hospital staff Work underway to improve process and relationships Improvements in goal planning Realistic, person-centred, SMART Better access to intermediate care Pilot underway

12 Residential Support Services Strengths Match of client to facility, dignity-enhancing approach Relationships & mutual respect between providers and ACC Person-centred decision making and planning Transitions working reasonably well Active supports and client input into activities frequently mentioned

13 Residential Support Services Opportunities for improvement Contract needs greater clarity ACC staff: How are providers rehabbing clients, managing risks, providing fulfilling environment? Providers: What are the requirements of us? Improving quality of service, particularly smaller regions Challenges around workforce and availability of right facility for each client Client-centred goal planning and monitoring of progress Assessing clients on their potential rather than their needs

14 Social Rehab Assessments Strengths Service valued highly by ACC staff Assessors had excellent communication, client-centred approach Clients kept informed by ACC about expectations, rationale for decisions and any delays in the process Processes and templates for simpler assessment types generally working well

15 Social Rehab Assessments Opportunities for improvement Templates changes to allow for professional judgement and reduce repetition Referral timeframes affected by provision of clinical information from public hospitals Routine feedback and training mechanisms for assessors Contracting fatigue opportunity to address referral disparities through future redesign

16 New Directions Assessment (Needs) Services (Facility/Community) Delivery (Timing) Outcomes (Client) Service Providers & Services Facility Community Shared assessment Multidisciplinary approach Co-ordinated service delivery Right service, right time, right place client impact Shared outcome Return to work Return to/maximise independence Return to school Smooth rehabilitation pathway One touch Clear plan Clear expectations and outcomes

17 Future Model Non Acute Rehab Break barrier between inpatient + community Outcome-focussed, flexible approach to rehab (packages) Gradual integration of community provider market where natural efficiencies exist Assessments Closer integration with Ministry of Health Interoperability of assessment approaches Move towards more effective limited vendor design Residential More clarity about objectives, requirements, pricing Continuum of service Consolidation of market where possible

18 Thank you Feedback