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RAS - resource allocation system (social care) The Resource Allocation System (RAS) is designed to be a fair funding system and to allocate money from adult social services. The RAS works against a set of strict guidelines to ensure it remains fair. It relies on a scoring system based on answers given to a series of questions and then places people within a series of funding bands.   Re-ablement PCTs received in their baseline  £70 million in 2010/11 for reablement.  This increases to  £150 million in 2011/12  and £300 million from 2012/13.  For the latest guide to these allocations see NHS support for social care: 2010/11 – 2012/13  There might be scope to use this to fund post-discharge support for people with COPD.   PCTs should be able to tell clinicians what they have spent/are planning to spend it on by sharing a written plan that is due by 31 December 2010. Current policy to provide services for people with poor physical or mental health and to help them accommodate their illness (or condition) by learning or re-learning the skills necessary for daily living.  Home re-ablement is typically offered as an intermediate care service by  local authorities  post-discharge free for six weeks, as part of intermediate care packages.    To help people accommodate their illness (or condition) by learning or re-learning the skills necessary for daily living such as the ability to get out of doors and walk down the road; wash face and hands; have a bath, shower or wash all over; get dressed and undressed; have bladder control How is it different from traditional home care? In traditional home care things are done for the individual. The home carer might wash and dress the individual, or prepare their meal. With reablement, the idea is to help the person to re-learn how to do things for themself in a safe way, gradually over a six-week period.  The reablement carer will work with the person on how, for example, to wash and dress themself, or prepare and cook their own meal.  Many people who receive reablement find they need less care and support afterwards, or even none at all.   Outcomes An interim study by the DH Care Services Efficiency Delivery (CSED) found post re-ablement phase, service users were reporting fewer problems with mobility, self-care, usual activities, pain/discomfort, anxiety/depression and improvements in their general health. Research commissioned by CSED amongst four councils showed that levels of independence achieved from a completed phase of homecare re-ablement are sustained see CSED’s Retrospective Longitudinal Study http://www.csed.dh.gov.uk/homeCareReablement/prospectiveLongitudinalStudy/ • 53% to 68% left re-ablement requiring no immediate homecare package • 36% to 48% continued to require no care package 2 yrs after re-ablement • 34% to 54% had maintained or reduced their homecare package 2 yrs after reablement   Who would benefit? As an example, an older person who •    lacks confidence following a fall or poor mobility •    would benefit from a health screen and health promotion, e.g. someone with poor diet or who is not managing their medication) •    needs guidance on how to manage long term conditions e.g. Diabetes or C.O.P.D. •    needs to learn easier ways to manage own personal care (e.g. washing, dressing and toileting) •    needs to learn how to undertake daily living activities (e.g.) cooking •    would like to socialise and join community groups (e.g. Age concern etc.) The services typically offer a multi-disciplinary approach and aim to •    Help people to remain at home and be as independent as possible •    Prevent unnecessary admission to hospital •    Help people recover faster from illness •    Support discharge from hospital •    Prevent unnecessary admission to long-term care homes The DH re-ablement toolkit is available here Funding for post-discharge support On 28 October 2010 The DH England wrote to SHA Chief Executives giving details of the £70 million 2010/11 funding allocations for re-ablement to improve hospital discharge.   See the letter here   The sum will be given to PCTs who have to have plans in place by the end of December 2010, agreed with the local authority.  It is for post-discharge support. The money is available for four years - increasing to over £100 million  per year from 2012. From April 2011, as announced in the June 2010 revisions to the Operating Framework, acute trusts will not be paid for readmissions within 30 days subject to local negotation with commissioners and this will help fund these re-ablement services.  From April 2012, there will be a new tariff to cover the costs of post-discharge support, including re-ablement. Emergency re-admissions increased by 50 per cent between 1998 and 2008.  At the launch of the reablement fund the Secretary of State for Health Andrew Lansley said : 'Too often, patients end up back in hospital because they haven’t had help readjusting to life at home. We need to do more to prevent this from happening. 'Re-ablement will give opportunities for the NHS and councils, by working together locally, to make savings. Services of this kind have shown dramatic benefits in supporting people and cutting readmission to hospital. Our objective is for people to be once again independent, in their own homes. 'This new funding will mean people will benefit right now and around 35,000 will start to get the help and support they need.' The additional funding for re-ablement has come from savings from central Department of Health budgets. The re-ablement funds could be used to support existing intermediate care schemes or to facilitate discharge in new ways (for example care bundle approaches) or to fund new services such as pulmonary rehabilitation.    The DH distinguishes between re-ablement from rehabilitation and prevention as follows: Prevention     •    Services for people with poor physical or mental health     •    To avoid unplanned or unnecessary admissions to hospital or residential care     •    Can include short-term and longer term low-level support Rehabilitation     •    Services for people with poor physical or mental health     •    To help them get better Re-ablement     •    Services for people with poor physical or mental health     •    To help them accommodate their illness (or condition) by learning or re-learning the skills necessary for daily living     Reference costs These are used in calculating the tariff. They are average costs for providing a defined service in a given financial year. They cover a broad range of NHS treatments and clinical procedures and have been collected since 1998. Their main purpose is to provide a basis for comparison within (and outside) the NHS between organisations, and down to the level of individual treatments. The 2008/09 costs show how £48 billion was spent. Each Trust has a Reference Cost Index – the lower the score, the higher their relative efficiency. Eg a score of 92 means costs are 8% below the average, a score of 125 means that the costs were 25% higher than the national average. The RCI is adjusted for the same market forces factor as the tariff. See here.  Related Words  Tariff Referral management Centres  see Clinical Assessment Services and also BMA guidance here. Related Words  Clinical Assessment Service (CAS) and Clinical Assessment and Treatment Service (CATS) Regional improvement and efficiency partnerships (RIEPs - social care) RIEPs play a key role in supporting councils. The nine RIEPs were created in April 2008 with a three-year funding package of £185 million from Communities and Local Government. The RIEPs harness the expertise of councils to add new capacity to local government in order to accelerate the drive for greater improvement and efficiency. They build on the successful foundations laid by the former Regional Improvement Partnerships and Regional Centres of Excellence. Put simply, they help councils deliver the ambitious outcomes, set through local area agreements (LAAs), by supporting them in their efforts to become more efficient, innovative and engaged with citizens. The report ‘Leading the Way by Working Together’ demonstrates that local government has taken responsibility for its own improvement by working together at a local, regional and national level. It celebrates the achievements of the sector, illustrated with a series of recent case studies and is published July 2009. Related Words  Local Area Agreement (LAA) Right care This is one of the workstreams of the quality and productivity programme (QIPP) in the NHS in England led by Sir Muir Gray, Chief Knowledge Officer ""Empowering patients make the right choices and empowering commissioners to improve value.”  It is also being piloted by the NHS London Respiratory Programme.  See the Rightcare pages.    Health Investment Packs were made available to every PCT in September 2010 by programme budget some of which highlight respiratory spend and outcome.   Right to provide Previously there was a Right to Request  in the Next Stage Review of the NHS, published in June 2008. The Right to Provide creates the opportunity for NHS staff to set up and lead new social enterprises.   We could see the establishment, for example, of AHPs setting up services.It enables NHS staff, specifically nurses and allied health professionals, who may be interested in establishing a social enterprise to put their proposals to their PCT board, and if approved, have their proposal supported.  See this link here for a series of 'webinars'.   RightCare Initiated as a term in 2009 by the Department of Health in England, it is part of the Quality, Improvement, Productivity and Prevention (QIPP)  programme led by Sir Muir Gray, Chief Knowledge Officer for the NHS.  RightCare is doing the right things and doing things right to achieve value based care.    http://www.rightcare.nhs.uk/index.html Whatever commissioner’s plan, it needs to be put into practice at the front line where a clinician is face to face with a patient. Sir Muir argues that "This is the crucial interaction in health care, where the clinician and the patient discuss the options available: treatment A, treatment B, and ‘let’s not do anything now as the benefit to you does not outweigh the risk’. Shared decision making provides a set of tools and behaviours that allow an honest and informed conversation to agree on the ‘highest value’ decision in that situation and at that time for the patient."    How will it come about? Sir Muir states that "Changing the NHS in this way, to one where each treatment decision is considered by both patient and clinician together in terms of value, requires a much wider cultural shift than one constrained to within current commissioning arrangements. It needs a move to: long term rather than short term and population wide rather than patient and service planning. This broad cultural movement to support the change in what is expected by the population from the health service must be led by the NHS but can only succeed if this conversation engages with society as whole."   To download the RightCare Project Document go here. To download the IMPRESS guide to value in respiratory care: More for Less. The concept is being tested in Respiratory by the NHS London team. Related Words  QIPP Risk stratification See Combined Predictive Risk and PARR Related Words  Combined predictive risk model; Patients At Risk of Re-hospitalisation (PARR) RSL registered social landlord (housing) Registered Social Landlords are government-funded not-for-profit organisations that provide affordable housing. They include housing associations, trusts and cooperatives. They work with local authorities to provide homes for people meeting the affordable homes criteria. As well as developing land and building homes, RSLs undertake a landlord function by maintaining properties and collecting rent.