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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views

Question 42: Does excluding the cost of reablement/intermediate care from the personal budget as defined above: Create inconsistencies with the way that reablement/intermediate care is provided in NHS personal health budgets? Affect the provision of reablement/intermediate care for people with mental health problems?


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  1. Anonymous says:

    Will depend on how personal health budgets develop – there is an assumption that reablement/intermediate care will remain free at the point of delivery. If so, the only thing to look out for will be debates around funding – would this be addressed by the Better Care Fund?

  2. Anonymous says:

    It is very important that re-enablement services remain free of charge. Any adverse health event leads to extra anxieties and costs for the family. Well qualified staff such as home makers, occupational therapists, physiotherapists, speech and language therapists and their helpers, coming in immediately after the event/discharge gives great support both to the person and their family. Some people live alone and without this help would be admitted to residential care. Those who have family, the family members may need to be trained. This work is the work that originally the NHS would have done as rehabilitation in a hospital or convalescent bed. If done well far better done at home. Re-enablement must be free to all people as there is otherwise a tendency by some people to feel that its just much easier to give up and rely on care.

  3. Anonymous says:

    Spent a lot of time reading the text and clarifying what it meant

    No – it should be clearer

    The issue is not necessarily about budgets but about availability of services (particularly MH)

    Complexities exist around section 117 – very few purist mental health teams – usually primary need is deemed as physical.

    No impact on MH – PB’s do not always work for people with MH needs

    Need to consider the unintended consequences of PB’s – particularly for people in long term residential care – will things change ? – some people are happy with the way things are and may choose not to have them – need to stress choice.

    There is currently no NHS personal budget

    You can’t challenge budget decisions unless you know what they are – more transparency is needed

    Transparency of budget is a good idea

    There should be more clarity within the act about what qualifies as reablement – define please

    Reablement within MH services is absent – there is no explicit reference in the Act to how MH services are included – perhaps case studies should be included?

    Advocacy should be mentioned as being excluded from PB’s
    There should be parity of esteem for mental and physical health

    How do NHS PB’s work if social care is prescribing as the lead professional?

    Breadth of advocacy services should include help with finances (dealing with complex issues)

    There is a lack of support for people with money to spend, lack of financial capability training.

  4. Anonymous says:

    The guidance is not clear. On the one hand the introduction to this chapter “excludes the cost of IC/reablement from personal budgets, where it is provided to meet needs, rather than as a universal preventative service” and then goes on to say it should not be included in the PB where it is provided free of charge. This led me to infer that a charge could be made for it if it were provided as a iniversal preventative service. However, 11.19 seems to contradict that saying “IC/reablement should be provided as a free, universal service under section 2 of the Act)

  5. Anonymous says:

    By excluding reablement it potentially stifles future innovation around different types of reablement to reallyork for all people.
    Existing models can over focus on domiciliary type of support, rather than the whole person .
    for example a person who acquires an impairment after a serious stroke will need emotional as well as practical support. To really focus on outcomes, people should have the choice of a personal budget, thus embedding and empowering people to regain independent living from the
    very start of the process.