Health and Social Care Integration
The Public Bodies (Joint Working) (Scotland) Act 2014 (the Joint Working Act) establishes the legal framework for integrating health and social care in Scotland. The Act requires each Health Board and Local Authority to delegate some of their statutory functions, and associated budgets, to their Integration Authority.
Regulations that underpin the Act set out which health and social care functions must be delegated. The provision of equipment and adaptations are functions which must be delegated to the Integration Authority.
Power of Ministers to Issue Direction and Guidance
Under the Joint Working Act Ministers have the power to issue Directions and Guidance to Health Boards, local authorities and Integration Authorities in relation to carrying out their functions.
This guidance is issued as statutory guidance under the terms of Section 53 of the Joint Working Act, and as such Health Boards, local authorities and Integration Authorities must have regard to the advice provided.
Purpose of the Guidance
This guidance covers the responsibilities of NHS Scotland and Local Authorities, Integration Authorities, and their Housing and Education partners for the provision of equipment and adaptations, and replaces all previous guidance on this issue. This updated guidance is issued with immediate effect.
The guidance outlines the responsibilities of all relevant agencies, with the aim of supporting partnerships, across Scotland, to deliver a more equitable and accessible approach to the provision of equipment and adaptations.
The overall aims of the guidance are to:
- Remove barriers in the systems promoting seamless pathways which are consistent and equitable across the country;
- Ensure services evidence that the service user, and unpaid carer (and family members providing support and care, but who may not identify as a carer), are at the centre of provision.
- Enable choice and control for service users and unpaid carers as partners in the process of assessment and support planning.
- Focus service provision on supporting the achievement of successful outcomes for the individual, and where relevant, their unpaid carer.
- Endorse a consistent approach to the assessment for, and provision of, equipment and adaptations, which promotes prevention and early intervention, and supports self-management.
- Ensure that service users and unpaid carers have access to up to date and relevant information on equipment and adaptations.
- Promote good practice and effective partnership working in relation to equipment and adaptation provision.
Equipment and adaptations are an essential component of an integrated health & social care service. Timely provision of these often simple solutions, enable people affected by disabilities and health conditions to achieve their individual outcomes, living in their own home, or a homely setting, for as long as possible. This enables them to participate fully in daily life and achieve the quality of life they wish, as well as being a cost effective model of intervention.
Scotland's population is ageing. The number of people aged 75 and over is set to increase by 85% by 2039. It means that, by then, over 800,000 people will be over the age of 75. This has implications for the services we deliver. More people are also living longer with complex conditions, from childhood into adulthood. However, there are also people living with incurable conditions for whom urgent and proactive actions are required. Our services need to support these varying needs in a seamless way.
Supporting as many people as possible to continue to live well in their own home, also crucially depends on effective strategic & operational joint working with housing partners, to help with the better planning, and delivery of barrier free housing solutions.
The provision of equipment and adaptations, including the opportunities provided by innovative technology, should be an integral part of mainstream housing, health & social care assessment and service provision.
Where this is not already in place, it can result in a breakdown of care, especially during periods of transitions across a wide range of our service settings e.g. from child to adult services, community to prison settings and vice versa, and between hospital and community settings, and with the changes and progression of health conditions.
It is therefore critical that effective policy, systems, processes, resources and infrastructure, are in place to ensure the seamless provision of equipment and adaptation solutions.
Since the publication of the previous guidance in 2009, service models have evolved, particularly in relation to the integration of health & social care, and also with improved alignment with housing. It is however acknowledged that there is still considerable work to do in terms of streamlining the pathways for provision of equipment & adaptations, and ensuring the best fit possible with new models of health & social care, and the effective interface with other relevant partners including, housing, education, and prisons.
This guidance recognises the need for more extensive service improvement, which is consistent with the intent and aspirations of the recent review of adult social care, The Independent Review of Adult Social Care, and subsequent proposals for a wider inter-agency, national care service.
- The sections in this guidance therefore highlight the need to support more fundamental change, and particularly address issues with equity of access, and the need to remove barriers which prevent responsive service provision, and the ability to help people to self-manage and make their own choices.
- The guidance also references the need to address inconsistencies in funding arrangements which create barriers in the service pathways, and ensure that community equipment and adaptation services are fully resourced, to be as effective as possible.
- The consistent themes throughout this document, focus on ensuring that prevention and early intervention are the objectives which dictate the way our services are developed and delivered, and help minimise, where ever possible, the need for reactive, and crisis intervention.
Key Actions are identified for each section in the guidance, with the expectation that all partnerships will review these by using the new self-assessment Equipment & Adaptations Baseline Assessment Tool which has been developed to help partnerships evaluate their performance in relation to the updated national guidance, and identify the actions required to address issues and improve their services.
Improvement work will also be supported by the revised 'Good practice guides' for both community equipment, and adaptations which are relaunched as accompanying documents. These document can be found on the Scottish Government's blog page.
The aim is to provide a standardised approach for the effective provision of equipment & adaptations across Scotland, to help improve the consistency, quality, and equity of service.
A summary of the Key Actions can be found at the end of this document.
Defining equipment and adaptations
The timely provision of equipment and adaptations, supports the health, housing, social care and educational needs of a broad range of children and adults, and can help reduce risk, and support independence and control. They support those with short, and longer term needs, and assist those with physical, or learning disabilities, mental health needs including dementia, and individuals who require support with communication, including Alternative and Augmented Communication (AAC) users. Many older people do not see themselves as disabled, but may be frail, or have difficulty with everyday tasks, and also benefit from these services.
Equipment can be defined as any item or product system, whether acquired commercially off the shelf, modified or customised that is used to increase the functional capabilities of individuals. Community equipment can include, but is not limited to:
- Equipment to support people with more significant health needs to be nursed or cared for, such as profiling electric community beds, pressure relief mattresses, and a range of moving and handling equipment.
- Equipment to support daily living tasks, or make caring for the individual safer and easier such as shower chairs and stools, bath lifts, raised toilet seats & frames, grab rails, and mobility aids.
- Technology enabled care products such as flood detectors, falls monitors, smoke detectors and movement sensors. These are often linked to a call centre, triggering a response when activated, and provided as part of a service.
- Children's equipment to support every day functions, including their education.
- Ancillary equipment for people with sensory impairments, such as flashing doorbells, low-vision optical aids, text-phones and assistive listening devices.
- Wheelchairs for short-term loans.
- Environmental control equipment.
- Communication aids (including AAC) – to assist children and adults who have difficulty with speech. Equipment includes aids to writing and reading as well as speech.
Note: It does not include any medical devices or anything that is invasive to the body (e.g. PEG feeding equipment).
The purpose of an adaptation is to modify an environment in order to restore or enable independent living, privacy, confidence and dignity for individuals and their families. As defined by The Public Bodies (Joint Working) (Scotland) Act 2014, the form of the adaptation can be wide ranging and is not restricted to defined types. Rather, the emphasis is on the intended goal, to maximise independence and ensure people of all ages are supported to live safely in their own home.
Adaptations can improve confidence, skills and mobility and reduce symptoms. They can form part of a range of options available to people experiencing a disabling environment. This could include, but is not limited to:
- Adaptations to a bathroom, e.g. replacing a bath with a walk in shower;
- Improvements to support access into, and around the home e.g. widening of a door frame to allow wheelchair access and external access improvements;
- Adaptations and equipment which provide safety features for people with autism, signage & tonal contrast for people living with dementia etc.;
- Fitting lower work surfaces in the kitchen;
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