Equipment and adaptations: guidance on provision
Guidance outlining the responsibilities of NHS Scotland, Local Authorities, Integration Authorities, and their Housing and Education partners for the provision of equipment and adaptations, with the aim of supporting partnerships, across Scotland, to deliver a more equitable and accessible service.
Children & young people
The provision of equipment and adaptations for children and young people is an essential part of the therapeutic support for their needs, and is effective both in terms of improving quality of life and potentially reducing costs for more intensive intervention and care.
Although some children and young people with very complex needs may require highly specialist bespoke solutions, the majority of equipment provided can be categorised as 'standard children's equipment'. This includes bathing/showering and seating solutions, as well as items to provide postural support (including sleep systems), mobility, and moving and handling. In some cases, it is also relevant to provide standard adult equipment, augmented with relevant accessories.
Services need to apply the ethos of anticipatory care planning when working with children and their families to help identify, at the earliest point, the types of solutions that may be required in the home environment, as the child grows and their needs develop.
This is crucial when it comes to considering the long-term suitability of their home. The earlier we can engage with families, it provides them with time to reflect and consider options and potential support available, as in many cases traditional family built homes over two levels or more, will not be the best solution over time, requiring either considerable disruptive adaptation to try to address changing needs, or be unsuitable for any type of adaptation.
Therefore, early engagement with Housing Services, and full exploration of rehousing options with all relevant agencies supporting, is essential to identify and promote suitable housing solutions. This approach should evidence a holistic approach to the whole family's needs and wellbeing, which recognises that there are often complex needs that require a combination of solutions or range of interventions to meet these most effectively.
Whilst acknowledging that not all services for children were formally integrated under the provision of the Public Bodies (Joint Working) (Scotland) Act 2014, it is essential that the provision of equipment to children and young people is provided in an integrated way, and recognised as an integral part of community equipment service provision within the integrated arrangements. This should include Education partners who play a pivotal role in providing equipment for use in educational settings. This will be particularly important in terms of achieving the aims of GIRFEC, and ensuring an effective joint approach to manage risk and address prevention and early intervention, across a multi-disciplinary team and operational and strategic contexts.
It is also crucial to highlight the importance of ensuring effective pathways for the transition of Children into Adult services, which require good planning arrangements in place that consider all aspects of relevant equipment, adaptation and housing solutions needs, e.g. some service have good arrangements in place which allow for equipment to be moved with the child, and funding is dealt with behind the scenes.
In March 2015, the Scottish Government issued guidance to Health Boards and local authorities on their statutory responsibilities in relation to the Provision of Equipment to Children and Young People with Disabilities.
This recommended that arrangements for the provision of children's equipment should be jointly agreed, and budgets should be set up in a way which supports direct access to equipment in line with the health & social care children's services pathways, and ensures appropriate funding by Education partners for equipment for use in school settings.
It also encourages Community Equipment services to establish 'Standard Core Stock for Children' for the range of needs most commonly met, to assist with delivering efficiencies in the service pathway including standardisation of practice and policy, procurement, and improved recycling which can deliver significant financial savings. This should include equipment commonly assessed for by occupational therapists, physiotherapists, and nurses, working in a range of relevant service settings.
Good Practice example
The guidance attached an example Joint Protocol for the provision of Children's equipment. This has now been updated to include arrangements for joint working with Education partners.
This provides a template to support IAs and their Education partners to establish effective and consistent pathways for the provision of equipment to children and young people with complex needs.
The Pathways should:
- Clarify roles and responsibilities of all agencies concerned in the provision of equipment to children and young people. Ideally in the form of a joint protocol and encourage integrated arrangements with all relevant stakeholders e.g. health and social care and education partners
- Identify sources of funding from a joint equipment budget which must also include monies to cover the cost of servicing, maintenance and replacement as a child grows or their needs change.
- Standardise and normalise equipment provision for children, establishing 'standard core stock' where possible.
- Clarify within the agencies responsibility for the provision of solutions not classified as equipment e.g. Environmental/behavioural solutions (see below).
- Encourage initiatives to maximise recycling efficiencies e.g. the employment of suitable experienced staff to support the refurbishment and reuse of children's equipment.
Children, and environmental supports
It is acknowledged that staff working with Children and their families may be sometimes asked to identify solutions which go beyond traditional equipment needs.
The Children (Scotland) Act 1995 created a broader duty to children with disabilities and it is recognised that an increasing number of children with behavioural issues are being managed at home which may require an environmental support component to the care package.
It is not appropriate for this type of solution to be provided via community equipment loan stores, and it should not be assumed that it the responsibility of occupational therapists to provide these.
Where the provision of an environmental solution is to support the wider needs of a child (e.g. emotional or psychological stress, behaviour, or sleep management) and extends beyond physical disability and functional needs, it is the responsibility of the health & social care services to determine which agency/clinician is most appropriate to lead on the identification of the needs e.g. this may be social worker/social care manager, and/or psychologist colleagues, or other relevant health professionals.
It is paramount that the views of the child are expertly sought and evidenced as part of the multi-disciplinary approach to any agreed provision, in line with the principles of the UNCRC Article 12, and that any concerns about potential restraint, are robustly addressed by the multi-disciplinary assessment process.
If it is agreed that the provision of an environmental solution is appropriate, it is the responsibility of the health & social care partners to agree the primary purpose of the provision, and identify funding for this type of environmental support from relevant Children's Services budgets, and to then monitor this provision, and evaluate the outcomes. Ideally, clear pathways should be agreed which clarify local roles and responsibilities and processes.
- The provision of equipment and adaptations to children and young people, for home and school settings, should be provided in an integrated way, and recognised as an integral part of community service provision, in order to streamline and standardise provision.
- Services should apply an anticipatory care planning approach to housing needs to ensure more effective early intervention work to help identify and plan for housing solutions as the child's needs change.
- Arrangements for the provision of children's equipment should be jointly agreed, and budgets should be set up in a way which supports direct access to equipment in line with the education, and health & social care children's services pathways.
- Community equipment services should establish a 'Standard Core Stock for Children' of equipment commonly assessed for by occupational therapy, physiotherapy, and nurse colleagues, for the range of needs most commonly met.
- Relevant local services should clarify responsibility for the provision of solutions not provided via local store services as equipment e.g. Environmental / behavioural solutions. Health & social care services should put in place arrangements which clarify for individual cases, the lead agency/clinician, the funding source, and monitoring arrangements.
- Services should ensure that the views of the child are sought and clearly evidenced as part of the multi-disciplinary approach to any agreed provision.
- Services should ensure effective transition arrangements for children moving into adult services to minimise disruption and ensure a seamless approach to the provision of equipment and adaptations.
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