Integrated service pathways for provision
Anyone requiring equipment and adaptations, or other care services should experience a seamless journey through the pathway of care, which then ensures they receive the right intervention at the right time. To guarantee that changing care needs are managed effectively, it is essential that equipment and adaptations are seen as an integral part of the service pathways and can be provided by a wide range of staff across all service settings.
Some service users have progressive conditions that change over time. Anticipatory approaches to provision are needed to ensure that services, including equipment and adaptations, are made available to accommodate these changes.
It is therefore essential that health and social care services extend staff roles, and move away from traditional professional boundaries, and service arrangements, which act as a barrier to effective equipment service provision.
The Integration of Health & Social Care has encouraged services to review their pathways and better utilise multi-disciplinary approaches to service provision. Within this context, work to integrate Occupational therapy roles in health and social care, has supported a number of partnerships to review the role of Occupational Therapy and the contribution of the profession through a wider lens, encouraging more targeted use of the specialist contribution, and a sharing of more generic roles (e.g. including equipment and adaptations). Nurses and physiotherapists are well placed in the service pathways to assess and provide equipment in a timely and responsive way, and pathways should be reviewed to ensure all other relevant staff and third sector partners are also able to take on these roles as appropriate.
Responsibility for provision
Assessment and provision of equipment is recognised as the responsibility of all care groups and services, as a means of supporting overall service delivery. Staff should therefore not be viewed as 'orderers of equipment', or this only to be the responsibility of certain professions or services. Instead, our pathways should be designed to ensure that any staff who are involved in assessing the needs of a person who may require equipment to support them, are then able to directly provide equipment, to complement their interventions, and/or support wider service goals.
Relevant Health & Social Care staff, should be able to access a wide range of equipment and simple adaptations, appropriate to the type of service they are providing, and not based on professional or agency boundaries.
- It is essential that financial arrangements support this, and that Integration Authorities have funding mechanisms which ensure that all equipment purchased by the Community Equipment Store services is paid for from the one joint funding mechanism ('pot'), and then recharged to partners according to the services which have assessed for and requested the provision of the equipment , rather than to do with certain types of equipment being funded by particular agencies.
- The same principles, of streamlining the funding arrangements should apply to the provision of Adaptations and these themes are more fully explored in the next section of this Guidance.
Consideration should also be given to the inclusion of other partners e.g. Housing, Education, and relevant third sector partners, in the service pathways, to open up and streamline access according to levels of need.
These arrangements ensure that staff can access ordering arrangements directly, without the need to refer on to a separate agency or professional group to order on their behalf.
Provision should differentiate between meeting straightforward, non-complex needs (Standard provision), and where a specialist assessment is required to meet complex and/or high risk needs (specialist provision). Through good assessment practice and by evidencing their reasoning, staff will be able to establish what the risks are around the provision, and consider their own competence to meet these needs. This approach is therefore not dependent on the type of equipment or adaptation being provided, as:
- some complex equipment (e.g. hoists) can be provided in a straightforward manner without fear of risk, if the service user and/or carers are familiar with that equipment and there are no other risk factors:
- Some very simple non mechanical equipment can pose significant risk if not provided with due consideration of the potential hazards (e.g. bath boards).
This is equally true of adaptation provision, and there are examples nationally where the assessment and provision of adaptations has been widened out to ensure staff other than Social Care occupational therapists (traditionally viewed as the assessors of adaptations), can competently meet these needs without referring on.
It is expected that the majority of provision can be met directly by staff who originally identify the needs, however if the member of staff does not feel competent due to the complexity of needs falling within another professions expertise, they should refer to that service for an assessment, and/or jointly assess as this can often be most effective in ensuring that all needs are considered. The referral should not prejudge what the outcome of that may be e.g. this should not be a 'prescriptive referral' for a certain type of equipment/adaptation, but identify the needs that require to be met.
Staff across services who are involved in identifying equipment and housing based needs should be trained to assess and provide a wide range of relevant solutions, irrespective of their own professional background, or agency. The training should strongly emphasise good assessment practice, the need for 'good conversations' which focus on personal outcomes, and encourage prescribers to consider their reasoning for provision, contraindications, recording of decision making, and ensures avoidance of over-prescription.
Core Training modules should be available as part of an annually updated training programme which is open to all relevant partners and agencies.
Where these arrangements are in place, this encourages:
- Robust and consistent approach to the assessment of need and prescription of appropriate solutions, simplifying service pathways across service and professional boundaries.
Promotion of joint working and partnership approaches in the assessment and prescription of equipment and adaptations, in the context of wider service provision for all care group services.
Protocols & policy
Inter-agency agreements (Protocols) should be in place, defining the arrangements between the Partners in terms of the roles and responsibilities of staff and their managers, and the processes for assessment, prescription, and provision of equipment and adaptations.
Partnership arrangements (including all relevant agencies e.g. housing and third sector partners) should prevent duplication in the assessment process by allowing staff to directly access equipment & adaptations, without having to refer to another practitioner, and widen access in the service pathway (allowing other staff/professions/services to order equipment & adaptations) so that service users and their carers receive equipment far quicker and more effectively.
This should result in the following outcomes:
- Streamlined access to service provision
- Improved speed, efficiency and effectiveness of service delivery
- Maximise the use of resources
- Better outcomes for people who need equipment and adaptation solutions
Increasingly a number of health and social care partners have chosen not to include some small, low cost items within their standard stock of equipment as these may not be vital to meet the desired outcomes of individual. Examples provided in the 'Prevention, Early intervention, and Self-management' section in this document, outline the initiatives developed by a number of partnerships to improve the signposting to advice, and self-assessment and self-purchase options, allowing people to independently access relevant solutions.
- Individuals with simple or non-complex needs should be able to access equipment and minor adaptations without the need for a specific professional assessment thus making services more accessible. A streamlined approach to assessment and provision, which avoids unnecessary bureaucracy will ensure that services are provided in a timely and efficient way. This can include models utilising direct access.
The refreshed Good practice guide for the provision of community equipment services, and a version for Adaptations (with an accompanying example Housing Solutions Protocol) and the self-assessment tool which accompanies this Guidance, should assist partnerships to review their arrangements in line with these aims. All these resources can be found on the Scottish Government blog page.
- Equipment and adaptations should be seen as an integral part of the wider service pathways and their contribution should be clearly articulated in local health and social care strategies.
- Relevant health & social care staff, should be able to access a wide range of equipment and relevant adaptations, appropriate to the type of service they are providing, and not based on professional or agency boundaries.
- Partnerships must have funding mechanisms which ensure that all equipment purchased through the Store service is paid for from the one funding 'pot', with no barriers according to type, or professional use.
- Staff across services who are involved in identifying equipment and adaptation needs should be trained to assess and provide a wide range of solutions, irrespective of their own professional background. The training should strongly emphasise good assessment practice, the need for 'good conversations' which focus on personal outcomes, and encourage prescribers to consider their reasoning for provision, contraindications, recording of decision making, and encourages avoidance of over-prescription.
- Inter-agency agreements (protocols) should be in place, defining the arrangements between the partners in terms of the roles and responsibilities of staff and their managers, and the processes for assessment, prescription, and provision of equipment and adaptations.
- Individuals with simple or non-complex needs should be able to access equipment and minor adaptations without the need for a specific professional assessment. This can include models utilising direct access and self-assessment tools.
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