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.
Contribution of Equipment & Adaptations
For people in our communities
Equipment and adaptations, need to meet the needs of people of all ages and disabilities, and respond appropriately when these needs change. Adults and children, affected by illness and frailty, can significantly benefit from equipment and adaptations, enabling them to lead independent lives and achieve their desired outcomes. For many people, particularly those affected by progressively disabling conditions, equipment and adaptations are vital to allowing people to remain at home, and to live life with dignity and care.
The provision of equipment and adaptations can reduce risk and injury, help with people's confidence and their mental well-being, and may prevent unnecessary admission to hospital or care settings. In terms of those within prison settings, over recent years there has been an increase in the complexity of needs, and it is recognised that these solutions are vital to support people to maintain or maximise their functional ability.
Children and students affected by disability, may need a variety of equipment and adaptations at home, school, college and university such as special seating, SleepSystems, mobility equipment, augmented communication equipment, and/or adaptations to the environment etc. Delays in the assessment of need, and the delivery of services may impede access to education, learning and the child's development; and may even cause greater dependency.
For people living with progressive terminal conditions, future needs should be planned for, by working closely with the individual, and specialist nurses and occupational therapists, to ensure that equipment and adaptations are provided in time. In these instances the prompt uplift of any equipment no longer required is also essential, to reduce stress on bereaved families.
Appropriate equipment provision is also vital to those who provide care, whether family members or care staff, enabling them to work safely and effectively.
Equipment and adaptations are essential to avoiding dangerous practices in terms of moving and handling. The range of equipment provided should be tailored to help the individual achieve their desired outcomes, and support them in a way that fits in with their chosen lifestyle.
Furthermore, the ability to communicate effectively is a fundamental human right. It is therefore vital that individuals with communication needs are provided with, and trained in the use of, appropriate communication equipment (e.g. Alternative and Augmented Communication equipment (AAC)).
The examples below are taken from a Service user Outcomes survey conducted by one of the community equipment partnership services in Scotland, and these comments evidence the impact simple equipment can make for people's overall mental well-being, and not just their physical health:
The shower chair improved her life so much she is going out more it's crazy to think that a small chair can make so much difference we live close to a supermarket and she'll go to the shops now.
She probably didn't feel dressed or clean before. She was like a prisoner in her own home. She's so much more confident
Just out of hospital having taken a stroke. I use the walking aid to get out the Zimmer was a godsend for the house and I now use the trolley to carry the injections, medicines and for my makeup in case Mr. Right comes to the door!
I'm 81 years of age. The equipment for the shower and the rail at the back door is fantastic. When I came out of hospital my leg was weak and I was walking badly. The equipment has helped me so I'm happy as Larry to get back into the greenhouse and look after my tomatoes.
Equipment Service User Feedback
For our services
The timely provision of Community equipment and adaptations, is a cost-effective solution which can contribute significantly to the streamlining of service responses and pathways, and support wider agendas including, hospital discharge and avoidance of admission, prevention and early intervention, frailty pathways, Anticipatory Care Planning, Mental Health & Dementia, child development, and the management of long-term conditions, including end of life care.
These interventions can allow people to do more for themselves and avoid the need for additional, more expensive, input from other services, and compliments rehabilitation intervention, for people of all ages.
A recent report from the Foundations Independent Living Trust on The Social Value of Aids and Adaptations Provided by Home Improvement Agencies, utilises blended, anonymised case studies, to illustrate significant cost benefits from early interventions and the provision of often very simple adaptations.
The Outcomes of adaptations sections of the Evidence review of home adaptations in the UK and other OECD countries, from the University of Stirling in partnership with the UK Collaborative Centre for Housing Evidence (CaCHE), details the economic benefits of adaptation provision, reviewing sources from across the world, to confirm evidence of reduction in home falls, reduction in the need for care provision (predominately informal), and reduced Care Home admissions.
One large store service in Scotland estimated that approximately 80% of equipment provided by community based occupational therapists is under the value of £50, equating to approximately 20% of overall equipment expenditure. This is because low cost equipment (procured effectively at competitive rates and/or recycled at very low cost) is often the main solution for people whose needs require to be addressed urgently within the community.
Equipment is prioritised in terms of the need it meets, rather than its cost value, therefore the low value of equipment is not reflective of the type of need it is being provided to address. Often this type of equipment supports the ability to quickly deal with crisis and at key stages in vulnerable people's life's e.g. prevention of falls, avoiding admission to Care Homes and hospital, supporting hospital discharge, maintaining people of all ages to live in the community.
These lower cost equipment solutions mainly support emergency needs such as toileting, safe transfers to prevent falls, and are provided to address critical and substantial needs.
Good Practice Example
One community equipment service has been able to evidence in 2020/21, that it provided 918 deliveries of equipment to people in their communities, which directly helped avoid an admission to hospital.
- When Integration Authorities, and other relevant partners e.g. Housing and Education, are reviewing their service provision, they need to recognise the value effective and efficient community equipment and adaptations provision makes to the delivery of key service goals. Any proposed policy changes need to have scoped, and fully considered the implications of stopping or inhibiting the provision of equipment, and its wider impact on meeting wider strategic service objectives.
- Equipment and adaptation services need to be fully resourced in a way that is effectively integrated, and does not create barriers and blockages by having different funding arrangements e.g. for different types of equipment by profession or agency.
In general terms, the main cost pressures on community equipment and adaptations budgets come from more complex needs, however the benefits of this provision are also substantial. Hospital and community-based services rely on the timely provision of beds, and moving & handling equipment, and also adaptations including bannisters, showers, and stairlifts, to support people who have increased frailty, often to support hospital discharge, but also to maintain people safely in the community.
Over recent years there has been a steady increase in the number of frail adults and those with long term conditions, being cared for in the home environment, and bariatric needs have also increased. Children with complex needs are also being successfully supported to live longer at home.
- Addressing these more complex needs with equipment and adaptation solutions, remains the most cost-effective way for health and social care services to support people in our communities. For example, standard specialist seating and postural care solutions can greatly assist both adults and children with complex needs to be more independent, address their health needs, and engage in social activities, education and work, avoiding dependency and the need for additional care. Many community equipment store services have standardised the provision of these categories of more expensive equipment and, as a result, recognised the benefits of procurement savings, significant recycling efficiencies, as well as ensuring that they are delivering effective person-centred outcomes for service users in line with strategic service objectives.
Good Practice Example
The EquipU community equipment Partnership has employed a paediatric occupational therapy technician to help support the more specialised recycling and refurbishment of all children's equipment provided for home use, and school. The cost benefits of this post are evidenced by increased volumes and values of both Core and non-stock recycled equipment, averaging savings of £300,000 per year (20/21). Equally important, the pathways have been improved, allowing quicker provision to the child, access to more recycled equipment, and improving the quality of the available products, with all options available for selection via the online ordering system.
- Integration Authorities (IAs) should work with relevant partners to capture data which evidences the value, effective and efficient community equipment and adaptation provision makes to the delivery of key service goals.
- IAs require to ensure they are resourcing their community equipment and adaptations services to be as effective as possible in providing responsive, outcome focused services, with fully integrated funding streams.
- Any proposed policy changes related to the provision of equipment and adaptations need to be scoped and reviewed to identify any potential implications of stopping or inhibiting the provision of equipment, and its impact on meeting wider strategic service objectives across health & social care, and other relevant partners e.g Housing.
- IAs require to ensure they have reviewed their pathways and access to equipment and adaptations, as part of delivering the aims of the Rehabilitation strategic framework.
- In terms of children's needs, Health and Social Care, Housing, and Education services, require to ensure that they are compliant with the relevant legislation, and the principles and values of wellbeing, early intervention, and child-centred practice are evidenced in all aspects of equipment and adaptations service provision.
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