Equipment and adaptations: guidance on provision - executive summary
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 for children and young people is an essential part of the therapeutic management of their disabilities, and is effective both in terms of improving quality of life and potentially reducing costs for more intensive intervention and care.
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.
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 health & social care partnership arrangements. This should include Education partners who play a pivotal role in providing equipment for use in educational settings.
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.
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.
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 is 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 or 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.
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