How will AAC equipment be provided?
As has been described, people who use AAC often experience difficulty and delay in receiving equipment. While some areas have designated budgets for this type of equipment, these are often inadequate, particularly given the increasing costs of new developments within the field. Other areas often rely on 'end of year monies' and cannot therefore respond in a timely manner to client need. Service providers report frustration at being unable to meet current levels of identified need and recognise that significant resource is frequently directed towards sourcing funding for equipment. Furthermore, it has been highlighted that lack of funding can sometimes result in poor clinical outcomes where service providers do not fully appraise clients of the best technology available to meet their needs. Services should at all times be identifying need even if needs cannot be met within existing resources.
Developments in technology are offering clients with severe physical disabilities alternative access methods to technology - for example, eye-gaze access to AAC systems as well as voice banking which enables people with deteriorating conditions to create a synthetic speech that sounds like their own voice. New technology requires robust evaluation by AAC advisors and specialists.
To ensure equitable, efficient and safe provision of AAC equipment for people who are required to use it, Health Boards and local authorities should work in Partnership with each other.
1. Regional AAC centres/networks to have representation on local Community Equipment Management Groups.
2. Local Partnerships to build on existing Partnerships to agree priorities, policies and processes for AAC equipment provision.
Clear guidelines govern public sector procurement in Scotland46 where the underlying principle of best value is at the core of public spending. AAC equipment is currently purchased locally by different agencies, and on occasion, through joint funding. In many cases AAC provision is significantly delayed while agencies reach agreement on funding. This impacts significantly on people who use AAC. As highlighted previously, the strategic aim of AAC provision is to ensure that equipment is provided as soon as a specified need is identified.
AAC equipment has clearly been identified within the Aids and Adaptations Guidance47 and as such should be part of any local partnership arrangement around provision of equipment across Health and Local Authorities. At present these generally involve health and social care but in some areas education equipment is now transferring into partnership provision. Partnership arrangements contain finance arrangements, agreed locally, but they may extend to joint funding or pooled budgets.
Quality standards demand that healthcare is safe and efficient. There are local issues around compliance with management of medical devices. Equipment is generally not traceable or routinely maintained. With increasing pressure on budgets, all services are required to adopt best value routes for provision of equipment.
Good Practice Example
'Equipment to the value of £2.3 million was reissued last year (10/11) at a cost to Partners of £278,000. These savings are significant and are visible across both standard provision of equipment as well as more specialist equipment e.g. a growing area of more effective recycling is within children's services where specialist provision has been standardised and staff are more able to select from items being returned to the store rather than having to buy new.
The other area where savings are made is in procurement where our recent re-tender has provided savings of 18% on core stock equipment and 6% on specialist equipment. Standardising more specialist provision and the ability to liaise with suppliers to negotiate better prices for specialist stock is something that would help drive down cost.'
Service Manager EQUIPU, Glasgow
There are concerns regarding the inclusion of AAC equipment within existing partnership arrangements. In the areas where dedicated joint budgets have been identified - for example, Dumfries and Galloway, and Fife - these arrangements work well. In these arrangements, budgets are administered by local, inter-agency management groups.
In some areas partnership arrangements include the use of joint stores. These resources support area-wide access to joint stores for trained staff to arrange provision of prescribed equipment from a central store within a partnership arrangement. At present AAC equipment is generally not part of this provision. There have been concerns regarding the proliferation of AAC equipment and provision of inappropriate equipment to individuals. The advantage of using these mechanisms is that some of the above issues around quality and efficiency are addressed. To enable AAC equipment to become part of a joint store arrangement would require restricted access for agreed core equipment, with additional specialist equipment only available via designated specialist assessment.
Achieving the transition to partnership provision for AAC equipment requires local service managers to work within the arrangements that exist locally, and agree what equipment is being prescribed and by whom. Local procurement and safety protocols should be adopted. Partnerships would be required to engage with one another to identify why equipment is provided, to identify the local need and to map total provision across all agencies.
National AAC services to provide strategic advice to appropriate agencies on AAC equipment to support planning, procurement and provision of AAC.
National AAC services to establish strategic links with Scottish Government Joint Improvement Team workstreams for (i) Equipment and Adaptations and (ii) Telecare.
With the increasing adaptability of mainstream technology and the ongoing advancements in specialist technology, combined with the need for smarter procurement processes and improved access to equipment, it is crucial that national services are able directly to influence the strategic direction of future AAC provision. There is still much work to be done at national and local level to ensure best value for AAC procurement as well as developing solutions regarding handling data and information technology security for AAC equipment. National AAC services will therefore take the lead role in this process by establishing formal strategic links within the Scottish Government and additionally will support regional and local services to implement the appropriate policies and procedures locally.
All AAC service providers to implement the use of Local AAC care pathways to ensure equitable and timeous provision of equipment and support for people who require to use AAC.
1. Local AAC Partnerships to agree and implement local AAC care pathways in collaboration with National services.
2. Local quality indicators to be developed by Local Partnerships and National services and to be monitored by appropriate agencies including the Scottish Government.
Future plans for AAC include the introduction of maximum whole journey waiting times. However this is not being recommended here, as there is currently insufficient data available to identify what resources would be required to deliver on such a target. It is proposed that local services develop a local pathway, with indicator timescales, for provision of AAC services and equipment.
A sample AAC care pathway is provided in Appendix 7. This pathway has been developed from quality indicators identified by the AAC Short Life Working Group. The pathway shows the potential journey for each client and attempts to encompass all AAC clients regardless of outcome (high-tech, low-tech or no AAC). The pathway incorporates service provision at all levels from local services to regional and national services. Clearly any locally developed pathway would be done in collaboration with the wider AAC network. It could be anticipated that a client, particularly a child, may make several journeys through the AAC pathway as their needs change.
Email: Peter Kelly