Community equipment and housing adaptations: draft guidance - executive summary

Introduction

Equipment and adaptations are an essential component of an integrated health & social care service. Timely provision of these often simple solutions, enable some of our most vulnerable citizens to achieve their individual outcomes, living in their own home, or a homely setting, for as long as possible. This enables them to achieve the quality of life they wish, can improve mental health and well-being, as well as being a cost effective model of intervention.

Since the publication of the previous Guidance in 2009, service models have developed significantly, particularly in relation to the increased integration of health & social care, and also with improved alignment with Housing. It is however acknowledged that there is still work to do, in terms of streamlining the pathways for provision of equipment & adaptations, and ensuring the best fit possible with new models of health & social care, and effective interface with other relevant partners including, housing, education, and prisons.

• The sections in this guidance therefore highlight the need to support more fundamental change, and particularly address issues with equity of access, and the need to remove barriers which prevent responsive service provision, and the ability to help people to self-manage and make their own choices.
• The Guidance also references the need to address issues with funding arrangements which create barriers in the service pathways, and ensure that community equipment and adaptation services are fully resourced to be as effective as possible.
• The consistent themes throughout this document, focus on ensuring that prevention and early intervention are the objectives which dictate the way our services are developed and delivered, and help minimise, wherever possible, the need for reactive, and crisis intervention.

Key Actions are identified for each section in the Guidance, with the expectation that all partnerships will review these by using the new self-assessment 'Equipment & Adaptations baseline assessment tool', which has been developed to help partnerships evaluate their performance in relation to the updated national Guidance, and identify the actions required to address issues and improve their services.

Improvement work will also be supported by the revised 'Good practice guides' for both Community Equipment, and Adaptations which are relaunched as accompanying documents.

The guidance enables professionals, service users, and carers, to review and understand local health and social care partnerships responsibilities, and to support the aim of a more consistent and effective approach to the provision of equipment and adaptations across all areas of Scotland.

The overall aims of the guidance are to:

• Remove barriers in the systems promoting seamless pathways which are consistent and equitable across the country;
• Ensure services evidence that the service user, and unpaid carer, are at the centre of provision.
• Enable choice and control for service users and unpaid carers as partners in the process of assessment and support planning.
• Focus service provision on supporting the achievement of successful outcomes for the individual, and where relevant, their unpaid carer.
• Promote a consistent approach to the assessment for, and provision of, equipment and adaptations, which promotes prevention and early intervention, and supports self-management.
• Ensure that service users and unpaid carers have access to up to date and relevant information on equipment and adaptations.
• Promote good practice and effective partnership working in relation to equipment and adaptation provision.

Contribution of Equipment & Adaptations

Equipment and adaptations, need to meet the needs of people of all ages and disabilities, and respond appropriately when these needs change.

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.

These solutions can support a wide range of people within the community, including:

• Frail older people
• Disabled adults, children and young people
• Older prison populations
• Palliative and end of life care
• Individuals with communication needs
• People with long term conditions

“It (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 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 make-up 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.”

The timely provision of Community equipment is also 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.

It can allow people to do more for themselves and avoid the need for additional, more expensive, support from other services, and compliments rehabilitation intervention, and self-management strategies, for people of all ages.

Key Actions

• Health & social care partnerships should capture data which evidences the value, effective and efficient community equipment provision makes to the delivery of key service goals.
• Partnerships 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.
• Local HSCPs 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, 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.