Equipment and adaptations: guidance on provision

Statutory Responsibilities & Policy Context

NHS and local authority

The National Health Service (Scotland) Act 1978 places a duty on Health Boards to:

• Promote a comprehensive and integrated health service designed to secure improvement in the physical and mental health of the people of Scotland, and the prevention, diagnosis and treatment of illness
• To provide medical, nursing and other services, whether accommodation or premises, in the home of the patient or elsewhere (e.g. a care home)
• To meet all reasonable requirements, for the purposes of the prevention of illness, the care of persons suffering from illness or the after-care of such persons.

Section 12 of the Social Work (Scotland) Act 1968 places a duty on local authorities to promote social welfare by making available appropriate advice, guidance and assistance, and such facilities as they may consider suitable and adequate to anyone over 18 who need assistance.

Section 12a of the 1968 Act places a duty on local authorities to carry out an assessment of need for anyone they are under a duty to provide care or assistance to, and decide whether those needs call for the provision of any service.

Section 2(1) of the Chronically Sick and Disabled Persons Act 1970, as enacted by the Chronically Sick And Disabled Persons (Scotland) Act 1972 places a duty on local authorities to provide assistance in arranging adaptations or the provision of any additional facilities designed to secure greater safety, comfort or convenience.

Health & Social Care Integration

The Public Bodies (Joint Working) (Scotland) Act 2014 established the legal framework for the integration of health and social care in Scotland. It requires each health board and local authority to delegate some of their statutory functions, and associated budgets, to their Integration Authority (IA). The IA is responsible for the planning and delivery of the related services using the entire delegated budget.

The Act also introduced the National Health and Wellbeing Outcomes that apply equally across health and social care services in Scotland. These outcomes aim to enable service users and unpaid carers to have a clear understanding of what they can expect in terms of improvements in their health and wellbeing.

• Outcome 2: People are able to look after and improve their health and wellbeing and live in good health for longer
• Outcome 3: People, including those with disabilities or long term conditions, or are frail, are able to live as far as reasonably practicable, independently and at home or in a homely setting in their community
• Outcome 4: Health and social care services are centred a helping to maintain or improve the quality of life for people who use those services

Successful integration of health and social care services should provide for more people to be cared for and supported at home or in a homely setting. This outcome aims to ensure delivery of community based services, with a focus on prevention and anticipatory care, to mitigate against inappropriate admissions to hospital or long term care settings. It recognises that independent living is key to improving health and mental wellbeing.

Delegated Functions

The 2014 Act provides the statutory framework for driving forward these changes and is supported by regulations and statutory guidance, including an Adaptations, aids and equipment advice note that prescribes the housing-related functions that must and may be delegated by a Local Authority.

The guidance defines equipment (aid) and adaptations as:

Any alteration or addition to the structure, access, layout or fixtures of accommodation, and any equipment or fittings installed or provided for use in accommodation, for the purpose of allowing a person to occupy, or continue to occupy, the accommodation as their sole or main residence.

The guidance also states that:

Where equipment and adaptations are provided, these services, along with the resources which fund this support must be included in the integration arrangements.

The Rehabilitation Framework

The impact of Covid-19 has sharply brought into focus the importance of the availability of comprehensive, multi-agency, and multi-disciplinary rehabilitation pathways, and the negative effect on our population, when this is not available. The Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 Pandemic, which was launched in August 2020, has been developed to mobilise our services and provide a strategic framework for the provision of rehabilitation in response to the impact of the virus.

By the end of 2025 all adults who require rehabilitation will have timely access to the right information and services in the right place to support them to participate as actively as possible and enjoy the life they choose

The Rehabilitation Framework

The Framework recognises that people in our communities have been adversely affected, both by more limited access to existing rehabilitation services as a result of the lockdown, as well as experiencing significant physical and psychological effects following direct exposure to the virus.

The timely provision of appropriate equipment and adaptations, easily accessible by all relevant services, will be crucial in supporting effective interventions. The Framework also highlights the importance of early intervention, prevention, and self-management and the need to help people to support themselves.

National Care Service

The Independent Review of Adult Social Care was initiated by Scottish Government in Sept 2020 and reported with a wide range of recommendations, in February 2021. The report highlights the requirement for new thinking in the provision of social care with emphasis on preventative and anticipatory approaches, and "a vehicle for supporting independent living".

If our aim, as so often stated in Scotland, is to emphasise supporting people to stay in their own homes and communities for as long as possible, we must do more to improve and adapt those homes to support a better quality of life.

The Independent Review of Adult Social Care

The report of the Independent Review of Adult Social Care raises expectations in terms of improving the provision of equipment, adaptations, and technology, in a range of community and institutional settings, with greater clarity called for on the responsibilities for the funding and delivery of these solutions.

Following these recommendations and a National Care Service consultation, the National Care Service (Scotland) Bill was introduced to Parliament on 20 June 2022.

The Scottish Government has committed to establishing a functioning National Care Service by the end of this parliamentary term in 2026. The National Care Service will have equality, dignity and human rights at its heart. It will empower people to make the choices that are right for them. You can read about the vision for a National Care Service in the National Care Service: Statement of Benefits

Health and Social Care Standards

The Health and Social Care Standards: My support, my life set out what people should expect when using health and social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights are upheld.

There are five headline outcomes:

1. I experience high quality care and support that is right for me.

2. I am fully involved in all decisions about my care and support.

3. I have confidence in the people who support and care for me.

4. I have confidence in the organisation providing my care and support.

5. I experience a high quality environment if the organisation provides the premises.

Within these headline outcomes the following standards are relevant in terms of individuals human rights:

1.1 I am accepted and valued whatever my needs, ability, gender, age, faith, mental health status, race, background or sexual orientation.

1.2 My human rights are protected and promoted and I experience no discrimination.

1.37 My meals and snacks meet my cultural and dietary needs, beliefs and preferences.

2.3 I am supported to understand and uphold my rights.

4.1 My human rights are central to the organisations that support and care for me.

4.4 I receive an apology if things go wrong with my care and support or my human rights are not respected, and the organisation takes responsibility for its actions.

National Carers Strategy

The National Carers Strategy was published in December 2022. The Strategy recognises the diverse experiences of carers and sets out a range of actions to ensure they are supported fully in a joined up and cohesive way. It brings together existing initiatives and new approaches, and proposes new and better ways to support carers. It seeks to reflect both the diversity of careers' experiences and their lives beyond caring to avoid pigeonholing people as carers and nothing else.

The key themes of the strategy intend to put the individual carer at the centre and focus on five different aspects of unpaid carer support:

• Living with COVID-19
• Recognising, valuing and involving carers
• Health and social care support
• Social and financial inclusion
• Young carers

Children and Education

Section 2 of the Chronically Sick and Disabled Persons Act 1970 is effective in Scotland through the Chronically Sick and Disabled Persons (Scotland) Act 1972. It applies to any disabled child to whom section 2 of the Children (Scotland) Act 1995 applies.

Sections 22 and 29 of the Children (Scotland) Act 1995 also place a duty on local authorities to provide services that promote and safeguard the welfare of children.

The Education (Additional Support for Learning) (Scotland) Act 2004 introduced a single structure for meeting the needs of children who require additional support to ensure they can make the most of their education. This ensures that education authorities identify, provide for and review the short or long term additional support needs of their pupils, as a result of the learning environment, family circumstances, health, wellbeing needs or a disability.

This was amended by The Education (Additional Support for Learning) (Scotland) Act 2009 and the subsequent Additional Support for Learning: Statutory Guidance 2017.

Education authorities have duties under the Equality Act 2010 to actively address inequality, prevent disability related discrimination and make reasonable adjustments for disabled pupils.

Under the Education (Disability Strategies and Pupils' Educational Records) (Scotland) Act 2002 education authorities also have duties to develop and publish accessibility strategies to increase pupils access to the curriculum, access to the physical environment of schools and improving communication with pupils with disabilities.

Getting it right for every child (GIRFEC) is the national approach in Scotland to improving outcomes and supporting the wellbeing of our children and young people by offering the right help at the right time from the right people. It supports them and their parent(s) to work in partnership with the services that can help them. The first version of the policy was published in 2008 detailing the practice model. The principles of the approach were then brought into law in the Children and Young People (Scotland) Act 2014. The aim of the Act is to put children and young people at the heart of planning and delivery of services, and ensuring their rights are respected across the public sector.

The United Nations Convention on the Rights of the Child (UNCRC) includes 54 articles that cover all aspects of a child life, from birth to 18 years, and sets out the rights they are entitled to.

Article 23 states that:

A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support disabled children and their families.

In addition, Article 12, states that:

Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously.

The Children and Young People (Scotland) Act 2014, the principles of GIRFEC, and the UNCRC, all underpin the development of 'Ready to Act' which is the first Children and Young People's (CYP's) services plan in Scotland to focus on the support provided specifically by Allies Health Professionals (AHPs).

The main aim is to work collaboratively and in partnership with children and young people, parents, carers, families, stakeholders and communities to understand what is needed to improve well-being outcomes.

Adaptations & Home owners

Local authorities currently have powers and duties under the Housing (Scotland) Act 2006 to assist home owners in certain circumstances, including assistance to adapt the home for a disabled person.

This updates previous arrangements under the Housing (Scotland) Act 1987, and includes a system of financial assistance with a wider range of structural adaptations attracting a mandatory grant of at least 80% of the cost of the work, and 100% for those applicants in receipt of certain income replacement benefits. The Scottish Government provided guidance on this in the Implementing the Housing (Scotland) Act 2006, Parts 1 and 2: Statutory Guidance for Local Authorities: Volume 6 Work to Meet the Needs of Disabled People.