Equipment and adaptations: guidance on provision

Assessment & provision

Assessment pathways

To enable the delivery of person centred, outcomes focused, and streamlined service provision for all ages, it is essential that the governance, and delivery of equipment, and adaptations (for children and adults), are effectively incorporated into the integrated arrangements for IAs, and their relevant partners, including Housing, Education, and Prisons.

In the context of the National Health & Wellbeing Outcomes, services should be able to evidence that the operational arrangements reflect a focus on prevention and anticipatory care, avoiding inappropriate admissions to hospital or long term care settings, and promoting independent living and self-management, as key to improving health and wellbeing.

It is important that clear links are established between health & social care, education (both school and post school), and housing partners, to develop and embed these principles within their service pathways. Links also need to be established with external providers of care services, such as housing and support providers, the residential childcare sector, care home sector, the care at home and housing support sectors, and the third and independent sectors.

Assessment Principles

Good assessment practice is fundamental to the provision of effective equipment and adaptations services. This should be in the context of promoting independence, and should balance risk with the need to maximise functional potential and avoid over-prescription.

Equipment and adaptations can support a range of needs and complement interventions including rehabilitation and the management of conditions, and should be viewed as integral to the delivery of wider service objectives.

• Service users and their carers require to be fully involved in all aspects of the assessment process and it is essential that there is a person-centred, personal outcomes focus.
• Early intervention and prevention must be the key focus to avoid the need for crisis response at a later date. This is particularly important for those with long-term and progressive conditions.
• Engagement should be on the basis of 'good conversations', with the assessor utilising the skills needed for anticipatory care planning discussions, with clear goals identified, agreed, and recorded, and the provision of the equipment and adaptation solutions, understood as a 'means to an end', rather than being 'an end in itself'.
• The principal of 'minimum intervention, in order to help people achieve, where ever possible, maximum independence', should underpin the assessment, and alternative methods of managing, been fully explored.
• Positive risk-taking must be embraced and engaged with to allow assessors to support individuals to achieve their full potential. The RCOT publication Embracing Risk, Enabling Choice supports this approach.

In terms of housing and adaptations, it is critical that all our agencies, and a wide range of staff, recognise their responsibilities in supporting people at the earliest possible stage to consider their longer term needs, with early consideration of alternatives to adaptations, which may provide a better long-term solution e.g. a move to more suitable housing. This type of 'Housing solutions' approach, should evidence that our services are working in partnership with the person, empowering them with information and options to enable them to think and plan ahead at a time when they are able to do so.

It is also necessary to remove any barriers in the assessment pathways, ensuring that direct access opportunities are maximised, for standardised equipment and adaptation solutions where needs are straightforward and non-complex.

The assessment process should also take into account the principles of the Health and Social Care Standards. The following Standards are relevant to the assessment process:

• I am accepted and valued whatever my needs, ability, gender, age, faith, mental health status, race, background or sexual orientation.
• My human rights are protected and promoted and I experience no discrimination.
• I am supported to understand and uphold my rights.
• My human rights are central to the organisations that support and care for me.

The next section in this document focuses on the types of models and service responses that can support prevention and early intervention strategies, and some of the approaches services have implemented to offer self-assessment and direct access pathways.

Individuals will have widely different attitudes and experience of illness, impairment or disability. This can be influenced by a number of factors including the person's own life experiences, the attitudes of those around them, and the availability of accessible information, services, and opportunities. For many, it is the environment they live or work in that is disabling.

It is therefore essential that our services apply the principles of the social model of disability, ensuring an approach which addresses the barriers created by society and our systems, rather than the focus on the impairment of an individual.

The ability to read and write is seen as a basic human right. For individuals with a sensory impairment or communication needs, access to equipment to enable them to achieve or maintain this function should be given a high priority.

It should also be recognised that many solutions for people with a visual impairment or Dementia may not require a piece of equipment or major structural changes to a person's home, and instead, improvements such as lighting, colour schemes, and layout should be considered. It is therefore essential that staff have a good understanding of the way different conditions can impact on a person's needs, and the wide range of solutions that are potentially available to support these. A good Practice Guide in Design for Dementia and Sight Loss is available from the Dementia Services Development Centre.

Additionally, Scottish Government have provided funding to develop accessible training resources in the form of 3 e-learning modules on deaf awareness, sight loss awareness and dual sensory impairment, recognised by NHS Education Scotland (NES). These training modules are available to anyone on the NHS Education for Scotland website. Whilst aimed at professionals in the health and social care sector, these modules can be accessed by anyone by registering and creating a username and password.

A guide on activities and care for people living with dementia and sight loss has also been developed. The guide is based on learning from a Sight Scotland Rights Made Real project funded by the Life Changes Trust, and their Dementia and Sight loss guide.

Person-centred, outcomes focused approach to assessment will identify the desired outcomes for the individual and support individualised interventions, including, where appropriate, equipment and adaptations. This should also be reflected in the services provided for children and young people where equipment and adaptations can play an important role in maximising development and potential.

Self-directed support in Scotland is part of the mainstream of social care delivery, targeted at empowering people to make their own choices about their support. Self-directed support encompasses what has historically been called direct payments, but can include personal budgets, and other forms of control and direction on how support is provided. It allows an individual more flexibility, choice and control over the support they receive, and promotes confidence and wellbeing for those with an assessed need.

A new Framework of Standards for Self-directed Support (SDS) was jointly agreed with COSLA and published in March 2021. The aim of developing the Standards was to help support the consistent, implementation of the Social Care (Self-directed Support) (Scotland) Act 2013.

To clarify if an SDS approach is the best outcome, it is important that, when services are supporting an individual to secure equipment and adaptation solutions, as part of wider interventions, that the person is provided with information and advice which explores all considerations..

Issues associated with the need to replace/renew equipment in response to changing needs, and systematically maintain equipment to meet health and safety legislation need to be considered. Often direct provision from an efficient community equipment service can meet the required needs most effectively, and ensures that equipment can be maintained, replaced, and effectively recycled when no longer required.

'Out of Area' Equipment provision

Equipment is provided through most community equipment services on a loan arrangement and should not be removed from the service. If a service user is moving out with the boundary areas of the community equipment service, it is important that arrangements are put in place to provide replacement equipment, and support a seamless transition for the service user and their family.

This should ensure that appropriate equipment can be provided in the receiving authority, and any ongoing assessment, and provision, maintenance and repair of required equipment can be met responsively by local services. The responsibility for funding this will be determined by whether the move is a permanent one, or temporary. This is in reference to the Scottish Government Guidance: The Recovery of expenditure on accommodation and services under section 86 of the Social Work (Scotland) Act 1968 published June 2015:

• When a service – user is permanently moving out with the existing partnership area, the care manager/practitioner lead, should liaise with the service-users new HSCP, to arrange for the receiving authority to assess and provide equipment as required, from their local community equipment service.

The service-user's needs become the responsibility of the HSCP they have moved to.

• For temporary moves e.g., foster placements, student placements, and circumstances where the service user remains the client of the placing authority, then the process should be as above to refer the child/adult to the local HSCP services, so that their needs can be responsively met within that locality.
• However, the funding for any replacement equipment and any ongoing costs for repair/maintenance, or new equipment needs, should be met by the placing authority. Section 86(1) of the 1968 Act provides that any expenditure incurred by a local authority in respect of a person who is ordinarily resident elsewhere, can be recovered from the local authority of ordinary residence

Highly specialised needs - In exceptional circumstances equipment can be transferred with the service- user, (e.g., where an item is bespoke (not off-shelf) and manufactured specifically for that individual, and therefore can't easily be replaced).

• For permanent moves, the original equipment service provider must ensure that financial reimbursement is secured from the out of area, new HSCP, for the equipment that has been transferred, and the receiving authority would take responsibility for that equipment for any ongoing maintenance.
• For temporary moves, the arrangements would be as above, with any ongoing costs for repair/maintenance for the highly specialised equipment, or new equipment needs, being met by the placing authority. The equipment would remain the property of the placing authority and should be returned if no longer required.

Key Actions

• Equipment, and adaptations assessment pathways, should be clearly evident in the integrated arrangements for health & social care, and relevant partners (e.g. housing organisations, education, prison service etc.), supported by robust governance arrangements.
• Operational arrangements for the assessment and provision of equipment and adaptations, should reflect a focus on prevention, early intervention, and anticipatory care, avoiding inappropriate admission to hospital or long term care, and promoting independent living and self-management as key to improving health and wellbeing.
• Service users (children and adults), and their unpaid carers, should be fully involved in the assessment process. There is a person-centred, personal outcomes focus to the assessment with clear goals identified, agreed, and recorded, and the provision of the equipment recognised as a 'means to an end', rather than being 'an end in itself', with the principles of the social model of disability informing practice.
• The principal of 'minimum intervention, maximum independence' should underpin all assessments, and alternative methods of managing, should be fully explored supported by Rehabilitation and reablement interventions as appropriate.
• Staff should have a good understanding of the way different conditions can impact on a person's needs, and the wide range of solutions that are potentially available to support these, with the assessment pathways recognising, and helping deliver, solutions which support mental well-being, as much as physical needs.
• Services should have clear policy and processes to support service users moving from one service boundary, to another, to ensure a seamless service.