Equipment and adaptations: guidance on provision - executive summary

Introduction

Health and Social Care Integration

The Public Bodies (Joint Working) (Scotland) Act 2014 (the Joint Working Act) establishes the legal framework for integrating health and social care in Scotland. The Act requires each Health Board and Local Authority to delegate some of their statutory functions, and associated budgets, to their Integration Authority.

Regulations that underpin the Act set out which health and social care functions must be delegated. The provision of equipment and adaptations are functions which must be delegated to the Integration Authority.

Power of Ministers to Issue Direction and Guidance

Under the Joint Working Act Ministers have the power to issue Directions and Guidance to Health Boards, local authorities and Integration Authorities in relation to carrying out their functions.

This guidance is issued as statutory guidance under the terms of Section 53 of the Joint Working Act, and as such Health Boards, local authorities and Integration Authorities must have regard to the advice provided.

Purpose of the Guidance

This guidance covers the responsibilities of NHS Scotland and Local Authorities, Integration Authorities, and their Housing and Education partners for the provision of equipment and adaptations, and replaces all previous guidance on this issue. This updated guidance is issued with immediate effect.

The guidance outlines the responsibilities of all relevant agencies, with the aim of supporting partnerships, across Scotland, to deliver a more equitable and accessible approach to the provision of equipment and adaptations.

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 (and family members providing support and care, but who may not identify as a 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.
• Endorse 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.

Background

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. These document can be found on the Scottish Government blog page.

The aim is to provide a standardised approach for the effective provision of equipment & adaptations across Scotland, to help improve the consistency, quality, and equity of service.

A summary of the Key Actions can be found at the end of this document.

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

The 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 a 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 makeup 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.

Equipment Service User Feedback

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

• Integration Authorities (IAs) should work with relevant partners to capture data which evidences the value, effective and efficient community equipment and adaptation provision makes to the delivery of key service goals.
• IAs 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 e.g Housing.
• IAs 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, Housing, 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.