Community equipment and housing adaptations: draft guidance

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.

Scotland's population is ageing. The number of people aged 75 and over is set to increase by 85% by 2039. It means that, by then, over 800,000 people will be over the age of 75. This has implications for the services we deliver. More people are also living longer with complex conditions, from childhood into adulthood, and our services need to support these needs in a seamless way. Supporting as many people as possible to continue to live in their own home, also crucially depends on effective strategic & operational joint working with housing partners, to help with the better planning, and delivery of barrier free housing solutions.

The provision of equipment and adaptations, including the opportunities provided by innovative technology, should be an integral part of mainstream housing, health & social care assessment and service provision.

Where this is not already in place, it can result in a breakdown of care, especially during periods of transitions across a wide range of our service settings e.g. from child to adult services, community to prison settings and vice versa, and between hospital and community settings.

It is therefore critical that effective policy, systems, processes, resources and infrastructure, are in place to ensure the seamless provision of equipment and adaptation solutions.

Since the publication of the previous guidance in 2009, service models have evolved, 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 considerable 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 the effective interface with other relevant partners including, housing, education, and prisons.

This guidance recognises the need for more extensive service improvement, which is consistent with the intent and aspirations of the recent review of adult social care, The Independent Review of Adult Social Care, and subsequent proposals for a wider inter-agency, national care service.

• 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 inconsistencies in 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, where ever 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 aim is that this will then 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 in the next section.

Summary of Key Actions

Contribution of Equipment & Adaptations

• 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 within their partnership.
• 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 the consequential impact on meeting wider strategic service objectives across health & social care, and other relevant partner services.
• 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.
• Health and social care partnerships 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.

Assessment & Provision

• Equipment, and adaptations assessment pathways, should be clearly evident in the integrated arrangements for health & social care partnerships, and relevant partners (e.g. housing organisations, education, prison service…), 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, 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 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.
• 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.

Prevention, Early Intervention, and Self-management

• Services should review and challenge their strategies, policies, and existing operational arrangements and service pathways, to ensure they are actively promoting and helping people maximise their own independence.
• Services should implement a range of approaches/solutions, at key stages in the service pathways (E.g. front door services, but also where service users and their families may require support when needs change), across all service settings (hospital and community), to assist people to self-manage and self-assess their needs, and make informed choices.
• Services should support measures to promote better access to quality information, and effective methods of sharing of information which helps people explore and understand their options, and manage their conditions, as part of early intervention strategies.

Unpaid Carers

• Assessors must take account of the views and contribution of carers when assessing the person in need, and fully engage them in discussions about future housing needs, and any associated equipment and adaptations which may support the service user to remain safely in the community.
• Carers must be informed of their right to an adult carer support plan or young carer statement to determine what is important to them and their own support needs, independent of any assessment of the person for whom they care.
• An adult carer support plan or young carer statement must be offered to anyone who provides care for a disabled or older person, or a disabled child.
• Carers should be fully involved in assessment and discharge planning from hospital.

Moving & Handling

• Assessments should evidence the views of the person who requires to be moved and handled and a person-centred approach should be promoted.
• Services should apply a minimum intervention ethos, which aims to maximise a person's ability to utilise functional performance and avoids practice which 'disables' the person and impacts negatively on their potential wellbeing.
• For 'end of life' ensure that services act in line with good practice/policy for those with palliative needs and ensure the service users wishes are central to the decision making, avoiding unnecessary equipment provision.
• Ensure that a wide range of professionals are able to assess for and provide moving and handling equipment as required, either to support hospital discharge and/or as part of the service they are providing.
• Services should ensure they avoid arrangements which encourage duplication in the assessment pathways and inappropriate onward referrals.
• Blanket solutions to moving and handling should not be applied and individual assessment is used to determine the number of carers required to safely move and handle the person, encouraging the use of single-handed care where appropriate.
• Partnerships should review arrangements to encourage good practice recommendations from the Scottish Manual Handling passport which aim to help standardise good practice across Scotland.

Postural Management

• Health & Social Care services should have an aligned strategy and policy, for the provision of equipment which helps support the Postural Management Strategy.
• Health & Social Care services should work with all key stakeholders, and community equipment store service providers, to develop effective arrangements for the provision of Sleepsystems and other relevant products which support effective postural management.

Hospital Discharge

• Health & Social Care Partnerships should utilise the Hospital Discharge Equipment Provision good practice guide, to support improvements in the provision of equipment or discharge.
• Health & Social Care Partnerships should ensure that a range of staff within the hospital can assess and order directly, equipment for 'safe discharge'.
• Health & Social Care Partnerships should ensure that clear pathways are in place to allow hospital staff to refer to relevant community staff for the assessment and ordering of equipment for more complex, ongoing needs.
• All services should avoid over-prescription for patients with standard needs, and agree simple solutions, to ensure a seamless, and safe discharge.
• Services should explore the opportunities to implement a Planned Date of Discharge approach, to improve forward planning for the provision of equipment for discharge

Children & Young People

• The provision of equipment to children and young people, for home and school settings, should be provided in an integrated way, and recognised as an integral part of community equipment service provision, in order to streamline and standardise provision.
• Arrangements for the provision of children's equipment should be jointly agreed, and budgets should be set up in a way which supports direct access to equipment in line with the Education, and health & social care children's services pathways.
• Community equipment services should establish a 'Standard Core Stock for Children' of equipment commonly assessed for by occupational therapy, physiotherapy, and nurse colleagues, for the range of needs most commonly met.
• Relevant local services should clarify responsibility for the provision of solutions not provided via local store services as equipment e.g. Environmental / behavioural solutions. Health & social care services should put in place arrangements which clarify for individual cases, the lead agency/clinician, the funding source, and monitoring arrangements.
• Services should ensure that the views of the child are sought and clearly evidenced as part of the multi-disciplinary approach to any agreed provision.

Care Homes

• Care homes should provide a wide range of equipment to fulfil their obligations to their service users and to their workforce, in line with the national Protocol for the Provision of Equipment in Care Homes.
• Services users who have been confirmed as having an assessed need for specific equipment should not be charged for this essential equipment, and families should not be asked to fund this provision, this includes people who are self-funding.
• Commissioning and equipment service leads within statutory providers should work with their local care home sector to agree the most suitable makes and models of generic equipment, and ensure this equipment is in place.
• These principles should also apply to interim care home models, and day and respite facilities.

Prisons

• Local partnerships should apply the principles of the Good Practice Guide for the Provision of Community Equipment to Prisons as a tool to help them jointly review any current service provision with their SPS colleagues, to streamline and improve the pathways for all equipment provision, and establish cohesive governance arrangements.
• It is expected that the following arrangements should be in place:
  • Robust and consistent assessment pathways with NHS healthcare staff within the prison able to assess and recommend equipment for non-complex needs, and HSCP staff assessing for more complex needs;
  • SPS to fund equipment for long term needs, and HSCP's to fund equipment for short-term loan;
  • Business efficiencies maximised with access to local Store service arrangements for the provision of effectively procured and standardised equipment solution for both long-term and short-term provision.

Wheelchairs

• Health Boards, local authorities and Integration Authorities must have suitable arrangements in place to meet any eligible needs for a wheelchair on short-term loan, for up to a maximum of 6 months, to ensure no gaps in service provision.
• These arrangements must also be monitored, and reported within the Integration Authority.

Communication Aids

• Health and social care services, working with their Adult services and education partners, should use the AAC National Core Pathway and the AAC Good Practice Model, to develop their local arrangements for the provision of AAC equipment, making best use of all local resources, and ensuring a focus on the principles of improving governance, robust systems, procurement, and financial and performance monitoring.

Technology Enabled Care

• Health and Social Care partners, with their Housing colleagues, should work together to maximise the opportunities provided by TEC, developing local strategy and policies, which help people to choose their own digital solutions as part of self-management and earlier intervention approaches, as well as utilising technology to address issues of isolation and frailty. This should include reviewing charging policies to ensure that these are not acting as a barrier in the system, preventing services from supporting those most vulnerable.

Sensory Impairment

• Health & social care services and their community equipment services should ensure that they work with relevant stakeholders and have effective pathways in place which meet the equipment needs of people with sensory loss
• This should include the provision of streamlined access to a core range of appropriate equipment for both hearing and visual impairment.

Integrated service pathways for equipment provision

• Equipment and adaptations should be seen as an integral part of the wider service pathways and their contribution should be clearly articulated in local health and social care strategies.
• Relevant health & social care staff, should be able to access a wide range of equipment appropriate to the type of service they are providing, and not based on professional or agency boundaries.
• Partnerships must have funding mechanisms which ensure that all equipment purchased through the Store service is paid for from the one funding 'pot', with no barriers according to type, or professional use.
• Staff across services who are involved in identifying equipment needs should be trained to assess and provide a wide range of community equipment irrespective of their own professional background. The training should strongly emphasise good assessment practice, and encourage prescribers to consider their reasoning for provision, contraindications, recording of decision making, and encourages avoidance of over-prescription.
• Inter-agency agreements (protocols) should be in place, defining the arrangements between the partners in terms of the roles and responsibilities of staff and their managers, and the processes for assessment, prescription, and provision of equipment.
• Individuals with simple or non-complex needs should be able to access equipment and minor adaptations without the need for a specific professional assessment. This can include models utilising direct access and self-assessment tools.

Community equipment Store service models

• Store service arrangements should be designed to effectively meet the partner objectives, ensuring that the equipment service is strategically aligned across all relevant services to help deliver key aims related to supporting hospital discharge, and effectively maintaining people in the community.
• Store services should be resourced by partners with a funding 'pot' which allows the Service to procure equipment into the service, according to demand, throughout the year, with all equipment funded equally from this arrangement. Costs for the use of the equipment should then be charged to partners according to use by their services, rather than by type.
• Funding model should allow the store service to procure a wide range of standardised core equipment for people of all ages and needs (e.g. including equipment assessed for by all relevant Allied Health professionals (AHP's), nurses, care staff, staff working in Sensory services etc.), with an annually agreed budget which guarantees appropriate levels of funding throughout the year.
• Operational and strategic managers should be clearly accountable for overall expenditure and actively support the store service managers to achieve business efficiencies, as well as providing a responsive and effective operational service.
• Partnerships should utilise the Good practice guide for the provision of community equipment, and the new self-assessment tool attached to this Guidance, to assess current services and ensure their arrangements are in line with the aims of the national guidance.

Health & Safety

• Partnerships should follow the Manual Handling Operations Regulation 1992 which provides a general framework for tackling handling activities at work.
• Health and safety risk management must form an integral part of the care assessment.
• All care workers (including unpaid carers) must be suitably trained in safer handling techniques. It is the responsibility of the employing agency to provide appropriate training for their staff and the assessor/care manager should refer the unpaid carer to relevant support for moving and handling training.
• Care service providers, or employing agencies must ensure that the equipment is in good working order, and that all care workers are aware of and understand the appropriate application and limitations equipment.
• Partners and their store service provider should ensure they have clarified what arrangements they wish to have in place as standard maintenance arrangements for all relevant equipment. It is then the store services responsibility to ensure robust servicing and maintenance arrangements are in place.
• Partnerships should have clear arrangements in place which identify the roles and responsibilities of all stakeholders, in the event of an incident, including reporting to IRIC.
• Store services should have arrangements in place for the circulation of relevant MHRA alerts, and appropriate responses to the alert.

Recycling

• Store services will have in place arrangements which ensure the robust cleaning, and refurbishment of all equipment returned to the Stores service.
• Partnerships and their equipment and adaptation service providers should ensure they maximise the potential benefits from recycling of all equipment, and relevant adaptations, and record and monitor the recycling benefits they deliver, as this information can be used to evidence savings and efficiencies as part of wider budgetary discussions.

Adaptations and Housing Solutions

• A national Adapting for Change Action Plan should be devised to compliment other policy work, and assist partnerships to drive forward the changes recommended from the original Adapting for Change report by the Adaptations Working Group.
• To assist with the practical implementation of the Adapting for Change recommendations, partnerships should implement Housing Solutions change programmes which assist all relevant partners to develop local Protocols, and deliver training programmes, which effectively promote:
  • Early intervention with full exploration of rehousing opportunities;
  • Better planning for the delivery of barrier-free housing and an inclusive design/living approach;
  • Robust joint governance, which provides a clear strategic direction and supports priority setting;
  • Joint finance arrangements which help streamline service improvements (e.g. pooled budgets)
  • Equity in the system, applying a 'tenure neutral' approach;
  • To address barriers in the system, removing the requirement for grant assistance for owner occupiers; the need for occupational therapists to provide an assessment for standard adaptations in housing association properties e.g. shower provision; and encouraging 'direct access' arrangements.
  • Maximising procurement and recycling benefits to help deliver efficiencies.