Community equipment and housing adaptations: draft guidance

Communication aids (Augmentative and Alternative Communication - AAC)

People who have difficulty speaking and who can be assisted by communication equipment have the right to get the equipment and support they need to use it, when they need it, whoever they are and where ever they live in Scotland, enabling them to participate in their communities and be fully included in society.

Vision statement from Guidance on the Provision of Communication Equipment and Support in using that Equipment.

Communication equipment may be used by people who have no speech, who are at risk of losing their speech, or whose speech is not sufficient to meet their everyday needs. The purpose of this equipment is to support a person to communicate in their daily life.

Communication equipment is either 'low-tech' or 'high-tech' and people may require to use a combination of these. The range of equipment may change over a person's lifetime.

Following the publication of the Provision of Communication Equipment and Support: Part 4 of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 the Scottish Government issued guidance on the Provision of Communication Equipment and Support in using that Equipment.

For NHS Boards in Scotland, it became a legislative duty to provide or secure communication equipment and the support in using that equipment. This brings a clear spotlight on the provision of Communication equipment (AAC), and increased urgency to the need for a streamlined and standardised approach to this provision.

• In August 2018, the Augmentative and alternative communication (AAC) National Core Pathway was launched as a reference guide for health boards and all relevant partners in Education, Social care, and the third sector. This supports local partnerships in the development of their own local arrangements, allowing flexibility in the implementation. It specifically highlights the importance of clarity on the processes, and roles and responsibilities in the procurement of equipment, with the aim of streamlining service provision and delivering much improved transparency.
• In most cases, across Scotland, Community Equipment Store services have been integrated within the new HSCP (Health & Social Care partnership) Integration models. It may be possible that further opportunities exist, working in partnership, to utilise the resources, experience, and systems that these services offer, particularly in relation to procurement and asset management, for the provision of communication (AAC) equipment.
• There are also existing good practice models which have evolved in line with local service arrangements between Education and Children's services, and exemplify joint working approaches with all relevant agencies, and these offer examples of good practice to build upon.

Therefore there is not one model which is recommended. Rather, the aim is to develop local arrangements which focus on the principles of improving governance, systems, and financial and performance monitoring, which in turn help improve the service for people of all ages who need this equipment.

Approaches should be flexible and inclusive, creating the opportunity for standardisation of provision, adhering to common principles, and exploring what that might look like, recognising the wider breadth of partners and agencies involved in supporting people of all ages in our communities. In particular, Education partners have a significant role in supporting the effective use and provision of appropriate communication aids to children.

Agencies providing support for people using communication/equipment should have a robust system for equipment management (this should include the communication equipment as well as any access and/or mounting equipment used). Equipment management relates to a range of services, systems, processes, and procedures that support the provision of the relevant equipment.

It is important that local partners jointly identify the most effective model, which best suits their local arrangements, to achieve these aims:

The Model framework diagram, outlined below, was developed by colleagues engaged in the development of proposals to help deliver the requirements of the AAC Guidance.

Effective Procurement

• providing the opportunity for a broader procurement strategy that helps supports standardisation of the provision of commonly provided products and more specialist equipment, and offers transparency and efficiencies around these business processes.

Asset Management

• including the maintenance of an IT system and database, which monitors activity relating to prescribing, loans, recycling, and equipment usage to support the review of core provision and replacement/removal of products as required.

Financial monitoring & reporting

• providing regular, standard reports which summarise activity, types of provision, and all costs associated with the provision of the service e.g. not just equipment expenditure but all relevant resource costs

Health & Safety

• Compliance with Health & Safety legislation (e.g. PUWER / LOLER)

Decontamination and infection control

• Repair, refurbishment, and recycling (incl. resetting and depersonalisation)

The aim is to assist partnerships to have an integrated, comprehensive, and structured approach to the provision of this equipment which effectively makes best use of all partner resources, and provides robust governance and strategic direction. This provides an infrastructure which supports and compliments the AAC National Core Pathway.

The template uses the example of the good practice approach by Fife Education and Health & Social Care partners to help illustrate potential application. Whilst providing a framework around the principles of the recommended approach, it also offers flexibility in the detail of local implementation.

FAACT (Fife Augmentative & Alternative Communication Team) Structure & Principles Good Practice Example

Governance

• Joint Governance with input from all agencies.
• Written protocol defining responsibilities
• Integrated funding arrangements and robust reporting.

• Advisory Group: Includes managers from each of the 3 funding organisations, Speech & Language Therapy (SLT) and teacher from FAACT. Group oversees budget and work together to provide strategic direction for the service. Meets quarterly and ongoing email communication between meetings.
• Funding: Integrated funding pot from Education and the HSCP.
• Monitoring and Reporting: Advisory Group reports to the clinical lead in SLT and the Education manager, with strategic lead on additional support needs. Expenditure is monitored by the FAACT Team and reported quarterly to the Group.

Service Delivery Model

• Integrated approach with all partners supporting specialist resources and clarity of service scope.
• Strategic and operational model of service delivery with best use of wider resources supporting targeted and universal intervention.

• Resources: FAACT are a dedicated team with specialist teacher (0.5), Speech & Language Therapist (0.6) and technician post (0.6). Roles are interchangeable between the teacher and SLT, working across all are groups.
• Service scope: Delivers services to children, adults with acquired and progressive conditions, and adults with a learning disability.
• Role: FAACT applies the model of supporting individuals, carers and staff through the levels of universal, targeted and specialist needs. They do this by raising awareness, building capacity of carers and staff to better support AAC needs without need for specialist intervention, and providing specialist support when required.
• Assessment Pathways: Individuals in the wider workforce are trained to identify communication issues and advise colleagues on support and onward referral, as required. Generic SLTs carry out early AAC assessment and interventions using toolkits, and FAACT carry out specialist assessment for a device, if required.

Equipment Provision

• Standardisation of procurement with transparency and evidence supporting business efficiencies.
• Best use of IT systems and processes for ordering and asset management of equipment.
• Best use of resources to support set-up and installation.
• Effective systems for the maintenance (H&S), repair, decontamination and recycling of equipment. Reporting of this activity and its impact on provision.

• Procurement: Whilst having an agreed set of providers and products, staff can order individual items to suit clients. FAACT use Enterprise Resource Planning (ERP) to procure and order equipment.
• Ordering: Laptops and IT equipment are ordered by FAACT via Fife Council's First Contact system. Other items are ordered, delivered and paid for by the clerical team.
• Installation & Provision: FAACT technician will support the programming, preparing and setting up of equipment. FAACT will ensure knowledge and skills are in place to support the use of devices supporting individuals, carers and staff.
• Asset Management: FAACT keep a log of equipment by retaining orders and invoices. Equipment is issued to clients and recorded via the loan agreement.
• Health & Safety: Compliance with PUWER and Health & Safety at Work Act 1974.
• Repairs: Repairs are logged and often carried out by the FAACT technician. Products bought with warranties are returned. Some equipment (e.g. laptops) will be scrapped if older or not repairable.
• Decontamination & Recycling: FAACT technician will decontaminate and recycle equipment which will be flattened and re-spec'd.

Key Actions

• 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 for the procurement and storage of equipment, and ensuring a focus on the principles of improving governance, robust systems, procurement, and financial and performance monitoring.