Community equipment and housing adaptations: draft guidance

Prevention, Early Intervention, and Self-management

Helping people to help themselves, understand and manage their conditions, and make informed choices which help minimise any potential future crisis, is critical to achieving the objectives set out in the National Health and Wellbeing Outcomes.

The promotion of Self-management is a crucial basis for the future of effective health and social care provision. The aim is to support people to make their own choices and decisions at the earliest stage, and maximise their opportunities for control and ownership, minimising the need for input from services.

If we are to effectively engage with people earlier, we have to move the conversations away from service responses informed by 'criteria' and 'eligibility'.

The focus needs to be on:

• simple engagement in the form of effective conversations, which helps holistically identify the issues;
• assistance, provided with the lightest of touches, and;
• ensuring the person is taking the lead in understanding and addressing any actions required.

Services should review their strategies, policies, and existing operational arrangements, to ensure they can help people maximise their own independence. A number of partnerships are developing new service models with this intent, and recognise that this requires a whole system approach which addresses, not just current service models, but the cultural attitudes and behaviours, within our services, as well as the general public, which sustain the current arrangements.

Work around the Rehabilitation Framework^[1] will help underpin the new approaches, and has highlighted the importance of engaging with people much sooner, and offering simple advice and signposting which will enable the person to better understand how best they can support themselves.

There are also simple mechanisms which can support prevention, early-intervention and self-management: A number of partnerships have worked with charitable or commercial organisations, or developed their own in-house solutions to assist people to be able to self-manage and self-assess their needs and make informed choices.

For example, East Lothian have developed their HILDA tool and, Borders HSCP and the Equipu Partnership have worked with the Disability Living Foundation (DLF) to customise their Ask Sara Tool, to provide this as an important development to their early intervention, and self-management service pathways.

The Equipu Ask Sara tool allows people to self-assess their needs, and provides a range of information and guidance related to equipment and adaptations, but also wider housing related needs, helping people to think about the impact their environment has, and planning for their future requirements, and options that may be available. There is a link to the DLF 'Living Made Easy' part of the wider website which provides access to more than 10,000 products and 950 national suppliers, supplemented with over 800 local retailers, which allows people to purchase items recommended by the online assessment.

In East Renfrewshire HSCP, colleagues have utilised the customised (Equipu) Ask Sara tool, to support new community models e.g. their Rapid Access, front door service response. They have also used it to review their waiting list, and are supporting their co-production, community based organisations and volunteers to promote the use of the tool as part of their Talking Points approach, supporting early intervention and prevention. They have planned some engagement with GP surgeries, and have been able to evidence some reduction in people being referred on, into the services.

In a similar approach, Aberdeen City, Bon Accord service, have developed their own in-house website, to help support people to make their own choices and manage their needs independently.

Following an initial retail project based within one of their local independent living centres, Aberdeen City developed a retail website offering a range of equipment which was not part of the eligibility criteria, which was launched in Sept 2020 –www.equipmeforliving.co.uk. Working closely with suppliers, the service has developed the website to provide access to a wide range of products including mobility, personal care, eating and drinking, seating, kitchen and household products. The website allows customers to buy directly or make contact for any specific advice they may require, and delivery within Aberdeen for the items in stock is free and usually the next day. Larger mobility aids are on display in one of their local centres and customers interested in these can make an appointment with an OT and receive a professional assessment, trial the products, and purchase these there and then with a Point of Sale system in place. They also offer a servicing plan for relevant products, and are considering expanding the service to offer a rental service for short term loans.

Approaches such as these described above, can also help assist with 'healthcare literacy', which has been one of the key issues highlighted as a barrier to supporting people to better understand their condition(s), and then to help them, help themselves.

It is critical that our services support measures to promote better access to quality information, and effective methods of sharing of information, which help people explore and understand their options, and manage their conditions, as part of early intervention strategies.

Key Actions

• 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.