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The Council entered into a contract with Inspire Community Trust (Inspire) in February 2005 to operate an Independent Living centre and to improve services for people with physical and sensory impairments in line with a Best Value review undertaken between April 2002 and July 2003. The transfer of the Integrated Community Equipment Service (ICES) to Inspire will be in keeping with the Best Value review outcomes. It will also enable the service to be developed in line with the Directorate’s Change Programme and in particular ensuring appropriate preventative services, by way of equipment for daily living requirements, are available to those clients not eligible for Adult Social Care services. This short paper is intended to complement the proposed consultation process on these changes. It describe the changes envisaged and seeks any further comments or suggestions on how the services are developed. 2. Background

The outcomes of the Best Value review of physical and sensory impairment services were reported to the Cabinet member for Social Care and Health in July 2003. A total of 85 recommendations were made and the following recommendations were summarised as the key outcomes:              Adoption of an Independent Living Centre model for future service provision Further exploration of service procurement options (i.e. partnering or creation of an independent trust) Revision of the Council’s Physical Disability Strategy into a commissioning strategy Integration of physical and sensory support team management to improve coordination Improve communication and provision of service information Improve transport and accessibility of services Improve rehabilitation services and equipment provision Promote and improve social inclusion for people with physical and sensory impairments Improve disability awareness training and communication skills for key staff Improve partnership working and co-ordination with health and voluntary sector organisations Improve assessment & care management through development of the single assessment process Improve respite care and services for carers through development of counselling & advocacy services Improve employment opportunities through special support and vocational training


Since then, Inspire has established itself as a credible and financially robust Social Enterprise organisation and has been developing and delivering services in accordance with the service specifications agreed with the Council. One of the key issues initially has been to develop accommodation for integrating services on one site and move staff from Council premises to Inspire at 20 Whitehall Lane to provide a range of services, which include:           Information and advice Advocacy and support with communication Assessment of daily living skills, training and rehabilitation and organising equipment Day services and short breaks “have a go” accommodation Administration and support with Direct Payments Physical disability registrations Transport related advice and support (Blue Badges, Freedom Passes, Taxi Cards etc.) Employment and training support services Support for young people, disabled parents and carers Raising awareness and changing attitudes

Having successfully developed the accommodation for the provision of integrated services by transforming the existing Whitehall Day Centre premises that were previously used just for day services Inspire is now looking to develop further services on the Whitehall Depot site, in partnership with Bexley Council and other relevant organisations. The following specific service areas which were recommendations of the original Best Value review link to this latest development: Rehabilitation services and equipment Explore with the Health Service the possibility of developing community based facilities at Whitehall Day Centre, including:  Physiotherapy, Occupational and Speech Therapy services; and  a wheelchair service, which will provide basic practical information on models and allow user testing Liaise with the Health and Social Care equipment providers to improve the equipment service for people with physical and sensory impairments by:  Provision of greater transparency around the eligibility criteria for equipment, aids, and adaptations  Provision of equipment at Whitehall Day Centre to allow for demonstration and users to try equipment before installation and be able to return unused items easily  Improving the arrangements for users to return unsuitable/unused items of equipment  Improving the response times in relation to the provision of large items of equipment (e.g. showers, stair- lifts etc)

Liaise with independent suppliers to provide a range of aids and equipment for demonstration purposes at Whitehall Day Centre. Linked to the above was the approval by the Leader of the Council in January 2005, when the contract with Inspire was formerly agreed, to consider the use of the former Whitehall Lane Depot site, which is adjacent to the Centre, for use by Inspire. This land was surplus to Council requirements and awaiting disposal and Inspire had expressed an interest in acquiring a lease of the site. The proposals indicate how this land might best be utilised given the above aspirations. 3. Equipment services

The National picture Over the past eighteen months or more the Government’s “Transforming Community Equipment Services” Team (TCES) has been advocating a national system of equipment distribution using regional and local bases from which to issue equipment and also giving choice to clients, not only in terms of suppliers but also looking at “Topping Up” options and issuing by a prescription system. Such services have been trialled in three locations, Cheshire, Manchester and Oldham but as yet no one model has evolved. It should be noted that the pilots were carried out in areas where such services were not as good as in Bexley and therefore some of these results would have been expected. An evaluation of the pilots completed in May 2008 by MORI considered the following objectives:      Identifying the types of aids which patients are using; Investigating levels of satisfaction with all stages of the pilot process from assessment to receiving the equipment or aid; Gauging levels of satisfaction with individual retailers; Investigating take-up and desire for “choice” in the system through topping-up prescriptions; and Levels of advocacy among users for the pilot system

The results of the evaluation were summarised in the report as follows: Satisfaction With The Pilot System The headline results of the survey are very positive. Users are satisfied with the overall service that they are receiving, as well as having high levels of satisfaction with each stage of the prescription process. The responsiveness of the staff, the speed of the service and the quality of the health equipment or aids are the most commonly mentioned factors for users’ satisfaction with the pilot system. Satisfaction with the individual retailers shows similarly positive results with users broadly very satisfied with the service that they have received as well as the time taken for their equipment or aids to be delivered. The System’s Reputation The reputation of the pilot system and the individual retailers used is currently


good. The high level of satisfaction, among users of the service, has clearly transferred into a positive reputation for both the system and retailers. Indeed, many users would speak highly of the service and retailers to others. A Desire For Choice There is an appetite among users for the system to offer choice and flexibility. Most users feel that it is important for them to be offered a choice when it comes to the equipment or aid they will use, as well as a choice in the individual retailer that fulfils their prescription. While desire for choice is high, awareness of the choices which are available within the pilot system are limited. The recommendations coming out from the report included:  improving the time taken to deliver equipment, the sample indicated over 20% of users waiting more than a week  Improving publicity around choice and alternative options such as topping up and prescriptions. The local perspective Bexley prides itself in having an efficient and cost effective service for assessment and delivery of both social and health care equipment. Both the national changes advocated and the local Change Programme require this service to move forward in order to give choice, improve outcomes and widen the service to residents that are not eligible for services from the Council but nevertheless can be offered support indirectly possibly through the third sector. One option for the future would be to subscribe to the national scheme, still only at pilot stage. There are two key areas of concern with this approach (a) information recently released on charges for equipment by retailers using this model show that they are higher than current costs being paid by Bexley and (b) more importantly, the limited scope for recycling of equipment which in Bexley runs at between 65% to 70% of equipment issued. It is therefore considered that moving to such a system could be significantly more expensive to Bexley. The alternative is to enhance the current service in line with the national system. A recent survey of London Boroughs has revealed a very low desire at present to consider the national system. This includes neighbouring authorities that have not shown a willingness to consider the new approach. Current developments by Inspire Inspire has taken a number of steps to create an equipment demonstration unit in the short term and to meet service users’ needs and it aims to continue its endeavours to create an ICES in the borough in partnership with Bexley Council. Phase 1 Inspire has created a room within its existing Independent Living Centre (ILC) accommodation for:  Providing information regarding equipment for independent living

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Facilitating self-assessment for equipment Demonstration of a range of small equipment Providing catalogues and online information regarding available equipment that may benefit service users for promoting independence

In addition Inspire is also in the process of transforming the assessment/training kitchen, bathroom, shower room and toilet areas within its existing accommodation to maximise its use for service users other than those who attend the ILC for day services. These areas will provide a range of kitchen, bathing and personal care equipment. This phase will:   enable Inspire to meet the needs of the community regarding physical and sensory impairment equipment self-assessment and trail of equipment by individuals, who in the short term while endeavours for further development and enhancement of equipment services continue.

Phase 2 Phase 2 will incorporate further enhancement to the space for assessment, demonstration of equipment and training for independent living skills by undertaking refurbishment of the accommodation acquired by Inspire following the closure of the meals-on-wheels kitchen at Whitehall Lane. The proposal is to free up the existing day services lounge and/or activities areas by recreating these in the accommodation previously occupied by the meals-on-wheels kitchen thus providing sufficient space and continuity of service for day services users. The enlarged areas will offer opportunity to:  widen the range of equipment available for assessment by professionals and trial by individuals interested in self-assessment, from small to large equipment such as orthopaedic/high chairs, recliner chairs, mobility equipment, stair-lift, through-floor lift etc. individuals to purchase their own equipment, if they do not fulfil the Council’s FACS criteria or if they choose to do so, using their own resources or direct payments. The way forward



Given the original desire under the Best Value review to enhance these services broadly in line with Government recommendations and the changes required to satisfy the Council’s Change Programme including moving to Individual Budgets there does appear to be a local solution. It is therefore considered that the existing Integrated Community Equipment service, which incorporates Health equipment, transfers to Inspire and is developed in line with current policy. As part of this process it is also recommended to seek authority to grant a long lease of the land comprising the former Council Parks Depot in Whitehall Lane, Erith to Inspire to enable them to construct a warehouse with offices to replace accommodation


currently provided by the Council in the Thames Road Depot, for the Integrated Community Equipment Service. The current accommodation is just adequate in terms of space, but is not ideal in terms of its location and is not easily accessible for people wishing to collect or return equipment. Moreover, siting the store along with services being developed by Inspire around demonstration facilities, assessment and supply options would improve efficiency and flexibility of the service. The move to Inspire Community Trust will also open up alternative service developments including expansion of a retail model, which might require more appropriate locations within the Borough. Also envisaged is an outreach service possibly using existing sites such as libraries or having a mobile vehicle appropriately fitted out. All these changes will fit very neatly into the phased approach for developing services on the Whitehall site. 5. Responses to this consultation

Your views are sought on the following aspects of this proposal: 1. Given the Best Value review recommendations and the proposed changes as set out above – do you consider this to be the best approach to enhancing these services. If not what alternative options would you propose If you agree in principle (a) What additional areas would you want to be considered (b) What would like to see altered or removed from these proposals Do you have any further comments to make or any involvement you might wish to have in developing these proposals

2. 3.


Responses to: Mr Keith Francis – Acting Lead Commissioner Social & Community Services Consultation ends: 28th August 2009

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