Transforming Community Equipment and Wheelchair Services programme by hcj


									Transforming Community Equipment and Wheelchair Services programme – a
CSED workstream

           Community Equipment – a vision for the future
The Transforming Community Equipment and Wheelchair Services (“TCE&WS”)
Programme was asked to develop a new model of service delivery that puts users and
carers at its heart.

We worked in collaboration with 266 stakeholders including, users and their carers, local
authority and health practitioners, current providers and suppliers, the third and private
sector, representatives of voluntary organisations and professional bodies. We also
worked with 11 councils and their health partners to understand the current service.

The model has been developed to „outline business case‟ level. This means that the
model, at the current level of design:
    is seen as broadly the right solution by the majority of stakeholders; and
    has been developed to a sufficient level of robustness to demonstrate that further
      investment in resources is worthwhile.

There is still a lot of work to do and at the moment, we do not have all of the answers.
Ivan Lewis, the Minister for Care Services, has approved the next phase of the
programme. We are looking forward to working with all partners to understand how the
model can be turned into reality.

What is the model?

The model is a retail solution and proposes that state bodies issue users and carers
where there is an assessed need with a „prescription‟ that can be exchanged for free
equipment at an approved/accredited retailer.

The model also proposes encouraging the development of new Independent Needs
Assessors who can assess an individual to determine not only what equipment may help,
but who can also provide other skills e.g. additional therapeutic intervention or other
supportive services and advice.

Finally, the model proposes to help all users and their carers access clear information so
that they can understand what is available in their locality and where to find. The
information will be standard across England, with clear signposting. The information
standard is intended to supplement information available locally. The proposals in
relation to information include access to a web-based information portal that will support
a web-based self-assessment tool.

The model is not mandatory. Councils and their health partners will decide whether the
model is the right solution for their local population.

Who are users?

Users and their carers are:
    Adults and children who currently receive state provided community equipment

In addition, we believe that there are some people who either choose not access state
provided community equipment or would prefer not to if they had a choice. There are
also those who are not entitled under locally agreed eligibility criteria in accordance with
Fair Access to Care Services Guidance to access equipment provided by councils.
There are also those people who are entitled to community equipment but want products
not currently provided by the state.

Who are the state bodies?

They are those councils and NHS bodies who currently issue free equipment as part of
providing care services and health support in the community.

What will the ‘prescription’ entitle users to?

The „prescription‟ will enable users and their carers to obtain the equipment that they are
currently entitled to receive and they will not have to pay for that equipment.

It is proposed that users and their carers will receive equipment from a national catalogue
– a catalogue with details of nationally agreed products and prices. If they would prefer
equipment not on the national catalogue, they can „top up‟ the „prescription‟. This means
that the „prescription‟ could form the state contribution to the cost of purchasing the
equipment the individual feels they would prefer to have. For example, a prescription
issued for a raised toilet seat: the individual prefers to have the toilet seat in a colour to
match his or her existing bathroom colour. The national catalogue currently only supplies
a white raised toilet seat. The catalogue price for the white seat can be „topped up‟ by
the individual so that they can buy a seat in the colour of their choice.

What is an approved/accredited marked retailer?

An approved/accredited retailer is a retailer that employs staff (both sales and installation
staff) who are trained to a minimum competency level. We think that retailers are likely to
offer to sell and to install equipment. We think that there could be a wide range of
services offered as each approved/accredited retailer responds to local population needs.

The private sector and some third sector organisations currently retail community
equipment. Assist UK is a network of Disabled Living Centres. We think that there is a
real opportunity for them to move into retailing the equipment that they currently only

Who will be an Independent Needs Assessors?

We think that these are likely to be professionally qualified people, probably, occupational
therapists or physiotherapists who will be able to offer an independent assessment of
equipment need to those individuals who are unable to or choose not to access state

We think that a wide range of different organisations could offer people an Independent
assessment of their equipment needs as part of other services they could offer. For
example, a private practice physiotherapist could offer additional therapy, a third sector
organisation could offer additional advice on other state benefits or provide advocacy or
link to a specialist service for people with sensory impairments. An occupational
therapist might offer therapy and guidance about new techniques to maintain
independence and autonomy at home, work and/or school.

We also see the potential for approved/accredited retailers working in conjunction
(perhaps in the same retail outlet) with mixed disciplinary therapists to offer easy access
to therapeutic support.

What will the staff currently employed by councils do?

Councils currently employ professionals (i.e occupational therapists and occupational
therapy assistants) who currently assess users and carers needs prior to providing a
range of interventions including the provision of equipment. We think that their skills are
better focused on providing therapeutic support to individuals who use equipment. We
think that by releasing occupational therapists and OT assistants from the burden of
assessing what particular or specific product is needed and how or where it should be
installed, they can be released to focus on clients with complex needs and their carers to
help them achieve the best level of independence within their own limitations. There will
continue to be a need for occupational therapists to work in long term teams, first
response teams, review teams etc within councils.

We think that this model can release valuable skills to undertake „re-abling‟. Please see
the Homecare Re-ablement section of the Care Services Efficiency Delivery website at for more details about „re-abling‟.

Each council will make local decisions about any changes and will determine whether
refocusing their staff in the way suggested is the right decision for their local population.

What about staff employed by NHS?

NHS currently employ a variety of professionals who issue equipment for community use.
The proposal only affects those professionals who issue equipment as part of the
hospital discharge process or who issue equipment as part of community services
through pooled budget arrangements (section 31 agreements).

We think that a move to a prescription process earlier in the pre- admission hospital
discharge planning phase will be beneficial however we will need to work with
professionals who issue equipment as part of community services provided through
pooled budgets and their professional bodies to understand how the model could benefit
their work.

The council and their NHS partners will jointly determine whether the proposed change is
appropriate for their local population.

What will happen to those staff currently employed in providing warehousing and
distribution (stores) activities?

In the model, the new approved/accredited retailers will take over the direct supply of
equipment to users and their carers who will own the equipment. This means that, after
the model has been fully developed and the impacts of change fully understood, a
council and its health partner may decide that a change to the new model is better for
their local population. In these circumstances, the stores that they currently operate will
no longer be necessary and will close.

We recognise that where a decision to close stores is being considered, this would be an
issue for local agreement. We do however believe that the skills of the staff involved:
store managers, store operators and delivery and installation staff will be highly sought
after. In particular, by those third sector organisations that would like to become retailers
of equipment, but who currently may not have these skills.

Additionally we recognise that existing resource centres and current links with the third
sector organisation can be developed to support a move toward the new model in
innovative ways that meet local needs.

This is a big change – can it be done?

We believe it can. Although overall this is a big change to the current system, it is spread
over all parts: as a result, for any one partner, the adjustment is comparatively small. In
addition we think that the majority of the model components are in place – for example,
there is an established web-based information portal (see DLF); a web-based self
assessment tool has been developed (see SARA); there is training available that could
be the minimum competency standard.

The model does not require much that is new - but in order to make this change people
will be asked to agree to do different things and that is a challenge for us all.

What happens next?

There is a lot to do and we do not have all of the answers yet. We will need to work
closely with all of our stakeholders to find answers and to understand how to move to
making the model a reality. We would like to pilot the model to test and validate the

design. A number of councils and their health partners in the north west have
volunteered to take part. We are exploring options to see how we could work with
partners across the country.

If you want to read more about how we currently think the model could work please go to
the Transforming Community Equipment and Wheelchair Services section of the Care
Services Efficiency Delivery website at


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