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ITEM EX11

EXECUTIVE – 1 OCTOBER 2002

INTEGRATING COMMUNITY EQUIPMENT SERVICES

Report by Interim Director of Social Services

 

Introduction

  1. The "Guide to Integrating Community Equipment Services" was issued by the Department of Health in March 2001. The Guide is part of the National Service Framework for Older People Standard Two ("Person-Centred Care") and follows the Intermediate Care Guidance issued in January 2001.

  2. This report outlines the objectives of the Guide and the action taken so far, and recommends an action plan for approval before being sent to the Department of Health. It also describes the current services. This report is also being presented to the Social & Health Care Scrutiny Committee on 25 September and any comments on their part will be reported to the meeting.

    3. Background

    Intermediate Care Guidance

  3. The Intermediate Care Guidance published in January 2001 set out the funding being made available to improve community equipment services. For the National Health Service £11.7 m was included in 2001/02 baseline allocations to health authorities, and £28m and £64m will be allocated in 2002/03 and 2003/04. The Government also took account of the need for additional investment in the Personal Social Services Settlement for 2001/02 to 2003/04 to enable councils to contribute an appropriate share to the expansion of these services. None of these investments were ring-fenced and there has been no additional funding allocated to equipment services in Oxfordshire for 2001/2 or 2002/3.

    4. Guide to Integrating Community Equipment Services

  4. The Guide identifies a range of specific requirements for Health and Social Services authorities. Particular action taken and planned in respect of these requirements in Oxfordshire includes the following:

    • Lead officers in Health and Social Services. Judith Argles, Service Manager Specialist Services in the Disabilities Division, is the Social Services lead and Mary Applegate, Head of Therapies, Cherwell Vale Primary Health Trust is the Health lead on behalf of all the primary care trusts and acute health trusts.

    • Baseline Audit of Current Community Equipment Services. This was completed in January 2002.

    • Action Plan. A draft was produced in June 2002 in partnership with a stakeholder group and has been circulated for comments. A final action plan is to be produced by October 2002 which includes the mechanisms for pooled budgets - stating the Health and Social Services contributions and what the budget will be used for by 2004.

    • Targets. 50% more individuals of all ages and types of disability (including sensory impairment and learning disabilities) to benefit from equipment that helps them be cared for or maintain their independence at home by 2004.

    • A Single Point of Contact for community equipment services is to be in place by April 2003.

  1. For these purposes community equipment services (available to all age groups including children) include:

    • assessments by occupational therapists, physiotherapists, nurses, and other health and social services staff;

    • information and advice services;

    • home nursing equipment;

    • equipment for daily living;

    • minor adaptations;

    • ancillary equipment for people with sensory impairments for instance flashing doorbells, low visual optical aids;

    • equipment for short term loan, including wheelchairs;

    • communication aids for people who have speech impairments;

    • telecare equipment for instance fall alarms, gas escape alarms, ‘wandering detectors’ for people who are vulnerable;

    • a state-of-the-art demonstration facility

Vision for an Integrated Equipment Service

  1. The National Audit Commission has produced two reports called ‘Fully Equipped’. A summary of the outcomes of these reports is attached as Annex 1. These, together with the Guide to Integrating Community Equipment Services, have informed the preparation of a "Vision for an Integrated Equipment Service for Oxfordshire", which is set out in Annex 2.

    2. Current Position in Oxfordshire

  2. Equipment is in the main supplied by Social Services and Health through a contract with an independent supplier, Huntleigh National Care, or from the District Medical Engineering Department (DMEED) facilitation service who provide primarily pressure mattresses and cushions.

  3. The Huntleigh contract for equipment loan and minor works, on behalf of Social Services, all the acute trusts and the five primary care trusts, expires in September 2002. This service has been retendered for a 2-year contract and Huntleigh has been successful in their bid. The provider will offer a similar service to the existing contract. Depending on the outcome of the action plan for integrating community equipment services, a new contract with an updated specification will be retendered to reflect the new service in October 2004.

  4. The current position on other aspects of community equipment services is as follows:

    • protocols are in place to supply some equipment through the three Carers Centres;

    • short-term loan of equipment is supplied from British Red Cross, Nuffield Orthopaedic Centre, Michael Sobell House and specialist societies e.g. Motor Neurone Disease Society;

    • information and advice is supplied via a Service Agreement that Social Services and Health have with Dialability;

    • paediatric physiotherapy equipment is supplied from the paediatric physiotherapy service through Cherwell Vale Primary Care Trust;

    • communication aids for children are supplied by the Speech and Language Service via tripartite funding from Health, Social Services and Education;

    • there is no specific funding identified at present for telecare equipment or for communication equipment for adults;

    • there is no specific funding identified at present for the provision for some equipment in Nursing Homes or Residential Homes.

  1. Equipment is supplied after an assessment by a Health or Social Services assessor. There are agreed protocols and eligibility criteria for both provision and assessment. Assessment for the provision of equipment by Social Services is primarily through the occupational therapy and sensory impairment services. At present there are 21 full time equivalent occupational therapists, 4.5 of whom are on temporary contracts funded by grants and 4 full time equivalent occupational therapy support workers. There are 6.5 full time equivalent hearing impairment workers and 7.3 full time equivalent visual impairment workers.

  2. Over the last three years there have been approximately 6000 referrals yearly to the occupational therapy service and 1000 referrals to the sensory impairment team. This has led to waiting lists for assessments for non-emergency or non-urgent referrals. 1200 people are waiting up to 16 months for assessments from the occupational therapy team and 240 people waiting up to 8 months for assessments from the sensory impairment team.

  3. A day audit of caseloads has just been undertaken. On analysis half the assessments carried out by occupational therapists resulted in referral to housing departments for major adaptations using funding allocated to registered social landlords and district councils including disabled facilities grants. The adaptations enable severely disabled people to remain in their own homes. Half of the assessments to support independence and to assist carers are carried out with individuals who are not known to other teams within Social Services. Assessments by occupational therapists result in issuing essential equipment in line with Social Services’ Eligibility for Services Matrix.

    4. Baseline Audit for Oxfordshire

  4. The baseline audit found that most equipment is provided in line with Department of Health guidance but telecare and communication aids for adults are not provided. See Annex 3 - Mapping Change.

  5. The equipment store is shared between Health and Social Services but equipment services are not yet fully integrated.

  6. There are varied views from users of the present service. The views ranged from ‘good’ for ‘responding quickly to emergency needs’ to ‘poor’ for ‘funding for communication equipment for adults’ and ‘little choice’ to ‘fair’ for ‘minimises number of assessments’. There is general dissatisfaction that there is a waiting list for non-emergency or non-urgent assessments from the occupational therapy teams.

  7. Performance Assessment Framework indicator PAF 38 (‘Percentage of items costing less than £1000 delivered within 3 weeks’) shows a success rate in 1998/99 of 88%, in 1999/2000 of 93%, in 2000/01 of 90% and in 2001/02 of 96%.

  8. A "SWOT analysis" of the current services has also been undertaken. This is attached as Annex 4.

    9. Next Steps and Action Plan

  9. The Guide requires all Health and Social Services authorities to produce an action plan by October 2002 of how they will implement an integrated community equipment service by 2004. The draft Oxfordshire plan has been devised by a stakeholders reference group that includes service users and carers – see Annex 5 for membership. The group has met five times during the last 12 months. The draft plan is attached as Annex 6 and covers:

    • co-terminosity issues and how they might be resolved;

    • how a single point of contact might be achieved alongside other initiatives such as single assessment;

    • reporting systems in place for adverse incidents;

    • working towards a pooled budget with joint eligibility criteria and a single inventory;

    • proposals for a new equipment service and contract by 2004;

    • setting of clear priorities for the use of funding and improved management of demand and resources;

    • ensuring that integrated community equipment service for Oxfordshire is in line with the Oxfordshire vision and the Department of Health guidance.

Financial Implications

  1. Spend in Oxfordshire on equipment services for 2000/01 was £900,000 by Health and £1,120,000 by Social Services, and for 2001/02 was £905,000 by Health and £1,062,000 by Social Services. Financial support for equipment was helped by using funding from other sources, for instance staffing slippage and charitable trusts, in order to relieve the pressures from hospitals to achieve timely discharges.

  2. For 2002/3 the budgets allocated for equipment services in Social Services are £908,000 for equipment and £1m for staffing to carry out the assessments. The primary health trusts and acute hospital trusts fund assessments by employing therapists and district nurses and fund equipment to support people to live in the community. The estimated figure from Health (based on indicative figures from the Oxfordshire Health Trusts) is in the region of £1,108,000. This figure excludes staffing costs.

  3. From information from the Department of Health we understand that finance allocated to Oxfordshire over the three year period 2001 to 2004 through the respective government funding systems totalled £1,396,240, shared between Health and Social Services. This funding has not been identified specifically for community equipment services in either the Health or Social Services budgets for 2001/2 and 2002/2003. This means that the target set by the Department of Health for the additional amount of equipment to be provided and people supported will not be achieved. It also means that telecare products, communication equipment for adults, community rehabilitation equipment and specialist equipment for deaf-blind individuals will not be funded or provided in Oxfordshire.

    4. Staff Implications

  4. In order to carry out the guidance effectively, adequate staffing levels need to be attained so that assessments are carried out and equipment is delivered in a timely manner. An integrated service may have implications for staff if when budgets are pooled and services are aligned if the pool includes staff as well as funding for equipment.

    5. RECOMMENDATIONS

  5. The Executive is RECOMMENDED to:
          1. note progress to date summarised in the report and that a further report is planned in April 2003;
          2. agree the Action Plan for Integrating Community Equipment Services as set out in the draft annexed to the report.

STEPHEN WILDS
Interim Director of Social Services

Background Papers: Nil

Contact Officers: Alan Sinclair, Head of Services (Disabilities) Tel 01865 815753

Judith Argles, Service Manager Tel 01865 787346

September 2002

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