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Equipped for Inclusion: Report of the Strategy Forum: Equipment and Adaptations

Summary of recommendations and questions

Comments by 26^th September 2003 are invited on:

• the overall direction of the strategy
• the content of each individual recommendation
• priorities for action

To establish the strategic direction:

Recommendation 1: to influence, lead and sustain change, encourage innovation, and support implementation of the strategy through a tasked agenda, the Scottish Executive should establish a national forum, the 'Implementation Steering Group: Equipment and Adaptations'.

Recommendation 2: to ensure that equality underpins all training, the Scottish Executive should commission an audit of education and training providers delivering 'pre' and 'post' qualifying courses for people involved in equipment and adaptation services.

Recommendation 3: the Scottish Executive should actively promote, through commissioned research and publishing further guidance as required, Direct Payments for people who want to use them to organise equipment and adaptations.

Recommendation 5: to promote mainstreaming, the Scottish Executive should commission a base line appraisal of the availability of equipment and adaptations in conventional commercial enterprise, against which the measurement of change can be established. The Implementation Steering Group should work with designers, manufacturers, retailers, and people who use equipment and adaptations to replace disabled and older stereotypes with a view of consumers coming from a broad spectrum of physical capabilities, irrespective of age and medical condition.

Recommendation 6: the Scottish Executive should encourage industry to expand the range of products that are available ‘off the shelf’, and to incorporate features that make everyday items easier for everyone to use. The International Year of Disabled People in 2003 should be used to 'kick start' this.

Recommendation 7: the Scottish Executive should encourage all sectors to place greater emphasis on universal housing. This should include amendment of the building regulations to increase the space standards for occupiers , and the introduction of an accessibility [or universal design] standard across all sectors.

Recommendation 8: the Implementation Steering Group should consider how best to capture the potential of technology, to create an integrated portfolio of products and services. It should also consider how to ensure that all sectors include the basic physical requirements, and the cabling and wiring capacity, for the flexible use of SMART technology in all new build property and conversions.

Recommendation 9: all services should ensure the inclusion of disabled and older people in the development of policies, priorities and objectives, relating to the delivery of equipment and adaptations.

Recommendation 10: to establish a lifelong approach to the implementation and development of this strategy, those responsible for implementing the agenda for children, together with partners across education, lifelong learning and employment should work with the Implementation Steering Group. A sub-group of the Implementation Steering Group should be formed to review equipment provision in care homes as a priority, and the Scottish Executive should commission an addition to the design guide series 'Housing for Varying Needs' for Care Homes.

Recommendation 15: local partners should ensure that equipment and adaptations are integrated fully with one another, and as integral components in the planning and delivery of community care. The Scottish Executive should assist in establishing a 'Joint Future Equipment and Adaptation Network' to share promising practice, to address any difficulties that may arise and to work with the Implementation Steering Group to ensure the expectations of the agenda for equipment and adaptation services are being realised. Particular attention should be paid to any potential barriers to the effective pooling of resources.

Recommendation 16: the Scottish Executive should evaluate progress to date on the sharing of storage premises, and advise the Implementation Steering Group on the benefits achieved and any issues raised. They should also commission a feasibility study on the concept of a Scotland wide store ['virtual' or otherwise], building on the achievements of the e-Care project in the Scottish Borders [see recommendation 11], and other alternative approaches that would deliver the same outcomes.

Recommendation 17: Local Partnership Agreements should be developed to include specific information on the joint resourcing and joint management of equipment and adaptations services.

Recommendation 19: the Scottish Executive should review the 'triggers' and indicators for professional expertise in specific areas of equipment and adaptations included within arrangements for Single Shared Assessment across Scotland, and work with the Implementation Steering Group to address any anomalies. This expertise should be made available to advice and demonstration services for people who wish to make their own purchases.

Recommendation 20: the Implementation Steering Group should commission a review of the training and resources available to assessors to assist them in the selection of equipment and adaptations, within a framework of finite resources.

Recommendation 21: the Implementation Steering Group should commission an audit of expertise in equipment and adaptation services, to inform an accreditation framework that ensures the competencies and expertise required in the assessment process leading to the provision of equipment and adaptations are clearly identified, agreed, and monitored.

Recommendation 22: the Implementation Steering Group should commission a review of existing Single Shared Assessment tools to advise on a sub-set of information, and available software packages, to support assessment for and selection of equipment and adaptations, including self-assessment.

Recommendation 23: local partners should ensure that care management is considered where individual circumstances suggest that a significant package of equipment and adaptations [and/or a change of accommodation] may be necessary to achieve an acceptable relationship between the person, their environment and their care needs.

Recommendation 24: the Scottish Executive should ensure that in determining the 'joint envelope' and developing Single Shared Assessment, local partners review the processes and procedures involved and challenge why they are there.

Recommendation 25: the Joint Performance Information and Assessment Framework should be developed to capture the effects of the integration of services on equipment and adaptation provision, and its contribution as a component of community care services.

Recommendation 29: the Implementation Steering Group should advise on minimum waiting times to be achieved across the equipment and adaptation spectrum.

Recommendation 30: the Implementation Steering Group should set targets for the recycling of equipment and adaptations [including those to capture the impact of registers of special and adapted properties].

Recommendation 31: The Implementation Steering Group should review the way in which equipment and adaptation services [statutory and commercial] are currently regulated to see if and how essential 'care components' are captured, and consider the action required to address any gaps. All local partners involved in the provision of equipment and adaptation services should ensure that requirements for routine maintenance and repair are met, and that systems are in place for any unforeseen events, including emergencies.

Recommendation 32: the Implementation Steering Group should advise on the development of the competency framework required in response to the Joint Future agenda [recommendation 21] and to meet the needs of the future.

Recommendation 33: the Scottish Executive should establish a 'Scottish Centre of Excellence and Development for Equipment and Adaptations', to support innovation and development and provide a national service focus.

Recommendation 34: the Rehabilitation Technology Services Advisory Group and relevant partners should consider the applications of the equipment and adaptation strategy for orthotic and prosthetic services, outlining the benefits of this approach.

[See also recommendation 4, 18 and 22, the self-selection of equipment and adaptations.]

Question 1: should reference to 'equipment and adaptations' continue, or should the phrase be replaced with a more encompassing and modern expression? If so, what should this be?

Identify core information requirements and minimum service standards for information, advice and demonstration, for service users and assessors:

Recommendation 11: the Scottish Executive should ensure that the work of the Scottish Borders e-Care project is developed, in partnership with the Implementation Steering Group, to create the comprehensive information resource described, including mechanisms to maintain and develop the content.

Recommendation 12: once the comprehensive information resource is available, a range of publicity and marketing initiatives should be put in place to increase access to this information for all. This should be underpinned by a robust system to deal with resulting enquiries.

Recommendation 13: the Scottish Executive should commission an audit of local information networks and how they link together, to identify any areas in need of support. They should also commission work on minimum standards for equipment and adaptation information provision, making use of existing mechanisms wherever possible.

Recommendation 14: the Scottish Executive should commission the Disabled Living Centres Council to audit the organisation and delivery of advice and demonstration services for equipment and adaptations across Scotland, to DLCC standards, and support local partners in the development of services that can reach the population of Scotland.

[See also recommendation 19, to establish the strategic direction.]

Advise on the self-selection of equipment and adaptations:

Recommendation 4: all services offering equipment and adaptation information, advice, demonstration, assessment and provision should actively promote risk taking as a reasonable component of daily life.

Recommendation 18: local partners should promote self-assessment and assessment by a wider range of assessors, for 'simple' equipment and adaptations. A national perspective should be encouraged through the 'Joint Future Equipment and Adaptation Network' [recommendation 15] where examples of promising practice can be shared and any concerns addressed.

[See also recommendation 22, to establish the strategic direction]

Question 2: what additional material would assist professionals to support disabled people taking risks as a reasonable component of daily life?

Suggest areas for research on the effectiveness of equipment and adaptations, and rehabilitation services:

Recommendation 26: the Scottish Executive should commission work to identify the current annual expenditure on equipment and adaptations across all sectors, itemised to compare the cost of providing equipment and adaptations and the cost of the equipment and adaptations themselves.

Recommendation 27: the Data Standards Project should work with existing initiatives and relevant partners to develop standard definitions for data relating to equipment and adaptations, in consultation with the Implementation Steering Group.

Recommendation 28: the Implementation Steering Group should commission work to explore approaches to the allocation of resources for equipment and adaptations. Specific attention should be paid to those that capture the dynamic relationship between equipment and adaptations, rehabilitation and care.

Recommendation 35: The Scottish Executive should commission a review of the evidence available on the effectiveness of equipment and adaptations, the impact they have on people's lives, and the relative impact of equipment and adaptations in terms of costs and effectiveness in relation to other health and care services. This should inform the commissioning of subsequent work to fill any gaps.

[See also recommendation 25 and 33, to establish the strategic direction.]

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