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

Chapter 2
Equipment and adaptations as part of every day life

2.1 Promoting social justice

Equipment and adaptation services need to be seen in the context of social justice: equality of opportunity and barrier free access. A wide range of potential support strategies, both informal and formal, may provide a 'step-up’ into inclusion. These include social networks, voluntary and statutory organisations, involvement in education or paid work. The potential of these support structures to prevent exclusion and promote inclusion can be enhanced by appropriate focus on equipment and adaptations.

Since the early 1960s disabled people have been seeking to redefine disability into a human rights or political issue, which society as a whole should address. Disabled people who feel that the individualist model does not provide an adequate explanation for their exclusion from mainstream society have developed the social model. Their experiences have shown that in reality most of their problems are not caused by their impairments, but by the way society is organised.

The social model of disability makes the important distinction between 'impairment' and 'disability', and encourages people, organisations and social systems to anticipate and respond appropriately to everyday needs of people who happen to have an impairment of some description. Given that ‘disability’ may effect everyone in time, it should be considered an issue of concern for everyone.

Within this context, the provision of equipment and adaptations is a crucial area of social policy in which the objectives of social inclusion and equality of opportunity for disabled and older people need to be more rigorously addressed to underpin all development for the future.

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.

2.2 The Disability Discrimination Act

The Disability Discrimination Act 1995 [DDA] is the first legislation in the UK to address the issue of discrimination against disabled people. It makes unlawful discriminatory treatment in relation to:

• employment [Part II];
• the provision of goods, facilities and services [Part III];
• the selling, letting or managing of land or premises [Part III].

Measures are being introduced over time. For service providers, including businesses and organisations:

• since December 1996 it has been unlawful to treat disabled people less favourably than other people for a reason related to their disability
• since October 1999 reasonable adjustments for disabled people, such as providing extra help or making changes to the way they provide their services must be made
• from 2004 reasonable adjustments to the physical features of their premises to overcome physical barriers to access may have to be made

In addition, the DDA requires schools, colleges and universities to provide information for disabled people, and allows the Government to set minimum standards to assist disabled people to use public transport easily.

2.3 European Year of Disabled People

To provide a conceptual framework for action for the European Year of Disabled People at all levels, the Madrid Declaration takes as a starting point the analysis of the current situation of people with disabilities in the European Union that very often leads to discrimination, social exclusion and poverty. It proposes a general vision, in which disabled people are not objects of charity and patients, but independent citizens fully integrated in society.

To achieve this vision, the 600 participants from 34 different countries at the European Congress of People with Disabilities held in Madrid in March 2002, developed a programme and suggestions for actions, in which all relevant stakeholders have a role to play. Local and national authorities, disability organisations, employers, media, teachers, parents, decision-makers can contribute to the process that will bring about real equality for all disabled people and their families.

2.4 Consumer choice

Every one needs equipment to manage everyday activities. When people purchase products and adaptations for themselves they are consumers who bargain in an open market and on a contractual basis. However equipment and adaptations for disabled people have become associated with rehabilitation and professional control.

When professionals are prescribing equipment they should act in a consultative rather than an authoritarian way so that people can still be consumers. However many people would have the confidence to purchase products if they could have access to reliable information and were able to try them out first. Professional advice would still be of value in anticipating potential difficulties and directing people to alternative options.

The National Consumer Council suggests seven key consumer principles: access, choice, information, equity, safety, redress, representation. For equipment and adaptations this translates into:

• awareness generally that equipment and adaptations exist
• awareness either of what specific equipment exists, or of how to find out about it
• awareness of how to get equipment, or where to find out how to get it
• awareness of where to get information or advice, before obtaining equipment
• ability, alone or with assistance, to achieve any of the above; and to be able to purchase or otherwise obtain the equipment or adaptation.

The consumer approach to buying equipment and adaptations and receiving advice from professionals, gives people the opportunity to make choices if they are able and wish to do so, to obtain equipment and adaptations that may be essential to basic, everyday living functions. The Citizens’ Charter, the Patients’ Charter and local Community Care Charters will help to clarify the concept of consumerism within the NHS and local authorities.

2.5 Direct Payments

There is a strong case for a consumer approach to equipment and adaptations supported by the use of Direct Payments: '…a payment made by a local authority to an individual whom it has assessed as needing Community Care Services. The local authority makes the payment instead of arranging the services it has assessed the person as needing. The person then uses the payment to secure for him or herself the relevant services.' [Scottish Office, Social Work Services Group, 1997]

The companion publication 'Using the law to develop and improve equipment and adaptation provision' considers the application of direct payments for equipment and adaptations according to legislation and guidance.

Direct Payments in lieu of service provision can increase the choice and control disabled people have over the arrangement of their care needs. They can increase independence and autonomy, and aid social inclusion. The Strategy Forum equated this area of development to that already achieved in relation to spectacles, where test and prescription have effectively been separated from dispensing, and where someone is eligible for assistance with the costs, this can be used flexibly towards their final choice. Using this approach, people should also have the option to 'top up' to their preferred [more expensive, higher specification] option.

The supply of equipment and adaptations is dominated by provision through statutory organisations, and many products are not available through conventional commercial enterprise. From 1^st June 2003 people in receipt of direct payment can purchase services, including [some] equipment and adaptations from the local authority.

Issues of ownership and responsibility for maintenance and repair require clarification. Some areas of service rely heavily on refurbishment and reuse to supply as many people as possible. This recycling can extend available resources considerably.

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.

2.6 Risk taking

Everyone uses equipment to manage his or her daily life, irrespective of age and ability, and we all adapt and change our environments to reflect our own individuality and preferences. We also all take risks, and expect to exercise choice and control in relation to lifestyle. The same principles should apply to the selection and use of equipment and adaptations. 'Using the law to develop and improve equipment and adaptation provision' seeks to clarify professional concerns that can hinder this [see paragraph 6.5 amongst others].

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.

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

2.7 Mainstreaming equipment and adaptations

The term 'mainstreaming' is used to describe an inclusive approach to products, services and opportunities for people who use, or could use equipment and adaptations.

Mainstreaming promotes a social model of disability, seeing the person as the expert, and only providing specialist advice and expertise where it is required. It is based on the premise that:

• varying ability is not a special condition of the few but a common characteristic
• if design works well for disabled and older people it works better for everyone
• personal esteem, identity and wellbeing are inextricably linked to our ability to function in our surroundings

Society as a whole tends to overlook the needs and aspirations of those who do not fit with the image of youth and fitness. A research project funded by the Engineering and Physical Sciences Research Council, found that:

"Many products continue to be designed to appeal to the younger generation and the lucrative, and growing, older market sector is being ignored. Consequently, large sections of the population are being excluded by industry attitudes. For example, of the FTSE 100 companies only 37% aim to produce products for the over-50’s; 31% take end-user age into consideration when designing a new product or service; 29% agreed that ageing will affect how they run as companies; and only 18% employ significant numbers of over-50’s."

Many equipment products and adaptations currently available are rejected by some older and disabled people because of the appearance of the product and the image it presents to those around them. The ageing population is a global issue and so needs a global perspective: equipment and adaptations that suit particular ethnic groups may not necessarily suit others. It is therefore essential to build an international dialogue.

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.

2.8 Mainstreaming products

Mainstreamed products can be achieved by making existing 'specialist' products more widely available, and by designing products that meet the needs of a much wider range of people.

Universal Design is a worldwide movement based on the concept that all products, environments and communications should be designed to consider the needs of the widest possible range of people. It encompasses seven principles:

1. equitable use
2. flexibility in use
3. simple and intuitive use
4. perceptible information
5. tolerance for error
6. low physical effort
7. size and space for appropriate use

The Disabled Living Centres Council [DLCC] campaign for easier living "challenges the perspective that all equipment should be viewed as 'specialist' and 'medical', and acknowledges the informed decisions [and risks] that people take in every day life".

Initiatives such as 'ideas into action groups' have explored how products for easier living can be promoted as a useful part of everyday life, with findings published in a summary report 'into the mainstream! bringing products for easier living out of the disability closet'.

By promoting products to be more accessible to the mainstream, rather than specifically developed for individual user groups, retailers can make a significant contribution to social inclusion.

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.

2.9 Mainstreaming housing

Housing is the cornerstone of independent living for everyone. Without user-friendly, appropriate housing it is more difficult to access employment, education or recreational and leisure opportunities. Government policy promotes the importance of the central role that housing, adaptations and equipment play in building a more inclusive society. Good practice in all housing design should give equal emphasis to the needs of all members of society. For example:

• the Joseph Rowntree Foundation in 1991 developed the Lifetime Homes concept. It includes sixteen design features that ensure a new house or flat will meet the needs of most households including: a teenager with a broken leg, a family member with serious illness, or parents carrying in heavy shopping and dealing with a pushchair.
• Communities Scotland requires all registered social landlords seeking funding support to comply with barrier-free standards defined within the two volumes of 'Housing for Varying Needs' guidance. The key features of 'Barrier free' housing enable most people, including those who may use a wheelchair from time to time, to reach the entrance from a road or parking area and enter, move around inside the property, and access facilities in essential rooms including the bathroom. It reduces the need to move home if abilities change, and it can be adapted more easily to suit specific needs should this become necessary. The guidance covers the design of self-contained houses and flats to suit people's different and changing needs throughout their lifetime.
• the amendments to the Building Standards [Scotland] Regulations in September 2001 incorporating standards for building work to accommodate the needs of disabled people in all other standards, as well as minimum requirements for 'visibility' of newly constructed property, represent an important first step towards supporting inclusive housing design.
• Local Housing Strategies across all sectors, as required by the Housing [Scotland] Act 2001 will form the basis for investment funding for remodelling and refurbishment to create more accessible accommodation.

People need to be able to find properties that are suitable for their needs, and where a property has specific features or has been adapted, contributing to accessibility and lifetime use, it should be available to people who can benefit most. Developments in hand to achieve this include:

• a common housing register involves a local authority and registered social landlords [RSL] developing a shared application form and single database of housing applicants. This means that people will no longer need to trail between different landlords, filling in separate application forms for each. There is an expectation enshrined in the Housing [Scotland] Act 2001 that every local authority will develop a register in partnership with RSLs.
• 'Ownership Options' is an approach that helps owner-occupiers move to more suitable housing when their own house cannot be adapted. They broker an agreement bringing together funding from Communities Scotland and the local authority to supplement the money a family has available so that they can purchase a house more suited to their needs. The package also covers any adaptation required to the new house.
• Glasgow Disabled Persons Housing Services [GDPHS] is a user-led organisation providing a range of housing information, advice and advocacy services covering the Greater Glasgow area. It also provides employment and training opportunities for disabled people within the housing sector. GDPHS can search its databases of over 120,000 properties to find suitable adapted and accessible housing for disabled people in housing need. Disabled people can do their own searches using the 'Glasgow Housing Options Register' - a database of adapted and accessible housing available over the Internet. [www.glasgowDPHS.co.uk].
• 'Care and Repair' projects help older and disabled owner-occupiers to stay at home by helping them to access Home Improvement Grants and other sources of funding to carry out improvements, repairs and adaptations to their homes, and supporting them through the work where required. Projects currently operate in 25 local authority areas, through 40 projects, funded through a variety of local partnerships, and receive up to 50% of the revenue costs required for administration from Communities Scotland.
• the report of the Housing Improvement Task Force [March 2003] includes recommendations on the inclusion of a limited report on accessibility within the proposed single survey for the sale of private properties.

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.

2.10 Technology

Developments in microelectronics and telecommunications to support daily living are producing a range of applications that can be expected to grow as new technologies are tested and validated. The introduction of technology into the home can take place relatively easily if the changing lifetime needs of residents have been taken into account at the property design stage. However it is anticipated that much of this equipment will be of low cost/high volume, with two or three small items of technology the norm, rather than full 'SMART' houses.

There have also been rapid advances in communication aid technology and design over the past 15-20 years. Augmented assistive communication [AAC] describes any system that enables a person to participate in personal and social activities. AAC systems are utilised by people with speech and language disabilities to enable greater communicative participation in social activities. Most electronic aids to communication are microprocessor based and as microprocessors have become faster, more sophisticated and more readily available, so too have the communication aids on which they are based.

Technology alone does not always provide a complete answer, and it is important to remember the impact on health and wellbeing of contact with other people. Where technology is used, people need not only to have access to technology, but also to be familiar with their use in an environment that has been designed or organised to function smoothly.

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.

2.11 Inclusive services

'Care Management and Assessment - Summary of Practice Guidance' [Scottish Office, 1998] noted that in the past conventional services have not satisfactorily addressed the needs of disabled people. In order to do so, agencies will require:

• policies, priorities and objectives developed with representation from disadvantaged groups
• staff recruited and trained from backgrounds of disadvantage similar to those in the communities they serve

A growing awareness of the potential capabilities of many people with physical disabilities may lead to improvements in the funding arrangements for equipment and adaptations and open up increased opportunity of employment.

A recent feasibility study commissioned by Glasgow Disabled Persons Housing Service [GDPHS] to assist with Lottery/European Social Fund bids found that over 90% of disabled people thought that employing disabled people within the housing sector would improve service provision. Additionally, over 70% indicated that they would personally be interested in such employment opportunities.

This together with research from disabled people themselves signals the need to involve service users in planning, monitoring and delivering public sector services. Changes that will require employers to invest in facilities for training and employing disabled workers.

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.

2.12 Children, transitions and a lifetime approach

Although the remit of the Joint Future Group was specific to older people, developments and improvements will benefit other care groups. For example the principles of single shared assessment are being extended to people with learning disabilities and to people with mental health problems.

The report of the action team on better integrated children's services 'For Scotland's Children' [October 2001] recognised the importance of single shared assessment for children. Services being developed for children should consider equipment and adaptations, including the transitional arrangements required between child and adult services.

The Education [Disability Strategies and Pupils’ Educational Records] [Scotland] Act 2002 requires responsible bodies to prepare and implement accessibility strategies to improve over time access to education for pupils and prospective pupils with disabilities. Duties came into force in October 2002 and will ensure that long-term strategic planning is carried out across school education in Scotland to improve access for all pupils with disabilities.

This legislation aims to ensure that those who do not currently plan for pupils with disabilities begin to do so, helping to promote a positive attitude towards disability in all Scottish schools. Guidance on preparing accessibility strategies 'Planning to Improve Access to Education for Pupils with Disabilities' [September 2002] advises on:

• the legal position and coverage of this planning duty;
• the three strands which accessibility strategies must cover;
• the main processes local authorities and non-local authority schools should consider in preparing accessibility strategies.

The Beattie Committee report [September 1999] made recommendations on the needs of young people who require additional support to make the transition to post-school education and training, or employment. This includes young people who have few or no qualifications, low basic skills and poor attitude and motivation; and others who need support because they have physical disabilities, learning disabilities or mental health problems. The Further Education sector was identified as a key agency in taking forward the core recommendation of inclusiveness: that post-school learning should be designed and delivered to meet the needs, abilities and aspirations of all young people.

The Access to Work programme offers grant aid plus practical help and advice to disabled people and their employers, to help overcome work related obstacles associated with disability. It is delivered by Disability Employment Advisers or Access to Work Advisers, working in partnership with external organisations of and for disabled people.

Care home residents should have access to the same service as people living in individual houses [either their own or rented]. The consultation on physical standards for single care homes supported the proposal for equipment for individual use to be provided from the community rather than by the care home. Interest was also expressed in design guidance incorporating the new physical standards.

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.

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