NHS 1979 (GEN) 27

4 May 1979

Dear Colleague

ENVIRONMENTAL CONTROL EQUIPMENT FOR SEVERELY HANDICAPPED PEOPLE

Summary

1. This Circular reviews existing supply arrangements and functions of environmental control systems and outlines new arrangements for the payment of certain charges (formerly the responsibility of the local authorities) by environmental control co-ordinators in the relevant Health Boards.

Current Arrangements

2. Local authorities and Health Boards will be aware of the existing arrangements for the supply of Patient Operated Selector Mechanism Control Systems (PSU 1 and PSU 3) for severely disabled patients which have been supplied through the National Health Service and also the provision of a PSU 2 system which is an environmental control aid for the social needs of a less severely disabled person.

PSU 1 and PSU 3 Systems

3. These systems are supplied through the National Health Service and their function, the criteria for supply, the steps necessary to initiate supply and additional equipment are outlined in Annex A to this Circular. The systems comprise the basic PSU 1 or PSU 3 unit (the PSU 1 is now obsolete but the units on issue will continue to be maintained) a cabinet to house the equipment, the microswitch and/or mouth tube to control the unit, the indicator and the calling system and, when required, an intercom and door-lock control system. Annex A also gives details of additional equipment. The facility to operate a loud-speaking telephone with automatic dialling - but not the telephone itself - is an integral part of PSU 3 equipment. Annex B to this Circular sets out details of the provision of the phone apparatus.

4. Hitherto provision of cabinets to house the PSU units, the installation of suitable power points for their operation and, when required, loud-speaking telephones and the costs of the services of a joiner and electrician on installation day have been the responsibility of the patient concerned but, where appropriate, social work departments have been asked to assist.

5. It has been decided that, as indicated above, the relevant and Health Boards will supply all of the environmental control equipment needed as well as the cabinet, pay for the services of the joiner and electrician and for installation, where required, of the power points. It is hoped, however, that social work departments will, following the usual case meetings (referred to in Annex A) at the person’s home, continue to assist with the pre-installation work by arranging locally for installation of the power points and for the services of the joiner and electrician on installation day. Costs incurred by social work departments in providing these services will be refunded on submission of an invoice the environmental control co-ordinator in the Health Board. Along with the PSU 3, the Health Board will supply a bell and buzzer, an external bell and door intercom and door-lock control systems.

6. Provision of the loud-speaking telephone (see Annex B) and other equipment controlled through the system are the responsibility of the patient concerned but social work departments are free in appropriate cases, as in the past, to help towards meeting these costs. Close liaison is required between the Health Board and local authority social work departments in reaching decisions as to equipment to be supplied and assistance to be given to persons and it is essential that, at the case meetings referred to above, a full assessment of the home, the family and the needs and wishes of the patient should be made.

PSU 2 System and similar devices

7. Local authorities will also be aware that a number of simpler and cheaper environmental control devices have been or are in the process of being developed to assist people less severely disabled than those who need PSU 3, but who lack mobility, eg those suffering from severe arthritis or the effects of a stroke. These devices generally take the form of a simple switchboard which enables the disabled person to control domestic appliances (eg a television set) by operating a convenient switch which is remote from the wall switch. An alarm system and door-lock control and door intercom system can also be incorporated. Annex A to this Circular also gives details of this system.

8. PSU 2 systems are designed to meet a social need for which medical prescription is not necessary they cannot be provided through the National Health Service; applications for PSU 2 systems or similar devices are therefore to be made directly to local authority social work departments in the usual way.

9. If local authorities wish to provide a device of this kind for a person as part of their services for handicapped people including those whose condition does not, in the view of the Health Board, warrant installation of PSU 3, they may wish to get in touch direct with manufacturers from whom comprehensive details of models available can be obtained on application. Information about other environmental control equipment and call systems which are available are listed for subscribers to the Disability Scotland Information Database, Princes House, 5 Shandwick Place, Edinburgh EH2 4RG. Local authorities will no doubt wish to consider the advantages of any offers by suppliers to provide an installation service, annual maintenance facilities and discounts for quantities ordered to bulk.

10. The Scottish Office Home and Health Department does not have the resources to evaluate all the simple environmental control devices which have been developed but local authorities can seek the Department’s advice in any case of doubt about the quality, safety or effectiveness of any particular model. Two models, which have so far been submitted to a technical evaluation and are regarded as satisfactory on grounds of safety and suitability are the POSSUM LINK (PSU 2) and the POSSUM AID; the manufacturer’s name and address is Possum Controls Ltd, 63 Mandeville Road, Aylesburn, Bucks.

11. A copy of the application/assessment form is at Annex C. Health Boards will notify social work departments of any case where an application for PSU 3 has been unsuccessful, but where supply of PSU 2 or its equivalent appears to be warranted; similarly where an application has been made to a social work department for supply of PSU 2 or equivalent equipment and the person, following assessment by an occupational therapist, is found incapable of using it as a result of muscle weakness or lack of directional control, local authorities are asked to inform the relevant Health Board so that an assessment for the supply of a PSU 3 system can be made.

Contact Point

12. Please direct any enquiries arising from this Circular to Miss Kathleen Giancy, The Scottish Office Home and Health Department, Room 279, St Andrew’s House, Edinburgh (telephone: 0131 244 2428) for health interests or to Miss M Forker, Social Work Services Group, Room 44, James Craig Walk, Edinburgh EH1 3BA (telephone 0131 244 5456) for social work interests.

Yours faithfully

GAVIN ANDERSON

ANNEX A

ENVIRONMENTAL CONTROL EQUIPMENT

CRITERIA FOR SUPPLY

1. Possum PSU 1 and PSU 3 systems are available through the National Health Service to patients who are permanently disabled by disease, injury or congenital defect to the extent that they are unable to carry out such simple tasks as feeding themselves or switching on a light and who:

a. have the ability and will to use the equipment.

b. have passed the acute stage of illness and have reasonably good survival prospects.

c. require all the facilities of the equipment and cannot be helped by simpler and less expensive means.

PSU 1 (now superseded by PSU 3)

2. The equipment (which is operated by mouth - a simple suck/blow mechanism - or by microswitch if there is some residual muscle function eg the flick of a finger) enables a very severely disabled patient who would otherwise be unable to do so, to ring a bell to call for attention - emergency and non-emergency within the home, to ring an external bell in an emergency to call help from neighbours, etc, to switch on and off a lamp, radio, television or heater, to use a loud-speaking telephone, to operate an intercom to the front door and to open that door. In all, up to 11 items of electrical apparatus which can be switched on or off may be operated through the equipment. With the equipment the person recovers a measure of independence and his continued care at home is made easier for his relatives. Supply of the equipment may sometimes make it feasible to discharge someone who would otherwise have to remain in hospital.

3. The basic equipment consists of an electronic control unit and an indicator/selector board and the input control is either a flexible tube with pipe-stem mouthpiece or a microswitch (mounted on the bed, wheelchair or both). The indicator is labelled to show the appliances which can be operated and is positioned where the operator can see without difficulty. The control unit is usually housed in a cabinet in the room most frequently used by the patient. The loud speaking telephone, if supplied, must be installed in the area of the cabinet.

4. The equipment is designed to be used 24 hours a day from both bed and chair, and includes among the safety features, a stand-by battery to allow the calling system and the telephone to be operated even if the mains supply should fail.

5. The PSU 3 system has been developed to supersede the PSU 1 and to give a wider range of facilities. In addition to giving control over a large number of outlets, the extra facilities include the ability to:

a. operate the telephone (including dialling) and to call up to two numbers on a pre-set automatic basis;

b. provide control of channel change and volume for suitable TV sets and radios.

6. PSU 1 units on issue will continue to be maintained.

Operation

7. To operate the PSU 1 or PSU 3 all the patient has to do is to depress the microswitch, or, alternatively, suck continuously on the pneumatic tube. This causes a white light to scan slowly down the indicator. At each step there is an audible bleep from the control unit. When the white light reaches the level on the indicator of the item which is to be operated, release of the pressure on the microswitch or of the suction will stop the light at that point and the next operation of the input will scan it horizontally across the indicator board. (The tone of the vertical and horizontal bleeps differ to facilitate identification.) When the light is stopped on the item selected, that particular item of equipment is automatically switched on and at the same time the indicator turns to red to confirm that this has been done. If the equipment was already switched on, the same procedure will switch it off. The audible bleep and the rate of scanning can be varied by a speed switch on the back of the unit, and as the user becomes more proficient, the speed can be increased if desired. The equipment automatically reverts to and scans from the start after each completed operation and the audible bleep allows a patient working from memory without having to see the indicator board to follow its course round the indicator board and to operate the unit by counting the bleeps until the appropriate item is reached.

WHAT HAS BEEN AND CAN BE SUPPLIED THROUGH THE NATIONAL HEALTH SERVICE

8. The basic PSU 1 and PSU 3 units, the cabinets to house the units, the micro-switch and/or the mouth tubes to control the units, the indicator boards, the bell and buzzer units, the external bells and, where required, intercoms and door-lock control systems and all the wiring from the units to the various appliances have been and are supplied without charge under National Health Service arrangements. The cost of installing a double 13 amp switchless socket on an independent circuit for operation of the equipment, and, when required, a single 13 amp switchless socket for the loud-speaking telephone and, after 4 May the services of an electrician and joiner on installation day will also be met by the National Health Service. The costs of maintenance and replacement of the systems is met also from National Health Service funds.

9. The loud-speaking telephone (present rental £12 per annum in addition to the basic rental) and other items of equipment controlled through the unit, except for the bell and buzzer, the external bell and the intercom and door-lock control system, are the responsibility of the patient. Where such equipment is regarded as essential and is not already available in the home, the social work department may help towards the cost.

Application for PSU 3

10. All applications for environmental control equipment should be originated by the patient’s GP or by the consultant who is concerned with the patient’s case. If a doctor thinks that his patient might benefit from PSU 3 equipment he should complete the appropriate application/assessment form and bring this to the notice of the consultant in order that he can confirm his interest and indicate any proposals that he may have. The consultant should then forward the completed form to the environmental control co-ordinator in the Health Board and copy his recommendation to the Chief Administrative Medical Officer. If, from the evidence provided, the patient appears to satisfy the eligibility criteria , the co-ordinator will arrange a meeting at the patient’s home to confirm the eligibility and to demonstrate the equipment and discuss the arrangements for installing it. A copy of an Application/Assessment form is attached to this Annex.

PSU 2

11. This system comprises a switch panel, a main distribution unit and a door intercom and door-lock unit. The switch panel which can be included at 30 degrees to the horizontal has 6 switches spaced in 2 rows and off-set for easy operation. Although long lever switches are supplied these may, if necessary, be replaced by switches of other types. The panel also houses the microphone and loudspeaker for the intercom systems. Because of its lightweight (5¾ lb) the panel can be carried easily and may be plugged into any electrical socket. The main distribution unit operates an intercom, a door-lock and an alarm in addition to giving on/off control over 3 electrical devices such as heater, light and television. A jack socket enables a standby battery (an optional extra) to be plugged in to operate the alarm, intercom and door-lock in the event of mains failure.

12. The door intercom, door-lock system and alarm are supplied as an integral part of the PSU 2 system. The appropriate switch is pressed to select the service required and in the case of the alarm a loud interrupted tone is transmitted through the door intercom loudspeaker.

Additional equipment

Typewriters

13. Typewriter control system, including a typewriter, are available through the National Health Service to severely disabled people who satisfy the conditions outlined above, who are unable to communicate verbally and who are physically unable to write. The ability to communicate by the written word is inherent in considering eligibility. The typewriter is independent of the environmental control equipment.

ANNEX B

TELEPHONE SERVICE WITH ENVIRONMENTAL CONTROL SYSTEMS

1. Patients supplied with the PSU 3 may also be provided with a telephone apparatus called the servophone which is obtained from the Post Office. The servophone enables the patient to use the telephone without having to physically dial or use the receiver.

2. At the case meeting the Health Board will advise whether a servophone is required. The social work department will however decide whether or not to assist with the cost of installation. Where a servophone is to be supplied the social work department should notify the Health Board, giving the patient’s name and address, and the name and telephone number of the contact with the social work department, and the Health Board will make the necessary arrangements with the Post Office Telecommunications Headquarters.

3. Social work departments should ensure that the patient is given whatever help is necessary to make application to Post Office Telecommunications for a telephone service. Any help which social work departments can give with installation and rental should be explained but it should be pointed out that social work departments cannot assist with the cost of call charges.

ANNEX C

ENVIRONMENTAL CONTROL EQUIPMENT - APPLICATION/ASSESSMENT FORM

1. Environmental control equipment enables very severely disabled people who would otherwise be unable to do so to exercise on/off control over electrical equipment, such as emergency and non-emergency calling systems, lights, heaters, radio, TV and telephone. The equipment may be operated by mouth - a simple suck/blow mechanism - or by micro-switch if the patient has some residual muscle function. If hand function is severely impaired, the micro-switch may be adapted for use by a particular patient to operate the equipment by means of chin, foot, elbow - it has even been adapted for use by an eyebrow. With the equipment the patient recovers a measure of independence and continued care at home is made easier for the relatives. Supply of the equipment may sometimes make it feasible also to discharge home a patient who would otherwise have to remain in hospital.

2. Environmental control equipment, either Possum PSU 1 and PSU 3, is available through the National Health Service to people who are permanently disabled by disease, injury or congenital defect to the extent that they are unable to carry out such tasks as feeding themselves or switching on a light and who:

a. have the ability and will to use the equipment;

b. have passed the acute stage of illness and have reasonably good survival prospects;

c. require all the facilities of the equipment and cannot be helped by anything simpler and less expensive. (eg Possum Aid or Possum Link).

TYPEWRITERS

3. Typewriter control systems, including a typewriter are available through the National Health Service to severely disabled people who satisfy the conditions outlined above, who are unable to communicate verbally and who are physically unable to write. The ability to communicate by the written word is inherent in considering eligibility. The typewriter is independent of the environmental control equipment.

APPLICATION FOR ENVIRONMENTAL CONTROL EQUIPMENT

4. All applications for environmental control equipment should be originated by the patient’s GP or by the consultant who is concerned with the patient’s case. If a doctor thinks that his patient might benefit from Possum PSU 1 or PSU 3 equipment he should complete the attached application/assessment form and bring this to the notice of the consultant in order that he can confirm his interest and indicate any proposals that he may have. The consultant should then forward the completed form to the environmental control co-ordinator in the Health Board and copy his recommendation to the Chief Administrative Medical Officer of the Health Board for the area. (Where there has been no consultant involvement for some years, the GP should forward the application to the co-ordinator direct). If, from the evidence

provided, the patient appears to satisfy the eligibility criteria, the co-ordinator will arrange a meeting at the patient’s home to confirm the eligibility and to demonstrate the equipment and discuss the arrangements for installing it.

POSSUM PSU 2 (Link)

5. Environmental control equipment for less severely disabled people (PSU 2 or ‘Link’ system) who do not require all the facilities of the PSU 1 or PSU 3 may be supplied by social work departments.

SCOTTISH OFFICE HOME AND HEALTH DEPARTMENT

St Andrew’s House

EDINBURGH

EH1 3DE

SCOTTISH HOME AND HEALTH DEPARTMENT

APPLICATION FOR THE SUPPLY OF ENVIRONMENTAL CONTROL EQUIPMENT

Name of patient: ............................................ Date of Birth: ....................................................

Address: ........................................................

.......................................................... Telephone No: ..................................................

(if known)

GP: ...............................................................

Address: ........................................................

........................................................ Telephone No: ..................................................

Consultant: .................................................... Hospital: ...........................................................

_________________________________________________

Brief description of disability and approximate date of onset

Has patient passed acute stage of illness? Yes/No

What are survival prospects? 3 mths/6 mths/1 year/longer

Is the patient bed-bound? Yes/No

Is the patient chair-bound? Yes/No

Does the patient use a wheelchair indoors? Yes/No

Is the wheelchair powered? Yes/No

If the wheelchair is non-powered, can he propel it himself? Yes/No

Can the patient walk at all, indoors? Yes/No

If so, how far? A few steps/3 yards/10 yards

Can the patient feed himself? Yes/No

Can the patient switch on a light? Yes/No

Is the patient left on his own? Yes/No

When on his own - How Long .................... Reason(s) ...........................................

How often .................... times/day ............... times/week .......

Do you consider the patient is motivated towards controlling his environment? Yes/No

Which of the following facilities would the patient wish to control

emergency and non-emergency calling systems .........................................................................

APPLICATION FOR THE SUPPLY OF A POSSUM CONTROLLED TYPEWRITER

(This information is required in addition to that outlined above)

Can the patient speak? With difficulty/Not at all

Is his speech intelligible? Easily/With difficulty/With great difficulty

Is the patient literate? Yes/No

Can the patient write with pen, pencil? Yes/No

Could the patient type using an ordinary electric typewriter? Yes/No

Could he be helped by simpler equipment than the possum controlled typewriter? Yes/No

Is he, without a possum controlled typewriter, unable to communicate verbally? Yes/No

PHYSICAL PROFILE

Please indicate the patient’s degree of controlled movement and power