Transforming Community Equipment
Programme
Keynote speech
Lynne Horn
National Implementation Manager
NAEP Conference 25th – 26th June 2008
Blackpool
Care Services Efficiency Delivery Programme
Where are we now
Care Services Efficiency Delivery Programme
Agenda
■ Policy context
■ Who are we working with
■ Fears and Concerns
■ Moving forward
Care Services Efficiency Delivery Programme
Policy Context
– enabling people to live as independently as possible,
– enabling people to exercise choice and control over the support they
receive,
– the promotion of high quality safe services; and
– Supporting equality, human rights and social inclusion
Ministers have committed themselves to
– personalised social care and health services,
– giving power and control to people to shape the services they need,
– working with commissioners, providers and regulators of services to
implement policy,
– improving the status of services and of the workforce in health and social
care,
– developing and sustaining a vibrant and innovative third sector; and
– ensuring value for money
The new model is aimed at the total population, not just those who
are supported by the state
Care Services Efficiency Delivery Programme
Model designed to deliver policy
Policy document
Our health, Our care,
Our say: a new
direction for
community services
(‘OHOCOS’)
‘Improving the life
chances of disabled
people’ - PMSU
Recommendations relevant to the Programme
Included by
programme
People assessed as needing equipment can choose to buy the equipment that
meets their needs through a direct payment. In the future, this may be part of
Individual Budgets in the event of national roll out.

People should be helped to live at home (e.g. through provision of community
equipment) where possible.

OHOCOS built on the Green Paper (Independence, Wellbeing and Choice)
commitment that local authorities should, in considering strategic needs, take into
account the care and support needs of the whole population, including those who
have the ability to pay for the services themselves

Piloting Individual Budgets to pull together funding streams, including funding for
community equipment and Access to Work, to give people more say in the
services they receive.

Programme
dependency
Equipment must be updated and maintained

Use centres for independent living to give disabled people greater say

Better information and advice, particularly on transition services (e.g. moving from
children to adult services)

Key desired outcomes:
•Increased ability to live independently
Children and their families able to lead ‘ordinary’ lives
•Young people and their families supported throughout transition
•More disabled people in employment

Services should be personalised and be available at times so people can get to
work

Care Services Efficiency Delivery Programme
Model designed to deliver policy
Policy document
‘Improving the life
chances of disabled
people’ - PMSU
National Service
Framework for
Children, Young
People and Maternity
Services
Recommendations relevant to the Programme
Included by
programme
By 2012 the DH should work together with DfES and ODPM (CLG) to deliver
equipment and adaptations that meets needs, is personalised, involves disabled
people and acknowledges them as experts about their needs, maximises choice,
minimises disincentive to seek employment or move locality and uses existing
resources to reduce social exclusion.

In 2006 the DH should assess whether the community equipment services,
communication aids provision and wheelchair services are able to deliver NSF
recommendations on children’s equipment. If not, make recommendations for
improvement

Standard eight: disabled children and young people and those with complex
health needs
These children and young people should “receive co-ordinated, high quality and
family-centred services which are based on assessed needs, which promote
social inclusion and, where possible, which enable them and their families to live
ordinary lives”. The NSF states that children and young people will need to have
increased access to therapy and equipment services and social services and that
organisations should undertake ‘multi-agency transition planning’ to support
disabled young people entering adulthood.

Standard three: children, young-people and family-centred services
Ensuring services are co-ordinated around the need of the child and family.

Standard two: person-centred care
Allow older people to make choices about their care package, regardless of
traditional health/ social care organisation boundaries. E.g. through single
assessment process, integrated commissioning and integrated community
equipment and continence services.

Care Services Efficiency Delivery Programme
Model designed to deliver policy
Policy document
Recommendations relevant to the Programme
Included by
programme
Standard one: rooting out age discrimination in health and social care

Standard eight: promotion of health and active life.
NHS should lead a programme to promote good health amongst older people,
supported by local councils.

Quality Requirement 7: Equipment and accommodation
People with long term conditions should receive equipment (e.g. wheelchairs) and
housing adaptations when they needs them, to help them lead independent lives
and lead health lives.

National Service
Framework for Long
Term Conditions
Following should be considered when assessing people for equipment:
For complex needs, provide specialist professional assessment with community
equipment/ AT
Equipment requirements to be part of the integrated care plan
Consider providing equipment on trial
Training on how to use equipment for users and carers
Consider how to respond to changing needs, e. g. frequent reassessments/
reviews and flexible provision of equipment for people with rapidly progressing
conditions
Responsive collection and repair and loan, where equipment breaks down
Consider changing needs of carers, e.g. due to illness, paid employment.

Sir Peter Gershon
‘Releasing Resources
to the front line’
Although this is not a policy requirement, both LA’s and PCT’s are required to
meet efficiency targets, and we have identified efficiency release as part of the
Financial case below.

National Service
Framework for Older
People
The new model has included all the policy requirements above
Care Services Efficiency Delivery Programme
Who have we been working with
in the North West?
Lead Partners
Live Micro Sites
Current Micro Site
Macro Sites
Care Services Efficiency Delivery Programme
Pre shadow running concerns and fears
Care Services Efficiency Delivery Programme
Early feedback from Practitioners
Q4 A supply market driven by 'choice' rather than
state funding - this is good for:
Q3 Open access to needs assessment w hich makes full
use of therapeutic skills of practitioner - this is good for:
Suppliers
Suppliers
Providers
Providers
Commissioners
Commissioners
Pract it ioners
Pract it ioners
Users
Users
0%
Q3 Strongly agree
Q3 Agree
20%
40%
Q3 Neutral
60%
Q3 Disgaree
80%
0%
100%
Q3 Strongly disagree
Q6 I would like to see this in my Local Authority or
Trust
Q4 Strongly agree
20%
Q4 Agree
40%
60%
Q4 Neutral
80%
Q4 Disgaree
100%
Q4 Strongly disagree
Q9 I would give up the following to make this happen:
In-house service
1
In house service
Assessment process
Assessment process
CE st ore
0%
20%
40%
60%
80%
100%
0%
Q6 Strongly agree
Q6 Agree
Q6 Neutral
Q6 Disgaree
Q6 Strongly disagree
Q9 St rongly agree
20%
40%
Q9 Agree
60%
Q9 Neut ral
80%
100%
CE Stores
Q9 Disgaree
Q9 St rongly disagree
Early messages from Oct – Dec 2006 showed positive view of policy –
but not in my back yard!
Care Services Efficiency Delivery Programme
Concerns
■ Older people do not want choice
■ Frail and vulnerable people prefer professionals to select
items for them
■ Older people are incapable of understanding what to do
with a prescription. Our clients are housebound and
can’t visit a retailer
■ Practitioners would have to spend more time on
assessments because of the need to revisit the user
■ Unscrupulous retailers will sell vulnerable users
equipment they don’t need
■ The model is wasteful as it does not encourage recycling
Care Services Efficiency Delivery Programme
Evidence from shadow running
Care Services Efficiency Delivery Programme
Evidence
Older people do not want choice:
The Importance of Choice
How important, if at all, do you feel it is that patients . . .
% Very good
% Fairly poor
% Fairly good
% Very poor
are offered a choice of retailers
to go to for their aids/
equipment prescriptions
have the opportunity to make a
choice about the aids/equipment
they receive.
% Neither good nor poor
% Don't know
57
21
72
2 5 3 13
17
24 6
Base: 102 Patients, October 2007 - April 2008
75% - 90% of Users believed in the importance of having a
choice of aids they receive and retailers to go to for their aids
Care Services Efficiency Delivery Programme
Evidence
Frail and vulnerable people prefer professionals to select
items for them:
Importance of topping up
How important, if at all, do you feel it is that patients are able to ‘top-up’ their
prescriptions in this way. Would you say it was…
Not important at all (1%)
Not very important
Neither/nor (1%)
Fairly important
Don’t know
3% 5%
29%
61% Very important
Base: 102 Patients, October 2007 - April 2008
An overwhelming majority of Users (90%) valued the ability to ‘top up’
Care Services Efficiency Delivery Programme
Evidence
Older people are incapable of understanding what to do with a
prescription. Our clients are housebound and can’t visit a retailer:
Who Redeems the Prescriptions?
And can I just check, for your recent prescription are you redeeming this for
yourself or on behalf of somebody else? And are you that persons carer or not?
On behalf of someone else - Other
On behalf of someone else Carer
9%
7%
84%
For myself
Base: 102 Patients, October 2007 - April 2008
All Users surveyed had redeemed their prescription with over 80%
Care Services Efficiency Deliveryredeeming
Programme it for themselves
Evidence
Practitioners would have to spend more time on assessments
because of the need to revisit the user:
Lead Partners:
■ Experienced a reduction in
the average number of
days from referral to
assessment from 18 to 9
days (a reduction of 50%)
and from assessment to
case closure from 45.5 to
27.5 days
Care Services Efficiency Delivery Programme
Evidence
Unscrupulous retailers will sell vulnerable users equipment
they don’t need:
Satisfaction with the Retailer
Advocacy of the Retailer
How satisfied were you with the . . .
And which of these phrases best describes the way you would speak about the
individual retailer that provided you with your prescription? Would you…
% Very satisfied
% Fairly dissatisfied
% Neither good nor poor
% Don't know
% Fairly satisfied
% Very dissatisfied
Length of time it took for your
aid/equipment to arrive once you had
presented your prescription
76
13 24 4
Don’t know/no opinion
Be critical without being
asked (1%)
2%
Be critical if asked
Neutral
13%
11%
48% Speak highly without
being asked
Individual retailer you used for your
aids/equipment prescription
71
19
31 7
Speak highly if asked
Base: 102 Patients, October 2007 - April 2008
25%
Base: 102 Patients, October 2007 - April 2008
Over 90% of Users were satisfied with the service received from
retailers and as many as 73% would speak highly of them
Care Services Efficiency Delivery Programme
Evidence
Unscrupulous retailers will sell vulnerable users equipment
they don’t need:
Patients’ views on Topping up
Were you aware that you are able to ‘top-up’ your prescription for an aid or
equipment that better suited your needs?
Did you ‘top up’ your prescription?
% Yes
Aware
% No
Topped up
7%
44%
56%
93%
Base: 102 Patients, October 2007 - April 2008
Base: All who are aware they were able to ‘top up’ their
prescriptions (45)
Reassuringly, although Users had limited awareness of their option to
‘topEfficiency
up’, there
was Programme
no attempt by retailers to exploit this concept
Care Services
Delivery
Evidence
The model is wasteful as it does not encourage recycling:
■ Case Study available
■ Template that you can complete yourself to understand
true cost of refurbishing simple aids to daily living
Care Services Efficiency Delivery Programme
Implementation
Care Services Efficiency Delivery Programme
We are working with 70
organisations across
England
x6 - Retail model active
x30 - Phase 1 implementation –
Business Case prep
x34 - Key Decision Makers Meetings
Care Services Efficiency Delivery Programme
The Minister’s decision – to implement
the model across England
■ He is considering writing, jointly with David Nicholson,
NHS Chief Executive, to all LA/NHS partnerships to
encourage implementation
He has asked me to
■ Recruit national implementation team
■ Support local authorities and their health partners to
implement
■ Continue to evaluate more effective options for complex
aids to daily living
The implementation plan has been completed and is under
review
Care Services Efficiency Delivery Programme
We will support LA/NHS partnerships to
implement
Start up readiness
assessment packs
PROJECT
PLANNIN
G
Partnership
agreement
Project management
toolkit
Local business
case template
Back
Initial
Office
Contact
Local Financial
Model
SPONSORHIP
4
1
3
2
Refurbishment case
study and template
Retail
Model
PROJECT
PROJECT
RESOURCING MANAGEMENT
(Impact on budgets:
Loan store
overheads,
equipment and back
office budgets)
Prescription
Issue
Demand
Mgmt
Needs
Assess
ment
9 x pulses (how to transition packs)
These tools and techniques are available and being used now
Care Services Efficiency Delivery Programme
Thank You
Care Services Efficiency Delivery Programme