Transforming Community Equipment and Wheelchair Services.
It is a year since the BSRM first aired its concerns regarding the TCEWS programme. It had then been surprised that Ministers perceived need to further restructure services set up only two years previously:- most had been established satisfactorily, but many still needed time to consolidate, to reorganise working practices and to develop accredited staff training programmes.
The Society had no difficulty in agreeing that improving the availability of assistive technology would make it easier for people with disabilities to live at home rather than in institutional settings. Additionally it had no objection to local statutory services working with pharmacies, mobility and do-it-yourself stores, supermarkets, charities and voluntary groups so as to offer better access to equipment – provided that these organisations could offer potential users face to face consultation with knowledgeable and properly accredited staff.
The BSRM considers appropriate equipment provision essential if people with disabilities are to be better integrated within their communities. It is important too that service providers have links with locality and regionally based rehabilitation services so as to control costs, improve clinical governance arrangements and support those of working age into remunerative employment.
It was concerned and remains concerned that the TCEWS proposals
· regard service users as uniformly articulate and informed when all too often they are confused and vulnerable
· fail to recognise the contribution made by the established statutory workforce
· skirt around the need to develop properly accredited patterns of training and clinical governance across the sector.
Despite the Society's concerns, despite on-going improvement in statutory provision and despite Primary Care Trusts being under no obligation to implement its proposals, TCEWS continues to be promoted as the way to optimize equipment provision.
It has now identified two equipment streams:
1 Items that cost less than £100 and do not require specialised technical support.
The provision of items such as bath-boards, commodes, raised toilet seats and walking aids should be managed within the retail, charity, or voluntary sectors and collected by the user. If provision has been authorised by accredited personnel, statutory services should contribute to the cost through a prescription or voucher scheme.
The BSRM foresees three problems:
Equipment would belong to the user. When requirements change as illnesses progress, there could be need to revise provision. A service model excluding the refurbishment of serviceable pre-used equipment could be expected to increase costs.
Participating retailers and non-statutory bodies would need to be able to facilitate simple technical support – for example the fitting of raised toilet seats, grab rails, or access ramps.
The prescription scheme would lead to the setting up of yet another new organisation - The Prescription Clearing House.
2 more expensive, costly and bulky items
Expensive and bulky items, those on loan and those requiring specialist support should be identified in the catalogue compiled by a new over-arching organisation - The National Commissioning Body.
These items would include beds, hoists, respirators and stair lifts as well as electronic and computer based technologies. The number of centres storing, distributing, collecting and then decontaminating this equipment would be limited with services nationwide coordinated by DHL and the NHS Supply Chain.
The BSRM foresees three more problems:
The difficulties that beset NHS PASA should be sufficient to deter the setting up of a National Commissioning Body. Regional purchasing cooperatives already work well and offer opportunity to retain and train locality based technical personnel within a framework of clinical governance.
The delivery of bulky, complex and expensive equipment by carrier from remote warehouses would be clinically inappropriate. Complex and expensive equipment needs to be formally received, assembled and fitted into the user's home, prior to user and carer being instructed in its usage.
Setting up equipment, instructing users and carers and offering on-going technical support on a call-out basis requires locality based expertise. Dispensing with this would be detrimental to patient care and would significantly increase equipment maintenance costs.
Despite on-going improvement in statutory provision and despite Primary Care Trusts not being obliged to implement the TCEWS agenda, it continues to be promoted from the centre. This cannot be right. Introducing new layers of bureaucracy whilst disempowering and deskilling local workforces would be detrimental to services and to their users - and probably more expensive as well.
Dr Emlyn Williams Consultant in Rehabilitation Medicine Liverpool Head of Service Electronic Assistive Technology [NW] Chairman BSRM Special Interest Group for Electronic Assistive Technology