The following item is part of the NAEP Conference report written for the August issue of THIIS magazine and relates to the Retail Model and the various programmes running around the country.
Retail Model Update at NAEP
The workshop programme provides delegates the opportunity to dip in and out of a variety of subjects, one of which was the progress of the various schemes relating to the retail model. It was the hot topic (or hot potato) a few years ago when the plans were first unveiled to a wave of apathy. At the time, it created high quality conference material with passionate debate and discussion. These days it seems to have been relegated to the odd spot in a smaller room and that's a shame because, actually, there is probably more going on in this area than ever before.
Susan Heap, Project and Performance Manager for Cheshire East Council and someone who knows more about the implementation and development of a service that has a toe in the retail model concept pond was joined by Gill Owen-John, Team Manager of the Equipment & Adaptation service in Stockport and Cath Scholefield, Disability Services Manager in Woolwich.
They gave delegates a run-down of where they were, what they had done, what had worked, what hadn't and why and where they might go in the future. On both days the workshop was well attended by a wide variety of delegates, from those who were looking to implement something, those who were at that stage right now, retailers involved in schemes in their own areas and people on the fringe who were just interested to know whether this retail model approach was as good or as bad as people are saying.
And that's the point really, there are still plenty of people in both camps. Some say it's the way to go, others that they wouldn't touch it with a barge pole but there are many that just don't have any information at all and for whom information is still key. Of course, trying to find information on how the various models have been working (or not working as the case may be) is as difficult as the proverbial needle in the haystack and that's why this workshop will have hit the right note with plenty of people.
On the Cheshire experience, Susan said: "We adopted the "retail model” for the provision of equipment back in 2007. Four years later the model is completely embedded across both Cheshire East and Cheshire West. Over the last four years we have addressed a number of issues such as prescriber attitudes, a change in the culture of provision, recycling and re-use, diminishing budgets and increasing demand. We believe that the success of the Cheshire model is due to a commitment to broadening access to all types of equipment, for people at varying levels of need. It was important that the Equipment Service moved at the same pace as health and Social Care services, particularly around personalisation, choice, prevention, reablement and timely provision of equipment for discharge and prevention of admission to hospital and A&E.”
Susan explained just how the Cheshire team had gone about it. "We ensured that the development of a new way of providing equipment included supporting services, such as three Independent Living Centres and a partnership with the local British Red Cross. The three ILC's, soon to be five across Cheshire, provide part of the reablement "offer” for people who do not require care packages and do not meet critical and substantial criteria. They provide advice, assessment, demonstration and the wherewithal to self purchase equipment or redeem prescriptions from a retailer of their choice. They also provide centre based assessments for eligible health and social care customers, as well as supported employment, training and a number of other health, social care and third sector services.
She added: "The Community Outreach Prevention Service (COPS) is provided to Cheshire via the British Red Cross and offers transport and support for people who wish to visit the ILC's or a retailer but are unable to access transport or assistance. These developments, alongside the Equipment Service and our partnership with suppliers and with local retailers, ensure that people with disabilities have appropriate information and access to a hitherto undeveloped equipment market.”
A lot of questions have been about the nitty gritty of money of course and, on this subject Susan said: "The focus on prevention and self help has meant that Cheshire's provision of equipment has been able to focus on people with more complex needs. The service has been under budget for the last two years, despite a 5% reduction in budget year on year. The retail catalogue was reduced from 52 to 25 items because the service given by the ILC's and the retailers meant that smaller items of equipment could be removed.”
And it seems that the ‘customers' are happy with the service. "Over the past four years we have held three customer surveys” Sue told us. "Average results were a 92% satisfaction in the service and less than 3% of prescriptions not redeemed.”
She added: "Cheshire adopted this innovative approach to equipment availability and provision in order to prepare for changes in budget allocation and demand. It was not our intention to save money. For the first two years we were over budget because we needed to purchase new stock with our suppliers. However, over subsequent years, due to not having to fund a store, staff and the cost of logistics, a shift in our approach - assisting people to access to equipment in different ways through ILC's and retail and our excellent relationship with suppliers and retailers we have managed to make efficiency savings.”
Another view was given by Gill Owen-John, Team Manager of the Equipment & Adaptation service in Stockport. She explained to delegates that Stockport started issuing simple equipment via prescription in February 2010.
"We have now issued over 8000 prescriptions, with a redemption rate of approximately 92%” she said. "We have around 350 prescribers from health and social care, including community teams, hospital teams and district nurses, and four retailers. We carried out an evaluation of the new service at the end of last year and the feedback has been extremely positive.”
As in Cheshire, Gill emphasised just what a big deal it was to go down the route they did. "This was a huge culture change for our workforce and our residents and we are delighted with the outcomes. Service users value the fact that the equipment they receive is brand new, and also the flexibility created by retailers' longer opening hours. Hospital OTs report that the new system works very well for hospital discharges as relatives can obtain the necessary equipment quickly and do not have to wait at home for delivery.”
Gill shed light on one of the issues that some people believed might be a problem, that of getting the equipment to the users. "Initial concerns that service users and relatives would be unable to collect and fit equipment have proved unfounded and 70% of prescriptions are collected from the store, with around 30% of service users visiting the retailers themselves. All the retailers provide a private delivery and/or fit service and we have found that service users who are unable to access the retailers themselves have been happy to pay for delivery; we presently prescribe delivery in only 7% of cases.”
And, on the subject of the retailers involved with the scheme, Gill was very positive in that regard too. "Our retailers are also very happy with the new process. We have had a limited number of top ups – raised toilet seats with lids are particularly popular! But all retailers have reported additional sales of a range of items from small kitchen and dressing aids to riser recliner chairs, scooters and stair lifts. Excellent relationships have been built between retailers and prescribers with prescribers reporting that they find the retailers a valuable resource.”
Gill told us that it isn't possible at present to give an exact picture when it comes to the financials. "It's difficult to assess our financial position this year as we are still running our loan store for complex equipment. In July we will move to an outsourced contract for complex equipment and will have a better idea of any savings made at the end of 2011/12.”
The third and final overview came from Cath Scholefield, Disability Services Manager for Greenwich Council. She explained how the retail model was developed in that area with support from the Department of Health and the London Capital Ambition programme.
"Prescribers across health and social care have issued 733 prescriptions between January and June 2011. This is a great achievement in such a short space of time. Success can be measured by the fact that 92% of prescriptions have been redeemed within 30 days.”
Cath added: "We have 17 pharmacy and mobility retail outlets. There has been positive feedback from service users about the greater flexibility of access to equipment from their local pharmacies.”
She told delegates that The Department of Health has acknowledged the robust training programme developed with retailers and the high take up of prescriptions to date and that having a paper free system has been well received by practitioners and retailers who are generating prescriptions and retailerinvoices via TCES Connections.
"The project links strongly with the Council's personalisation agenda” she said, "increasing choice of access to simple gadgets for vulnerable people including self funders. It is anticipated that the retail model and associated move to the London Consortium for complex equipment will bring greater quality and efficiency for users as well as savings to both health and social care.”
As I said earlier, the retail model discussion clearly carries some interest, at least for some people. Tissue Viability Specialist Nurse Susan Knight attended and commented: "I found it very interesting, especially as I am a clinical nurse specialist in tissue viability. It would appear that we have very different approaches to working with the private sector and I do understand that the pressures are different – however there are many similarities. My general feeling from the group I sat with was a certain amount of uncertainty of how things would progress and for some a real concern about service delivery and quality.”
Annabelle Waterfield, Chief Executive of Hadnet added: "This was a very valuable workshop which clearly indicated that the success (or otherwise) of the retail model depends entirely on the commitment of the local authority to its principles. It was a real pleasure to see areas in which it is successful.”
However, it seems that the development of a ‘retail model type' system is not something that everyone puts at the top of their agenda as Liza Alexandra, Community Equipment Services Manager at Trafford Provider Services told us: "I did not attend as I felt the subject matter has ‘dated' already and is yesterday's news. I believe the choice agenda has been driven through mandatory routes like Right to Control, Putting People First as these strategies offer choice at source – assessment. We have found through this model, no-one given the choice is opting to purchase their own equipment. I believe the model in Cheshire was reactive at the time of TCES and has forced a single route on its population for which I am not convinced there was any real evidence of demand. To be honest I have lost interest in the TCES agenda as it is not mandatory and believe the ‘wind has gone out of the sails'.”
Clearly there are still very different views on this subject and undoubtedly we will see a number of other initiatives in this sector during the past few years.