Providing Equipment (Occupational Therapy)

1. When to use this Procedure

This procedure should be used by any Occupational Therapy practitioner who is arranging equipment or minor works under either:

1. The duty to prevent, reduce or delay needs under the Care Act; or
2. The duty to meet eligible needs under the Care Act.

This procedures should not be used by anyone who is arranging a major adaptation to meet needs under the Housing Grants, Construction and Regeneration Act 1996 (HGCRA).

2. Using Independent Advocacy

If the need for independent advocacy has not already been established at assessment and you feel that the person may lack capacity or have substantial difficulty being involved in exploring and deciding which equipment and minor works are required then you must consider whether the duty to make independent advocacy applies and, if so make the necessary arrangements.

3. Exploring Options and Making Decisions

As part of the assessment process you should have talked broadly about the equipment and minor works that may be suitable and available. You must now build on this conversation to determine specifically which equipment or minor works are required.

Who must be involved

The following people must be involved in any decision about equipment or minor works to be provided:

1. The person (or their representative if they lacks capacity);
2. Any carer;
3. Anyone that the person asks you to involve;
4. Anyone else that you feel needs to be involved with the person's consent; and
5. When the person lacks capacity, anyone that you feel it is in their best interests to involve.

The process of exploring options

When exploring options you should:

1. Explore all available options and not limit yourself to 'standard' or most frequently used options;
2. Specifically explore any options requested by the person or carer; and
3. Take opportunities to provide good information and advice about ways to prevent, reduce or delay needs.

Factors that should be taken into account when weighing up available options include:

1. Whether the option is appropriate to meet (or prevent, reduce or delay) the need;
2. Whether the option is proportionate to meet (or prevent, reduce or delay) the need (or could the need be met in a less restrictive or intensive way);
3. The impact of the option on risk (to the person and carers);
4. The impact of the option on the person's independence;
5. Whether the options will support the person to meet any outcomes (either outcomes identified at assessment or outcomes identified in any existing Care and Support Plan).

A simple pros and cons list can be an effective way to explore and weigh up available options.

Risk assessment

As part of the process to explore options you will need to consider:

1. The impact that a particular piece of equipment or minor works will have on current risk; and
2. Any risk likely to be associated with the equipment or minor works if it is provided.

Depending on the level of risk a formal risk assessment may need to be carried out. Click here to access the procedures for carrying out a risk assessment.

Making a decision

It is the responsibility of the Local Authority to decide the best way to meet a person's eligible needs (or the best way to prevent, reduce or delay needs). As such this is your responsibility as you are the local authority's representative.

Any decision that you make must have regard to:

1. The views of the person about the equipment or minor works required;
2. The views of any carer; and
3. The impact of the decision on the person's Wellbeing.

Other factors that you should consider before making a decision are:

1. Whether the person's involvement in the decision has been maximised;
2. Whether the full range of available options been explored;
3. Whether there are any alternative options that could meet the need;
4. Whether any risks associated with the preferred option have been identified and mitigated (for example through a period of direct support);
5. Whether the preferred option represents a good use of Local Authority financial resources (or is there an alternative more affordable option that will meet the need as well as the preferred option); and
6. Whether the preferred option is likely to be sustainable (taking into account anticipated changes in the person's needs or circumstances over time).

Recording the decision

When a decision has been made about the preferred option to meet the need (or prevent, reduce or delay the need) you must make a proportionate record of:

1. The decision;
2. The rationale for the decision (why the preferred option is deemed to be the most appropriate and proportionate provision); and
3. What alternative options have been explored (and why they were not suitable).

If the person is not happy with the decision

Sometimes the person (or their representative) will not agree with the decision that you have made about the equipment or minor works required to meet eligible needs (or to prevent, reduce or delay needs).

In this situation you should be open to reviewing the available evidence and your rationale to ensure that the decision you have made is robust. You should be open and transparent about the evidence sources you have used and take steps to try and:

1. Support the person to understand the decision you have made; and
2. Understand the benefits of the equipment or minor works proposed.

If the person is still not happy with the decision you should seek the support of your line manager as required to decide:

1. Whether to proceed to make the arrangements as proposed; or
2. Whether to alter the arrangements in line with the person's views about the most appropriate equipment or minor works.

Where a decision is made to proceed to arrange equipment or minor works as planned you should consider providing direct support as a mechanism to ensure safe and effective use of equipment or minor works. Direct support includes:

1. Training of informal and paid carers in the safe and proper use of equipment; and
2. Supporting the person to safely and confidently use equipment or adapt to their environment after an adaptation.

Click here to access the procedure for providing direct support.

You must also make the person aware of their right to complain about the decision that has been made.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Click here to read the complaints policy and procedure.

If equipment is over £1000

If the proposed equipment is over £1000 you will need to confirm:

1. Local policy about charging for equipment over £1000; and
2. If the policy is to charge, request a financial assessment; and
3. Whether you are authorised to agree the provision of equipment over £1000; and
4. If not, make arrangements for this to be agreed and authorised.

Agreement and authorisation

If you do not have the authority to proceed to arrange equipment or minor works after making a decision about the best way to meet needs (or prevent, reduce or delay needs) you should:

1. Explain this to the person (or their representative); and
2. Seek agreement and authorisation.

4. Agreement and Authorisation

Requesting agreement and authorisation

If you do not have the authority to proceed to arrange equipment or minor works after making a decision about the best way to meet needs (or prevent, reduce or delay needs) you should:

1. Explain this to the person (or their representative); and
2. Seek agreement and authorisation.

You must provide the person with responsibility for authorising the equipment or minor works with all of the information available about:

1. The person's eligible needs (or the needs that are to be prevented, reduced or delayed);
2. The options that have been explored;
3. The rational for the preferred option (including why other options were not suitable).

Providing further information

If further information is required prior to equipment or minor works being agreed or authorised you should:

1. Provide this where it is available; or
2. Gather this where it is not available (for example through consultation with the person or carer).

If equipment or minor works are not agreed

If the equipment or minor works are not agreed you will be notified of the reason for this. If you do not understand the reason you should seek clarity.

You will need to decide the most appropriate next steps based on the situation, which could include:

1. Providing additional information as appropriate;
2. Exploring alternative equipment or minor works with the person.

Providing agreement and authorisation

This guidance should be used by anyone with responsibility for agreeing and authorising equipment and minor works.

The practitioner requesting agreement and authorisation must provide you with information about:

1. The person's eligible needs (or the needs that are to be prevented, reduced or delayed);
2. The options that have been explored;
3. The rational for the preferred option (including why other options were not suitable).

From the available information you must be satisfied that:

1. A proportionate assessment of need has been carried out;
2. A determination of eligibility has been made (where equipment or minor works are to be provided under the duty to meet eligible needs);
3. The person's involvement in the decision has been maximised;
4. The practitioner has given regard for the person's views, any carers views and the impact on the person's Wellbeing;
5. The full range of available options been explored;
6. There are no alternative options that could meet the need;
7. If the person lives in a care home, the care home do not have a legal responsibility to provide the equipment or works;
8. Any risks associated with the preferred option have been identified and mitigated (for example through a period of direct support);
9. The preferred option represents a good use of Local Authority financial resources (and there is no alternative more affordable option that will meet the need as well as the preferred option); and
10. The preferred option is likely to be sustainable (taking into account anticipated changes in the person's needs or circumstances over time).

If further information is required

If you require further information before agreeing and authorising the equipment or minor works you should request this from the practitioner that carried out the assessment.

If you do not agree equipment or minor works

You should not agree or authorise the equipment or minor works if you find that, having taken into account all available information:

1. The equipment or works are not appropriate and proportionate to prevent, reduce or delay needs (when the duty to prevent, reduce or delay needs applies); or
2. The equipment or works are not appropriate or proportionate to meet the eligible needs of the person (when the duty to meet eligible needs applies); or
3. The equipment or works proposed do not make best use of available local or financial resources.

If you are unable to agree equipment or minor works you must provide the practitioner with information about:

1. Why you have not been able to agree the equipment or works; and
2. The steps that the practitioner may take to resolve any issues identified.

5. When the Person Intends to Make their Own Arrangements

When a person may decide to make their own arrangements

Sometimes a person will decide, following an assessment that they want to make their own arrangements to obtain equipment or carry out an adaptation. You must be satisfied that the person (or their representative) understands that:

1. They are under no obligation to do so; and
2. The Local Authority must provide equipment free of charge up to £1000.

Whether or not the person will want to make their own arrangements will likely depend on a range of factors, and could include:

1. Whether or not the Local Authority is willing or able to provide their preferred equipment;
2. The availability of equipment providers or contractors locally;
3. The financial implications of services for the person;
4. The complexity of their need, including any fluctuation in need and the need for multiple Care and Support services;
5. The person's ability to make and sustain arrangements; and
6. The level of on-going support likely to review and monitor the person's needs or situation.

The information and advice that must be provided

If the person intends to make their own arrangements you must:

1. Provide them with the information and advice they request (or you feel would be beneficial) about available appropriate equipment and local services/suppliers to meet their needs;
2. Provide them with information and advice about ways they can prevent, reduce or delay needs;
3. Provide them with any other information that they request or that you feel will be beneficial;
4. Consider the support the person may need to explore and make their own arrangements and whether the advocacy duty applies;
5. Explain to them what to do if they change their mind about making their own arrangements;
6. Explain to them what they should do if their needs change; and
7. Carry out, or arrange to be carried out any processes to support carers.

All of the above information should be confirmed in writing.

When the person has eligible needs under the Care Act

If equipment or minor works were to be provided under the duty to meet eligible needs (as opposed to the duty to prevent, reduce or delay needs) the duty to meet those eligible needs is not discharged until an appropriate alternative service is in place. This means you will need to consider:

1. Information and advice required to ensure that any equipment or adaptation that the person arranges will meet their eligible needs; and
2. Supporting the person to access an appropriate provider;
3. The need to provide short term equipment; and
4. Monitoring the situation to ensure that eligible needs are being met as intended.

Closing the case

You can proceed to close the case when:

1. There are no outstanding actions for the Occupational Therapy service;
2. The person has been provided with all information and advice required (or that would be beneficial);
3. There is no need to monitor whether eligible needs are being met.

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship.
2. Deputyship
3. Carers support
4. Tenancy in extra sheltered housing.

Click here to access the process for ending your involvement and closing a case.

6. Arranging Standard Equipment

Standard equipment

Standard equipment refers to any equipment that is available direct from Local Authority equipment stores. The availability of standard stock items is monitored by equipment stores, who replenish stock as and when required.

Standard equipment items can change from time to time and you must familiarise yourself with the items that are currently available from standard stock before proceeding to make arrangements.

Providing specific information

You must take steps as required to provide additional information to equipment stores if:

1. There are specific order requirements;
2. There is a sense of urgency; or
3. You require notification when the equipment is delivered.

Specific order requirements could include:

1. The location in the person's home where equipment needs to be placed;
2. The height that equipment should be set at (to ensure safe and effective use);
3. The size required (when the equipment is available in a range of size options).

After ordering equipment

You should make a proportionate record of:

1. The equipment that has been ordered and when it was ordered;
2. The proposed delivery date (if known);
3. Agreed arrangements for delivery made with equipment stores;
4. Steps taken to ensure proper and safe use of equipment after delivery.

It is the responsibility of equipment stores to:

1. Liaise with the person (or their representative) to agree suitable arrangements to deliver equipment; and
2. Notify you of any problems, issues or delays.

Short term equipment provision

Sometimes equipment needs to be provided on a short term basis, for example:

1. To facilitate discharge from hospital where the person is expected to recover;
2. During a period of illness or following an injury;
3. During a period of reablement;
4. As a way of 'testing out' how best to meet long term need when this was unclear;
5. As an urgent interim measure.

Equipment to be provided on a short term basis should be arranged in the same way as equipment that is to be provided longer term. However, you must:

1. Record the date that the short term equipment loan is going to end (when this is known); and
2. Agree appropriate monitoring arrangements to regularly review the need for the equipment.

When to close the case

You can consider closing the case when:

1. You have confirmed the equipment is in place and being used as intended to meet eligible needs;
2. There is no need to provide direct support or monitoring;
3. There are no outstanding actions for the Occupational Therapy service (for example further assessment or referral to another service).

Before closing the case you must provide the person (or their representative if they lack capacity) with the following in writing:

1. Information and advice about maintaining and repairing equipment;
2. Any other information and advice requested, or that you feel would be beneficial;
3. What they should do if their needs change;
4. What to do if the equipment no longer appears to be meeting their needs; and
5. What they should do if they (or a carer) requires further direct support in the future to use the equipment safely.

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship;
2. Deputyship;
3. Carers support;
4. Tenancy in extra sheltered housing.

7. Arranging Specialist Equipment

Specialist equipment

Specialist equipment refers to any equipment that is not available through Local Authority equipment stores as standard stock. Specialist equipment must be ordered directly from the manufacturer.

Specialist equipment is normally appropriate when:

1. The person has specific or complex long term needs; and
2. Standard and non-standard equipment options are not appropriate or proportionate to meet eligible needs.

Ordering specialist equipment

Specialist equipment should be ordered using the manufacturers preferred procurement processes unless:

1. The Local Authority has spot contract arrangements in place to purchase items; or
2. The Local Authority is able to set up spot contract arrangements to purchase items.

It is your responsibility to establish:

1. Whether there is a spot contract arrangement in place for a particular manufacturer before proceeding to place an order; and
2. If so, how to place an order via this arrangement; and
3. In all cases, invoicing arrangements.

The information that should be provided

Aside from the equipment item details and invoicing arrangements, you must take steps as required to provide additional information to the manufacturer if:

1. There are specific order requirements;
2. There is a sense of urgency; or
3. You require notification when the equipment is delivered.

Specific order requirements could include:

1. The location in the person's home where equipment needs to be placed;
2. The height that equipment should be set at (to ensure safe and effective use);
3. The size required (when the equipment is available in a range of size options).

The information that should be sought

When ordering specialist equipment direct from the manufacturer you should establish:

1. When the equipment is likely to be delivered;
2. Whether the manufacturer will contact the person directly to arrange delivery (if not you must update the person);
3. The delivery service that the manufacturer provides.

Different manufacturers provide different delivery services. For example:

1. Some will provide a delivery service only, placing the equipment in a generic location and leaving any packaging on the item;
2. Some will place the equipment in a specified area of the home and remove packaging;
3. Some will place the equipment in a specified area of the home, remove packaging and set the equipment up to required specifications; and
4. Some will deliver equipment, set it up to required specifications and provide direction to the person and any carers about safe and proper use.

It is your responsibility to liaise with the manufacturer to agree the delivery service that they will provide. Depending on what is agreed you will need to consider:

1. Any advice that you should give to the person and any carer about using/not using the equipment after delivery;
2. The steps that should be taken to monitor progress of the delivery; and
3. Appropriate and proportionate direct support arrangements following delivery.

After placing the order

You should make a proportionate record of:

1. The equipment that has been ordered and when it was ordered;
2. The proposed delivery date;
3. Agreed arrangements for delivery made with the manufacturer;
4. Any advice or information given to the person about using the equipment after delivery;
5. Any steps that you intend to take to ensure proper and safe use of equipment (for example, through direct support or monitoring).

Closing the case

You can consider closing the case when:

1. You have confirmed the equipment is in place and being used as intended to meet eligible needs;
2. There is no need to provide direct support or monitoring;
3. There are no outstanding actions for the Occupational Therapy service (for example further assessment or referral to another service).

Before closing the case you must provide the person (or their representative if they lack capacity) with the following in writing:

1. Information and advice about maintaining and repairing equipment;
2. Any other information and advice requested, or that you feel would be beneficial;
3. What they should do if their needs change;
4. What to do if the equipment no longer appears to be meeting their needs; and
5. What they should do if they (or a carer) requires further direct support in the future to use the equipment safely.

Make sure it is only your own involvement that ends when the Local Authority is to remain involved in some way, for example:

1. Appointeeship.
2. Deputyship
3. Carers support
4. Tenancy in extra sheltered housing.

8. Urgent and Interim Support

If the provision of equipment or works is delayed you must consider whether:

1. There is appropriate support in place to meet the person's eligible needs (where the equipment is being provided to meet eligible needs); and
2. If not, the steps that need to be taken to ensure any urgent needs are met.

If there are unmet urgent eligible needs you must take steps to ensure that these are met. Urgent needs can be met under the Care Act without a determination of eligibility having been made.

If a practitioner from a social work service is already involved with the person you should:

1. Inform them that the equipment has been delayed and that the person appears to have unmet urgent needs;
2. Advise them of a possible timeframe for the equipment to be provided; and
3. Provide them with access to any information gathered through assessment so they can prioritise and consider the most appropriate course of action.

If the person is not known to a social work service you will need to decide with them whether to make an urgent referral/request to a social work service.

9. The Care and Support Plan

Equipment or works carried out do not have to be recorded on a Care and Support Plan unless:

1. They are being provided under the duty to meet eligible needs; and
2. The person already has an existing Care and Support Plan.

You should provide the following information to the practitioner or service with statutory responsibility for reviewing and maintaining the Care and Support Plan:

1. The equipment and works that have been provided under the duty to meet eligible needs;
2. The date that the equipment or works was provided; and
3. The cost of any equipment over £1000 (where the local policy is to charge a person for equipment costing more than £1000).

You should make a proportionate record of the information provided and the name of the practitioner it was provided to.