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.

It may also be helpful to involve the Equipment and Adaptations Manger in discussions, especially if the nature of the most appropriate equipment is unclear.

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 or Moving and Handing Plan may need to be completed.

Click here to access the procedures for carrying out a risk assessment.

Click here to access the Moving and Handling Risk Assessment form.

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.

Click here to access information about the different ways a person can complain.

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.

4. 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.

The general Local Authority letter template should be used for this purpose. Click here to access it.

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.

Click here to access the checklist for closing a case.

6. Arranging Minor Works and Low Level Equipment

Click here to access the procedure for arranging minor works and low level equipment.

7. Arranging Standard Equipment

Submitting an Order

The TCES Connections online system should be used to order all standard stock, which should be selected from the pick list.

Where relevant the following information should also be included;

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 Clinical Reasoning Form completed as part of the assessment process should be attached to the order, which should then be submitted to your line manager for authorisation. This should contain the following information;

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).

Assuming there are no issues with the information submitted or the equipment being proposed your line manager will authorise the order.

At this point it will be released to Medequip for processing. The Equipment and Adaptations Manager will;

1. Monitor progress; and
2. Notify you when the equipment is in place.

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. As a way of 'testing out' how best to meet long term need when this was unclear;
4. 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.

After equipment is in place

You are responsible for making appropriate and proportionate arrangements to monitor the on-going effectiveness and safe usage of the equipment.

Click here to access the Direct Support Procedure.

Where the person is known to have a Care and Support Plan you should also notify the relevant social worker (or team if unallocated) and request that the equipment is added to their Care and Support Plan.

8. Arranging Specialist Items

Specialist Items

Specialist items are pieces of equipment that are not available as standard stock through Medequip.

Specialist equipment is normally appropriate when;

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

Submitting an Order

The TCES Connections online system should be used to order all specialist items, which should be uploaded on to the system.

If you are not familiar with the process for uploading a specialist item you should seek the support of your line manager as required.

Where relevant the following information should also be included;

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 Clinical Reasoning Form completed as part of the assessment process should be attached to the order, which should then be submitted to your line manager for authorisation. This should contain the following information;

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).

Assuming there are no issues with the information submitted or the equipment being proposed your line manager will authorise the order.

At this point the Equipment and Adaptations Manager should be notified. They will then;

1. Purchase the equipment;
2. Monitor progress; and
3. Carry out any checks in the person's home to make sure it is set up and the person knows how to use it; and
4. Notify you when the equipment is in place.

After equipment is in place

You are responsible for making appropriate and proportionate arrangements to monitor the on-going effectiveness and safe usage of the equipment.

Click here to access the Direct Support Procedure.

Where the person is known to have a Care and Support Plan you should also notify the relevant social worker (or team if unallocated) and request that the equipment is added to their Care and Support Plan.

9. 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 whether to;

1. Proceed to arrange the urgent support yourself (if you have the capacity and knowledge to do so); or
2. Make an urgent referral/request to a social work service.

You can find out how to access social work services by using the How to Access the Service procedures in each service/team area within this site.

If you will be arranging urgent or interim support yourself click here to access the general procedure, including when to arrange urgent support and how to seek funding agreement for urgent support.

10. 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.