Equipment and Adaptation Service
North Lanarkshire Council · 21 February 2023
Back to Adult Care and Social Work Committee — 21 February 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☒ Yes ☐ No Ref DF/MF Date 21/02/23 Equipment and Adaptation Service From Diane Fraser, Chief Officer of Adult Social Work Services E-mail Flavelm@northlan.gov.uk Telephone 07939284700 Executive Summary This report is to inform Committee of the current position of the Equipment and Adaptation Service (EAS). The EAS provides an essential service through the provision of equipment and adaptations to enable people to live independently and safely at home. It also provides essential supports to discharge planning. Since the pandemic, the service has faced several challenges, and these will be evidenced in this report. Despite these challenges the service continues to prioritise those most at need who are at risk of admission to hospital or care home and are being discharged from hospital. The report will outline the current demand, performance, premises, workforce, and governance arrangements and will highlight the recommendations for change within the service. The main recommendations made in this report aim to ensure that the service continues to meet the growing demands and delivers on key performance indicators and that the service is quality assured to meet the needs of people living in our communities. Recommendations It is recommended that the Adult Care and Social Work Committee: 1. Acknowledge the contents of this EAS report. 2. Endorse refreshed governance arrangements. 3 Acknowledge the change of current electronic stores management system: Managing Integrated Community Equipment Service (MICES) previously approved at the EAGG. 4 Endorse the service review and anticipate future reports seeking approval for recommended changes. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities
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1. Background 1.1 The Equipment and Adaptation Service (EAS) situated in Motherwell, serves the population of North Lanarkshire Council and all of NHS Lanarkshire patients living in North and South Lanarkshire Council area. It is a valued and effective service supporting the whole spectrum of need from prevention and early intervention to end of life care. Timely delivery of equipment and adaptation supports people to live independently in the community whilst avoiding unnecessary admissions to hospital or care settings and supporting timeous discharge. 1.2 The Equipment and Adaptation service (EAS) helps the Partnership support National and Local strategies in prevention and early intervention: - • The AHP Public Health Implementation Plan 2022 focus on prevention and early intervention and planning for the aging process, preventing and delaying or managing crisis. • NCS (Scotland) Bill 2022 which directs partnerships to ensure that people are supported to lead fulfilling, independent lives. • GIRFE 2022 model by which we are guided to support person centred outcomes and promotion of early intervention, joined up working holistic and flexible. • Rehab and recovery A once for Scotland Approach 2022, which provides guidance on rehab delivery. Main themes are that we provide services which are provided at the right time and integrated and are easy to access for all individuals. • The service supports the North Lanarkshire Health and Social Care partnership to achieve 3 of the key ambitions in the Strategic Commissioning Plan 2020 – 2023: o Provide a Range of community services to support people to live well in connected communities. o Promote prevention and early intervention. o Be at the forefront of technical and sustainable solutions. 1.3 The EAS is jointly funded by North Lanarkshire Council and NHS Lanarkshire. The EAS arranges or directly provides all equipment or housing adaptations for people with disabilities in North Lanarkshire. The service also provides equipment to residents in South Lanarkshire on behalf of NHS Lanarkshire. 1.4 Requests for service come from many sources, including occupational therapists, district nurses, social workers, hospital discharge teams, and importantly, from people themselves through on-line self-assessment via the Making Life Easier web site. 1.5 The service plays a vital role in supporting people, often with very complex needs, to be independent, assists with the implementation of reablement, and facilitates early discharge from hospital. It also plays an important role in preventative and early intervention responses which help people themselves and family carers to live full and active lives safely and with dignity. 1.6 The service is also available to children and young people who benefit from equipment solutions and adaptations to increase independence.
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1.7 The service response to ever increasing growth in demand which reflects demographic changes in ageing and prevalence of long-term conditions, has required close monitoring, impacting on the future funding and operational requirements. 1.8 The impact of the pandemic has resulted in fluctuation and changes in demand. Whole system pressures in managing recovery and redesign have more recently resulted in significant areas of pressure, particularly to support hospital discharge and avoid unnecessary hospital admissions. 1.9 This report outlines the current arrangements for the provision of community equipment and adaptations and summarises the strengths and risks associated with the available service provision. 2. Report Service Redesign 2.1 Prior to the pandemic a proposal to review the operating model of the EAS was agreed however progress has been delayed as the service focused on delivery through covid. As the provision of equipment and adaptations has developed, there has been some activity in the last year in supporting the reviewed. A refreshed Governance Board, improved communication strategy and practice, attention to staff recruitment and retention working with Business Partners has been a priority. Furthermore a comprehensive training plan has been devised across all roles within the service working with Talent and Organisational Development and the successful integration of the Assistive Technology section. 2.2 Increased emphasis has been placed on the service to support hospital discharges through the provision of equipment. This correlates with a lesser priority being given to support people living in the community and often these individuals have much longer waits. 2.3 The service redesign needs to incorporate opportunities for career progression and succession planning within the establishment this should impact on staff retention and recruitment into the service. 2.4 The review workstream has been interrupted by the need to respond to the demand pressures through the pandemic but is expected to make recommendations by September 2023. 2.5 The service redesign exercise will take account of: The staffing structure, recruitment and retention, staff training, the logistic model, software, operating hours, premises, and the prioritisation framework. The service is struggling to recruit to vacant positions, the Senior Technician post has been advertised 3 times with no suitable candidates identified. Further discussions have taken place with our Business Partner and agreement reached that current staff and others will be able to apply for this type of post by “working towards” the required qualification in an agreed timescale to encourage internal candidates to apply for this post. This model may be applied to other posts currently vacant and is under discussion. The current staffing levels are contributing significantly to the current reduction in service performance increasing waiting times.
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• Demand modelling, including the steady increase in the number of two person deliveries required with a steady rise in the number of larger pieces of equipment requested as urgent for discharging people from hospital e.g., beds, hoists and riser recliner chairs. • Increased portfolio, including the significant increase in smart technology to support independence, but could also include an increased role in assessing and supporting specialised equipment use, smart tech, but also including moving and assisting equipment. • Service delivery Model- Locality/Sector based response, creating the capacity for same day responses which dovetail with practice developments in relation to discharge to assess, home first and relationship with integrated rehabilitation teams. Refreshing structures around a locality model will improve responses which cover the spectrum of intervention from proactive, preventative supports to complex, and end of life care. It is proposed that the EAS will develop a locality or geographical based response which supports the wider aspirations of the Health and Social Care Partnership to ensure that the six localities of North Lanarkshire and the four of South Lanarkshire are responsive and reactive to communities and neighbourhoods. • Review of operational groupings, to reshape the EAS operation into three distinct groups: o Stores and Logistics. o Equipment delivery and collection. o Service and maintenance. 2.6 Engagement with staff has already commenced, with various large team, and sub team meetings taking place over the last 6 months and the formation of a local Health and Safety Committee to ensure staff inclusion with the review process. An external provider -Think Distinct has met with most of the staff on a one-to-one basis to allow open and honest discussion on how they feel in regard to the service, its current operating model and future developments. 2.7 Extensive work has been undertaken with the Talent and Organisational team in conjunction with all staff to identify both individual and service training needs which will assist with future service redesign and allow staff to achieve their own career progression. An initial service training plan has been completed which has identified and prioritised these requirements and will be progressed. 2.8 Initial meetings with Joint Trade Unions on raised issues and concerns have taken place and these will be continued on a regular basis to ensure any local issues are identified and dealt with as and when they arise. 2.9 Staff and Trade Unions will be fully involved in the service redesign, which will come back before Committee for final approval by September 2023.
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Service demand 2.10 Several key variables have an increasing impact on the demand for and performance of the EAS. a) Increase in the number of people who choose to die at home and require equipment to allow care to be provided. b) Population changes, particularly in people aged over 75 and aged over 85 which has grown by 20% in the last 10 years in North Lanarkshire. c) The rise in the number of single person households, with associated demand for equipment and adaptations as natural supports not being as available which has grown by 20% in the last 10 years in North Lanarkshire. d) Reduction of the length of time people spend in hospital with increased health and social care provided at home. e) There is an increased complexity of health needs at home, multiple long-term conditions, people with very complex health issues are surviving with high needs e.g., ventilation. f) Increase in the number of people who have severe or profound learning disabilities which has grown by 20% in the last 10 years in North Lanarkshire. g) Increase in people who are clinically obese. 2.11 The EAS activity in relation to delivery and uplift of equipment over the past 5 years is provided in the table below, it is expected that 2022/23 activity will be like 2020/21, however this is anticipated to increase as services normalise in 2023/24. The decrease in activity is due to the change in prioritisation during the pandemic when only P1 and P2 requests were being fulfilled. As can be seen in Table 1 the projected demand to April is showing a 17% increase from 2021 and the service now has extended waiting times for Deliveries and Collections across all equipment groups. Waiting lists for referrals into the service are also increasing – currently there are approximately 1000 assessments pending from the Integrated Rehab Teams across the localities. Table 1 Year Equipment Request Collection Request Total activity 2018/19 44102 19646 63748 2019/20 47395 23087 70482 2020/21 30463 15690 46153 2021/22 31528 19962 51490 2022/23 Projection 34921 17076 51977
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2.12 Whilst demand reduced during the pandemic and in the recovery period by around 30%, expenditure on core equipment only decreased by around 20% from 2019/20 - which is indicative of the cost increases to equipment experienced in the last 18 months. Equipment Spend 2018/19 £2,284,955 2019/20 £2,478,023 2020/21 £2,012,331 2021/22 £1,965,865 2.13 The delivery and collection of beds averages 51 activities per week, representing 24 deliveries, 25 collections and 2 moves There are currently 2447 profiling beds in people’s homes across Lanarkshire, that equates to 371 per 100,000 population compared to Dumfries and Galloway 353, Fife 245, and Edinburgh 200. 2.14 Work is ongoing to ensure that all requests are properly screened to ensure these are appropriate. There are numerous lower-level alternatives to hospital beds, and these must be explored first before referrals are made for profile beds, which can be very disruptive in the service user’s home. This work has resulted in no increase demand in the last 12 months against a background of increasing demands from Hospital discharge Teams for other pieces of equipment and other Partnerships reporting significant increases for this type of equipment. Adaptations 2.15 The EAS also manages the adaptation service for North Lanarkshire. 2.16 Major adaptations include wet floor showers, ramps, specialist toilets, through floor lifts, external stairlifts and bathroom extensions. 2.17 A moderating group operates to provide consistency and equity across the 6 localities. 2.18 Increased cost pressures from contractors have been incurred post pandemic with the average grant awarded increased from £3200 in 2021 to £4231 for this financial year. Service Performance 2.19 The service has a target that 80% of all core equipment deliveries should be being within 7 working days. Overall performance for equipment deliveries from April – Dec 2022 was 68% of all requests delivered within 7 days.
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Deliveries Collections Total Activity SLA Achieved 2017-18 48551 20327 68878 78% 2018-19 44102 19646 63748 79% 2019-20 47395 23087 70482 78% 2020-21 30823 15694 46517 77% 2021-22 31528 19962 51490 68% 2.20 The impact of urgent requests for Hospital Discharge and admission prevention continues to be a significant challenge on the services resources, with over 92% of these requests being completed within 4 days to the detriment of other equipment requests. 2.21 This rise and prioritisation in equipment being required to support people with hospital discharges has had an understandable impact on the store’s ability to provide standard equipment to meet key performance indicators. 2.22 Bed deliveries and collections demand have been increasing this year, with waiting lists increasing - currently 110 beds are waiting for delivery and 150 for uplift with a service capacity of 10 units per day (combined deliveries and collections). Community Beds Deliveries Collections Total Activity SLA Achieved 2017-18 1544 1394 2938 86% 2018-19 1542 1556 3098 91% 2019-20 1454 1440 2894 92% 2020-21 1378 1463 2841 92% 2021-22 1164 1367 2531 92% 2.23 Adaptation referrals are returning to pre-pandemic levels, with 2077 new requests received so far from April - Nov 2022. Average time to complete across all tenures is 125 days. This is mainly due to the availability of external contractors which is proving to be problematic despite extensive work being undertaken to identify additional companies willing to undertake these types of works. NLC properties average 35 days completion for works undertaken by MEARS. 2.24 Key performance indicators are currently being reviewed to refine and improve the reporting on performance and to better reflect the complexities of EAS and inform future service development.
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Adaptation Referrals received - All Tenures 2.25 2.26 The recycling of costly equipment is essential to ensure a sustainable cost model going forward. This activity has been impacted upon due to covid restrictions and social distancing in the building space, these have now been lifted, however uplifting equipment remains challenging with activity having to be balanced to meet service delivery expectations. 2.27 Equipment supply has improved in the last 6 months with most core stock lines now being readily available. Assistive Technology products are still problematic due to worldwide microprocessor supply issues. Governance 2.28 The governance arrangements are being refreshed to increase the routine monitoring of performance and offer increased support to the service across key partners. 2.29 The new Governance arrangements will ensure the alignment of the services activities to support the Strategic Commissioning Plans ambitions particularly on prevention, early intervention and empowering people to live fulfilling lives. 2.30 The refresh takes account specifically of the need to provide assurance to the senior leadership team, IJB and Adult Health and Social Care Committee with analysis of demand impact and on recovery of performance. The refresh is an opportunity to update representation from the health and social care partnership locality teams, realising the benefits of the creation of the two overarching sectors. The interface with the localities creates the dialogue about the practitioner assessment and planning role which impacts directly on the performance of the EAS. South Lanarkshire representation will be secured. 2.31 The EAS Board has been replaced with a Governance Group, chaired by the Senior Manager – Adults Social Work, to include locality managers, acute staff, finance staff from the Council and Health, Performance and data analyst, Nursing representation, Allied Health Professional representation, Business Partners and a Housing representative. There have been initial meetings and discussions to agree membership and the Terms of Reference for this group and this will continue into 2023 alongside a schedule of meetings. 2.32 The Integrated Equipment Review Group has been reinstated to ensure that consistency in nonstandard stock ordering (such as specialist seating and riser recliners). Number of Referrals Received. P1 P2 P3 P4 Rails 2017-18 3520 19 361 896 5 2239 2018-19 3626 14 413 836 0 2363 2019-20 3463 8 393 793 0 2031 2020-21 2306 89 531 628 1 1031 2021-22 3137 10 403 790 2 1918
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2.33 The Housing Solutions Moderating Group has also reconvened following cessation because of the impact of Covid 19. The Moderating Group ensures robustness over decision making and equity across all localities for adaptation recommendations. 2.34 Both the Integrated Equipment Review Group and the Housing Moderating Group will report to the Governance Group. Premises 2.35 The service is currently located in a 743 Sq. metre (8000 square feet) industrial unit in Motherwell which hosts warehousing, recycling, repairs workshop and office space. 2.36 The current building is not delivering in the context of demand and flow and there is a need to consider relocation. The Service currently has 3 temporary off-site storage locations for collected equipment, PPE, and bulk deliveries this is in addition to the PPE stored at the NLI premises in Wishaw used for Home Support PPE distribution. These premises are not suitable for any long-term storage of equipment, and one of the locations (Albert Street) has almost been fully vacated. The Cook and Indies building will have to be vacated by early summer in 2023, which will require further suitable storage to be identified and discussion is ongoing to source appropriate space. 2.37 The present store space no longer meets the space requirements for recycling and equipment storage. 2.38 The demand modelling being undertaken will inform the potential increase in demand for equipment. It is known, however, that there is an increased need to store bariatric equipment, a continued increase in recycling of stock to minimise spend on new equipment, and the potential for additional areas of work to be added to the EAS portfolio. 2.39 A review of the current premises did not identify any significant opportunities to reconfigure or expand the property. IT System Development 2.40 As noted previously the differencing IT systems used across the partnership can lead to duplication of requests and limited visibility to a services user’s history of equipment provision. CES 360 was identified as a replacement for the current MICES system as the operating system for the EAS. This system was expected to be in place by the end of quarter 1 of 2022 but the vendor has now advised that they will no longer continue any further development of the CES360 system and will not proceed with its implementation but will undertake some minor improvements to the current MICES system, which will not provide any of the benefits previously identified with CES360. 2.41 It is therefore imperative that an alternative solution is identified to improve the current system which will have the noted identified service requirements: • Direct ordering and tracking of orders, but specifically in terms of the operation of the EAS the system will be much more sophisticated in the construction of delivery routes and times, based more on the complexity of work rather than the number of deliveries.
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• A system that will also link directly to the stock control process, reducing administrative functions. • Field staff will be provided with handheld devices which will greatly reduce the reliance on printed paperwork, provide real-time delivery information to the prescribers via email and route management based on current traffic conditions. • Improved monitoring of equipment due for review and maintenance. • Give prescribers direct access to equipment catalogues stock levels and Service Users equipment history. • Interoperability and data sharing with the new social work system being provided by Mosaic and other external service contractors to reduce duplication of input 3. Measures of success 3.1 The service will achieve agreed operating standards as set out by the Governance Group. 3.2 Customer satisfaction and quality outcomes for people. 3.3 Redesigned service to meet partnership ambition 4. Supporting documentation 4.1 N/A Diane Fraser Chief Officer of Adult Social Work Services
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The main purpose of the EAS is to address the impact of disability through providing equipment or adaptation designed to overcome physical barriers or limitations and increase independence. Through the provision of equipment or adaptation the EAS children, adults and older adults with disability can fulfil their potential. Localising the structure of the service fits better with wider Health and Social Care developments to ensure the right service at the right time for people locally. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? The detailed financial information will be populated through completion of the Service Review. The 2022/23 gross expenditure budget for the Integrated Equipment and Adaptation Service is £5.081m as highlighted in the table below. £m Equipment 2.413 Adaptations 1.152 Employee Costs and other overheads 1.802 Total Gross Expenditure 5.367 In addition to the revenue funding described above the service has historically received an approved Capital budget for aids and adaptations. In the current 5-year approved capital programme the service was initially allocated £11,640k through to 2025/26. However, this has now been reduced by £650,000 to £10,990k. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development?
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Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? Changes to the management and operating structure of the EAS will be subject to detailed discussion with HR Business Partners and the Job Evaluation team. 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? The implementation of the new stores system will allow the service to introduce technology that improves efficiencies in all areas of the service from real-time automatic updates to prescribers through to route management for field staff. The continued development of smart technology to support independence will remain under review and development. Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact?
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The increased capacity to manage the full process of recycling existing equipment will have a positive impact on the environment through reduction of waste. A new stores system will introduce route management and improve fuel efficiency. 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? Communication across the Partnership will be required, and a Communication Plan will be agreed and implemented. 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? The model proposed will give increased capacity locally to provide equipment timeously to facilitate hospital discharge and prevent admission and support urgent repair requests. Presently EAS sits on the risk register. The routine and regular testing of equipment will ensure compliance with national Health and Safety standards, protecting people in their use including people with a disability, family carers and paid carers 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in-Service or ex- Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services.