BLACKPOOL COUNCIL
REPORT
of the
DIRECTOR OF HOUSING AND SOCIAL SERVICES
to the
SOCIAL SERVICES AND HEALTH SERVICE DEVELOPMENT COMMITTEE
on
27TH JANUARY 2005
EQUIPMENT ADAPTATIONS SENSORY IMPAIRMENT TEAM (EASIT)
1.Introduction
1.1EASIT provides equipment and or adaptations to help disabled people manage more easily to live independent lives. EASIT assesses the individual needs and arranges delivery and fitting of equipment and adaptations, and in the case of low vision, rehabilitation.
2.Equipment - Integrated Community Equipment Service (ICES)
2.1Blackpool Council is in partnership with; Blackpool Primary Care Trust (PCT), Wyre PCT, Fylde PCT and Lancashire County Council. Each partner contributes financially and Blackpool Council’s contribution for 2003/4 is £189,000.
2.2The community equipment service is managed by Wyre PCT and covers the Occupational Therapists (OTs) as well as the Community Loan Store.
2.3The OTs receive referrals from Social Services or the GP and then assess the individuals need for community equipment. They assess for equipment such as hoists, bathing aids, kitchen aids, helping hands, and dressing aids. Once the assessment has taken place they contact the Loan Store who deliver the item to the person’s home and the OT returns if any fitting is required or demonstration of usage. Care and Repair install items such as grab rails and key safes that require simple fixing by their Handyvan Scheme.
2.4Each year we review the equipment and adaptations supplied, by questionnaire with the clients and follow up on any queries raised. We have a full time Reviewing Officer working on this project on EASIT.
2.5The Department of Health has introduced two new targets from December 2004 - D55 and D54.
2.5.1D55 - relates to assessments:
All assessments to begin within 48 hours of referral, 70% completed within 2 weeks and 100% in 4 weeks.
Performance
October 2004 performance - 15 weeks waiting, with 325 patients on the waiting list.
Barriers
- The OT service use manual records rather than electronic systems, which slow down the exchange of information.
- Referrals from Social Services and Health (GPs) are sent direct to the OTs rather than via the single assessment service.
- Wyre PCT manages the staffing and therefore Blackpool Council is dependent on them to deliver this target.
What is being done to address the barriers above?
- We are working with the OT Service to develop a strategy to meet this target.
- Blackpool Council pays for a full time OT on the Frontline team.
- Social Services provides additional funding to Health for staffing to reduce the waiting list.
2.5.2D54 - relates to delivery of equipment:
From December 2004 the target is that equipment is delivered and satisfactorily installed in the opinion of the Council within 7 working days, which includes bank holidays.
Barriers
- Time is critical to the achievement of this target to achieve delivery and fitting within 7 days. Therefore the present use of manual systems is too slow. There are problems with recording the information we need to calculate this indicator, due to the electronic information system not being joined between Health and Social Services.
- The Council’s eligibility criteria (FACS) Fair Access to Care Services is not being used in the assessment of equipment.
What is being done to address the barriers above?
On the 11th November Wyre PCT held “a Community Equipment Mapping Day” and as a result has set up a project to achieve improvement in equipment delivery.
Achievements on the delivery target (D54)
2003/2004 performance - percentage of items delivered was 67.8%.
April to September 2004 performance - percentage of items delivered was 80.59%.
3.Adaptations
3.1Adaptations are alterations to property as recommended by OT assessment. They can be major adaptations such as extensions and level access showers or minor such as widening doors. Adaptations are provided for all ages.
3.2Council
3.2.1As a landlord we provide major and minor adaptations for council property. The Budget for 2004/5 was £225,000.
3.2.2296 adaptations are committed to, including:
-37 Level access showers
-27 over bath showers
-16 ramps
-19 stair lifts.
3.3Private
3.3.1Adaptations in private houses are paid for via a Disabled Facilities Grant (DFG). Central Government provides 60% of the funding. Blackpool Council provides the remaining 40%. 2004/5 total grant is £828,000; of which £331,200 is provided by Blackpool Council.
3.3.2For 2004/5 to date 148 adaptations have been funded, including:
-11 extensions
-44 level access showers
-6 ramps
-40 stair lifts
-4 vertical lifts
-10 step lifts
-15 over bath showers.
3.3.3The DFG is means tested by a Test of Resources (TOR) as set out by Central Government grants legislation. The maximum DFG is £25,000 and generally applies to large extensions or when a number of adaptations are required. For private adaptations there is an agency fee charged against the DFG of 15% over £2500 for the cost of the agency project management. In addition there is a Local Authority Fee charged of £459.20 against each adaptation.
3.4The 2 adaptation officers survey the property and draw up plans for the adaptation. They supervise the project and the contractors from start to finish. Large extensions are project managed by Architects. The Adaptation Officers check the quality of all the work and obtain a certificate of satisfaction from the client in line with grant legislation.
3.5Barriers
- The waiting list to see a surveyor is 12 months for council properties and 16 months for private properties. In addition is the 15-week delay from referral to OT assessment. The waiting time generates the most complaints.
- The Council’s eligibility criteria - FACS are not applied by the OTs as part of their assessment process so a Priority meeting procedure is held to determine those that are ‘critical’. The priorities’ jumping the list then increases the waiting time for others on the list.
- The more hoists and lifts installed the greater the cost of maintenance and repairs, the highest cost is for replacement stair lifts. There are 27 stair lifts needing replacing this year at a cost of £76,307, funded by social services. This places pressure on the available budget. (Please refer to Appendix 1 for the waiting list analysis.)
- The current budget is insufficient to meet demand, for example the number of level access showers (Council properties) committed to in 2004/5 is 37 and there are another 62 waiting. The number of level access showers (Private properties) committed to in 2004/5 is 44 and there are another 117 waiting. Based on commitments in 2004/5 it will take up to 2.5 years to clear the waiting lists.
3.6What is being done to address the barriers above?
- A procurement audit of adaptations is being carried out by Internal Audit. On the basis of Internal Audit recommendations the adaptations system will be reviewed to reduce costs especially on private adaptations.
- A report is being prepared for the accountants to highlight budget pressures to review allocation of finance.
- The community equipment project is looking at applying FACS to assessments, which will help prioritise the waiting list.
- Statistics have been obtained from the grant monitor spreadsheets this year to identify where better financial management of budgets can help reduce the waiting list and economies of scale.
- Savings have been identified in the use of council architects rather than external architects in terms of fees. A pilot has taken place this year and will be reviewed next year.
- Minor works are now £1,000 or less and minor adaptations that require structural work or construction are carried out by OSD. The £1,000 limit means that some straight stair lifts can now be financed as minor works.
4.Sensory Impairment Team
4.1The Sensory Impairment Team comprises:-
- A Technical Officer for Deaf/Hard of Hearing (part-time),
- A Rehabilitation Officer Visual Impairment (ROVI full time),
- A Dual Sensory Officer (full time)
- An administrative assistant.
(Please refer to Appendix 2 for details of their roles and functions)
4.2Numbers on social services records
At March 2004 there were 74 Deaf clients and 681 Hard of Hearing.
At May 2004 there were 958 clients with low vision.
4.3Barriers and how we are over-coming them
- The numbers of hearing impaired people are increasing so waiting lists have been over 4 weeks, but by the end of January using the screening by the admin assistant the waiting list should be 4 weeks or less.
- Work needs to be carried out on mapping the service in line with national standards and linking in more with the Deaf Community Worker.
- We are producing a catalogue of equipment available in line with FACS and to improve procurement costs. We are considering in the future moving sensory equipment into the Loan store but at present there is not the facility.
- We are talking to the Blackpool Fylde and Wyre Society for the Blind about streamlining the service and producing a project outline to take this further.
- Direct payments for equipment have not yet been introduced. The Blackpool Fylde and Wyre Society for the Blind may be able to assist.
- We are developing systems to fully computerise the records for sensory impairments so that the social workers can access assessments and equipment provided.
- Sensory equipment is reviewed in the equipment review alongside community equipment and adaptations.
- The action points raised by the Low Vision Committee raised the lack of counselling available to newly registerable clients with Low Vision and suggested that a volunteer scheme be set up to link between the hospital and social services to support these clients.
4.4Achievements
A Low Vision Committee (LVC) has been set up in line with the standards in a document called ‘Progress in Sight’ and as recommended by the RNIB. A service mapping took place in April 2004, which has identified action points to improve the service. The LVC comprises of professionals and service users and have developed lemon pages- the directory of information for low vision, and lemon page a laminated list of important numbers to keep on the fridge or by the ‘phone. All clients registerable as blind or partially sighted receive this pack. We are liasing with the Eye Clinic and Optometrists to introduce a new low vision registration scheme as specified by the Department of Health.
4.5Dual Sensory Impairment
The Dual Sensory Officer has identified 418 people in Blackpool with Dual Sensory Loss (Deafblind) and is assessing what services and equipment is required. In the past there have been no services specifically for people with dual sensory loss.
4.6Issues to be addressed
- Identifying funding available for the services required.
- Identifying funding Assistive technology in terms of equipment is important for people with dual sensory loss such as vibrating clocks to tell them what time of day it is.
- Provide training for Communicator Guides as there are none trained in this area, the nearest are in Manchester.
4.7The project worker has produced data and information on the needs of individuals with dual impairments which could form the subject of a separate report if required by members.
5.Recommendations
To note the report of the Equipment Adaptations Sensory Impairment Team (EASIT).
JENNIFER JAYNES
ASSISTANT DIRECTOR OLDER ADULTS AND PHYSICAL DISABILITY SERVICES
Appendix 1
Analysis of Council and private waiting lists at December 2004
Council Adaptations
Total number of clients on waiting list 188
Comprising:
62 Level Access Showers estimated Cost £155,000, which is 63% of total cost
49 over bath showers estimated cost (including tiling) £36,050, which is 15% of total
31 tiling for over bath showers
1 Clos-o-mat toilet
3 door alterations
2 stair lifts
2 kitchen/bathroom alterations
9 Ramps
29 0ther
Estimated cost to clear this list £246,757.81
There is £18,893.49 remaining of the council grant this year.
Private Adaptations
Total number of clients on waiting list 263
Comprising:
3 Clos-o-mat toilets
6 door widening
17 Extensionsestimate 7 < 6sqm) (Extensions in total = 24% of total estimated cost)
estimate 10 > 6sqm)
15 ground floor WC
117 level access showers (Showers = 46% of total estimated cost)
34 over bath showers including tiling
10 ramps
47 stair lifts estimate 20 curved
estimate 27 straight
8 step lifts
6 vertical lifts
Total estimated cost £1,404,929.60 to clear this list based on current average prices from private grants (not allowing for inflation or fees).
The DFG is fully committed this year (2003/4) any more spending will be over-commitments to pay in April 2005.
Appendix 2
Sensory Impairment Team Roles and Functions
The administrative assistant monitors stock control of equipment, ordering and payments. Provides a screening service for low vision referrals and some small equipment. We are extending this screening function to Hard of Hearing clients as well. Then the officers have an idea of what equipment is needed and can take it out on the assessment day, helping to meet D54/D55 targets. The admin assistant manages the low vision registration scheme. The Eye Clinic at the hospital informs social services if a person is registerable as blind or partially sighted. The person is then contacted by the admin assistant and are provided with an information pack and offered a visit by the ROVI. In addition this person manages the bookings for British Sign Language Interpreters corporately in line with the BSL policy.
TheTechnical Officer receives referrals via BIFAS and they may be from individuals, Social Workers, Hearing Therapists at the hospital or the deaf community worker. The Technical Officer then visits the client and assesses what equipment is needed such as loop systems, vibrating fire alarms (fitted by the Fire Brigade), flashing doorbells etc.
The ROVI receives referrals via BIFAS and direct from the Low Vision Registration Scheme. The ROVI visits clients to assess for equipment and rehabilitation. The equipment supplied is symbol canes, liquid level indicators etc. The rehabilitation provides support in daily living such as cooking and getting around in the local neighbourhood for people with low vision. The ROVI is involved in the Mobility Panel and has provided training to the OTs on Low Vision, as well as general advice when needed. At present there is no waiting list for referrals.