Frequently Asked Questions
How has the programme classified equipment?
Community equipment has been classified into two main areas
- Simple aids for daily living that support people to maintain their independence in mobility, toileting etc. These have the potential to benefit the whole population, not just those eligible for statutory support. These items are low value but high volume equipment, most often costing less than £50 but up to around £100.
- Complex aids to daily living that are products, largely provided by the state, to support care in the home setting eg profiling beds, hoists and standing frames. These items often have electrical or hydraulic components and cost more than £100.
- Bespoke equipment that is equipment uniquely specified and sourced for an individual. This is a relatively small amount of equipment.
How will users get equipment?
- Individuals who have a health requirement or may be in need of community care services are entitled to receive an assessment of their needs. Equipment may be provided to meet such needs.
- Simple aids to daily living will be provided to free of charge to users supported by the state via a prescription. The prescription will be redeemed at an accredited retailer.
- Complex aids to daily living will be provided on loan to the user by the home delivery service. When the user no longer requires the equipment, it will be uplifted and made ready for reuse.
- Many individuals purchase equipment through their own resources (self-fund). This may be because they choose not to access state provided community equipment services. Individuals may not be entitled to receive equipment under locally agreed eligibility criteria in accordance with Fair Access to Care Services guidance. There are also individuals who are entitled to community equipment but want products not currently provided by the state.
Who owns the equipment in the new model?
- Simple aids to daily living will be owned by the user.
- Complex aids to daily living will be loaned to the user.
- It is also likely that bespoke equipment will be loaned to the user.
Older people will struggle to access retailers
Our research by Ipsos MORI has overwhelmingly confirmed that the majority of service users (84%) redeemed their own prescription during our shadow running exercise. Where the user is unable to access the new model the social services support network will continue in its statutory duty to meet the needs of the individual including their need for delivery, installation, support and advocacy.
Will practitioners have to spend more time on assessments because of the need to revisit the user and ensure safe use of equipment?
The evidence from our Lead Partners has demonstrated a reduction in the average number of days from referral to assessment by 50% and from assessment to case closure by 60%. Practitioners undertake a risk assessment as part of the needs assessment process and this currently involves assessing the need to check and ensure safe use of equipment. This will not change in the retail model.
The model is wasteful as it does not encourage recycling?
The model supports recycling of equipment and the national waste strategy.
The national waste strategy employ the terms ‘re-use’ and ‘recycle’ as distinct and separate steps in the waste hierarchy. This contrasts with the use of the terms within the community equipment service currently. In order to remove the confusion the model uses the following terms:
- ‘Refurbishment’ describes the process for collecting, decontaminating and refurbishing equipment for re-use
- ‘Recycling’ describes the practice of working closely with equipment manufacturers and retailers to encourage and promote the production of equipment using recyclable materials. It also covers the segregation of waste that households increasing undertake so that as little unwanted material ends up in landfill.
Local Authorities and their health partners should work with their Waste Management Authorities to develop a local collection infrastructure that enables households to return discarded equipment to manufacturers for processing as raw material for new production.
Simple aids to daily living, owned by the user, should be recycled
Complex aids to daily living, loaned to the user, will be refurbished where economically viable.
The programme has developed a tool for local authority/health partners to calculate the true cost of their current refurbishment process to inform local decision-making.
NHS/DHL has struggled to deliver incontinence to users homes so what confidence or evidence have you that they can meet the greater demands of supply and fit for complex equipment?
We are in discussions with NHS/DHL, and other organisations, as part of our understanding and evaluation of the options that are available to develop a more efficient home delivery service. DHL are a global leading logistics provider. Home delivery, warehousing and distribution, technical delivery and installation services and engineering services form part of the wide range of services they provide internationally.
The evaluation process is expected to be completed by the autumn when it will be discussed with LA/NHS senior executives.
How do you reconcile the waste in ICES investment in new premises, cleaning equipment and training of staff?
We do recognise that there has been considerable investment in some services and examples of good service across the country.
However, we have had to take a step back to attain a national view. It is evident that by taking this wider view, the current logistics service of 138 stores across England, is inefficient and does not match the principles of good practice. It has also been noted that even good services are struggling to meet increases in demand now.
This is not a reflection on the dedication and commitment of staff, which we fully acknowledge.
How can commissioners afford to pay for 2 services – prescription costs and the national delivery service?
The new model for community equipment is about delivering quality improvements to individuals and enabling them to have independence, control and choice over the services they require. Users have been very clear that they wish to be treated as consumers, as they are in all other aspects of their life.
This is not a model about 2 services. It is a total system approach, looking at the best methods for delivering the components of the system to users and their carers. This includes assessment, provision, review and aftercare.
The ADASS (Association of Directors of Adult Social Services) Resource Committee have validated and signed off the retail model, including the financial elements of the business case.
The model is not mandatory and each local authority/health partnership will need to consider their local business case. We have developed a template and toolkit for organisations to use and this will facilitate benchmarking in the future.
How can you justify the move to a retail model when there has been insufficient volume tested through shadow running?
The shadow running process demonstrated improvements in the user experience and efficiency of the service.
Our lead partners have decided to implement the model locally. This confirms that the new prescription processes are effective and are capable of being scaled up to support full implementation of the retail model.
Why have you not consulted older people and organisations representing them?
The programme has been open, transparent and collaborative since its inception. We have worked in collaboration with users, carers, local authority and health practitioners, current providers and suppliers, representatives of voluntary organisations and professional bodies. Our Steering Board had a strong cross sector of stakeholders from 34 different organisations including a number representing older people. In addition, there has been information available regional public events designed to share information, canvass opinion and collect feedback and through the web.
Local organisations who may be considering the retail model will follow local consultation protocols
How can you justify the move to a retail model when several of the pilot sites have had retailers refuse to participate or abandon the programme?
The shadow running process has been challenging. It has uncovered a number of issues including local market viability and it was useful to test different pricing approaches. This is why we tested the model through a shadow running process to enable a small, yet controlled change to take place. We could measure and understand the impact of the change thus enabling us to improve and retest the operating design. This is the right time to bottom out any issues before wider implementation.
The process, however, has reinforced the Programme’s belief that a national tariff and market management strategy will be required to deliver the full benefits of the retail model and provide stability in the marketplace.
Why were there different prices for the same products through different organisations during shadow running?
See answer to previous question.
Have you relied on the third sector becoming involved as retailers because this model doesn’t work for independent retailers?
There are independent retailers that are very positive about their increased market share and profitability through shadow running. The programme believes that there are opportunities for both the private and third sector in the new marketplace.
What is the risk to statutory organisations if there is a delay between the prescription and redemption for equipment?
The same risk occurs now. Practitioners undertake a risk assessment as part of the needs assessment process and make recommendations based on that assessment.
If a user arranges to have something privately installed and then has an accident who is to blame?
If there is a problem because of the installation then the person who installed the equipment may be liable. If the equipment is faulty then the manufacturer may be liable. If the user has contributed through an act or omission on their part then they may be liable too.
If, at the point of assessment, it is clear that the user requires support (such as requirement for delivery or installation) the local authority/health partnership will continue in its statutory duty to meet the needs of the individual.
Who in the retail model is required to instruct the user on the safe use of equipment?
Equipment manufacturers are required to provide appropriate instructions on the safe use of the products they produce.
Prescribers will continue to undertake risks assessments as part of the needs assessment process and undertake user instruction that is proportionate to the complexity of the equipment provided.
Who owns equipment that is ‘topped up’?
In the retail model the user owns simple aids to daily living. These are the ones most likely to be topped up so therefore the user will own them.
How can you have confidence in the robustness of the financial model when it has been questioned in the anonymous report recently submitted to THIIS?
See answer to the question above "How can commissioners afford to pay for 2 services – prescription costs and the national delivery service?"
The programme has not shared any financial information publicly.
Can we buy equipment off the national catalogue even if we do not implement the model?
No. It is not a catalogue in the traditional sense. The national tariff is the local authority/health partnership wholesale price for redemption of prescriptions. It is based on a generic specification and is not a named product price list against named suppliers.
How will we be able to access the national catalogue?
The national catalogue can be accessed from the Catalogue and Tariff page on this website.
What is the value of the retailer margin for the national tariff?
The retailer margin differs by product and the information is commercially sensitive.
Are we comparing the PASA price when we set the national tariff?
This initial tariff has been calculated as follows:
- The lower quartile of the weighted average of current local authority community equipment purchasing costs for each item was calculated
- From (1), a local authority / health partnership wholesale price was calculated
- The resultant figures have been benchmarked against prices agreed by accredited retailers in areas where the model has already been implemented
- Finally, the views of a number of independent retailers have been sought and reflected in the tariff as necessary.
The final national tariff for 2008 is being calculated through a commercial price benchmarking exercise being undertaken on behalf of the Programme. It is expected to be published during autumn 2008.
The national catalogue and tariff will be reviewed and updated regularly to incorporate additional items that are subsequently identified as necessary and to align with changing market conditions.
How can we downsize stores if we still issue complex equipment?
It is not efficient to continue to provide loan equipment through 138 separate home delivery services as currently. There are a number of models which deliver more effective home delivery services, regionally or nationally. Some services are already collaborating to share premises and transport.
How can there be adequate instruction provided to the user if a carer redeems a prescription and is instructed by the retailer on the correct use of the product?
See answer to question above "Who in the retail model is required to instruct the user on the safe use of equipment?"
Equipment manufacturers are required to provide appropriate instructions on the safe use of the products they produce. Prescribers will continue to undertake risks assessments as part of the needs assessment process and undertake user instruction that is proportionate to the complexity of the equipment provided.
Who is responsible for the ongoing maintenance, replacement and re-assessment of equipment?
Complex aids to daily living, which are hydraulic and electrical items still loaned to individuals, will continue to be maintained as now.
The model does not propose any change to the assessment process which would be required for replacement or re-assessment of equipment
When is a piece of equipment delivered – at the point of raising the prescription or when it is delivered into the home?
This question exists now but with ‘requisition’ replacing prescription. The model proposes no change to current interpretation.
What if the retailer doesn’t have the item of equipment in stock?
Customers may be advised to contact the retailer to check before making a special journey out to a store.
During shadow running 80% of retailers surveyed were able to fulfill prescriptions within 24 hours.
As now, when a store does not have an item in stock, there may be a reference back to the prescriber to discuss issuing functional equivalents or referring to an alternative retailer.
How are you going to trace items?
Hydraulic and electrical equipment will still be loaned equipment and there are systems and processes currently in place to track and trace products.
Simple aids to daily living items will be owned by the user. As with other consumable products manufacturers and retailers have systems in place for product recall.
Are you suggesting that we assess people financially before we assess their need and they have to self fund?
Absolutely not. The model proposes no change to assessment processes.
Local authorities and health partnerships currently provide around 3 million individuals with community equipment.
There are over 4 million people who currently fund their equipment requirements themselves. This may be because they choose not to contact state services or they have been signposted away as ineligible for state services. They may have accessed self assessment tools or information services and made their own decisions.
The retail model recognises the need for improved information, the normalisation and availability of community equipment in the high street to provide universal service delivery for all.
What about data protection risks with retailers having user information?
Retailers will need information if home delivery/installation is required but this is no different to services offered to those currently funding their own equipment.
The programme has taken legal advice on data protection and the prescription has been designed to limit personal information, e.g. date of birth is 4 age ranges rather than actual dates. All prescription forms have to be returned to the prescription clearing house.
Why do you believe it is possible for councils to concentrate on providing equipment to those with complex needs?
The model proposes no change to FACS (Fair Access to Care Services) which is under review. We know that local authorities are already making decisions about what levels of need they will support and many have raised their levels of support to critical or substantial.
The retail model supports prevention and personalisation policies by moving simple aids to daily living into the retail marketplace, improving information, normalising their availability and increasing access and choice for all. This empowers individuals to self-help whilst still supporting those who are eligible to receive state services based on a thorough assessment of their needs.