The Retail Model for users and their carers/personal assistants
Overview: The primary objective of this programme is to deliver a new service delivery model that has users and carers/personal assistants at its heart.
Part of understanding who uses community equipment is shaped by understanding the fundamental purpose of the equipment provided - the products. The products fall into three main categories:
- Those that are sometimes called ‘Aids to Daily Living'
- Products that support care in a home setting
- Bespoke or special products
Aids to Daily Living form the cornerstone upon which the concept of ‘independence' is built - chairs, eating and drinking utensils, raised toilet seats, grab rails. This means that the user is anyone with a need to support and maintain his or her own independence at home, at work, at school and in normal social interaction. This doesn't just mean those people who who have had, or are eligible for state support - it means everyone who might benefit. The general duty of both health and social care is to ‘secure the health and wellbeing of the whole population' in their locality.
Products to support care in a home setting, for example beds or pressure mattresses, hoists, lifts or ramps, are for users and their carers/personal assistants have different and more complex needs. Some users and their carers/personal assistants are at home because their conditions are terminal, some have been discharged from hospital and need some equipment to be provided quickly for a short period of time, or perhaps they have a condition likely to deteriorate over a longer time and need equipment for a number of years.
Bespoke or special products are items that are infrequently required or very specific to an individual.
The main tenets of the new retail model
Following the review of existing Community Equipment services in England, and the extensive consultation with all stakeholders, the retail model was published in May 2007. The main tenets of the new retail model are that:
- The free provision of equipment and services to people elligible for state support will continue
- Only prescribers employed by the state can prescribe equipment funded by the state
- A state funded individual will be issued with a prescription to exchange for agreed community equipment needs
- Assessment and therapeutic services for self funders are provided through Independent Assessors (Independent Assessors issue a list of recommended products for their clients)
- Users/carers/personal assistants can visit an approved retailer and/or order from a catalogue but the prescription will only be redeemed through a retailer - it will not be able to be redeemed on line at present.
- Retailers can be private sector or third sector (voluntary) organisations and are accredited by an independent accreditation body
- A prescription entitles the user/carer to free equipment but can be used in conjunction with a top-up payment to upgrade to a piece of equipment that they prefer in the functional range of equipment as the prescribed item
- Standard clear information will be produced and available across England to supplement particular localised information
The model will put power in the hands of service users. It will create choice and allow for a greater number of market participants, enable the creation of an environment for innovation where new products can be developed and showcased. Users will be able to access equipment from a greater number of outlets at a time that is convenient to them and the decision about what products to take home will be made by the person who will be using it.
Information
Only informed users and their carers/personal assistants can make choices and take control over decisions affecting their lifestyle and their care.
We are proposing that standard national information will be available at any point of entry into the community equipment environment be it:
- A call or visit to a GP
- A call into your local council or health service
- A call or visit to a third sector organisation
- A visit to a third or private sector retail outlet or online enquiries
- In fact, everywhere that we expect any individual would normally consider going to get advice about community equipment
This standard national information will explain the new system: how it works, where to go and what to expect. This standard information does not replace locl information, it overlays it and provides a nationally consistent message to help people navigate the new model.
This standard national information will be supplemented by web-based information. The Disabled Living Foundation (DLF) already has a comprehensive web-portal and they have been working hard to develop their site to meet the design requirement in the model. Their website information portal is enhanced by including Self Assessment Rapid Access (SARA). SARA is one of the self-assessment tools available and users, their carers//personal assistants, family members or advocates can support self-assessments. Other self assessment and mediated assessment tools are available, such as SmartAssist from ADL Smartcare.
The programme has developed a standard information leaflet with our partners in the North West. The leaflet provides clear information about the components of the retail model and an insert can be added with details of local accredited retailers and key contact information for local sources of advice.
It is intended that local authorities and their health partners will develop their local information and communication materials about the changes to service which could cover information about, e.g.:
- needs assessment
- prescriptions
- retailers
- the loan equipment home delivery service
- recycling
- what to do if you wish to comment or complain
- further sources of information and help
State Funded Service Users
Central to the Retail Model has been the development of a prescription-based system for issue of Aids to Daily Living equipment. This equipment will be owned by the individual.
The Process: In place of a Prescriber (e.g. an occupational terapist, social worker or district nurse) generating an internal requisition on a community equipment store, the user will be given a prescription to take to a retailer of their choice:
Assessment: An individual, or their carer, who has identified difficulty undertaking tasks for daily living or has continuing care needs can approach their local authority for an assessment of their needs. Individuals who are being cared for by health professionals will have their needs assessed by those professionals or their appropriate colleagues.
If the individual is supported by the state their equipment needs are likely to be provided free of charge.
Prescription Based System: Where there is an assessed need, state bodies issue users or their carers/personal assistants with a 'prescription' that can be exchanged for free equipment at an accredited retailer. Users are enabled to ‘top-up' the prescription (choice empowerment) if they wish to have a similar item of different style or colour.
Obtaining equipment: Retailers will have to be accredited to redeem prescriptions. They will be required to stock items from the national catalogue through their retail outlets or via call off from suppliers. Some retailers may choose to specialise in one range of products, e.g sensory equipment.
Delivery and/or installation - Under the new system there will continue to be a number of ways to have equipment installed:
- Retailers provide a delivery and installation service - either through their own staff or through a linked service
- Third Sector organisations such as Age Concern provide handy man services
- Your local authority/NHS partnership will still provide this service to those who cannot access the new system (conditions apply)
Fitting equipment: Some items of equipment need to be assembled and fitted to the user, e.g. specialist mobility or standing equipment. There will continue to be local arrangements with manufacturers or suppliers to provide this service. It is intended that there will be national standards and contract terms for these arrangements.
Where an individual needs more complex pieces of equipment, e.g profiling beds or hoists the prescriber will complete an electronic "e"-prescription for the item to be ordered through the loan equipment home delivery service
Self Funded Users
Independent needs assessment: It is intended that a market will be created for people who pay for their own equipment and support (self funders) to enable them to have access to assessment and therapeutic services for which they will be charged a fee. Independent needs assessors are likely to be occupational therapists or other suitably competent individuals. The practitioner will undertake an independent, professional, proportionate and appropriate assessment of needs. The assessment will be a full equipment need assessment and, if requested by the user/carer, an assessment of on going therapeutic support to re-able or rehabilitate. Self funders will not receive prescriptions but will be issued with a list of recommended products they can purchase themselves.
The Marketplace - What are the benefits for users and their carers/personal assistants?
- An open retail market will drive product innovation and choice
- Products and services will be available in more localities during normal retail trading hours improving accessibility for all individuals and normalising the experience, e.g
- High street stores
- Pharmacies
- Supermarkets
- DIY and Home Improvement stores
- Specialist retailers
- Retail Parks
- Mobility stores
- Independent Living Centres
- The top-up option will allow users to get what they really want, not just what the state can afford
- Better information will sign-post users and carers/personal assistants to the right point for assessment and equipment purchase, i.e.
- State assessment
- Self assessment (self-funders)
- Assessment by an independent needs assessor (self-funding only)