1 Summary

1.1 This report updates the Executive Member on the plans for the Integrated Community Equipment Stores (ICES) in Hampshire and seeks agreement to invest in a Hampshire store to provide a service for Eastleigh and Test Valley South and New Forest Primary Care Trusts (PCTs) by 1 April 2004. The report also outlines the future plans for the development of equipment services.

1.2 The following decisions are sought:

1.2.1 That a community equipment service to Eastleigh and Test Valley South and New Forest PCTs is established with effect from 1 April 2004 within existing levels of investment and staffing.

1.2.2 That pooled budget arrangements under Section 31 of the Health Act 1999 are developed by April 2004.

1.2.3 That work is undertaken with Portsmouth City PCT and Portsmouth City Council, post April 2004, to explore the potential of a county wide service.

1.2.4 That an action plan be developed to address differential investment between PCTs

2 Reason(s)

2.1 Social Services plays a key role in the community equipment service across Hampshire, both as a direct provider and as a commissioner from other agencies.

2.2 These decisions support Aims 1, 5 and 6 of the Corporate Strategy (Maximising Life Opportunities, Improving Services and Developing Councillors and Staff). This will be achieved through the provision of equipment to enable vulnerable and older people to live independently for longer in their own communities, by implementing service developments required by the Integrated Community Equipment Services Initiative and through workforce developments outlined in this report.

2.3 As 80% of Community Equipment is provided to older people, this supports the County Council priority for Older People.

2.4 These decisions support the conclusions of the Occupational Therapy, Equipment Services and Technician Best Value Review 2000.

3 Other options considered and rejected

Not applicable

4 Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

Not applicable

5 Dispensation granted by the Standards Committee

Not applicable

6 Reason(s) for the matter being dealt with if urgent

Approved by: Date of decision:

Councillor Felicity Hindson

1. Summary

The Development of an Integrated Community Equipment Service outlines how Social Services intends to meet both national and local requirements in response to the Integrated Community Equipment Services initiative, which is featured in the National Service Framework for Older People, Supporting People, Fair Access to Care Services and other Government guidance. Challenging targets for increased equipment provision have been set by the Government as part of the Priorities and Planning Framework 2003/2006.

2. Introduction

2.1 The purpose of this report is to update the Executive Member on the background and key developments whilst planning the implementation of an Integrated Equipment Service in Hampshire. Further, to gain agreement to invest in a Hampshire store to provide a service for Eastleigh and Test Valley South and New Forest Primary Care Trusts (PCTs) by 1 April 2004. Finally, to identify plans for the future development of an Integrated Community Equipment Service able to meet the Governments targets. Social Services is working in partnership with Primary Care Trusts to meet the requirements of the Integrated Community Equipment Services agenda.

3. Update on Integrated Community Equipment Services in Hampshire

3.1 Current Equipment Service Provision :

There are three Joint Equipment Stores operating within Hampshire:

3.1.1 Basingstoke and North and Central Hampshire store, managed by Hampshire County Council, which provides a service to North Hampshire, Mid Hampshire, Blackwater Valley and Hart PCTs and part of Eastleigh and Test Valley South PCT

3.1.2 Southampton and South West Hampshire store, managed by Southampton City Council, serving Southampton City residents, New Forest PCT and part of Eastleigh and Test Valley South PCT.

3.1.3 Portsmouth and South East Hampshire store, covering Portsmouth City Council, Fareham and Gosport and East Hampshire PCTs. This store is managed by Portsmouth City PCT.

3.1.4 Population served and activity levels.

Details of the population served by each Joint Equipment Service and the numbers of items of equipment delivered and collected during 2002/2003 are given below. The recycling of equipment is a high priority with all three services and almost all the items collected and returned to Stores are cleaned, refurbished, if required and re issued. The average cost of each item of equipment delivered or collected is also shown.

NB - the figures for Portsmouth and S East are those recently provided by the Manager who considers the system is under reporting activity, it is being investigated.

3.2 Background to developing Integrated Community Equipment Services

The Audit Commission paper on Community Equipment Services, entitled Fully Equipped (2000) called for urgent action to improve standards, provide a fairer service and make equipment services an important component of strategies designed to promote independence. The NHS Plan includes the Government's intention to achieve a single integrated community equipment service by April 2004. A Department of Health project team has been established to provide appropriate guidance and set milestones and to assist both health and local authorities meet the various targets for implementing this service.

3.2.1 In working with health, other local authority and voluntary sector partners, it was agreed in November 2002 that a County wide approach would be taken to meeting the Integrated Community Equipment Service agenda.

3.2.2 In February 2003, Southampton City Council stated that their preferred option was to develop a service for Southampton residents and gave twelve months notice to all the partners involved with Southampton and South West Hampshire Joint Equipment Stores.

3.2.3 March 2003, a decision was taken to provide an integrated equipment service developed around the two remaining local authorities, Hampshire and Portsmouth.

3.2.4 Four potential service models were presented to the Partnership Board meeting on 22 October 2003, with a preferred option, which included the introduction of a single management structure, the provision of an enhanced service, with driver/fitters and the integration of the Technician Service. There was general support for the proposal, although it was recognised that additional clarity was required around performance, financial pressures and personnel issues.

3.2.5 In November 2003, Portsmouth City Council and Portsmouth City PCT indicated that they were not in a position to embrace a Hampshire and Portsmouth service by April 2004.

3.2.6 As a result of this, efforts are now focussed on establishing a fully functional community equipment service for service users within New Forest PCT and Eastleigh and Test Valley South PCTs by 1 April 2004 in addition to the existing North and Central Hampshire Service.

3.2.7 This enlarged service will serve a population of 896469 and will expect to deliver and collect at least 67000 items of equipment between 1 April 2004 and 31 March 2005.

3.2.8 The organisations involved in this process are Hampshire County Council, North Hampshire PCT, Mid Hampshire PCT, Blackwater Valley and Hart PCT, New Forest PCT and Eastleigh and Test Valley South PCT.

3.2.9 The launch of Social Services Occupational Therapy Direct (OT Direct) in November 2003 provided Hampshire County Council with a single point of access for the Occupational Therapy and Equipment Services. Referrals are received directly from service users and carers as well as from professionals from other organisations. Service Users are able to self assess for a small range of equipment/minor adaptations, without an assessment by an Occupational Therapist. The staff at OT Direct are currently requesting the provision of equipment from all three Joint Equipment Stores and will benefit from the arrangements post 1 April 2004, when only two Stores will be involved in the supply of equipment.

4. Requirements for the provision of a community equipment service to include New Forest and Eastleigh and Test Valley South PCTs

4.1 Premises

4.1.1 The current Joint Equipment Store in Basingstoke has insufficient storage space to manage the additional demands of an enlarged service. A second storage facility will be required and it would be logical to site this closer to the south west of the county, to reduce journey times for the drivers. Work is already under way to secure additional premises. This will take into account the fact that the lease on the Basingstoke Joint Equipment Store expires in three years.

4.2 The staffing requirements will be met by the transfer of existing posts from the Southampton service. At this stage it is not envisaged that there will be an increase.

4.2.1 Drivers/Transport

Two drivers will be required to provide the current level of equipment deliveries and collections within New Forest and Eastleigh and Test Valley PCTs and maintain stock levels within the substores and the second storage facility. They will require delivery vans with appropriate arrangements for insurance and fuel costs.

4.2.2 Administrative support

In order to cover the clerical duties/data inputting and support the professional advisers, there will be a need for one full time post.

4.2.3 Specialist advisers

It is anticipated that there will be a need for 0.66 whole time equivalent Equipment Therapist and 0.5 whole time equivalent Nurse Adviser. They will provide advice and training to the professional users of the Integrated Equipment Service and help to support the running of an efficient equipment service.

4.3 Set up costs

There will be initial costs associated with establishing a service to the New Forest and Eastleigh and Test Valley South PCTs. These will include IT, preparation of new premises, data transfer and training costs. These costs have been identified and are included in 03/04 budget outturns.

It is also planned to contact all service users who will be transferring to the new service, to inform them of the arrangements and to ensure equipment in current use is returned to the Hampshire store when no longer required.

4.4 Financial details

4.4.1 Current contributions made by relevant organisations are detailed below.

Figures for New Forest and Eastleigh and Test Valley PCTs are currently being validated as part of the decommissioning information.

** this includes staffing funds for two countywide Moving and Handling Advisers and Headquarters overhead costs.

4.4.2 The service will be developed within existing investment arrangements. There is currently work in progress to develop a plan to address inequity of contribution issues and funding arrangements.

4.4.3 There is a plan in line with national expectations to develop arrangements for a pooled budget for equipment services as outlined under Section 31 of the Health Act 1999.

All of the partners are confident that the service described above can be achieved by 1 April 2004 with current financial arrangements.

5. Plans for the future development of an Integrated Community Equipment Service

5.1 Future Expectations

In order to meet the Government targets regarding increased equipment provision and support the initiatives outlined in the Priorities and Planning Framework 2003/2006 it is vital that community equipment services are developed to support this additional capacity. This section sets out the development work that will be continued whilst establishing the service set out in Section 3 above.

5.2 Current Business Process

5.2.1 At present, following an assessment visit by an Occupational Therapist/other professional, the appropriate equipment is requested from and delivered by the Joint Equipment Service. Following delivery, the requester visits again to fit and demonstrate the item and ensure that it meets the service users needs. If a minor adaptation is also required, then the Technician Service will visit as well. On occasions a check visit will be made by the requester after the Technician has completed his work.

5.2.2 There is therefore considerable overlap and duplication in a number of areas within this process and Occupational Therapists/other professionals are required to make several visits.

5.2.3 Driver/fitters

The introduction of drivers who are able to fit and give instruction on the use of some items of equipment is regarded as a service enhancement and would reduce the need for Occupational Therapists and other professionals to make additional visits, thereby enabling them to focus on other aspects of their work.

Additional posts would be required, as the number of deliveries/collections made each day would decrease due to the extra time taken to fit the equipment. Proposals for this aspect are being worked on.

5.2.4 Technician Service

Hampshire County Council Technician Service is based at Segensworth, near Fareham, where there are workshop and storage facilities. Three Technicians are based at the JES in Basingstoke, but managed by the Technician Service.

The Technician Service is responsible for carrying out minor adaptations in privately owned property, repairing special equipment, constructing bespoke items (particularly for children) and installing equipment for Deaf and Hard of Hearing Service Users.

It is anticipated that the Technician Service and the Joint Equipment Service will merge into a single Integrated Community Equipment Service. The advantage of this would be to further enhance the skill mix of the staff within this service and reduce the overlap and numbers of visits to service users.

6. Conclusion

6.1 A considerable amount of time has been invested in developing a Hampshire/Portsmouth solution but unfortunately it is not possible to complete this by April 2004.

6.2 This report has therefore dealt with the issues needed to establish a service that will cover a substantial part of Hampshire and five PCTs, to be run by Hampshire County Council. This will be available from 1 April 2004.

6.3 A Hampshire and Portsmouth solution still remains our preferred medium term position and officers will continue to work with colleagues to try and achieve this.

6.4 Important areas of service enhancement have been identified. It is likely that these will be further developed during the next financial year.

RECOMMENDATIONS

1. That a community equipment service to Eastleigh and Test Valley South and New Forest PCTs is established with effect from 1April 2004 within existing levels of investment.

2. That pooled budget arrangements under Section 31 of the Health Act 1999 are developed by April 2004.

3. That work is undertaken with Portsmouth City PCT and Portsmouth City Council, post April 2004, to explore the potential of a county wide service.

4. That an action plan be developed to address differential investment between PCTs

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act