Providing Equipment

The following people must be involved in any decision about what is required:

1. The person (or their representative if they lack capacity);
2. Any carer;
3. Anyone that the person asks you to involve;
4. Anyone else that you feel needs to be involved with the person's consent; and
5. When the person lacks capacity, anyone that you feel it is in their best interests to involve.

When exploring options you should:

1. explore all available options and not limit yourself to 'standard' or most frequently used options;
2. specifically explore any options requested by the person or carer; and
3. take opportunities to provide good information and advice about ways to prevent, reduce or delay needs.

Factors that should be taken into account when weighing up available options include:

1. whether the option is appropriate to meet (or prevent, reduce or delay) the need;
2. whether the option is proportionate to meet (or prevent, reduce or delay) the need (or could the need be met in a less restrictive or intensive way);
3. the impact of the option on risk (to the person and carer(s));
4. the impact of the option on the person's independence;
5. whether the options will support the person to meet any outcomes (either outcomes identified at assessment or outcomes identified in any existing Care and Support Plan).

A simple pros and cons list can be an effective way to explore and weigh up available options.

Depending on the level of risk, a formal risk assessment may need to be carried out.

See: Risk Assessment

It is the responsibility of the Local Authority to decide the best way to meet a person's eligible needs (or the best way to prevent, reduce or delay needs). As such, this is your responsibility as you are the local authority's representative.

Any decision that you make must have regard to:

1. the views of the person about the equipment or minor works required;
2. the views of any carer; and
3. the impact of the decision on the person's wellbeing.

Other factors that you should consider before making a decision are:

1. whether the person's involvement in the decision has been maximised;
2. whether the full range of available options been explored;
3. whether there are any alternative options that could meet the need;
4. whether any risks associated with the preferred option have been identified and mitigated (for example, through a period of direct support);
5. whether the preferred option represents a good use of Local Authority financial resources (or is there an alternative more affordable option that will meet the need as well as the preferred option); and
6. whether the preferred option is likely to be sustainable (taking into account anticipated changes in the person's needs or circumstances over time).

When a decision has been made about the preferred option to meet the need (or prevent, reduce or delay the need), you must make a proportionate record of:

1. the decision;
2. the rationale for the decision (why the preferred option is deemed to be the most appropriate and proportionate provision); and
3. what alternative options have been explored (and why they were not suitable).

Sometimes the person (or their representative) will not agree with the decision that you have made about the equipment or minor works required.

In this situation, you should be open to reviewing the available evidence and your rationale to ensure that the decision is robust. You should be open and transparent about the evidence sources you have used and take steps to support the person to:

1. understand the decision you have made; and
2. understand the benefits of the equipment or minor works proposed.

If the person is still not happy with the decision, you should seek the support of your line manager as required to decide whether:

1. to proceed to make the arrangements as proposed; or
2. to alter the arrangements in line with the person's views about the most appropriate equipment or minor works.

Where a decision is made to proceed to arrange equipment or minor works as planned, you should consider providing direct support as a mechanism to ensure safe and effective use of equipment or minor works. Direct support includes:

1. training of informal and paid carers in the safe and proper use of equipment; and
2. supporting the person to safely and confidently use equipment or adapt to their environment after an adaptation.

See: Providing Direct Support.

You must also make the person aware of their right to complain about the decision that has been made.

If the proposed equipment is over £1000 you will need to confirm:

1. local policy about charging for equipment over £1000; and
2. if the policy is to charge, request a financial assessment; and
3. whether you are authorised to agree the provision of equipment over £1000; and
4. if not, make arrangements for this to be agreed and authorised.

Process for prescribing non-contract specials (SharePoint)

The practitioner requesting agreement and authorisation must provide you with information about:

1. the person's eligible needs (or the needs that are to be prevented, reduced or delayed);
2. the options that have been explored;
3. the rational for the preferred option (including why other options were not suitable).

From the available information you must be satisfied that:

1. a proportionate assessment of need has been carried out;
2. a determination of eligibility has been made (where equipment or minor works are to be provided under the duty to meet eligible needs);
3. the person's involvement in the decision has been maximised;
4. the practitioner has given regard for the person's views, any carers views and the impact on the person's wellbeing;
5. the full range of available options have been explored;
6. there are no alternative options that could meet the need;
7. if the person lives in a care home, the care home does not have a legal responsibility to provide the equipment;
8. any risks associated with the preferred option have been identified and mitigated (for example, through a period of direct support);
9. the preferred option represents a good use of Local Authority financial resources (and there is no alternative more affordable option that will meet the need as well as the preferred option); and
10. the preferred option is likely to be sustainable (taking into account anticipated changes in the person's needs or circumstances over time).

It is important that decisions about how to meet needs (or prevent, reduce or delay needs) are made in a timely, consistent and transparent way.

If you require further information before agreeing and authorising the equipment you should request this from the practitioner that carried out the assessment.

If you do not agree equipment

You should not agree or authorise the equipment if you find that, having taken into account all available information:

1. the equipment is not appropriate or proportionate to meet the eligible needs of the person (when the duty to meet eligible needs applies); or
2. the equipment proposed does not make best use of available local or financial resources.

If you are unable to agree equipment you must provide the practitioner with information about:

1. why you have not been able to agree the equipment; and
2. the steps that the practitioner may take to resolve any issues identified.

Any subsequent requests to agree and authorise equipment must be considered again.

Sometimes a person will decide, following an assessment, that they want to make their own arrangements to obtain equipment or carry out minor works. You must be satisfied that the person (or their representative) understands that:

1. they are under no obligation to do so; and
2. the Local Authority must provide equipment free of charge up to £1000.

Whether or not the person will want to make their own arrangements will likely depend on a range of factors, and could include:

1. whether or not the Local Authority is willing or able to provide their preferred equipment;
2. the availability of equipment providers or contractors locally;
3. the financial implications of services for the person;
4. the complexity of their need, including any fluctuation in need and the need for multiple care and support services;
5. the person's ability to make and sustain arrangements; and
6. the level of ongoing support likely to review and monitor the person's needs or situation.

If the person intends to make their own arrangements you must:

1. provide them with the information and advice they request (or you feel would be beneficial) about available appropriate equipment and local services/ suppliers to meet their needs;
2. provide them with information and advice about ways they can prevent, reduce or delay needs;
3. provide them with any other information that they request or that you feel will be beneficial;
4. consider the support the person may need to explore and make their own arrangements and whether the advocacy duty applies;
5. explain to them what to do if they change their mind about making their own arrangements;
6. explain to them what they should do if their needs change; and
7. carry out, or arrange to be carried out any processes to support carers.

In most cases, it is appropriate to signpost the person or refer them to the Wellbeing Service.

See: The Wellbeing Service

All of the above information should be confirmed in writing.

You should also consider monitoring, as the duty to meet eligible needs is not discharged until alternative arrangements are in place and there may be a need to provide interim equipment, or provide direct support to ensure safe use of the equipment when it is in place.

You can close the case when:

1. the equipment is in place and being used as intended to meet eligible needs (or prevent, delay or reduce needs);
2. there is no need to provide direct support or monitoring;
3. there are no outstanding actions for the Occupational Therapy service.

All equipment orders must be placed through IRIS on the NRS website.

See: IRIS

Only practitioners with a prescriber PIN can login to IRIS and place orders.

There is guidance on IRIS for ordering equipment. This includes both standard stock and NCS.

Note: Before ordering NCS you must apply the process set out in section 4 above. Failure to do so will result in NRS being unable to process the order.

Requesting a PIN 

In all cases 

The procedure to request an LCES prescriber PIN is as follows:

• The OT Team Manager is required to confirm with the LCES Team within People Services, Information and Commissioning that they are confident the proposed prescriber is sufficiently skilled and equipped to assess needs and order community equipment;
• The OT Team Manager is required to complete the PIN application form which is available through the LCES team;
• There are two different scenarios when creating a PIN. One is that the prescriber is a new starter and never used IRIS before and the other is that the prescriber has used IRIS before but has moved team/organisation and requires a new PIN.

The procedure to request a new LCES prescriber PIN (never used IRIS before) is as follows:

• The OT Team Manager is required to complete the PIN application form which is available through the LCES team (ices.lcc@lincolnshire.gov.uk). They must complete the ‘Application Form’ tab completing all details, as well as the ‘Declaration’ tab which confirms the applicant is confident the proposed prescriber is sufficiently skilled and equipped to assess needs and order community equipment.
• The LCES team will create the PIN for the prescriber. Once the PIN has been created, the LCES Team will send an email to the prescriber and the OT Team Manager (person who requested PIN) stating that a PIN has been created and NRS will be in contact regarding the link to the IRIS training. NRS will then send an email with details for IRIS training. All training from NRS is received on the hour. Once the training has been completed, the prescriber will receive an email from NRS with their PIN and temporary password. This is when the prescriber will be able to access their account.

The procedure to amend an existing LCES prescriber PIN (prescriber has used IRIS before but has a new team/organisation/job role) is as follows:

• The OT Team Manager is required to complete the PIN application form which is available through the LCES team (ices.lcc@lincolnshire.gov.uk). They must complete the ‘Application Form’ tab completing all details, as well as the ‘Declaration’ tab which confirms the applicant is confident the proposed prescriber is sufficiently skilled and equipped to assess needs and order community equipment.
• The LCES Team will update the prescriber’s existing account. Once updated, the LCES Team will send an email to the prescriber and Lead Practitioner (person who requested PIN) informing them of this. The prescriber will continue to login with their usual login and password where they will be able to see the limits and other settings applicable to their account under the ‘My Limits’ section to the left-hand side of the main page.

You must take steps as required to provide additional information upon ordering if:

1. there are specific order requirements;
2. there is a sense of urgency; or
3. you require notification when the equipment is delivered.

Specific order requirements could include:

1. the location in the person's home where equipment needs to be placed;
2. the height that equipment should be set at (to ensure safe and effective use);
3. the size required (when the equipment is available in a range of size options).

You should make a proportionate record of:

1. the equipment that has been ordered and when it was ordered;
2. the proposed delivery date (if known);
3. agreed arrangements for delivery made with equipment stores;
4. steps taken to ensure proper and safe use of equipment after delivery.

It is the responsibility of equipment stores to:

1. liaise with the person (or their representative) to agree suitable arrangements to deliver equipment; and
2. notify you of any problems, issues or delays.

Equipment stores stock can also be provided on a short term basis, for example:

1. to facilitate discharge from hospital where the person is expected to recover;
2. during a period of illness or following an injury;
3. during a period of reablement (see below);
4. as a way of 'testing out' how best to meet long term need when this was unclear;
5. as an urgent interim measure.

Equipment to be provided on a short-term basis should be arranged in the same way as equipment that is to be provided longer term. However, you must:

1. record the date that the short-term equipment loan is going to end (when this is known); and
2. agree appropriate monitoring arrangements to regularly review the need for the equipment.

Reablement 

Equipment may be issued during episodes of care provided through the Reablement Service.

Reablement provided through this Service is usually provided prior to an Adult Care eligibility assessment taking place. Adult Care assessors asked to undertake assessments with a view to equipment provision for people receiving short term reablement support should undertake a proportionate assessment, and may issue equipment as follows:

1. Low level equipment may be issued during an episode of home based reablement where it is required to support reablement goals;
2. Complex equipment (i.e hoist and sling) should only be issued to people eligible for ongoing support. Consequently, this equipment should only be issued during reablement where it is vital to the safe provision of that service or to complete the assessment;
3. As a general rule, equipment, such as bath lifts, should not be issued during reablement until it is evident the person meets eligibility for the ongoing support;
4. Any circumstances where it is felt necessary to issue Local Authority funded major equipment for people not meeting eligibility criteria should be discussed with OT Team Managers. Any major equipment issued during reablement is done so on the understanding with the person that it is a short term loan and may be withdrawn where people do not meet criteria for ongoing support.

You can consider closing the case when:

1. the equipment is in place and being used as intended to meet eligible needs (or prevent, delay or reduce needs);
2. there is no need to provide direct support or monitoring;
3. there are no outstanding actions for the Occupational Therapy service.

Before closing the case, you must provide the person (or their representative if they lack capacity) with the following in writing:

1. Information and advice about maintaining and repairing equipment;
2. Any other information and advice requested, or that you feel would be beneficial;
3. What they should do if their needs change;
4. What to do if the equipment no longer appears to be meeting their needs; and
5. What they should do if they (or a carer) require further direct support in the future to use the equipment safely.