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Memorandum submitted
by the Welsh Occupational Therapy Service Leads Group (CBPS 31) EQUIPMENT PROVISION FOR CROSS BOUNDARY
DISCHARGES Report submitted by: Welsh Occupational Therapy Service Leads Group ( WOTSLGs ) 1. Introduction Whilst welcoming the current
Welsh Assembly Government initiative for Community Equipment Service
Integration, there are concerns that this has to date focused on local
solutions and has not yet taken into account the wider issues of cross boundary
service provision. This paper aims to outline
current concerns and make recommendations which will reduce the current
organisational barriers and lead to more effective service provision for
patients. 2. Background Health and Social Services in
Wales are delivered via 11 NHS Trusts and 22 Local Authorities. There will be
times when patients access services across the boundaries of these
organisations. Wales also borders many of the English Counties and Welsh
patients may access services across the border into England. Each of these
differing authorities, both in England and Wales will have different policies
and procedures for the provision of equipment, different paperwork, different
core equipment which they routinely provide and different staff responsible for
this role. Patients are often treated
outside their geographical area for both elective surgery and specialist
regional services. This can create planning and communication difficulties when
implementing discharge plans or future follow up of care. This lack of joined
up thinking can result in wastage of clinical time and delayed discharge. Occupational
Therapy staff are often faced with the challenge of negotiating arrangements
for individual patients, in order to ensure a safe discharge, in the absence of
an All Wales agreed system. Clinical staff from Trusts discharging patients
from out of area may be forced to spend considerable time being passed from
authority to authority in an attempt to make contact with local staff with the
appropriate responsibility for authorising the provision of equipment for
patients returning from out of County. Patients are now being
offered elective surgery in a variety of Trusts across the country and the
implications for equipment provision are rarely factored into the commissioning
and planning of these services. Areas where pre operative screening is
completed in partnership with local services are able to plan ahead regarding
equipment needs. This is successful in facilitating earlier discharge, but may
be compromised when waiting lists are transferred to other providers. Patients are often put at
risk where discharge is unplanned, poorly planned, or equipment is considered
at the last moment. This puts increasing pressure on the OT or equipment
provider in the local area who may have to rearrange or cancel scheduled work
to accommodate people returning to the area following inpatient episodes
elsewhere. WOTSLGs recently carried out
a survey of the current arrangements for the provision of cross boundary
equipment. This is attached as Appendix A. Appendix B indicates the
complexity of a potential patient journey and the associated risks. 3. Current Concerns 1. There
is no clear policy / guidance on respective responsibilities for discharging
trusts and local services. This leads to disparity of service provision with
some services carrying out home assessments and providing equipment whilst
others do not even assess patients from outside their catchment area. A variety
of methods of equipment provision currently exist including direct delivery by
equipment provider with no further assessment , equipment provided for
relatives to fit, home assessment with delivery and fitting of equipment by OT
support staff, and occasionally, home assessment by qualified Occupational
Therapist. The method is often dictated by lack of agreed systems, lack of OT
resources and time pressures rather than clinical need. 2. Usually,
the OT assessing the patient pre discharge is not able to assess the home
environment and relies on information from patients / relatives / local OT
service. This creates a potential clinical risk and it is unclear whether it is
the discharging authority, or local service, who retains responsibility for the
patient. 3. Service
level agreements for elective and emergency treatment do not factor in therapy
time and equipment provision. 4. Generally
Health provide for short term need, and Social Services provide for long term
need but this is not consistent across Wales. Intermediate care teams often
bridge the gap, however the availability / criteria for these teams varies
across areas. This compounds the confusion over who is responsible for
equipment provision. 5. Health
care provision is based on the location of the GP and Social Services provision
is based on their postcode. This will potentially cause problems with integrated
services. 6. Each
service provides a different range of equipment as its core stock which makes
it difficult for the discharging OT to identify appropriate equipment to meet a
patients needs. 7. Each
service may have different criteria for the provision of equipment. 8. Each
service may require information in a variety of forms - there is no
standardised transfer of information form or equipment requisition form. 9. There
is no standard pathway so clinical time is wasted negotiating with equipment
providers and local services. 10. Current
focus on reducing length of stay increases pressures on both discharging OTs
and local services to respond in a timely manner, and lack of services and
agreed systems can sometimes lead to unnecessary increases in length of stay 4. Recommendations
1. Clear
All Wales Policy on respective responsibilities of discharging trusts and local
services. 2. Acknowledgment
of respective responsibilities in Commissioning agreements with consideration given
to any resource implications. 3. Agreed
All Wales safe systems of work to utilise resources most effectively including
roles of OTs, support workers and equipment providers, adhering to the COT Code
of Ethics and Professional Conduct and
hpc Standards of conduct, performance and ethics. 4. All
Wales agreement on core equipment both type of equipment and criteria for
provision 5. Pre
operative clinics for elective surgery should include out of area patients to
ensure discharge planning commences prior to admission 6. WOTSLGs
to establish database of OT services and equipment providers. Appendix
A ALL WALES SURVEY OF CROSS BOUNDARY
PROVISION OF COMMUNITY EQUIPMENT 1. Aim of questionnaire To
clarify current arrangements regarding discharge of patients who live outside
of the normal catchment area of the Trust / LHB All
OT Services accept referrals for these patients, assessing for post discharge
need, however the scope of the services varies between Trusts in Wales and
along the borders which interface with England 2. Methodology Questionnaires were sent out
via the All Wales Network of OT Service managers to all services within Health
and Social Care The questionnaire was
designed to collect both quantitative and qualitative data relating to
equipment provision across Wales Responses were received from
11 NHS Organisations and 6 Social Service organisations. The low number of
responses from Social Service departments may indicate the current reliance on
the NHS to provide cross boundary services to patients being discharged from
out of County hospitals 3. Analysis of data Responses received: 11 Welsh NHS Trusts/LHB :
6 Welsh Local Authorities Section 1: Completed by
discharging services Section 2: Completed by
those services receiving referrals
19 March 2008 |
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