SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE – 12
JUNE 2003
OCCUPATIONAL
THERAPY ADAPTIONS AND WORK DELAYS
REPORT OF THE ACTING HEAD OF ADULT SERVICES
REASON FOR SELECT COMMITTEE CONSIDERATION
To consider current waiting times for adaptations within the Occupational Therapy Service.
ACTION REQUIRED BY THE SELECT COMMITTEE
For noting.
BACKGROUND
The Occupational Therapy Service on the Island is managed by the joint Occupational Therapy Manager who manages Occupational Therapists working in both Health and Social Services. This arrangement has been in place since the end of October 1997, and has resulted in many changes in practise that have prevented duplication of resources for assessment. New services have been introduced, which mean that people have shorter waiting times from referral to assessment and then to completion of service.
The Occupational Therapists work in many areas however; this report is restricted to their work with adaptations, which are provided for all age groups – adults and children.
The department employs two technicians who do minor adaptations in peoples homes. This ranges from simple grab rails, second stair rails, rails to assist people out of their homes and the provision of temporary ramps. This service assists people to regain independence with activities, which are essential to daily living, or to make them safer with continuing with these tasks. It can also be an interim service assisting people while they plan for major changes to their environment through a Disabled Facilities Grant (DFG).
The service completes about 950 jobs a year and has the following timescales.
Following assessment to work completed:
Urgent are completed within 24 hours
As soon as possible within 2 weeks
Routines within 8 weeks
These standards have been maintained for 4 years until this past year when long-term sickness adversely affected the service. These targets are now back on course, but the government has now set performance indicators against minor adaptations with a ‘7 day target’ for all minor adaptations, to be in place by December 2004. This has led to investment in the service from the Access and System Capacity Grant.
This service comprises of one technician and an Occupational Therapy Assistant who work together from a van. The Occupational Therapy Assistant assesses the person’s needs, and the technician fits the equipment and rails at the time of the visit.
This service has been particularly useful in preventing delayed discharges, as the Occupational Therapy Assistant can liaise with the Hospital Occupational Therapists and visit the patient in their own home on the day of discharge. It also works with people referred on from Occupational Therapy Mobility Clinic or Wheelchair Service who are having
difficulties living at home and who could be waiting a long time for an assessment and/or service.
This service works by accurately estimating at the point of referring the person to the ‘MOT’s’ that the person's needs can be met by a single visit from both the assistant and the technician.
There are about 400 referrals to this service every year.
This service contributes in a major way to the Performance Indicator Targets for the department with the assessment and delivery of equipment and it will also help boost the figures for the 7 day adaptation service when it comes into effect next year.
The Department of Health recently issued a consultation paper on future arrangements for "Delivering Adaptations". This states that…
‘The purpose of an adaptation
through a ‘DFG’ is to modify disabling environments in order to restore or
enable independent living, privacy confidence and dignity for individuals and
their families. It is therefore not
primarily a matter of building work, the provision of equipment or otherwise
modifying a dwelling, but providing an individualised solution to the problems
of a person experiencing a disabling environment’.
In order to realise this there needs to be partnership working not just between housing and social services but increasingly with health, planning, architecture, education and leisure’. (Delivering Adaptations Consultation Paper - February 2003).
The Occupational Therapy Service, because its staff are employed by Health and Social Services, is already meeting some of those challenges laid out in this consultation paper.
Many people who need a ‘DFG’ or major adaptation have spent some time during their assessment with the Occupational Therapist discussing the implications of various aspects of the proposed adaptation. Because people need time to reflect this becomes a lengthier process. The majority of people needing a ‘DFG’ have had minor adaptations to make their situation safer in the interim.
There has been a steady increase in both the demand, and the number of major adaptations, which have been carried out in people’s homes since March 1998.
At that time a new system for prioritising was introduced with 80% of the DFG budget being allocated for people whose needs met the High Priority criteria for urgent work and 20% for the remaining "standard" applications. Since then, a panel of Occupational Therapists and a Housing Officer has met once a month to consider and agree requests, deciding on their priority and ensuring they can feasibly be processed through the Disabled Facilities Grant System.
Prior March 1998 people could expect to wait from 2 to 4 years for an adaptation to be processed. People can now expect to have their grant processed within a year at the maximum or within a month if it is urgent. Both owner occupiers and tenants can apply for DFG's but there are proportionally more applications from housing association tenants.
The average cost of an adaptation is £5,000.00 with very few exceeding £10,000.00, which is also a reversal in trends from 1998. On average there are 15 cases presented at each panel.
There are about 150 cases at any time on a rolling programme with the Housing Section at some stage of the Grant process. They are of course still all open to the Occupational Therapy Service until the job has been completed. From April 2002 until the end of March 2003, 96 adaptations were completed, 101 were approved and 45 are waiting for people to return their forms so that they can obtain grant approval. There are therefore only 15 people who are waiting at this point in the year for their grant to be processed.
The need for extra funding was clearly identified by the Housing Department as the number of people needing the Service has risen steadily each year.
The annual budget for financial year 2002/03 was £600,000.00, an increase of £263,000.00 on the previous years budget. The annual budget can be rolled over two years because of client delays in getting estimates, and returning forms. However, the increase in this labour intensive area of work for both the Housing section and the Occupational Therapy section causes problems. Without additional administration support and resources to cope with the work, it will continue to cause difficulties in processing work. The Occupational Therapy section and the Housing section are at present working together, with the DoH consultation document as a basis, to facilitate a new way of working to enable more people to benefit from the Disabled Facilities Grant System.
RELEVANT PLANS, POLICIES, STRATEGIES AND PERFORMANCE INDICATORS
D38: The "% of items of equipment costing less
than £1000 delivered within 3 weeks". This PI is to be changed to include
Minor adaptations costing less than £1000 as well as equipment.
Our
performance over the last few years was as follows:
98/99 83%,
99/00 84%, 00/01
93%, 01/02 96%,
02/03 forecast 95% (December 2003 forecast – drop in performance
expected due to staff vacancies and sickness)
CONSULTATION PROCESS
Housing
section staff consulted
FINANCIAL, LEGAL, CRIME AND DISORDER IMPLICATIONS
Speeding up the waiting times for adaptation work through DFG's would involve further investment in Housing and OT staffing. £50,000 from the Access and Systems Capacity Grant has already been allocated for improving the Minor Adaptation service to meet the required targets for response times.
BACKGROUND PAPERS USED IN THE PREPARATION OF THIS REPORT
Delivering Adaptations – Department of Health Consultation Paper February 2003
Contact Point : Maggie
Convery Joint Manager, Occupational Therapy, St. Mary’s Hospital Occupational
Therapy, Telephone No. 524081.
J LOWE
Acting Head of Adult Services