Assistive Technology (AT) Forum News Bulletin No. 13 October 2004

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  1. Report onSpecialist Equipment Services
  2. Using Direct Paymentsfor Community Equipment
  3. Audit Commission Report on ImplementingTelecare
  4. MHRA Device EvaluationService Annual Report
  5. PolicyFramework for "Choose & Book"
  6. Part 3 of the Disability Discrimination Act (DDA) Comes intoEffect
  7. DH Website Speech Enabled
  8. National Service Framework (NSF) for Children, Young People and Maternity services
  9. Common Assessment Framework for Children in Need
  10. Information Booklet for Disabled Parents
  11. Report on Independent Livingin Later Life
  12. Growth in Specialist Stroke Units
  13. Report on Social Care Regulation
  14. Strategic Agreement between the Department of Health, the NHS and the Voluntary and Community Sector
  15. Manifesto for People with Long-term Conditions
  1. Report on Specialist Equipment Services

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For many disabled people, assistive technology is crucial to their ability to choose how they want to live and whether they can live independently. Technological support comes in many forms - it can be as simple as a tap turner, or as complex as an environmental control system. While many disabled people are already using these technologies successfully, some people have very complex needs, which are not met by the current equipment or service models.

A new discussion document produced by the Royal College of Physicians and the Institute of Physics and Engineering in Medicine emphasises the importance of multi-professional input to customise the equipment, design individual bespoke solutions and to safely integrate different kinds of equipment.

The document focuses on four key areas of assistive technology - communication aids, computer access, environmental control systems and telecare. It includes specific examples to show that designing the technology around specific needs can have life-enhancing effects.

"Specialist Equipment Services for Disabled People: The Need for Change" makes eight key recommendations in four areas to improve access to specialist equipment and professional expertise:

Access and assessment

  • Specialist equipment services for disabled people should be widely and equitably available
  • Complex need and the integration of disparate technologies should be overseen by specialist equipment services

Delivery of services

  • Evolving equipment services should build upon established provision so as to harness and best deploy experienced specialist personnel
  • Specialist services require substantial investment in expertise and infrastructure and should serve catchments in excess of one million people

Clinical Governance and Competence

  • Clinical governance offers a framework within which specialist professionals should facilitate and oversee a co-ordinated provision
  • Supernumerary training posts should be established to facilitate training, promote innovation and support professionals seeking to further their expertise

Allocation of resources

  • Budgetary provision for specialist equipment services should be sourced jointly from local authorities and Specialist Commissioners
  • Services should highlight any financial shortfall rather than tolerating inappropriate and delayed provision

The document marks the beginning of an eighteen-month consultation process with service users, user groups, professional bodies, service providers and commissioners to stimulate debate and promote best practice. At the end of the consultation period, the RCP and IPEM intend to host a symposium and produce a final set of recommendations.

"Specialist Equipment Services for Disabled People: The Need for Change" is featured on the RCP and IPEM websites, details of how to respond to the consultation.

Hard copies can be purchased priced £7 incl.UK p&p. from the RCP Publications Department on 020 7935 1174 ext.358.

A weblink to the document appears below.

Specialist Equipment Services for Disabled People

  1. Using Direct Payments for Community Equipment

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The ICES team has asked local services about use of direct payments for community equipment.

Responses have indicated that there is still a considerable number of organisations who "don't do" direct payments for the provision of equipment.

This is for a number of reasons, namely:

  • It appears to be complex to administer.
  • It appears that suppliers are charging individuals a hugely inflated purchasing price.
  • No requests have yet been made for a direct payment for equipment.
  • There are concerns about warranty and maintenance.
  • There are concerns about ownership.

Direct payments guidance issued in 2003 makes it clear that if a service user requests a direct payment, then it should not be turned down unless the user is unable to give informed consent and neither should the user be advantaged or disadvantaged through the receipt of a direct payment.

The ICES team have urged services to put in place a mechanism for dealing with an equipment request via a direct payment, as the recent trawl has shown that requests are increasing quickly.

Guidance, including on legal issues, is available on the ICES website at:

Contacts can be made via the website to share good practice and experience.

  1. Audit Commission Report on Implementing Telecare

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The Audit Commission has published "Older people - implementing telecare", which complements the recently published ICES document "Telecare: Getting Started" Resource Pack (ICES, 2004) and the Audit Commission's publications on assistive technology and telecare (Audit Commission, 2000, 2002, 2004a).

Publication is timely because the 2005-08 Spending Review introduced a new preventative technology grant (£80 million over two years) to fund local councils to provide alarm technology to 160,000 vulnerable older people.

The report:

  • describes what telecare is and what it can do;
  • discusses the evidence for its benefits at both the individual and health system levels;
  • describes the generic components of a telecare service;
  • provides guidelines on developing and implementing a telecare service, drawing on the lessons from pilot and trial projects;
  • provides conclusions on the part that can be played by government in helping to unblock the current implementation barriers.

The report is available on the Audit Commission website at

  1. MHRA Device Evaluation Service Annual Report

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The Medicines and Healthcare products Regulatory Agency (MHRA) Device Evaluation Service (DES) is the only independent provider of medical device evaluations for the NHS.

The first DES annual report (on the MHRA website summarises work during 2003/4 covering pathology, imaging, acute care and assistive technology.

2003/04 combined success with some difficulties and some evaluation centres had to be closed due to budgetary constraints. The DES is currently subject to a strategic review, due to report later this year.

Evaluation reports are now available electronically on the NHSNet website and an e-mail alert service is available at

  1. Policy Framework for "Choose & Book"

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The Department of Health has published "Choose & Book" - Patient's Choice of Hospital and Booked Appointment: Policy framework for Choice & Booking at the point of referral.

The Choose and Book policy framework sets out the policy for offering choice at referral and deals with many questions raised over how choice should be offered. The document provides guidance to local NHS organisations in their transition to a fully booked NHS, which offers patients a choice of hospital and of date and time of their appointment through a new electronic booking system. Choice of provider already applies to patients waiting more than six months for an elective operation.

By December 2005 all patients who need a referral to hospital (or a suitable alternative provider) for elective care (from initial outpatient appointment to subsequent treatment) can expect:

  • to be offered a choice of 4-5 hospitals or suitable alternative providers from a directory of providers;
  • to be able to book their appointment with their preferred hospital/suitable alternative provider;
  • information to be available locally to inform their choice;
  • to be supported in making their choice by their GP or primary care professional and, where necessary, by a range of practice, PCT and community and voluntary sector based services;
  • aftercare and rehabilitation normally to be provided locally following any hospital treatment.

Choice of hospital may not be appropriate for all services. The services that will not be required to offer a choice of 4-5 hospitals (or suitable alternative providers) by December 2005 will include services where speed of access to diagnosis and treatment are particularly important, maternity and mental health services, and secondary and tertiary referrals.

Information should be developed in four key areas to support and inform patients' choice of hospital:

  • waiting times
  • location and convenience of the hospital
  • patient experience
  • clinical quality.

Local implementation plans should be developed and further guidance on implementation will be issued in the form of a Delivery Framework, which will explain the process for SHA state of readiness in October 2004.

The national IT programme has already issued a range of documents covering the new electronic services to support Choose and Book.

The policy framework, IT documents and other information are available on the Choose and Book website at:

  1. Part 3 of the Disability Discrimination Act (DDA) Comes into Effect

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New equal access laws which came into force on 1 October will have as dramatic an effect on opening up business and services to disabled people in the UK as similar laws have had in the United States, according to the Disability Rights Commission (DRC).

Part 3 of the Disability Discrimination Act (DDA) requires every business, large or small - from the local shop to restaurants, health clubs, dentists and supermarkets - to become more user-friendly to Britain's 10 million disabled people. The law means that businesses will need to make reasonable changes - such as adapting premises, removing physical barriers or providing the service another way - so that disabled people can use the service. The change will affect over 2 million British businesses. Failure to act could result in legal action.

The DRC is investing heavily in projects aimed at making sure that disabled people know about and assert their new rights post October. Increasing the capacity of disabled people and organisations to monitor progress and complain is also a key aim.

For further information see the DRC website

  1. DH Website Speech Enabled

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To improve its accessibility, the Department of Health website now speech enabled with Browsealoud.

When plugged in it reads webpages aloud, highlighting text as it goes. That makes it more accessible for those who are dyslexic, with learning difficulties, those for whom English is not their first language, and those with mild visual impairment.

  1. National Service Framework (NSF) for Children, Young People and Maternity services

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The Government has published the "National Service Framework (NSF) for Children, Young People and Maternity Services". It aims to ensure fair, high quality and integrated health and social care from pregnancy, right through to adulthood. The NSF includes national standards for health and social care services for children and young people.

Full implementation of the standards is intended to take up to ten years and the pace of change and immediate priorities are expected to vary locally. No specific ring-fenced money is attached to the NSF and it has no specific year-by-year targets to measure progress. Nevertheless, the NHS and local authorities will increasingly be assessed on the quality of their services and whether they are making progress towards meeting the standards.

The standards will feed into the new integrated inspection framework for children's services and the NSF delivery strategy - to be published later this year - will be closely aligned to the wider "Change For Children - Every Child Matters" implementation programme.

There are five overarching standards, which will apply to all children, whatever their circumstances.

These are:

Health Promotion and Prevention; Supporting Parents; Integrated child and family centred services; Growing up; and Safeguarding children. In addition, there are standards on: Children in Hospital (already published); Children who are ill; Children with mental health problems; Disabled children; Medicines; and Maternity. Services for disabled children and their families are mentioned in all the Standards.

The Disabled Children's Standard says:

"Children and young people who are disabled or who have complex health needs receive co-ordinated, high-quality child and family centred services which are based on assessed needs, which promote social inclusion and, where possible, which enable them and their families to live ordinary lives."

The main themes of this Standard are:

  • Services promote social inclusion for disabled children and young people, to enable them to participate in childhood, family and community activities.
  • Disabled children and young people have increased access to hospital and primary health care services, therapy and equipment services and social services. Services are co-ordinated around the needs of the child and family.
  • Services provide early identification of health conditions, impairments and any social and physical barriers to inclusion, through integrated diagnosis and assessment processes.
  • There is better early intervention and support to parents of disabled children through the development of multi-agency packages of care, including the use of direct payments and employment of Key Workers.
  • Palliative care is available for those who need it. A range of flexible, sensitive services is available to support families in the event of the death of a child.
  • Services have robust systems to safeguard disabled children and young people, who are more likely to be vulnerable to abuse than non-disabled children.
  • Multi-agency transition planning takes place to improve support for disabled young people entering adulthood.

The full NSF can be downloaded from

  1. Common Assessment Framework for Children in Need

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The "Every Child Matters" Green Paper proposed the introduction of a Common Assessment Framework (CAF) as a central element of the strategy for helping children, young people and their families.

The Department for Education and Skills has published a consultation paper, inviting comments on the proposed CAF from anyone involved in working with children.

The aim is to improve the consistency and quality of assessments by introducing a non-bureaucratic, common method of assessing the needs of children and young people that can be used by the whole children's workforce.

The CAF is seen as providing the main (or only) assessment approach used at the first sign of emerging vulnerability, and the main method for establishing whether and to whom a referral to another agency is indicated. The CAF would essentially act as a common front-end to more specialist assessments, which would need modification to accommodate the standards imposed by the CAF. As such, the CAF is a development that is relevant to every practitioner and agency providing services to children and young people.

The paper is available at:

  1. Information Booklet for Disabled Parents

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The National Centre for Disabled Parents has been funded by the Joseph Rowntree Foundation to publish an information booklet for disabled parents:

"'They said what?' Some common myths about disabled parents and community care legislation", by Jenny Morris.

The booklet (covering England and Wales) explains the assistance available to disabled parents. It is made up of a series of questions and answers, which identify and explain common misconceptions about the assistance and equipment available to disabled parents to help them look after their children.

The idea for this booklet came from disabled parents who had difficulties getting what they required. Some of the things they were told by social workers and other professionals were not accurate, but the parents usually did not have the necessary knowledge about their rights to challenge these statements.

This booklet sets out some of these statements and gives information about what disabled people are entitled to. At the end of the booklet is a list of legislation and government guidance and details of how to get hold of them. There is also information about organisations that can provide advice and information.

Printed copies of the booklet are available free of charge from: National Centre for Disabled Parents, Unit F9, 89/93 Fonthill Road, London N4 3JH, Tel: 08702 410450 (select option 2),

e-mail: .

Or download from the Joseph Rowntree Foundation website at

  1. Report on Independent Living in Later Life

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The Department for Work and Pensions has published "Independent living in later life", Research Report 216, carried out for the Department by the Policy Studies Institute, available on the DWP website at

The report presents the findings from a qualitative study designed to explore older people's concepts of independence. It also looks at how their service needs and their behaviour in approaching services impacts on their ability to live independently.

Older people's understandings of independence in later life encompassed a number of interrelated elements, reflecting their circumstances and changes in these over time, as well as individual values and preferences. Notions of autonomy and self-sufficiency underpinned interviewees' subjective perceptions of what it meant to be independent. The balance between an emphasis on 'doing what you want to do' and 'doing things for yourself' shifted to reflect older people's capabilities, social context and expectations.

Intersecting these priorities were a series of sub-components to independence. These included the importance older people attached to staying in their own homes, maintaining personal mobility and good health, and having sufficient income to live comfortably.