The Department of Health has provided guidance for planning in this field under HSC 2001/008 and LAC (2001)13. The guidance refers officers and authorities to the NHS Plan, and its proposals for modernising and streamlining the equipment services currently provided by both local authorities and the HS.
Intermediate care monies and the Health Act flexibilities for joint working are seen as key for building on equipment services. The number of people expected to benefit from a heavyweight injection of funding into the system, is to be increased by 50%, by March 2004, by which time the services should be integrated, the existing stock unified, with a single operational manager for the services, and a board to advise the manger, consisting of members from all stakeholder organisations.
The NHS funding is subject to Joint Plans showing what health and local authorities will each contribute, and the pooling of funds, using the Health Act flexibilities.
The current scope of equipment from the statutory services is equipment for home nursing, such as pressure relief mattresses and commodes, and equipment for daily living. The question of which authority is expected to provide a particular item of equipment, pursuant to its own statutory powers, depends on which side of the line the thing is seen to fall, and has been classically a ‘grey area’ which has led to gaps in service and long waiting times in the past. Minor adaptations, equipment for people with sensory impairment, communication aids and short term wheelchair loan are seen as social services. Permanent wheelchair use is prescribed and funded by the NHS. A hoist could be one thing or the other, depending on its purpose and for the benefit of which sort of staff its use was intended.
Implications of ‘integration’
‘Integration’ in the government language of the moment does not mean a new joint statutory framework for equipment. It means closer co-working, or formal delegation of functions from one statutory agency to another. In our view, since social services remain chargeable at the discretion of the local authority, it is senseless to integrate a service at pooled budget and lead commissioning level, if the social service side of the service is to remain chargeable. All the sterile debate which is supposed to be avoided by the flexibilities under the Health Act, as to whether a thing is a health item or a social services item, would still have to be gone through, at some point further down the line, if social services were still going to charge for equipment as a non-residential service.
Thus we think that the logic of this strategy for ‘integrated’ services is that equipment should either all be free to the user, or else the vast majority of it should be chargeable, (at no more than a reasonable rate of course, under s17 HASSASSA 1983) on the basis that equipment is largely a social service. The input then from health would more properly be a s28A payment, not the formal delegation of the NHS equipment function to social services.
The current statutory functions under which equipment is provided are as follows:
s2 Chronically Sick & Disabled Persons Act 1970 (daily living equipment for disabled people)
s3(1) (a-c) and (e) National Health Services Act 1977 (equipment for home nursing)
s45 Health Services and Public Health Act 1968 (daily living equipment for older persons)
ss23 – 24 Housing Grants Construction Regeneration Act 1996 (housing authority grants for adaptations)