Effective provision of community equipment needs to sit at the
heart of health and social care. It can make the difference between
someone living independently in their own home or having to move
into residential care or go into hospital. This equipment ranges
from simple mobility and bathing aids to high-tech items that can
monitor a person’s well-being from a distance.
In March 2000, the Audit Commission’s report, Fully Equipped,
painted a largely negative picture of the state of equipment
services for older or disabled people. It described the
organisation of equipment services as a recipe for confusion,
inequality and inefficiency. In response, the government provided
new money for three years from 2001-2 for community equipment
services, set demanding new service targets and provided a
route-map for services to follow to achieve full integration across
health and social care by April 2004.1
The national Integration of Community Equipment Service (Ices) team
was also established to support the efforts of local services to
meet these targets. The team comprises a full-time team leader and
eight part-time team members.
Two years into the project, what is the state of play, and what are
the prospects of providing better community equipment
Despite the difficulties that many services have had in getting
additional funding, much progress has been achieved. Three-quarters
of local community equipment services integration leads report that
they will hit the April 2004 integration target, and the Ices team
is working hard to bring the others up to speed.
For many services, successful integration will depend on successful
outsourcing of the service, and much depends on the capacity of the
private sector to be able to respond. Moreover, it is clear that
some services are simply adopting a “tick-box” mentality towards
integration. This may enable them to say that they have integrated
but we are looking for much more than that. We want to see
genuinely user-led integrated services because we believe that
community equipment services are not just about vans and delivery
times. Rather, they are central to tackling the isolation and
social exclusion experienced by many older or disabled
We have asked each service lead five questions to find out how many
services have already taken the key steps towards
– Action planning: Has an action plan been written for the purpose
of integration by all relevant partner councils and NHS
– Single point of contact for users: Has a single point of contact
– Unified stock: Is social services and NHS equipment pooled and
managed within a single inventory?
– Pooled funding: Is there pooled funding for the equipment
services under Health Act 1999 flexibilities arrangements?
– Manager’s advisory board: Has it established a board or group of
stakeholders to advise the manager?
The general workload on social services and primary care trusts is
enormous so, not surprisingly, the planning, commissioning and
delivery of community equipment services has not yet been seen as a
high priority. As a result, most services are moving only slowly
towards using the powers available under the Health Act 1999 to
establish lead commissioning arrangements and pooled budgets. But,
because the ring-fenced funding for councils for community
equipment (included in the systems and access grant) is expected to
be used in a pooled budget, the pace of change is expected to grow
during the year.
The Ices team remains optimistic, however. The practical know-how
of the team has been underpinned by advice from various sources
such as an external reference group and a panel of disabled
equipment users. The team is also supported by the Audit Commission
and the Social Services Inspectorate (SSI) as they work together to
raise awareness of the importance of community equipment.
Crucially, expertise within equipment services themselves is
Perhaps most important of all is government commitment. Current
government policy stresses a whole systems approach to maintaining
the independence of older people: spending plans for 2003-6 include
a public service agreement between the Treasury and the Department
of Health to “improve the quality of life and independence of older
people so they can live at home wherever possible”. This will be
achieved by increasing, by March 2006, the number supported
intensively in their own homes to 30 per cent of the total
supported by social services at home or in residential care. The
growth in emergency admissions is to be less than 1 per cent a
year. Community equipment can contribute to both targets.
The government’s determination to see extra investment in keeping
people independent was signalled by then health secretary Alan
Milburn’s announcement on delayed discharges in July 2002. By 2006,
an additional £1bn for social services will be provided. The
reforms associated with the additional funding have significant
implications for equipment services. The package of reform
– Faster assessment. By the end of 2004, first contact by social
services will be made within 48 hours and the assessment completed
within one month. Equipment is to be in place within one
– Expanded range of services. Double the number of intensive home
care packages by 2005 compared with 1995, 70,000 more
rehabilitation packages and a 50 per cent increase in the number of
extra care housing places.
– Easier access to community equipment. Half a million more pieces
of free community equipment, benefiting an estimated 250,000
– Increased choices for older people. After assessment of care
needs, all councils will be obliged to offer direct payments
allowing people to take more control of their care if they
There are three agendas that should ensure increased investment in
the management of equipment services: direct social care payments;
reimbursement of hospital trusts for delayed transfers of care, and
the national service frameworks (NSFs).
The first provides for increased choices for older people. After
care needs are assessed, councils will be obliged to offer direct
payments to older people, allowing them greater autonomy in
decisions about how their needs are met. Service commissioners will
have to think about how local arrangements are to be
Second, the Community Care (Delayed Discharges etc) Act 2003 sets
out local authorities’ financial responsibility for the cost of
patients’ care once they are ready to leave hospital. Clearly,
effective community equipment services will be needed if patients
are to be discharged promptly.
Third, the implementation of the various NSFs also depends on
effective equipment services and the wider use of assistive
With vision, networks of commissioners and providers could become a
powerful instrument for change in care service provision. Most
people active in the field are agreed that these services have
never had a better opportunity to take a more prominent role in
health and social care provision.
We are at a possible turning point towards better equipment
services but service commissioners need an attitudinal sea-change
to grasp the opportunities open to them. They can achieve this
l Talking to service users, carers and voluntary organisations for
l Talking to the local equipment service integration lead.
l Talking to local councillors and complaints departments to pick
up the issues being raised by the public.
l Talking to GPs and consultants in orthopaedics, geriatrics and
rehabilitation about the impact that improved equipment provision
could have on their workloads.
l Talking to finance colleagues to identify opportunities to shift
investment from care services into equipment provision.
There are several initiatives in train to help to raise the profile
of equipment services. First, in the months ahead, the Ices team
will work with local services to help them achieve meaningful
integration. We shall be carrying out regular surveys of progress
to help target those services that appear to be off course.
Second, the Ices team and the Audit Commission are working with the
NHS Purchasing and Supplies Agency to develop a model service
specification to help those services that are seeking to outsource
their services to private companies.
And third, in September the Audit Commission will be publishing a
report on the role of the electronic assistive technologies in
promoting the independence of older or disabled people. The Ices
team will be supporting this project and is working with the
Modernisation Agency at the NHS to help implement its
Ian Salt is national team leader for the Department of
Health’s implementation team. Nick Mapstone works for the Audit
Commission’s review of progress towards the integration of
1 Department of Health, Guide to Integrating Community Equipment
Services, DoH, 2001 www.doh.gov.uk/pdfs/cesguidance.pdf
The Integration of Community Equipment Service team has an
informative website at