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Councils and the National Health Service need to do more to improve the planning, organisation and delivery of equi...
Councils and the National Health Service need to do more to improve the planning, organisation and delivery of equipment and adaptation services to support people living in their own homes, according to a new report from Audit Scotland.

Equipment and adaptations cover a range of items including walking frames, bath aids, stairlifts, wheelchair ramps and lowered kitchen worktops. They enhance a person's quality of life by enabling them to do things that many of us take for granted like having a bath or going out into our gardens. They can also help prevent admissions to hospital, speed up discharge arrangements from hospital and reduce the need for other community care services and the support of carers.

Deputy auditor general, Caroline Gardner, says: 'About a third of households in Scotland have at least one person with a long-term illness, health problem or disability. One in three adults with such difficulties have equipment or adaptations in their home.

'We found that the way in which these services are currently organised, where councils and the NHS are involved in managing and delivering community equipment and adaptations, is confusing for people using these services as well as for staff working in them. While it should be easy for people to find out key information like what is available, who they can get help from and how long they may have to wait, this is not always the case.

'With the move towards joint working between councils and the NHS, now would be a good time to revise national guidance on responsibilities for community equipment and adaptations as some of this pre-dates these new ways of working.'

The report says:

-Community equipment and adaptation services make a positive difference to people's lives and can prevent more costly interventions. Users also speak highly of the staff with whom they have contact.

-Some national guidance is out of date and does not support new ways of working between social work, housing and the NHS. These services remain fragmented, and the split in responsibilities between councils and the NHS is unhelpful and confusing for users and providers alike.

-Information about services is not easy to access and some people wait a long time for community equipment and adaptations.

-There is poor information in general on the cost, management and quality of services which is limiting the development and evaluation of services. Council social work services spend about£30m on equipment and minor adaptations. But it is not possible to estimate total national expenditure on equipment and adaptation because of gaps in councils' housing service information and in NHS information.

-A lack of formal policies and procedures in many places is exposing users and providers to risks. For example, not all places have systems for recalling faulty equipment.

Alastair MacNish, chairman of the Accounts Commission says: 'Demand for these important services will increase as Scotland's older population grows. We need to see improvements in how they are planned, managed and delivered so that service users get what they need when it is needed.'


1. Audit Scotland defined community equipment as that which provides help towards daily living or meets a home nursing need. Some examples of such equipment are raised toilet seats, kitchen trolleys, and commodes. Adaptations are changes to a property that can be minor (such as an external grabrail) or major (such as installing a lift or widening doors for wheelchair access).

2. Audit Scotland reviewed 29 council housing services, 28 council social work services and 20 NHS trusts. The fieldwork for the study was carried out before the recent abolition of trusts but the report's recommendations are aimed at the new NHS boards. Audit Scotland also carried out a Scotland-wide survey of just under 1000 members of the general public and held five in-depth focus groups with users and carers.

3. The findings and recommendations in this report will be followed up by Audit Scotland on behalf of the Auditor General and Accounts Commission in due course.

4. The report, Adapting to the future: the management of community equipment and adaptations, is available hereand the key findings here. will be available here later this morning.

5. The auditor general is responsible for securing the audit of the Scottish Executive and most other public bodies in Scotland, except local authorities. He investigates whether spending bodies achieve the best possible value for money and adhere to the highest standards of financial management. The auditor general is independent and is not subject to the control of the Scottish Executive or the Scottish Parliament.

6. The Accounts Commission for Scotland was set up in 1975 and is independent of both central and local government. The commission checks whether local authorities, fire and police boards spend£9bn of public money properly and effectively.

7. Audit Scotland is a statutory body set up in April 2000, under the Public Finance and Accountability (Scotland) Act, 2000. It provides services to the Accounts Commission and the auditor general for Scotland.

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