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Specialised Services National Definition Set: 5 Assessment and provision of equipment for people with complex physical disabilities (all ages)

  • Last modified date:
    8 February 2007

This page provides descriptions of the various services covered and includes specific issues considered to be important by the working group concerned.

This definition has been subdivided into five main areas:

  • Prosthetics and complex orthotics
  • Specialised wheelchair provision including complex postural seating/postural management systems and specialised powered wheelchair controls
  • Communication aids (excluding all forms of hearing aids and cochlear implants)
  • Environmental controls and other electronic assistive technology
  • Specialised aspects of telecare

For all of these services, it is the expertise of the patient assessment process that determines the specialised nature of the service. Ideally it would be possible to describe the specialised elements of the service by the level of complexity of the assessment process. However, currently there are no standard tools available to do this and therefore at this stage these services are identified by the nature of the equipment prescribed rather than by the assessment process.

Whilst the focus of the definition is on specialised equipment, it is essential that commissioners look at the whole model of equipment service provision. A hub and spoke model may be an effective service delivery model for these services with the hub playing a key co-ordinating role whilst ensuring high standards are maintained throughout the service. The critical mass of patients dealt with by the hub ensures the multi-professional team has the range and level of skills to deal with specialist cases. The spokes provide services to a wider group of patients while ensuring appropriate referral back to the hub for those patients requiring the full services of the multi-professional team. The development of services should be informed by relevant user involvement.

The services included in this definition involve the provision of equipment to adults and children and are characterised by:

  • the complexity of service user needs (complex physical/cognitive/ language/sensory disability)
  • the complex and expert nature of the assessment
  • the need for effective training and on-going maintenance and user support
  • issues of maximising procurement economies of scale

Whilst the services are based on the provision of equipment in some form, the hardware does not comprise the totality of any of these services. Specialist assessment, provision of equipment and training should be delivered as part of a total package of care, to ensure that service users are provided with the most appropriate equipment and are enabled to use it to optimal advantage.

The other aspect common to many of these services is the long-term nature of the provision. Users will often need provision throughout their lifetime. Commissioning arrangements should therefore provide the resources to review and maintain equipment in order to accommodate the changing needs of this client group.

There is a growing need for integrated links between these services. Developments in electronic technology make it possible for some users with complex needs to have communication aid, environmental control and wheelchair control functions provided by a single system. There are also those who do not require such sophistication, but who can be expected to benefit from telecare or 'smart house' technology. Some assessments for environmental controls are likely to result in the provision of a telecare solution.

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