The organisation of equipment services for elderly and disabled people is 'a recipe for inequality and inefficiency', the Audit Commission has found.

In a report published yesterday, the commission says there are 'unacceptable variations' in services providing orthopaedic footwear, external splints and callipers, surgical collars, artificial limbs, audiology and wheelchairs.

Audit Commission controller Andrew Foster said: 'While some areas are making good progress, the quality of equipment services is unacceptably poor in many parts of the country.

'Long waiting times, unclear eligibility criteria and poor-quality products threaten to undermine plans to promote independence in the community. A higher priority needs to be given to these services at all levels of the NHS.'

The report says senior managers neglect equipment services and they are under-resourced and often poorly planned as a result.

Trust boards should review the management of equipment services, ensure they are clinically led and that managers of 'adequate calibre' are directly accountable for performance, it recommends (see box).

The report also identifies areas in which division of services between the NHS and social services affects quality, such as in provision of independent living equipment.

And poor clinical outcomes 'compound the waste of public money' when users' needs are not met first time, it says.

Charities and disability organisations welcomed the report. Sam Gallop, chair of emPOWER, a consortium of 35 disability organisations, said: 'We believe that standards for disability equipment should be set and met.'

Age Concern welcomed the recommendation to consult users more closely.

Policy officer Stephen Lowe said including equipment services in the national service framework for older people would 'promote a nationally consistent level of services' and 'raise their priority'.

Royal National Institute for Deaf People spokesperson Kevin Shinkwin said audiology services had been 'near the bottom' of the 'Cinderella list' of equipment services, but there wasn't a greater opportunity anywhere else in the NHS to make 'such a great difference to such a number of people'.

The report's recommendations 'chart an essential way forward', he said.

Royal Association for Disability and Rehabilitation spokeswoman Sue Pratt said: 'Eligibility criteria are the biggest problem. We are calling for national eligibility criteria and national funding for this.'

Fully Equipped: the provision of equipment to older or disabled people by the NHS and social services in England and Wales. Aud it Commission Publications. 0800 502030.£20.

Main recommendations:

Specialist rehabilitation centres should be created for a range of services;

NHS and local authority equipment stores should be combined, as should their hearing services;

equipment services should be included in national priorities guidance and the forthcoming national service framework for older people;

commissioners should review waiting times for equipment with providers;

equipment tracking should be improved.