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Published: 27/06/2002, Volume II2, No. 5811 Page 18 19

Efforts to ensure elderly and disabled people receive good-quality equipment have made depressingly little progress.What's the problem? Alison Moore reports Providing good-quality equipment to old and disabled people when they need it should not be rocket science.Aiding independence and cutting hospital stays by investing in equipment should pay for itself, with potential savings for the NHS and local authorities.

But an Audit Commission report, Fully Equipped 2002: assisting independence, shows how far the NHS is from adequately funding, organising and commissioning equipment services for four million people.

Sadly, it is not the first time the Audit Commission has pointed out these problems: two years ago its initial report, Fully Equipped, pointed out the many failings of the service and brought promises of action from ministers.

It painted a picture of poorquality equipment which did not meet patients' needs - and thereby wasted money, equipment services which were small and fragmented, and little involvement from senior managers and clinicians.

The NHS plan foresaw a single integrated community equipment service, to be set up by 2004, increasing the number of patients benefiting by 50 per cent and providing better equipment.

So what has changed? So far, depressingly little, despite the government making an extra£220m available through health authorities and local government to improve equipment services - money that has got lost in the system and been spent on higher priorities.

'Very little has got through, ' says Nick Mapstone of the Audit Commission, who wrote both reports. 'HAs and commissioners have not commissioned these services, trusts have not invested in these services.'

Only 13 per cent of the equipment services surveyed for the report had received extra money in 2000-01. Promises of extra money may have done more harm than good, as it built up expectations within the service, which were dashed when none materialised, Mr Mapstone adds.

One of the few areas to make progress in the past two years is audiology. Newborn babies are now screened for hearing loss and digital hearing aids are becoming more widely available.

Mr Mapstone puts this down in part to the way money for upgrading services was distributed through the Royal National Institute for Deaf People to pilot sites.

But elsewhere the picture is still bleak, especially in mobility services. In community equipment, an implementation team has been set up to drive forward the plans for a single integrated service but there has been slow improvement.

To get equipment, patients have to jump through eligibility hoops which often have more to do with budgets than need.

'Many of the managers of these services are investing huge amounts of time in putting up obstacles rather than trying to help people, ' says Mr Mapstone.

Equipment issued to patients is then forgotten, with little effort put into checking it is still appropriate and reclaiming items such as wheelchairs for other patients to use when they are no longer needed. Better IT systems could alleviate this.

And patients are still having to wait: six weeks is the average wait for a conventional wheelchair.

They also have to wait in hospital for pressure ulcer equipment which would enable them to be discharged: one trust lost 456 bed days in a year because of this.

Structural changes to the NHS have not helped the slow progress.

Mr Mapstone says HAs were not good at commissioning equipment services, and PCTs are unlikely to be better. The report describes commissioning of equipment services as 'exceptionally weak'with little regard paid to health trends, such as the increasing incidence of diabetes, which will influence demand for services in the future.

Commissioning often did not reflect health improvement and modernisation programme objectives, and did not look at the wider effects of failing to provide good services.

The report suggests using a hub-and-spoke approach to commission integrated services.

Services are often provided in small centres, which cannot make use of economies of scale and may not have the necessary leadership, management information and logistics capacity.

More private sector involvement might help, says Mr Mapstone, as might direct payments to users to procure the equipment they want.A pilot scheme to distribute money and improve services - as was used in audiology - might engage senior managers more: Mr Mapstone says equipment services lack 'product champions'.

Above all, there is a need to see the wider picture.

'The things chief executives are going to be sacked for are waiting lists and times. They are not going to be sacked for having a poor wheelchair service, ' he says.

'But if you can stop old ladies falling over at home through good equipment services then you keep them out of hospital.

People need to think about how investment in these services can have a big impact on their priorities.'