Consultation: Provision of Equipment, Aids and Adaptations

HSC are asking the GDA, other stakeholders, individuals with impairments and their carers for help to progress a review of the current provision of equipment, aids and adaptations. An ambitious time frame means HSC aims to include recommendations within the Primary Care Review, due before the states in July.

In June 2019, the States agreed:

… that the funding of disability-related equipment, aids and adaptations, under section 10 of the Income Support (Guernsey) Law, 1971 ('section 10'), is an area requiring transformation in order to be more structured, fair and effective, consistent with the principles of the Partnership of Purpose and of the UN Convention on the Rights of Persons with Disabilities;

… to direct the Committee for Employment & Social Security and the Committee for Health & Social Care, in consultation with relevant States Committees and other stakeholders, to review this area, and any associated services or schemes for the provision or funding of equipment, aids and adaptations which they may consider relevant, and to return to the States, no later than the end of July, 2022, with recommendations, which shall include a proposal to transfer the powers conferred by section 10 (or any proposed replacement scheme), and an associated general revenue budget, from the Committee for Employment & Social Security to the Committee for Health & Social Care.

There is more information in the explanatory note to the agreed amendment at: CHttpHandler.ashx (gov.gg).

Section 10 of the Income Support (Guernsey) Law, 1971 (referred to throughout as 'section 10') is a provision which allows the Committee for Employment & Social
Security (ESS)  to make funding available to individuals or families who need to access disability-related equipment or aids, or to adapt their homes.

Although section 10 is part of the Income Support Law (which relates to welfare benefits for people who lack the basic income necessary for a decent quality of life), it isn't restricted to people who are in receipt of benefit. This is because the costs of some aids – and especially home or vehicle adaptations – are so expensive as to be unmanageable for many people, and would be unachievable without some form of government support.

Under section 10, the Committee for Employment & Social Security has the power to consider applications from anyone who needs assistance with the costs of disability related equipment, aids and adaptations, and to decide whether to provide some financial support – which might be for the full cost, or part of the cost, of the equipment; and which might be provided as a grant, or a loan, or a mixture of both.

HSC are looking for feedback on what people have found to be the problems of the current system. However, in bringing forward this review a number of issues were considered which are explained below.

Section 10 is a completely discretionary power. This means that ESS can make whatever decision it sees fit, within reason, as to whether or not to fund the equipment or adaptations someone is requesting.

In practice, this can allow the Committee to make sensitive, individualised decisions on complicated applications. But it also means that people don't know what help they can expect when they are facing significant costs; that two people in similar circumstances could be treated quite differently by the same Committee; and that different Committees, over time, could interpret this provision quite differently.

This is not in accordance with the States' commitment to fairness and transparency in the way that health and care services are provided, which is summed up in the guiding principles of the Partnership of Purpose, especially those relating to fair access to care, a universal offering, and user-centred care. Eligibility for services, including financial support from the States, should be based on clear and fair criteria, and those who are refused services should have a right of appeal.

Section 10 needs to be put into the context of the overall provision and funding of equipment, aids and adaptations in Guernsey, as follows:
Children and adults who need disability-related equipment, aids and adaptations will usually be assessed by an Occupational Therapist or other relevant professional working for HSC. There is a specific Wheelchair Service for people who need wheelchairs. These services may assist people (and/or
their families or carers) to order the equipment they need, and to navigate the various funding options available – but ultimately responsibility for this sits with the individual.

Those who can't afford the costs of necessary equipment or adaptations can either apply to ESS for assistance through section 10, or can seek assistance from local charities. The voluntary sector in Guernsey plays an important role in making equipment and adaptations affordable to individuals and families who can't cover the costs themselves. Some charities provide grants towards the cost of aids and adaptations, while others sell on (at low cost) or redistribute donated equipment.

There is no form of regular, predictable public subsidy for disability-related equipment, aids and adaptations. The costs of specialised items can run into hundreds or thousands of pounds.

The current system is challenging for families and individuals to navigate, and is especially hard on families of children with complex needs (who grow quickly and therefore regularly need new equipment that suits their size and stage of development) and for adults with rapid degenerative conditions, such as motor
neurone disease, who may need several increasingly-specialised wheelchairs, for example, in a space of a few years or even months.

There is a general acknowledgement that there are weaknesses in the current system and that work needs to be done with charities and islanders with disabilities to understand their experiences and shape solutions accordingly.

HSC are currently in a fact-finding period so that they can plan further work and add to their knowledge of the current systems and provision and what gaps the third sector are already filling.

We need your help to answer the following questions. Firstly questions for charities or organisations.

1. Does your charity or organisation hold equipment and if so please indicate what sort and how many items you hold?
2. How many people a year do you support?
3. Is this support for the under 18yr age group or adults?
4. Is the equipment given, loaned and do you make a charge?
5. Is there a cost to you in storing and maintaining equipment?
6. Do you share equipment with other organisations or charities?
7. Do you provide assistance or advice to members in making applications to access disability related equipment, aids or adaptions under Section 10, currently administered by ESS?
8. Should there be a consolidated equipment library in the community on which people with a disability or their carers could draw on when they are needed

Questions for Individuals:

1. Have you ever applied to ESS for support under Section 10?
2. Did you know you could apply for a states grant or loan under Section 10?
3. How did you find out you could apply for a states grant or loan towards the cost of equipment, aid or adaptions?
4. What support or advice did you get in making that application?
5. Was the application for someone over or under 18yrs old?
6. Should there be a consolidated equipment library in the community on which people with a disability or their carers could draw on when they needed?

From a users perspective, HSC are also very interested to know.

1. What the current system feels like, is it meeting the need?
2. Were you/Are people, helped through the system by particular professionals, perhaps your GP or the community occupational therapists?

Please add any general comments you think relevant.

The more data you can provide us with the better and ideally should indicate numbers of items, type of items and numbers of clients (for the organisations).

Responses  return  to carol@disabilityalliance.org.gg  or provided at  the meeting on the 8th June have now been added to the GDA report in response to the consultation.

Many thanks to all those who attended and gave their time to respond to the questions.

Following all the responses to this consultation and meetings with members a report was compiled from the GDA. This can be downloaded by clicking the button below.

This has been sent to the relevant civil servants at HSC and ESS.