4.3.6 Lambeth Equipment Provision Guidance

1. Purpose, Context and Objective

The first choice, where appropriate should be for the person with care and support needs to receive a period of rehabilitation or reablement or training in alternative techniques to carry out a daily living task, rather than to rely on equipment.

The purpose of prescribing equipment is to increase or maintain the functional independence of the person.

See “Legal Framework for Equipment Provision – Guidelines” updated 2024, Michael Mandelstam.

2. Scope

Equipment can be prescribed following an assessment carried out by an Occupational Therapist or trained member of staff.

For needs that require simple equipment and / or minor adaptations this can be assessed for by Trusted Assessors (includes Assessors and Occupational Therapy Assistants) who have received training to prescribe and issue specific pieces of equipment. It could also include relevant staff with the appropriate training from hospital or private or out-of-borough hospitals who require simple equipment and / or minor adaptations with adult social care oversight.

For needs that require complex or specialised equipment and/or minor adaptations this will require an assessment by an Occupational Therapist.

3. Equipment Provision Process

• Assess the person’s needs and record on the appropriate form on Mosaic.
• Assess the carer’s needs at the same time as the needs of the disabled person, if they consent.
• Take into account, if the person would have difficulty making a decision about having equipment and whether a mental capacity assessment is required.
• Take into account ethnic and cultural aspects of the As part of the assessment, establish the usual practises for the family. It may be necessary to seek advice from appropriate cultural groups.
• Take care not to over-prescribe equipment. Always offer the simplest and most cost-effective solution to the problem.
• Demonstrate all equipment prescribed to the person to ensure safe and correct use.
• If, although equipment is needed, there is an issue about its safe and / or correct use, then as part of the assessment make a clinically reasoned decision as to whether or not the equipment can be issued. Make the decision in consultation with a manager and record it on the person’s record on Mpsaic.
• Take care not to create pressure care problems when issuing equipment. Seek advice from a community nurse or tissue viability nurse as required.
• As part of the assessment, consider where the equipment will be stored. Take into account other users and / or occupants of the home in which the equipment is to be used.
• If during the course of the assessment, you discover significant changes in the adult’s needs, then arrange to complete a full functional assessment in person.
• When equipment supplied on loan reaches the end of its life and is not repairable, replace it following an assessment of need by telephone to check that:
  • the person meets the current guidelines in use; and
  • the most appropriate equipment is being used.

4. Prescribing Equipment

Please note: Staff must never provide equipment that they do not know how to use correctly. An individual professional who advises against manufacturer’s instructions may take on liability for that device.

4.1 Equipment assessment considerations

• What are the adult’s presenting needs based on your assessment?
• Have you considered reablement / rehabilitation?
• Have you considered the adult’s:
  • physical and mental capabilities;
  • sensory capabilities – for example, vision, hearing, sensation;
  • ability to understand and remember advice regarding safe and correct use;
  • previous experience with equipment and minor adaptations;
  • priorities, concerns and expectations?

• Have you considered:
  • the environment in which the equipment / adaptation will be used?
  • the needs and requirements of other occupants of the home and family members?
• Has a risk assessment been undertaken? (You need to continually assess risk at every stage of assessment and provision.) Are any risks associated with the equipment acceptable? Can risks be further reduced?
• What equipment or minor adaptation available best meets those needs?
• What are the adult’s wishes and what are the criteria for provision?
• Will equipment provision reduce risks to health, safety and wellbeing?
• Will equipment provision remove or reduce the need for a care package? Or reduce dependency on a carer and reduce carer stress?

4.2 Equipment provision considerations

Ask yourself:

• Do I know how to set up and use this equipment?
• Have I read the user instructions, and are they attached to the equipment?
• Have I been trained in the use of this equipment?
• How was my competency in relation to the equipment assessed?
• Do I know how this equipment should perform and the monitoring that needs to be done to check its performance?
• Am I using the correct additional equipment (for example, toilet frame and raised toilet seat)?
• Do I know how to recognise if the equipment has failed?
• Do I know what to do if the equipment fails?
• Do I know how and to whom to report an equipment-related adverse incident?
• Have I or others modified the equipment? If so, has liability been checked with the manufacturer?

During use:

• Does checking the equipment indicate that it is functioning correctly and to the manufacturer’s specifications?
• What action should be taken if the equipment is not functioning properly?
• Has this been documented?
• Is there up-to-date documentation to record regular checking of the equipment or information given to the adult / carer?
• Is the equipment still appropriate in the light of changing needs of the patient or person – for example, deteriorating conditions?

After use:

• How will the equipment be returned to the Community Equipment Stores or be disposed of, or safely stored?
• Does the equipment / adaptation show any signs of wear, damage or faults that should be reported?
• Is any servicing, maintenance or repair required?
• Were there any problems using this equipment which should be noted and could be rectified for the future? For example, was any information missing from the patient / carer guidance which would have been useful?

4.3 Plus size (Bariatric) equipment

Plus size equipment is generally issued to adults whose body weight is above the weight limit of standard equipment. When issuing plus size equipment, assess the environment in which the person is using the equipment as there can be a health and safety risk. Equipment must fit through doorways and should not cause an obstruction within the room it is to be used in.

Equipment that is used to lift bariatric adults must be suitable for the task and have a Safe Working load (SWL) limit greater than the weight of the person.

5. Information for Adults and Carers

Demonstrate the equipment/adaptation and ensure the adult and carer know how to use it in the way it is intended to be used, and with the lowest possible risk.

Check the following points to make sure that adults and carers are fully aware of their responsibility for equipment / adaptations:

• Has the equipment been demonstrated with client and or carer?
• Have they been given written instructions by the Community Equipment Provider which supports the use of the equipment / adaptation and covers:
  • the name of the equipment, the operation of the equipment, their responsibility for checking the equipment while in use, checking the adaptation is secure, recognition of any failure or fault in the equipment / adaptation, action to be taken in the event of failure or fault of the equipment/adaptation, their responsibility for reporting an untoward event to the Community Equipment Stores / Provider;
  • telephone numbers of contact points in an emergency, including out of hours.

5.1 Private purchase equipment

Make sure that adults who purchase equipment / adaptations privately are made aware of their personal responsibility to ensure they are appropriately used and maintained.

5.2 Equipment already in place

If assessing an adult / carer who is using existing equipment prescribed by another person, it is your responsibility to check that the equipment is fit for purpose, meets the current needs of the adult / carer and is being used safely and correctly.

Record any issues that arise and take appropriate action.

6. Other Considerations

• British Standards and CE markings are on many items of equipment. Select such items where possible in order to give some assurance that the design meets acknowledged safety and performance standards. If modifications are made to equipment, then that equipment is outside regulations and responsibility under the ‘manufacturer’s liability’. The responsibility for safety, `fitness for purpose’ and so on, transfers to the person or authority that made the modifications. The OT service does not make any modifications to equipment.
• Read and action medicines and healthcare products Regulatory Agency hazard notices, (MHRA) safety notices, alert notices and device bulletins.
• The Community Equipment Provider will ensure instructions in an appropriate format or language are left with the person, including what to do if they encounter a problem with the equipment – for example, equipment breakage. The Community Equipment Provider is responsible for the repair, maintenance and replacement and servicing of equipment subject to specialist equipment which may require specialist servicing.
• The Lifting Operations and Lifting Equipment Regulations 1 98 (LOLER) require that in some circumstances, equipment used at work to lift or move people should by default be examined every six months or in accordance with a competently drawn up alternative examination scheme. Even in those situations where LOLER does not apply, it is essential in both law and practice that lifting equipment is examined and maintained at intervals appropriate to the level of risk present. (See: The Provision and Use of Work Equipment Regulations 1998 (PUWER) and LOLER and the MHRA device bulletin on managing medical devices, DB2006(05))
• The Community Equipment Provider maintain records of the location of all equipment, so you must inform the Community Equipment Service of any equipment delivered direct to adults, so that the equipment can be added to their records.

7. Record Keeping

Records should provide evidence that equipment has been prescribed, demonstrated, checked and maintained correctly and is fit for its intended purpose.

Ensure:

• You have met all legal requirements and have adhered to Lambeth standards, procedures and guidelines concerning the assessment, prescription and safe and correct use of equipment.
• You have demonstrated safe and correct use, fitting / installation and maintenance of the equipment and have given all related instructions to the user/s.

8. Moving and Handling Equipment

Manual Handling Equipment is designed to minimise the risks to a carer assisting a person to transfer or to facilitate independent transfers for a person.

Items include one-way glide, sliding sheet, transfer belt, transfer board, turning disc, rope ladder, handling sling, leg raiser, glideabout commode, and various types of hoist.

The Occupational Therapist must:

• Complete a Moving and Handling Risk Assessment form to identify and propose equipment to reduce risks.
• Complete Moving and Handling plan and give it to the adult and carer.
  • • If the person has a formal care package, a copy of the Moving and Handling plan should be given to the Care Agency involved.
• Put any special instructions in writing or leave photographs. Scan these documents, then attach them to the person’s record on Mosaic.

9. Rail and Minor Adaptation Provision

9.1 Rails

Types include: Newel rails, grab rails, stair rails (internal handrails mop sticks), external galvanised rails and fold-down or wall-mounted rails.

Where rails are required, establish who owns the property at the start:

• If the property is owned by a Housing Association (HA) and rails are the only recommendation, you can advise the tenant to contact the HA direct to arrange for this work to be done. Under the RCOT Guidance “Minor Adaptations Without Delay”, housing associations can provide minor adaptations directly without coming to the OT service. You can alternatively contact the housing association direct on the tenant’s behalf. You may have to complete a minor adaptation request document and send it with any required diagrams to the housing association for them to provide the rails.
• For work in Lambeth Council properties, complete an M5 / minor adaptation request form and send to ACS Equipment, the Business Support Officer will then process and send to Community Works with the request for rails / minor adaptation to be installed. You may have to complete a diagram to confirm details i.e. location of the rail.
• Where the person lives with the person who owns the property you would not normally need to get written permission (email or letter) to carry out the work but there may be exceptions to this depending on household circumstances. Again as above for Lambeth Council properties (with permission if required) complete an M5 minor adaptation request.
• Where the property is rented or owned by someone who does not live there, you will need to get written permission from the landlord / home-owner before the rail is requested. Bear in mind that this may take some time to organise and make allowances for this with your planning. Again, with permission complete an M5 minor adaptation request.

The Community Works install rails only where indicated by the Occupational Therapist / Trusted Assessor. If the adult or their carer asks for something different, Community Works should contact the referrer to discuss, but this may mean that the installation is delayed.

Advise the person (and family members if you have contact with them) that if / when the person dies or leaves their current home, Lambeth Social Services does not remove or retrieve rails which we have installed.

You are responsible for checking (as soon as possible after installation), that the rails you have requested / M5 request has been completed via telephone or home visit.

9.2 Rails on stairs considerations

If the person declines to or is unable to manage more than a couple of steps, it is unlikely that the provision of a stair rail will enable them to manage the full flight. Consider alternatives solutions, for example:

• In a hallway the person may manage adequately if encouraged to use an appropriate walking aid rather than having several rails installed.
• For a person with some lower limb weakness, toilet transfers may be improved sufficiently with a simple raised toilet seat.
• A person may manage bath transfers more safely with the provision of a bath board and seat than with a wall-fixed grab rail.

There may be occasions where going up / down stairs is the only form of exercise available to a person, and where there are no contra-indications, they should be encouraged to do so, and a rail is unlikely required for this purpose.

9.3 Minor adaptations may typically include

• Grab rails
• Half steps
• Raised plug sockets
• Re-hanging of doors
• External galvanised rails

10. Types of Equipment

Bathroom equipment	Bath seat	Seat positioned in the bath to aid person transferring in and out of the bath. A bath seat may be used in conjunction with a bath board.
	Bath board	A bath board fits across the top of the bath and may be necessary for people who have difficulty stepping into the bath. The bath board may be used as a single item or in conjunction with a bath seat and / or bath rails.
	Swivel bathers	Plastic seat with arms mounted on a rotating locking metal frame which sits across the bath. It is useful for people who have difficulty with a bath board or rotating their trunk.
	Bath step	Step positioned outside the bath to enable the adult to access the bath easily if the bath is too high for safe transfers.
	Specialised portable bath lift	This equipment is placed in the bath and can be raised or lowered into the bottom of the bath by the adult or carer by means of battery power, compressed air or by a spring mechanism. Note that this requires the person to have good upper body strength to use.
	Shower stool	Free-standing stool for use in showers: it can be made of plastic-coated metal or plastic. Some models can be height adjustable.
	Static shower chair	Chair used for showers made of plastic-coated metal or plastic it can be height adjustable and is available with or without arm rests.
	Mobile shower chair	Wheeled shower chair with brakes for use in a level shower area: it can have a commode facility and can go over some toilets. It can be self or attendant propelled. It comes with various different arms, seats and back rests.
Toilet equipment	Raised toilet seat (RTS)	A plastic device that clips onto the existing ceramic toilet bowl and raises the height of the toilet.
	Toilet frame	A U-shaped frame which fits over the existing toilet to provide arms to assist the adult transferring on / off the toilet. The toilet frame can be adjustable in height: it has armrests or can be floor fixed.
	Toilet frame with integral seat	A frame incorporating an integral toilet seat which fits over the bowl of the existing toilet. It can be adjustable in height, or can be floor fixed.
	Chemical commode	A free standing, height adjustable toilet frame with arm rests. It has a large internal container with a lid and handle to assist with emptying. It contains a chemical fluid, which needs emptying (when the container is half full) down the household toilet or the manhole once or twice a week depending on the frequency of use. It should be issued only if safe to do so due to risk of burns from the chemical liquid used.
Bedroom equipment	Bed raiser	Equipment to raise a bed dependent on the legs of the bed, see community equipment provider catalogue for all options.
	Bed Rail Also referred to as cot-sides	See separate Guidance on Bed Rails (MHRA 08.24), risk assessment required. Attaches to bed to stop a person falling out.
	Bedstick	See separate guidance on Bed Rails, risk assessment required. A looped handle at both sides of the bed, fitted between the mattress and solid base of a bed. It can be adjusted to fit a double bed. It is not to be used for slatted beds.
	Bed lever	See guidance on bed rails, separate risk assessment required. A single looped handle for use on either side of the bed: it can be used for slatted beds or a single rail with clamps for use with a profiling bed.
	Leg loop	A reinforced webbing strap with a loop at the end 900mm long 150mm loop size, which is hooked over the foot to assist lifting one leg at a time.
	Over bed pull handles (monkey poles)	A pole that rises above the bed and bends over. It has a handle which is attached to the hanging part that the adult can hold onto. It can be freestanding, floor-fitted or integral to a hospital bed.
	Mattress variator	A powered sit up device with or without a bellows that is fitted between the mattress and the bed base can be single or double.
	Chair raisers	A set of four moulded blocks or metal sleeves in various heights, some are linked diagonally – for example, Langhams. The chair must be suitable to be raised safely.
Seating and Chairs	Height adjustable high back armchair	A height adjustable and seat depth adjustable metal framed chair with a high back, washable covering and arms to assist with leverage and positioning.
	Powered riser / reclining chair	Electrically operated armchair that can rise and recline by a touch button hand control. When the seat back tilts backwards, the front of the chair lifts up behind the adult’s legs so that the adult can be moved from a sitting to a lying position or any point in between. It can be single or dual motor.
	Specialist seating	For adults with complex needs, generally for pressure relief, stability, posture etc. This type of chair is generally specific to the needs of adults with complex disabilities and high care needs, following a seating assessment by a qualified professional.
Kitchen and domestic	Trolley	A specially designed trolley to enable a disabled person to put their weight through the handles in order to allow the person to transport items they would otherwise not be able to carry. Some trolleys have a single bar handle which are useful for people with limited use in one hand. A trolley should only be issued if there is no seating area in the kitchen, the person is unable to carry food and drink, and there is no one else in the house who could carry food and drink into another room. The person must demonstrate they can use the trolley safely with no trip hazards. A trolley should not be issued as a substitute for a walking aid. For adults using a walking frame, consider other methods – for example, a flask and net bag.
	Perching stool	A specially designed stool with an angled seat to enable a person with low standing tolerance to take some weight off their legs whilst carrying out activities of daily living for which it would be appropriate to be seated. Consider where the stool will be stored – of particular relevance in small kitchens. Do not issue a perching stool in situations where an ordinary high stool will do.
Ramps	Portable ramps and modular ramps.	Ramps need to be level so if the path or ground the ramps are to be used on is too uneven, do not use the ramp. Make sure the spacing of the ramps allows the wheelchair wheels to run in the middle of each track UPVC door frames are sometimes not strong enough to support the weight of channel ramps and user and can be damaged. Portable ramps are not provided for use with mobility scooters or powered wheelchairs.

11. References

Legal Framework for Equipment Provision – Guidelines, Michael Mandelstam, 2016.

Adaptations without Delay: A guide to planning and delivering home adaptations differently, Royal College of OT (RCOT), 2019

Keeping Records: Guidance for Occupational Therapists, RCOT, 2018