CELG(4) HA 03
Response
from : Powys Teaching Local Health Board
1. Please note that the following response to the questions posed in the Welsh Government letter of 11 December 2012 has been produced with the help of other local agencies (including Powys County Council and the Third Sector)
Why are there
still significant variations in the time it takes to deliver aids
and adaptations funded by the Disabled Facilities Grants across
Wales?
2. The process for accessing Disabled Facilities Grants is extremely complex, involving distinct phases and many different departments and agencies. It rightly tries to emphasise client involvement in decision making but this often contributes to the delay.
3. Means testing can introduce a delay and further complexities are introduced through part funding. The tender process for the adaptations themselves can also be a slow process.
4. While Occupational Therapy Assessment waiting lists have improved, this improvement is fragile, and with increasing demand it remains a concern.
5.
One
voluntary sector organisation has commented on a possible tendency
to shift to the lowest cost adaptation rather than the most
appropriate.
Has sufficient progress has been made on implementing recommendations from the Equality of Opportunity Committee’s 2009 report on home adaptations?
6 In Powys there have been significant improvements since the 2009 report. Short term funding has enabled a robust tracking system to be established for DFGs and some additional funding has enabled the RRAP programme to be delivered across all tenures
7. The development of a schedule of rates for more standard works has also helped to speed up adaptations
8. One of our key agencies has also recently restructured to meet frontline demand more effectively in the future.
9. Nevertheless there is undoubtedly room for further progress. Although the Social Service OT waiting list situation has improved there are clearly difficulties within the middle phases of the DFG process.
What impact will reduced resources for housing likely to have on the provision of home adaptations?
10. Any cut in housing funding is likely to increase the need for adaptations, since if appropriate adapted new housing were available then people would be more likely to move rather than undertake complex adaptations to existing buildings. In the private sector, the housing stock in Powys is older and adaptations are often more costly or difficult to achieve. In some areas there is a paucity of alternative suitable accommodation.
11. The reduction of resources has a greater impact in Powys because of the larger percentage of older people and will put further pressure in forthcoming years.
12. The Disabled Facilities Grant is means tested, Third Sector organisations have become very skilled in identifying sources of funding for people who need to self-fund but who do not have resources to pay for the full cost of necessary adaptations. There is increasing competition? for the charitable funding available for specific conditions or workforce but this may itself may be affected by economic down turn. One of the difficulties with this is that some people may not be eligible for any of the sources of funding.
Is the Welsh Government effectively monitoring the provision of adaption services?
13.There is a need for standardised measurement to ensure equity. In particular more clarity is required regarding the start date for monitoring across all areas in order to compare like with like.
14. Some measurement around service user responses would also be useful eg perhaps giving the user a target time for responses or the agent a time limit for submitting the grant application once they have been invited to do so.
15. Welsh Government needs to take account within its monitoring of the alternative methods of securing adaptations employed in some areas (fast tracking). For example in Powys use is made of RAGs (Rapid Adaptation Grants) and MAGs which are not counted within the DFG performance statistics
16. Adaptation services are delivered by a number of agencies and there does not appear to be comprehensive or coherent approach nationally to monitoring adaptations and to plan for future demand.
What more needs to be done to improve?
17. See above.
18.
There is some concern regarding the means testing element of the
process with questions being asked about whether the income
generated outweighs the expenses in terms of staff time etc.
However if this were abolished then the likely demand would soar,
since many clients currently utilise their own funds to secure
adaptations where this can be afforded.
19. The use of a specific temporary post for tracking/progress chasing adaptations in Powys has made a significant difference. Continued ring-fenced funding would be advantageous
20. Health Funding for RRAP etc should be maintained or increased to enable the delivery of small adaptations, which facilitate hospital discharge or prevention of admission, to be delivered across tenure.
21. There should be greater coherence of planning at a local and national level
22 Mapping of existing housing stock to ascertain baseline and areas for development is required.
Other Issues
23.Because of the emphasis on care at home and the increasing number of older people in the population demand on RRAP and handyman services is increasing.
24 Variation in access to housing adaptations is inherent in the current system for following reasons
· Nature of housing tenure determines funding route and provider
· (There is a need to ensure that that the RRAP criteria are being interpreted consistently by assessors.)
.