Mapping the use of AT in the UK: DLF’s submission to the APPGAT

The DLF is a charity that for over fifty years has been providing impartial information, advice and training about assistive technology to enable independent living. Our mantra dates back to Lord Morris’ early support for the charity: ‘adding life to years through practical advice’. We work with industry and over 900 manufacturers and retailers of assistive technology (AT) to produce Living Made Easy a searchable database of over 10,000 solutions across a wide range of aids and adaptations including technology enabled care solutions https://www.livingmadeeasy.org.uk Many of the simpler aids can be ordered directly from those retailers and delivered to people at home and this facet of our work has grown in importance during the Covid-19 pandemic.

An important component of our information and advice services is the impartial advice that our OTs (occupational therapists) write. This clinical advice reduces the risk of poor selection and surrounds the product information with guidance.
The latest figures show that over 2 million people used our mainly online resources in the last year, our telephone Helpline handled over 10,000 calls. We could reach more people with investment in promotion of the services to the general public. We currently receive no government support although historically we were previously funded to develop some of our services by the Department of Health.

Our Helpline is currently reporting an upsurge in enquiries relating to personal alarms and monitoring, we suspect that a major factor in this is the enforced distancing between family members that is leading them to look for ways of tracking the safety of loved ones who are remote and in isolation. In general however we are seeing that the profile of searches online continue to be dominated by the enduring need for AT solutions to essential daily living tasks. Our conclusion is that when people’s needs change either through a change in functional needs, the effects of ageing or a change in ability it is the basics of daily life that become the barrier. The new factor within the pandemic is that because people are tied to the current home environment the urgency is now for a solution within that current home setting. The top searched categories currently are:

• Bathing and showering 10%
• Eating & drinking; preparing food 7%
• Bedroom; sleep solutions 7%
• Toileting 6%
• Alarms and sensors 5%
 

As a response to the pandemic in June we provided a fast-tracked version of our AskSARA online self-assessment tool to Carers UK https://careresuk.livingmadeeasy.org.uk in order for them to reach the UK’s millions of unpaid carers. It was clear that unpaid carers were in the frontline feeling the brunt of restrictions whilst we knew from our own data that they carry out a significant amount of the research to find AT solutions. It is the friends and family of older and disabled people that face the immediate changes brought on by events relating to decline in ability or illness and who need the urgent practical solutions to maintain daily life. Helen Walker, Chief Executive of Carers UK, said ‘Having the right equipment at home can make a big difference to carers – giving them peace of mind as well as allowing them and the person they care for more choice and freedom. We’re pleased to have worked with DLF to help shape the AskSARA tool which will help carers and their families find the equipment and products that work for them – making life that bit easier.’

Recent research launched by carers UK highlights the stress that carers are facing as we head into the winter and a potential COVID second wave https://www.carersuk.org/news-and-campaigns/press-releases/reduced-services-see-unpaid-carers-pushed-to-the-limit-and-desperately-worried-about-winter

DLF hosts and moderates the Youreable online forum for disabled people https://www.youreable.com – current posts are dominated by benefits-related queries and situations that people are facing in lockdown. The forum relies on advice posted by members and there is a thriving cohort of contributors helping guide others to the solutions they need.

One of the main shifts that we have seen during Covid-19 is an accelerated trend towards self-assessment away from statutory OT-provided assessments. Our rapid access online self-assessment tool AskSARA is being relied on as a ‘front-door’ triage tool in a number of areas to direct the public to source and self-fund AT solutions where they can in the knowledge that if users’ needs are complex the tool will direct those users back to the health and social care provider to triage those in need or waiting for a formal intervention and on long OT waiting lists. Users choose from over 90 daily living topics, answer questions devised by OTs and receive a report suggesting AT solutions that might help, they can then click-through and purchase those products from online specialist retailers listed on Living Made Easy.

In addition to the free national version https://asksara.livingmadeeasy.org.uk , a number of AskSARA projects have been fast-tracked through to launch during Covid-19 including a version backed by EquipU a collaborative venture involving seven health and social care partners in central Scotland. The service is being promoted to residents across a wide area reaching a population of 2.46 million. Since 2002, the EquipU Community Equipment Partnership has been providing equipment and assistive technologies to help vulnerable people live as independently and comfortably as possible in their own home. The Community Equipment Partnerships comprises of NHS Greater and Clyde (NHSGGC), and the six local authorities of East Dunbartonshire, West Dunbartonshire, Glasgow City, East Renfrewshire, Renfrewshire and South Lanarkshire. Alison Docherty EquipU Project Manager who has been leading the new venture says, ‘With the increased pressure on service delivery due to Covid-19 restrictions, launching a resource that is accessible digitally on a wide variety of devices is a timely and important move for us. This initiative forms part of our partners’ Maximising Independence agenda, and underlines our commitment to support people to independently identify their needs, and self-manage their conditions, wherever possible.’

Pressure from hospital discharge teams in the first phase of lockdown led us to urgently reformulate our previous face-to-face training for trusted assessors in another programme designed to reduce pressure on the previous pre-Covid-19 norm for service delivery. The trusted assessor framework recommended in RCOT’s 2019 report ‘Adaptations without Delay’ report https://www.rcot.co.uk/news/rcot-launch-adaptations-without-delay-report as a means of reaching and assessing people more quickly came into sharp focus as a now vital method of enabling a wider range of professionals to provide the assessment needed to discharge people safely home. In the last few weeks we have trained hundreds of learners via an online learning management system and our courses are set to be approved as the national standard ensuring consistency of practice UK-wide. Learners have come from roles as varied as housing officers, care and repair teams and grants and information teams within local authorities.

The scheme has enormous potential to mobilise a wide variety of professional carers in improving older and disabled people’s immediate home settings to enable good conversations about people’s functional abilities and potential risks at home. Conversations regarding the current state of their property and peoples risks of falls can identify potential early intervention solutions that can mitigate risk while saving the health and social care system resources and costs as well as alleviating the stress and worry felt by the individual or their carer of the potential harm that the individual may experience. Without supportive equipment to keep them safe at home many older and disabled people will struggle to attend to their own basic functional needs to wash, dress, toilet, bathe, take medication on time and stay safe. A study done by the SFHA in Scotland reviewed the disparate evidence available and identified the cost saving potential to the health and social care system to support people to age in place by providing equipment information and advice and access to markets in a timely manner. (Inclusive Living Evidence Review S.F.H.A. Produced by Dr Vikki McCall, Trudi Tokarczyk, Jill Pritchard, and the Homes of the Future: Inclusive Living Innovation Team 2020.) https://www.housinglin.org.uk/Topics/type/Inclusive-Living-Toolkit-Inclusive-Living-Evidence-Review/

We are committed to leading on the trusted assessor concept to drive its adoption in new areas to further relieve pressure on the already stretched OT waiting lists across the UK. One current project is focussing on wheelchair service provision and how new trusted assessors could be mobilised to enable faster deployment of wheelchairs and other seating solutions.

COVID 19 restrictions and shielding has created a crisis in loneliness across the UK, the increased number of suicides and with many older people at risk of a failure to thrive can be addressed by giving people information on support available both locally and Nationally. DLF are currently in talks with a number of organisations to discuss how combining their social prescribing software alongside AskSARA could support and address these issues.

Across the board online solutions to access information, advice and training has become the mainstay of our provision during Covid-19. The government’s aspirations of digital by default can be realised in the area of equipment provision by a campaign to highlight to the public the resources available to them to support their continuing independence when affected by conditions such as dementia or other physical limitations due to a short or long term condition. Rehabilitation, reablement and discharge can be fast-tracked instead of delayed with the correct information, support and equipment.

Intergenerational connectedness to their friends, family and community can be enhanced and nurtured creating an AskSARA portal that is based on the social model of health and addresses people’s urgent needs for trusted information, advice and signposting to sources of support and AT solutions. We are rolling out mobile-responsive versions of our resources as fast as possible to address the increased demand in access from mobiles and tablets from people at home. We could do more with government backing and funding to support our work and to run a campaign to raise awareness with the general public.

Janet Seward / Dianna Stirling
October 2020

DLF is the UK member of Eastin the Global Assistive Technology Information Network http://www.eastin.eu/en/Partners/Index, which links to the GATE initiative of the WHO. We are also strategic partners with TSA, NAEP, BHTA, UK Telehealthcare and BATA.

DLF is part of The Shaw Trust a charity registered in England and Wales 287785 and Scotland SCO398566.