Specialised Services Policy: CP25 Assistive Technologies

Transcription

1 Specialised Services Policy: CP25 Assistive Technologies Document Author: Specialist Services Planning Manager for Neurosciences and Complex Conditions Executive Lead: Director of Planning Approved by: 05 March 2013 Issue Date: February 2014 Review Date: February 2014 Document No: CP25 Page 1 of 16

2 Document History Revision History Version No. Revision date Summary of Changes Updated to version no.: 28 th August 2008 Text updated and circulated to 0.3 members of the Commissioning Policy Group for comment Minor text amendments nd September rd September Minor text amendments th September Minor text amendments February 2013 Transferred onto new template, minor 1.1 amendments made 1.2 March 2013 Ratified through Chair s Action on 2.0 behalf of Management Group Date of next revision February 2014 Consultation Name Date of Issue Version Number Approvals Name Date of Issue Version No. Commissioning Business Meeting 3 rd September National Commissioning Advisory Board 18 th September WHSSC Management Group Distribution this document has been distributed to Name By Date of Issue Version No. Page 2 of 16

3 Policy Statement Background Summary of Access Criteria Assistive Technology (AT) is a product or service designed to support an individual in order to maximise their social and occupational roles, to maximise ability and minimise disability. The AT services funded by WHSSC and provided across Wales through the Artificial Limbs and Appliances Service are: Posture and Mobility Service; Prosthetics; Orbital prosthetics; and Electronic Assistive Technology. WHSSC funds Assistive Technologies for the population of Wales according to the following overarching criteria: The individual is permanently resident in Wales or is registered with a GP in Wales; The individual has a permanent disability defined as 6 months or longer; In line with the NHS criteria for the provision of essential equipment while striving to meet lifestyle needs; Initial referral must originate from a registered health professional; and The AT service assess the patient is able to benefit significantly from the service. Responsibilities Referrers should: Inform the patient that this treatment is not routinely funded outside the criteria in this policy; and Refer via the agreed pathway. Clinician considering treatment should: Discuss all the alternative treatment with the patient; Advise the patient of any side effect and risks of the potential treatment; Inform the patient that treatment is not routinely funded outside of the criteria in the policy; and Confirm that there is contractual agreement with WHSSC for the treatment. In all other circumstances an IPFR should be Page 3 of 16

4 submitted. Referrals are managed using the Single Point of Referral model. Initial referrals to the Service must be from a registered health professional. Page 4 of 16

5 Table of Contents 1. Aim Introduction Relationship with other Policies and Service Specifications Scope Definition Codes Access Criteria /3.2 Clinical Indications and Criteria for Treatment Referral Pathway Exclusions Exceptions Responsibilities Putting Things Right: Raising a Concern Equality Impact and Assessment Annex (i) Referral Pathway Annex (ii) Checklist Page 5 of 16

6 1. Aim 1.1 Introduction The document has been developed as the policy for the planning of Assistive Technologies for Welsh patients. The policy applies to residents of all seven Health Boards in Wales. The purpose of this document is to: Set out the circumstances under which patients will be able to access Assistive Technologies services; Clarify the referral process; and Define the criteria that patients must meet in order to access treatment. 1.2 Relationship with other Policies and Service Specifications This document should be read in conjunction with the following documents: All Wales Policy: Making Decisions on Individual Patient Funding Requests (IPFR); Specialised Services policy for Neuro-rehabilitation; and Specialised Services Service Specification: All Wales Posture and Mobility Services. Page 6 of 16

7 2. Scope 1. Purpose 2.1 Definition Assistive Technology (AT) is a product or service designed to support an individual in order to maximise their social and occupational roles, to maximise ability and minimise disability. In line with NHS criteria, ALAS is resourced to provide essential equipment whilst striving to meet lifestyle needs. The Services funded by WHSSC and provided across Wales are: Posture and Mobility [ Wheelchair and Special Seating ] Services; Prosthetic Service; Orbital Prosthetic Service; Electronic Assistive Technology Service - Currently a Specialist Speech and Language Therapy assessment for the Communication Aid element of the service is only resourced for South Wales; and War Veterans Service Codes The activity of the assistive technology services is not represented within procedure or HRG codes. There are a wide range of diagnoses that may lead to a requirement for assistive technology. The activity of the assistive technology services is not represented within procedure or HRG codes. There are a wide range of diagnoses that may lead to a requirement for assistive technology. Page 7 of 16

8 3. Access Criteria 3.1 & 3.2 Clinical Indications and Criteria for Treatment Access Criteria/Rationale The overarching criteria for referral to the services are as follows: The individual is permanently resident in Wales or whose GP practice is in Wales and who lives within a PCT bordering Wales 1 ; and Initial referral must originate from a registered health professional. Posture and Mobility Services The individual has a permanent (6 months or longer) disability which affects their posture and/or mobility; and Joint funding with other agencies is considered when appropriate. Prosthetic Service Patients are screened on the basis of their potential ability and willingness to use a prosthesis; and Full clinical assessment by the multi disciplinary team. Orbital Prosthetic Service Patients are referred by an ophthalmic surgeon 6 weeks post enucleation to fit their first eye prior to having a moulded prosthesis when the socket is healed and stable. Electronic Assistive Technology Service Referral to the service is accepted from any registered health care professional and is followed up with a home visit from a member of the multi-disciplinary team. War Veterans Service The War Pension Agency in Blackpool manages all initial applications from War Pensioners. Any disabled exserviceman is entitled to apply for a war pension and depending on the severity of their disability will be awarded a 1 Western Cheshire, Shropshire County, Herefordshire, West Cheshire, Gloucestershire Page 8 of 16

9 percentage of the full war pension. This is known as the Accepted Disability (A.D.); All War Pensioners access ALAS services in the same way as other Welsh patients/clients and have the same rights to assessment and equipment provision. Funding is through the NHS funding arrangements. In addition to accessing the main services identified, each of the three ALAS centres also hold separate budgets for War Pensioners for the provision of Home Adaptation Grants (HAGs), Appliances (e.g. callipers), Home Nursing Aids (e.g. special beds and/or mattresses/pillows) and Orthotics (e.g. customised footwear); Clients must be in receipt of a War Pension from Blackpool before they can access any of these particular ALAS services; and Equipment provision relates to war injury. 3.3 Referral Pathway Referrals are managed using the Single Point of Referral model. Initial referrals to the Service must be from a registered health professional. If the patient wishes to be referred to a provider out of the agreed pathway, an IPFR should be submitted. The Services funded by WHSSC and provided across Wales are: Posture and Mobility [ Wheelchair and Special Seating ] Services managed by Cardiff ALAS and Wrexham ALAS, and the three Rehabilitation Engineering Units (REU) in Bryn y Neuadd, Cardiff and Swansea. Prosthetic Service managed and provided by Cardiff ALAS, Wrexham ALAS and Swansea ALAS. Orbital Prosthetic Service, provided by Cardiff ALAS. Electronic Assistive Technology Service, managed by Cardiff ALAS supported by the REU in Cardiff. Currently the Specialist Speech and Language Therapy assessment for the Communication Aid element of the service is only resourced for South Wales. War Veterans Service provided by Cardiff ALAS, Wrexham ALAS and Swansea ALAS. Page 9 of 16

10 3.4 Exclusions There are a number of reasons why patients may require / wish to have access to other providers. If this is the case then the referring clinician or user should contact their local ALAS centre providing full details of the case. The centre will review the case and will agree with the user and the alternative provider, the most appropriate way forward. Patients in Nursing Homes: The service will supply a wheelchair and/or special seating where it can be demonstrated that the individual will be supported to meet any of the following: Propel the wheelchair themselves; Gain measurable benefit in their mobility from having a transit wheelchair (in practice this usually means that they have family/carers who help them to access the community on a regular and frequent basis); and Accommodate or manage postural problems. If any individuals have very specific posture and mobility needs then they should be referred to the service, especially where they would be able to self-propel their wheelchair and so improve their independence. If the wheelchair is for use for frequent trips into the community and a relative will accompany the individual then the wheelchair will be issued to that family member s address and not the nursing home. The service will not supply a wheelchair where: The wheelchair will only be used to move the individual between rooms and they are then transferred onto another chair or bed, or they are only taken outside on rare occasions; and The wheelchair will be used by a number of individuals. 3.5 Exceptions If the patient does not meet the criteria for treatment, but the referring clinician believes that there are exceptional grounds for treatment, an Individual Patient Funding Request (IPFR) can be Page 10 of 16

11 made to WHSSC under the All Wales Policy for Making Decisions on Individual Patient Funding Requests (IPFR). If the patient wishes to be referred to a provider out of the agreed pathway and the referring clinician believes that there are exceptional grounds for treatment at an alternative provider, an Individual Patient Funding Request (IPFR) can be made to WHSSC under the All Wales Policy for Making Decisions on Individual Patient Funding Requests (IPFR). Guidance on the IPFR process is available at Responsibilities Referrers should: Inform the patient that this treatment is not routinely funded outside the criteria in this policy; and Refer via the agreed pathway. Clinician considering treatment should: Discuss all the alternative treatment with the patient Advise the patient of any side effect and risks of the potential treatment; Inform the patient that treatment is not routinely funded outside of the criteria in the policy; and Confirm that there is contractual agreement with WHSSC for the treatment. In all other circumstances an IPFR request should be submitted. Page 11 of 16

12 4. Putting Things Right: Raising a Concern Whilst every effort has been made to ensure that decisions made under this policy are robust and appropriate for the patient group, it is acknowledged that there may be occasions when the patient or their representative are not happy with decisions made or the treatment provided. The patient or their representative should be guided by the clinician, or the member of NHS staff with whom the concern is raised, to the appropriate arrangements for management of their concern: When a patient or their representative is unhappy with the decision that the patient does not meet the criteria for treatment further information can be provided demonstrating exceptionality. The request will then be considered by the All Wales IPFR Panel. If the patient or their representative is not happy with the decision of the All Wales IPFR Panel the patient and/or their representative has a right to ask for this decision to be reviewed. The grounds for the review, which are detailed in the All Wales Policy: Making Decisions on Individual Patient Funding Requests (IPFR), must be clearly stated. The review should be undertaken, by the patient's Local Health Board; When a patient or their representative is unhappy with the care provided during the treatment or the clinical decision to withdraw treatment provided under this policy, the patient and/or their representative should be guided to the LHB for NHS Putting Things Right. For services provided outside NHS Wales the patient or their representative should be guided to the NHS Trust Concerns Procedure, with a copy of the concern being sent to WHSSC. Page 12 of 16

13 5. Equality Impact and Assessment The Equality Impact Assessment (EQIA) process has been developed to help promote fair and equal treatment in the delivery of health services. It aims to enable Welsh Health Specialised Services Committee to identify and eliminate detrimental treatment caused by the adverse impact of health service policies upon groups and individuals for reasons of race, gender re-assignment, disability, sex, sexual orientation, age, religion and belief, marriage and civil partnership, pregnancy and maternity and language (welsh). This policy has been subjected to an Equality Impact Assessment. The Assessment demonstrates that the policy is robust and that there is no potential for discrimination or adverse impact. All opportunities to promote equality have been taken. Page 13 of 16

14 Annex (i) Referral Pathway Page 14 of 16

15 Annex (ii) Checklist CP25 Assistive Technologies The following checklist should be completed and retained as evidence of policy compliance by the receiving centre. It is expected that this evidence will be provided at the point of invoicing by the receiving centre. i) Where the patient meets the criteria AND the procedure is included in the contract AND the referral is received by an agreed centre, the form should be completed and retained by the receiving centre and retained for audit purposes. ii) The patient meets the criteria AND is received at an agreed centre, but the procedure is not included in the contract. The checklist must be completed and submitted to WHSSC for prior approval to treatment. iii) The patient meets the criteria but wishes to be referred to a non contracted provider. An Individual Patient Funding Request (IPFR) Form must be completed and submitted to WHSSC for consideration. iv) The patient does not meet criteria, but there is evidence of exceptionality. An Individual Patient Funding Request (IPFR) Form must be completed and submitted to WHSSC for consideration for treatment. Page 15 of 16

16 To be completed by the referring gatekeeper or treating clinician The following checklist should be completed for all patients to whom the policy applies, before treatment, by the responsible clinician. Please complete the appropriate boxes: Patient NHS No: Patient is Welsh Resident Patient is English Resident registered with NHS Wales GP Post Code GP Code: Patient meets following access criteria for treatment: The individual is permanently resident in Wales or whose GP practice is in Wales and who lives within a PCT bordering Wales 2. Patient wishes to be referred to non-contracted provider If the patient wishes to be referred to a non-contracted provider an Individual Patient Funding Request (IPFR) must be completed and submitted to WHSSC for approval prior to treatment. The form must clearly demonstrate why funding should be provided on the basis of exceptionality. The form can be found at d= Patient does not meet access criteria but is exceptional An Individual Patient Funding Request (IPFR) must be completed and submitted to WHSSC for approval prior to treatment. The form must clearly demonstrate why funding should be provided as an exception. The form can be found at d= Yes No Name: Designation: Signature: Date: Authorised by TRM Gatekeeper Name (printed): Signature: Date: Yes No Authorised by Patient Care Team? Authorised by agreed other? (Please state whom) Patient Care Team/IPFR TRM Reference number: 2 Western Cheshire, Shropshire County, Herefordshire, West Cheshire, Gloucestershire Page 16 of 16