I have been in correspondence with council staff recently over a resident who was unable to safely use her bath.

After two months delay came the following response from the Occupational Therapy Service in Hammersmith and Fulham Council’s Adult Social Care Department:

“Due to client difficulties with transfers and lack of space/restricted bathroom layout and close proximity of bath to WC as well as need for long term independence with bathing, the OT has agreed to support level access shower with drop down seat in place of bath.

“This will be processed as a Major Adaptation and sent to the adaptations team as required for the installation of a level access shower.”

Good news. Except that it is estimated it will take another six months for the work to be done. What actually makes this all the worse is that it is entirely typical. I was told:

“I can confirm that the estimated time line for all major adaptations is approx. 6 months, some do happen faster but some do take longer, this is due to the vast myriad of different contributing factors.”

Six months is too long, isn’t it? If I broke a leg and needed some adaption done in my house it wouldn’t take a builder that long to get the work done. I wouldn’t have to strip wash for six months.

I am told other councils are as bad or worse. So what? We should minimise delay to the greatest possible extent. It
is much cheaper to help people stay in their own homes than for them to be put into care.

The assessments take 2-6 weeks even before we get on to the six months delay. I was told this is due to shortage of staff. Yet I have already highlighted how the £22.7 million a year in the Council’s Public Health budget is largely wasted.

The contracting process is very cumbersome and bureaucratic – apparently due to EU procurement rules.

Anyway I put through the following queries:

1. I note the point about a shortage of staff to process the work. Could we get more staff using funds from the Public Health budget? And/or more efficiency through a tri-borough arrangement or tendering the service? It seems to me that the 2-6 weeks it takes to get an initial assessment is an avoidable delay.

2. I also note there is sometimes delay getting a surveyor. Could we find retired surveyors willing to work for free.

3. I note that we take two weeks to send out the Disabled Facility Grant form. Could we email it to those who are on email? Could we get volunteers from Age Concern to help send out the forms and help people fill them in quickly? Also what if someone is too rich to be given a Disability Facility Grant – shouldn’t they be warned about this earlier so they could get on with paying for the work themselves making private arrangements? Also pleased provide the figures for the funding from central government for the Disabled Facility Grant for the last two years and for the Council’s spending on these grants.

4. I note that there is more delay with the contractors needing to get three competitive quotes from subcontractors for each individual job. Could that not be streamlined? For instance one firm contracts for all stair lifts in Shepherd’s Bush, or all adapted baths in Fulham, etc? I can see that requiring individual quotes for each job would cause delay – and perhaps increase costs?

5. What are the comparative costs to the Council for assistance for people to remain in their own homes and paying for them to have residential care? Would not a quicker service for adaptions reduce the risk of their condition deteriorating and thus reduce the number and thus cost of residential care placements.

This was the reply I had:

Dear Councillor Phibbs

Thank you for your recent enquiry.

Thank you for your email and concerns regarding trying obtain an efficient and cost effective Occupational Therapy Service for your residents.  We also share your concerns and are constantly looking at ways to improve to meet the growing demand for the Service.

Last year from April 2015- April 2016 the Occupational Therapy Service received over 1,400 referrals.  In order to ensure that clients with urgent needs such as people who are terminally ill, at risk of injury, or a breakdown in family relationships and care we operate a priority system as follows :-

*       If the case is urgent the client is seen within  1- 2 days and are seen by the Rapid Response Team.
*       If the case is awarded a Priority 2 they are seen within 2 – 4 weeks  depending on the urgency of the case.  This may be for Stair lifts, Ceiling Track hoists. Difficulty with Access.
*       A P3  is a low priority and will be seen within  6 weeks.  This may be for bathing assessments and showers..

The Occupational Therapy posts funded via the Public Health Funds (CLCH) will deal with Rapid Response urgent  cases.  The OT’s funded from the Local Authority will see the  P2’s and P3’s the more complex long term cases.

In regards to point 2,3,5 the Adaptation process is currently under review and a proposal has been drawn up to move the management of the Adaptations Service back to the Housing Department.  This should happen within the next 2 months.   Your comments will be passed to onto the relevant people who are looking at the existing processes and what needs to change to improve the Service.

The Disabled Facilities Grant is a very complex process. You first have to be assessed by an Occupational Therapist to determine if you meet the functional criteria for the provision of the Grant.  At this stage clients will be informed of the process and sent out a Preliminary Test of Resources Form to complete. Most people prefer to be assessed even if they do not meet the criteria and are over the financial threshold for a Disabled Facilities Grant  This is due to the fact that the  Occupational Therapist can still provide equipment, minor adaptations, advice, information, and if the client decides to pay for the Adaptations privately the OT can still work with the Contractor commissioned by the Client on their behalf.

I do not feel that using Volunteers from Age Concern would help this process as most clients struggle to divulge their personal financial information.  You also require specialist training to ensure that  the financial information received is processed accurately. I will provide the information you have requested separately regarding the funding for the Disabled Facilities Grant.   This is also under review by the Housing Department so I will also pass on your comments and suggestions.

In regards to point 5 I can assure you that once an Occupational Therapist or Social Worker completes a comprehensive assessment  if it possible for the client to remain at home in their own home environment then this would be the preferred choice. Placing someone in a residential establishment is the last resort and is only considered as an option if the person is unsafe , the family unable to cope or the home is not suitable to accommodate their needs.

Janice Blake

Manager of  the Occupational Therapy Grants and Adaptations Team
Hammersmith & Fulham Council