Successive Government’s always bring with them high hopes for some significant changes in provision for UK social care. Unfortunately, Rachel Reeves’ recent Spending Review has only allowed for an extra £4bn to Adult Social Care, widely seen as a drop in the ocean for what’s needed. The review of the Disabled Facilities Grant may also throw up new opportunities with a change of focus that puts At Home and prevention first. Whatever the outcomes, both will put the OT at the very heart of the changes.  

Ask any OT if the provision for the disabled or elderly infirm is adequate and I’m sure that the answer from everyone would be a resounding ‘No!’. Local authorities have borne the brunt of budget and staff cuts but there is a new recognition that, in the words of Benjamin Franklin, “out of adversity comes opportunity”. The result has seen some creative new initiatives to bridge the communications and operations gap between social care parties. 

The desire we have to live at home as long as possible (or to get back home after injury or illness) has never been stronger since Covid struck. Getting those who find themselves in hospital, back home to a familiar environment as quickly as possible is well known to improve recovery. Indeed, there has been a lot of campaigning for many years to reduce the burden on the NHS and social care system by keeping people comfortable and cared for at home. And the loss of confidence in the Care Home sector has added to this by encouraging the elderly and their families to look at alternatives. This dovetails with the OT’s mission to help people get the most out of an independent life and the Royal College of Occupational Therapists has rightly launched an initiative to promote the significant role of the OT to a wider public. 

An out-of-date DFG

It does appear to me that every local authority has a different approach to managing the issue and the DFG process is a good example of this, as there is no cohesive, cross-country wisdom. Best practice is often only shared by the individual initiatives of the professionals themselves. 

Clearly, it is a really important step that OTs now see themselves advising more and more on providing key adaptations before there’s a fall or a stay in hospital.  But making these adaptations readily available is often hindered by the tortuous DFG application process which is often the only funding available for most people. Many feel that at 30 years old, the DFG is out-of-date and often a postcode lottery as to timescales which can take more than a year. A third of applicants drop out, probably because it’s so clunky and lacks the timeliness necessary for the elderly or the terminally ill. The current review may help this by raising the maximum limit, updating the methods of evaluation and means testing and giving more financial discretion to the local authority to provide solutions that work. 

Let’s not hold our breath though as only in January, the High Court announced that the Government’s National Disability Strategy, introduced with 100 pledges to improve the day-to-day life of those with a disability, was unlawful on the grounds that there was an insufficient and poorly directed consultation. The Government has a right to appeal but it does encourage us to consider whether the rights of the disabled are being sufficiently addressed in this caring society.

Bed-blocking Continues to Cost

Growing waiting lists and bed blocking are also back in the news. Current figures from the NHS highlight that more than 10% of hospital beds are occupied by people who have been declared fit for discharge but who are unable to go home because they need community equipment or a home adaptation. This equates to 12,500 NHS beds stock at a daily cost of more than £6 million.

With this huge waiting list, the support and advice from OTs is going to be more needed than ever, with pressure to supply a quick fix for a long-term solution.  Advising on equipment is equally important and as we know, there are many simple ways a home can be adapted to make life easier for the less mobile.  In the long-term, more complicated adaptations can be made if necessary but in the short-term the quick wins will make the greatest difference. 

“But when small adaptations and alterations such as grab rails and ramps, are insufficient, it all changes” says Phillip Mumford, Managing Director of inclusive design specialists, Cowan Architects. “You enter the realms of lengthy funding requirements, structural planning applications and unsettling disturbances in the house. And in rental properties, there’s the added difficulty of persuading landlords to alter their property with the adaptations”. 

Landlords May Not Always Welcome Adaptations

The OT’s job in specifying the appropriate remedial work gets even more complex when landlords do not want to accommodate changes to their property.

The current law (the Equality Act 2010) states that landlords, when renting to a disabled tenant, are responsible for providing necessary, reasonable adaptations to make the property accessible and suitable to their tenant’s individual needs. This can include additional services or equipment but it does not extend to the removal or change of physical features in the property or the need to adapt communal areas. 

“Instead of offering the minimum, wouldn’t it be great if landlords found it easy to offer a lot more?” asks Lewis Gopsill, who is Operations Director for the WashPod range of mobile, temporary disabled wetrooms. “Increasingly, there are a few useful disabled adaptations that don’t require extensive reworking of a property and if more new builds were designed for lifelong accessibility, there would be less change required in later life” says Lewis. 

Equipment and innovations that don’t require extensive adaptation are so much more appealing to landlords and housing associations who must think of keeping their properties attractive for future tenants. For example, the range of WashPod temporary disabled wetrooms, which are robust enough for hoists but ‘pop-up’ in a day, was the result of an unlikely collaboration between architects and modular specialists. More examples of this type of lateral thinking will lead to a new set of answers. 

Going back to Franklin’s words, we must find new collaborative ways of implementing a system that works in a timely manner, that put OTs at the heart of process, while giving them the range of equipment that adapts to their needs, budgets and timescales.   This year will see the results from the DFG consultation, a rewrite of the National Disability Strategy and hopefully some real solutions that help landlords meet their disability requirements. Let’s hope that some of these improvements continue to help OTs provide some speedy answers that give those in need a future of independent living at home.