Organisation and Management of Services for the Provision of AIDS to Daily Living

Social work

Dutton, Marjorie E

University:University of Glasgow

关键词: Social work;   

Others  :  http://theses.gla.ac.uk/78199/1/11007591.pdf

来源: University of Glasgow

【 摘 要 】

1 . This study was undertaken with funding from the Nuffield Provincial Hospitals Trust to examine services for the provision of aids and adaptations with a view to improving their efficiency and effectiveness. 2. The data on which the study is based came from specially mounted surveys in contrasting areas of Glasgow. Samples of consecutive referrals for aids and adaptations provide the main data base; these surveys are supplemented by retrospective surveys of equipment use, an assessment of unmet need and a study of professional work practices. 3. Provision of aids and adaptations is split between community nursing services (operated by Health Board) and community occupational therapy services (operated by Local Authority Social Work Departments). This division is confusing to patients/clients and gives rise to duplication and overlap in service provision. 4. In both services patients/clients experience considerable delay in obtaining aids and adaptations. Delays in the occupational therapy service occur at two stages:- between referral and assessment and between assessment and delivery: 1 in 2 clients waiting for more than a month for assessment and just under 1 in 3 experienced a further delay of more than a month before receiving their aids and adaptations. Delays are shorter and less frequent in the nursing service, yet around 1 in 3 patients waited for more than a week and 1 in 9 more than a month for equipment from the nursing stores. 5. For both services delays were attributable to inefficiencies in the storage and delivery systems. Stores were too small, inadequately staffed and badly organised. Drivers often had other competing duties and were not replaced over holidays and at times of sickness. 6. In the occupational therapy service the limited time OTs spent on assessment contributed to further delay for the client. In the present study OTs spent 30% of their time with clients compared with 48% on clerical duties. OTs felt that approximately one third of their duties could be delegated to assistants and/or clerical workers. 7. Both services are predominately reactive and no concerted effort is made to identify unmet need. The study does not provide first hand evidence of the extent oof unmet need, but data available from a local survey showed that almost 1 in 2 of those found to be disabled were without an appropriate aid/adaptation. Of those with such an unmet need, only 14% were already on the waiting list of the local occupational therapy service. 8. In both services a substantial proportion of equipment, around 15%, remains in patients' homes unused and unavailable for reissue. The potential for recycling is further limited by inadequate facilities for cleaning and repair of returned equipment. 9. Improvements in both services can be achieved by Introducing Improved forms, changes in staff deployment and upgrading of storage facilities. Specific recommendations are made in relation to these and other proposed changes. 10 Further improvements require a more fundamental restructuring and a move from the present dual service arrangement to an integrated system. Strong arguments are made for a single assessment form and for a single storage and distribution system.