Standards for Service Provision

In its position paper the AT Forum reported that the Assistive Technology (AT) sector has a large number of service standards but that there is no formal mechanism to evaluate or endorse them and none of the service standards have been nationally adopted. It is difficult for professionals to assess relevant standards and there is little information for users  about the standards of service they can expect.

On behalf of the AT Forum, FAST conducted a mapping exercise of AT service standards in 2005/6. The resultant report, Assistive Technology: Standards for Service Provision, reviews the current quality standards for AT services and makes recommendations about the future development of standards in this field. The report includes:

• An overview of government AT policy for health and social care, housing, education, employment and leisure services
• An index of all AT service standards reviewed
• An analysis which examines standards documents on a sector by sector basis
• A series of recommendations for the production of standards
• An action plan for the AT community

Overview of the report’s analysis:

The report’s analysis seeks to identify why many AT service standards documents lack coherence, presenting high level vision statements alongside operational requirements for local services, evidence from expert consensus and, with little clarity on the relationship, the document recommendations. The authors conclude that one reason for this might be that there are few definitive and comprehensive Government standards guidelines for AT services in general or for substantial sectors of AT services. This reflects the lack of a coherent strategy across Government departments for AT services for disabled and older people.

The analysis also highlighted a commonly recognised barrier for services that are seeking to improve their standards, or seeking appropriate levels of resources, namely that there has been negligible investment in establishing the evidence base for what works in AT services. Without evidence of the cost efficiency of AT, these service are vulnerable when funding cuts have to be made, reducing morale and undermining any improvements gained by working to agreed standards of service.

The analysis enabled report authors to note the variety of formats and development methodologies apparent in standards documents across AT sectors. There are some models of good practice in relation to development methodology. Some of these documents have followed established guidelines for the development of standards, such as the AGREE instrument, which results in a coherent presentation of the case made within the document.

The analysis also looks at potentially useful methods for establishing standards at a regional level, highlighting current examples of the successful adoption of a care pathway process within the AT field.

 

Action Plan for the AT Community
 

The report concludes with an action plan for the AT community, for Government departments, service commissioners and regulatory bodies. The main action for Government departments is to commit to the strategic planning of AT services on a cross-departmental basis. Without this commitment there is little chance that providers can fulfil their responsibility to work for service efficiencies, focus their service on the user and work effectively using a multi-agency approach. AT services need this strategic championship and without it they will fail to deliver Government policies to support independence and well-being and to empower self-care to anywhere near the extent that is possible.

Given the widening choice in service provision that will increasingly characterise this field, it is essential that users have the tools to assess good services from bad and to bring service providers to account. The current situation provides few national minimum standards, little direction on good practice and minimal levels of accountability. The regulatory bodies are asked to consider a closer focus on AT services in their inspection regimes. To complement quality assurance by professionals, commissioners, providers and regulatory bodies, voluntary sector organisations representing AT service users are asked to support initiatives to engage their members in auditing and monitoring the standards of the AT services they receive.

Service commissioners are challenged to tackle the urgent requirement for appropriate outcome measures but would receive high levels of support if they did so from service providers themselves, across statutory services, third sector and industry. Now is the time to address this perennial problem which lies at the heart of the failure to provide service standards guidance at every level for AT services. Related to this is the requirement to establish methods by which to weigh evidence and to systematically assess existing research. This would unlock the energy of providers and research funding bodies who have demonstrated commitment to investing in building the evidence base to demonstrate what works in AT service provision.

Despite the lack of tools such as appropriate outcome measures, soundly-based services standards can contribute to the remodelling, coordination and improvement of AT services at a time of increasing funding restrictions. Service providers are challenged to use the GATeSS process, or similar methodology, when developing future service standards, to ensure future documents have maximum credibility and impact. They are also asked to keep FAST, on behalf of the Forum, informed of future activity in this area, so that the community can be alerted to new developments and a greater coherence across sectors can be achieved.

The publication of this report provides an ideal opportunity for Government departments, regulatory bodies and the AT community to learn the lessons that have been drawn from this substantial mapping exercise.