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Environmental control systems – an audit of existing provision in three inner London districts

Locum Consultant in Rehabilitation Medicine, King's Healthcare NHS Trust, London, UK

Objective: To undertake an audit of existing environmental control system (ECS) provision to see what lessons could be applied to developing a new model of service.

Design: Structured interviews and assessments making use of questionnaires and algorithms.

Subjects: Users of environmental control systems in the inner London boroughs of Lambeth, Southwark and Lewisham (population 720 000) supplied with equipment prior to April 1996 out of National Health Service funds.

Setting: All users were assessed and interviewed in their own homes.

Results: In all, 29 users of ECSs were surveyed. Six users were found to have systems either so outdated or poorly planned as to be nearly useless. Seven users were felt not to justify an ECS and many systems were felt to be over specified, leading to wastage of equipment. Many medical and nonmedical needs, not directly related to the users' ECSs, were identified.

Conclusions: While the recommendations of the British Society of Rehabilitation Medicine special interest group on ECS are welcomed, it is thought that these do not go far enough. In particular the role of the environmental control assessor needs to extend to participation in the case conference where the exact equipment requirements of the prescribed ECS is agreed, and thereafter to include responsibility for ensuring regular review of users. In such a model of service the current single payment for a one-off assessment is felt to be inappropriate.

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