Equipment Store Delivery vs Retailer Model: Reflection by Judith Hardman

Background:

When I first qualified as an Occupational Therapist in 1997, I worked in Stockport who used the Equipment Store delivery service to provide assistive equipment to patients. After much objection from the Occupational Therapists the local authority decided to adopt a retailer model.

I continued to work with this model until 2019 when I began working in Manchester, who continue to use the Equipment Store delivery method to provide assistive equipment. This is a personal reflection on the pros and cons of using both systems.

Why did we originally object to the retailer model?

As far as the Occupational Therapists were concerned the equipment store worked well. We knew and trusted the staff and had built a relationship based on mutual respect and they were considered part of the team. During opening hours I often visited the store to pick up equipment to try out with patients and if it didn’t work, simply return it. All the equipment was delivered and collected, cleaned and recycled and so appeared to be far more cost effective than the retailer model.

The retailer model relied on retail shops to supply the equipment, by the Occupational Therapist who provided a ‘prescription’ to the patient or family member, who then took it home themselves with no returns. How could this possibly be better??

The equipment store vanished and most of the staff were made redundant. Only wheelchairs and complex paediatric equipment remained and the only recycled equipment was beds and hoists which were passed onto a centrally located private company.

This was a traumatic time for many staff who could not realise the benefits or necessity for this transition. I have since completed change management training and now recognise the mistakes that were made and how the process could have been easier. It took a couple of year to embed the new process into practice, during which time the equipment store was mourned and staff were very unhappy.

However, with the passage of time this became the new normal. The retailer model became standard practice and part of everyday working routine and the Equipment Store became a distant memory.   

When I started working in Manchester, I was surprised and a little shocked to find that they continued to house all the assistive equipment in a central store and delivered and collected and recycled it. This felt like I had stepped back in time and this gave me the opportunity to consider the pros and cons of each system.

Retailer Model Pros and Cons:

Positives to the patients

• Equipment can be collected at their leisure and convenience

• Increased choice - they may choose an alternative, upgraded model instead of the basic (at a cost to them)

• Patient chooses whether to collect the equipment or not

• Can be discharged with essential equipment on the same day instead of waiting for a delivery

• Can discuss their needs with a trained member of retail staff,  who will advise on other products available to purchase (all retailers are accredited by Social Services)

• All the equipment was new and unused – no infection control concerns

• Patients receive more rehabilitation options rather than just given equipment. 

Positives to the therapists

• Built up trusting relationships with retailers – we could ring, tell them what I wanted the equipment to do and they would take out a selection to try e.g. chair raisers 

• Flexible access to equipment as shops are open later and at weekends

  • This was more evident with the emergence of the 7 days service

• More autonomy – I dealt directly with the retailers to arrange an emergency supply of essential equipment. This proved invaluable when working on A & E to avoid unnecessary admissions

• Time efficient – in most cases I didn’t have to revisit the patient to make sure the equipment was suitable as the retailers were trained and would contact if they had any concerns

  • This level of trust took time to develop and if any doubt, I used band 4 support workers to double check

• Confident that the equipment had no internal damage or infection risk

• More opportunity to develop different rehab skills – providing equipment became an absolute last resort.

Positives to wider society

• Is it cheaper? My initial thoughts were probably not, however, the cost of the store i.e., rent/rates and maintenance, the staff (and all that entails), the purchase of equipment, cleaning products and facilities, collection, vehicles, and the potential litigation for unseen damage when reused. We were told it was cheaper and so a better use of tax-payers money. In retrospect, this is probably correct.

• Increased footfall on the high street – not just the direct retailer involved.

• Competition rather than monopoly should keep prices down.

• Other businesses may benefit such as charity shops / metal merchants. However, whether they should is subject to moral debate.

• Reduced hospital admissions and duration of admissions - the population benefits if hospitals are more efficient. 

Negatives to patients

• May have no-one to collect the equipment (not everyone has a family member who drives).

• Even if they can collect the equipment, it may need to be taken upstairs or placed in a difficult to reach area.

  • Originally the retailer would deliver and fit for a small charge, but as this is business model and competition high, they agreed to deliver and fit free of charge).

• No options to return equipment, as once collected it belongs to them.

  • A frequent complaint; particularly if their disability was short lived such as a fracture or elective surgery. Many patients feel this is not cost effective, particularly those who remembered the equipment store, and an expense to the planet as inappropriate use of resources. I have seen many pieces of equipment being sold at charity shops or on metal recycling plants.

• For equipment that needs to be fitted e.g. bed lever, they still had to wait in for the delivery. 

  • This can still delay discharge from hospital in some cases.

Negatives to therapists

• Having to trust family members to collect the equipment is a timely manner

• Frequently having to justify the expenditure to patients / families

• Receiving complaints about non collection of unwanted equipment

• Learning new processes of administration (not more, just different)

• Potential dilution of role

• When equipment is absolutely required in the short term to achieve a goal – creates a dilemma, knowing that it will no longer be required but will then be discarded.   

Negatives to the wider society

• Increased waste of resources.

Personal Reflection.

Now I am back working in the Equipment Store Model, I have found myself longing for the Retailer Model. I feel less able to provide a flexible service and must depend on equipment being in stock and someone else to determine when it will be delivered. In the case of crisis response, the patient must be referred on to another service to assess it, due to the wait, which is inefficient with poor continuity of care for the patient.

I have also found that far more equipment is issued to solve a problem, as opposed to finding alternative techniques and providing actual rehabilitation. Many patients that I visit have already been ‘kitted out.’ The MDT appear to view the role of the Occupational Therapist as being related to equipment and miss the underlying focus of purposeful activity; which is not surprising as that is what is seen, and I feel that the Trusted Assessor’ role often leads to this.   

However, it is not all bad; having unlimited access to equipment that can be returned enables me to try things out at an earlier stage, in addition to therapy, which I wouldn’t normally do within a retailer model. It also provides more flexibility with short term disabilities and can be used as a stepping-stone to recovery, which is the main drawback of the Retailer Model.  The greatest danger though, I feel, particularly with short term services, is of staff issuing equipment ‘just in case’ which has a potentially longer-term disabling effect.

I am aware that the services I currently work for are short-term and aim to stabilise a situation, and the Retailer Model works well in this environment. However, there is also an argument for having some form of equipment store availability alongside this to facilitate longer term rehabilitation where equipment can be recycled and limit the waste on resources.  

Perhaps it is time to consider developing a whole new model, which considers the benefits of both but reduces the negatives and the costs of recycling.

Judith Hardman.