• prescriptions for low risk items, worth less than £100, called Simple Aids for Daily Living (SADLs) which can be redeemed at retail outlets, called ‘retail prescriptions'
• prescriptions for special items, which will be subject to local arrangements for commissioning as and when needed for approved suppliers – called ‘special item prescriptions' and lastly
• prescriptions for complex and high cost items (also known as Complex Aids for Daily Living CADLs) and suites of products, on loan, delivered to the service user's home – called ‘home delivery loan equipment prescriptions'

Says BHTA DG Ray Hodgkinson : “BHTA supports the objective to transform the delivery of community equipment, but the devil is in the detail and clearly there is a need to find a workable solution. Currently the retail model does not look attractive to retailers who will struggle to recover the overhead costs they incur.

“Our evidence suggests the retail model will cost more because equipment will not be retrieved and refurbished and the DH team has yet to convince the industry that this is not the case. The National Association Equipment Providers (NAEP), whose members are professionals and non professionals working in the community equipment services sector, has also indicated that a significant majority of its membership is not persuaded that the TCES model is financially robust, clinically safe and locally deliverable.”

BHTA says in its position paper that until a clear plan is defined, discussed and cost projections are made for the Home Delivery Loan Service (representing 80% by value and 20% by volume of the equipment handled by a community equipment service), it will not be possible to achieve projections of the savings that could be made.

Although BHTA is keen to support the initiative there are discrepancies in figures quoted by DH. For example, according to BHTA, the projected market for community equipment products is £71 million whereas DH quoted the figure as £240 million.

BHTA lists its main concerns and recommendations as follows:

1. the programme needs long term oversight by a senior civil servant
2. there has been inadequate testing and information
3. there are significant concerns about the true cost of the programme
4. there is a need for a publicity campaign to raise awareness
5. there are dangers of a post code lottery across
6. work needs to be done to persuade those in the state sector that they can trust retailers to provide a good service
7. key aim of the programme is to increase customer choice, but this has not been demonstrated in the shadow running pilots
8. wheelchair services should not be separated out from the programme.

Says Ray Hodgkinson : “There should be more public sector investment in community equipment services. Primary care is cheaper than secondary care and community equipment can be vital in getting people home again. Indeed, Lord Darzi has stated that the focus must shift from secondary to primary care.