How community equipment services can support people to live more independently – and should be valued as core infrastructure 

Mark Rance explores how the Kirklees Integrated Community Equipment Services model is reducing costs and tackling inequity, while delivering better outcomes for people who draw on care and support, their families and carers. 

Building on what we now know 

In ‘Innovating to support independence: The Kirklees approach to Community Equipment Services,’ I set out the rationale for redesigning community equipment services (CES) in Kirklees and described how a clinically led, person-centred approach improved performance, outcomes and system value. Equipment systems are not peripheral, they are core clinical and statutory services shaping independence, hospital flow and system sustainability. 

Why CES design matters for people, carers and families: 

CES is often described in operational terms, but its impact is deeply personal and shapes lived experience, not just system performance.  

When services are designed well: 

• People can leave hospital sooner 

• Individuals can remain safely at home 

• Carers can provide support safely and sustainably 

• Families maintain stability and dignity, rather than responding to crisis 

Conversely, when services are constrained: 

• Delays lead to extended hospital stays or unnecessary admission 

• Equipment is inappropriate or unused, reducing effectiveness 

• Carers experience greater physical and emotional strain 

• Access becomes inconsistent, creating postcode inequity 

Reframing the question 

Despite this, a familiar question persists: ‘How do we reduce CES spend?’ but actually the question should be, ‘How do we reduce total system cost and risk while improving outcomes for people, carers, and families?’ When framed correctly, community equipment services are not a cost to control, they are a clinical intervention that prevents demand, enables independence and reduces pressure across the wider system. 

What this means for professionals and the wider system 

Community equipment sits at the point where clinical decision-making has real-world impact. Professionals assess risk, function and independence, but outcomes depend on the system’s ability to enact those decisions. The Kirklees model highlights the importance of alignment between occupational therapy and embedded contract and operational leadership, working together within the service. This ensures: 

• Clinical reasoning is translated into timely provision 

• Prescribing is supported, consistent, and evidence-based 

• Operational realities stock, delivery and demand are visible in real time 

• System risks are managed collectively rather than left with individual clinicians 

This alignment enables prescribers to practise at the full extent of their role, focusing on prevention and independence rather than adapting decisions to constrained systems. 

Four design pillars where alignment has the greatest impact: 

Aligning Decision‑Making 

• Supported professional judgement with clear expectations 

• A unified prescribing framework 

• Consistent clinical governance 

Governance 

• Joint oversight between health and social care 

• Governance moved to the point of decision, not after the fact 

• Shared KPI’s linked to outcomes, not service outputs 

• One route to assurance 

Workforce Capability 

• Consistent training 

• Shared understanding of risk 

• Confidence in decision-making 

• Support for professional reasoning 

Resource Use 

• Asset lifecycle management 

• Reuse and recall 

• Shared System intelligence 

• Contracts aligned to outcomes 

Alignment across these pillars reduces inequity and total system cost. 

What good looks like in practice 

Effective CES delivery includes: 

• Urgent delivery pathways to support discharge and crisis response 

• Clinically governed catalogues, avoiding budget led restrictions 

• Embedded OT leadership within service operations, not separate advisory roles 

• High-performance delivery standards, sustaining reliability and responsiveness 

• Integrated recycling and reuse models, maximising stock availability 

Aligned decision-making across local authority and NHS partners, measuring system outcomes as a whole 

These are practical, proven approaches, already delivering in practice. 

Practical recommendations for local authorities 

1. Recognise CES as system infrastructure: CES must be seen as more than a transactional service. Its function is to enable decisions to be enacted, supporting discharge, preventing escalation and stabilising demand. 

2. Support decision-making at source: Focus effort where decisions are actually made. Ensure practitioners have clinical support, clarity of provision and confidence in how the system will respond, reducing the need for retrospective challenge or correction.  

3. Align governance with practice: Position governance alongside decision-making, not after it. This shifts assurance from retrospective control to real-time support, improving consistency without introducing delay or constraint.  

4. Bring delivery, resources, and accountability into coherence: Ensure that logistics, asset management, and operational delivery are aligned with clinical decision-making and statutory responsibility. Fragmented components will continue to produce inconsistent outcomes, regardless of individual performance.  

5. Measure and manage system behaviour, not just service activity: Shift performance focus from unit cost and throughput to system outcomes; flow, demand, and resource utilisation. Understand how provision influences discharge, independence, and long-term care demand.  

The challenge is no longer understanding what works. The issues we face are systemic, not local, and incremental change alone will not resolve them. We do not need to reinvent CES, we need to align what already exists. It’s a theme I explore further in my forthcoming publication on Community Equipment as system infrastructure. The task now is to apply that understanding with confidence, designing services accordingly and scaling what we know delivers. 

Mark Rance, Contract Manager, Kirklees Integrated Community Equipment Service (KICES)