Adaptations Without Delay – improving access to housing adaptations

j3Jill Pritchard, Specialist Housing Occupational Therapist & Business Change Consultant

Twitter @jillpritchard5

It is a well-established fact that having a suitable home is crucial to our health and well-being and contributes hugely to our ability to live as we want, participate in community life and fulfil our personal outcomes. However we also know that many people live in unsuitable housing with the ‘Still Minding the Step’ Report[1] identifying that 17,200 wheelchair user households had unmet housing needs in 2015 and Equality & Human Rights Report[2] highlighting that around 61,000 people required adaptations in the same year.

AHPs will be aware of the positive impact that adaptations can have for people living at home, in terms of safety, independence, supporting rehab & preventing falls, to name but a few of the many benefits

Adaptations can include the installation of grab rails, stair lifts, ramps and technology to improve the health and wellbeing of people living at home. Many people can benefit but particularly older people, and adults or children with physical, cognitive, sensory or learning disabilities.

Traditionally, the vast majority of adaptations have had to be assessed for and recommended by an Occupational Therapist but there are many situations (and existing examples) where the situation is straightforward and does not need the involvement of a qualified Occupational Therapist.

Screenshot 2019-11-03 at 10.18.45The revised “Adaptations without delay” guide was commissioned by the Royal College of Occupational Therapists and the work carried out by the Housing Learning & Improvement Network in consultation with colleagues from across all 4 Countries.

It provides practitioners and organisations across Health, Social care, Housing & the Third Sector with tools & practical examples of ways in which adaptation services can be organised on a more proportionate basis to provide an improved and more timely response.

The guide will help AHP Leads to work with relevant colleagues to simplify access to straightforward adaptations

It will also enable housing providers to consider how to provide a wider range of adaptations to their tenants without the direct involvement of an occupational therapist – reducing delays in the delivery of adaptations and helping to support an early intervention and preventative approach.

The guide moves away from categorizing adaptations in terms of ‘minor’ and ‘major’, or ‘cost’ and focuses instead on the complexity of the person’s situation. Crucially it provides guidance on when an Occupational Therapist is and is not required.

Within our Health Housing and Social Care integration agenda we need to use our staffing resources to the maximum benefit for the people who need our services. Intervention should be proportionate to need as per the tiered model below

j2Non Occupational Therapy staff can be involved at the Universal & Targeted levels and can be empowered and supported to undertake straightforward adaptations as an integral part of their interventions, avoiding the need for unnecessary ‘handovers’ and potential protracted waiting times. The iHub’s Housing Solutions Training can help support this approach.[3] ( Look out for our next blog on this topic!). Occupational Therapists can then focus on the many and increasing numbers of more complex cases which require their specialist skills

Integration provides us with the perfect opportunity to improve and ‘join up’ a whole range of services for the people who need them and there are many examples across Scotland of where this is already happening.

I would urge colleagues to get together locally with all relevant stakeholders and use the Guide as a catalyst to develop improved pathways for adaptation service delivery across all housing tenures and make best use of the skill mix within your local staffing resources. Talk to your AHP Lead locally and find out who leads on Adaptations & Housing solutions for your HSCP, lets see what we can achieve together.

The full report can be found and downloaded here.

Any queries contact Jill Pritchard, RCOTSS-H (Housing Specialist Section) Scotland Rep:

Jill Pritchard is an Occupational Therapist specialising in Housing issues & also a Business Change Consultant. She previously worked with the Joint Improvement Team of the Scottish Government & has continued supporting Health, Housing & Social Care partnerships via the iHub within Healthcare Improvement Scotland. She supports improvements in the delivery of adaptations & housing interventions at operational & strategic levels within the Integration arrangements & promotes best use of Occupational Therapy & wider partnership staffing resources to produce better housing/adaptation outcomes for people. She was on the steering group for the revised ‘Adaptations without Delay’ guidance and is passionate about mainstreaming inclusive design and inclusive living.


[1] Still Minding the Step

[2] Housing & Disabled People, Scotlands Hidden Crisis

[3] Housing Solutions Change Programme.


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