Transforming Community Equipment Services: The Kirklees Model

Meeting the Moment: A System Under Pressure

Across the UK, councils are facing severe financial constraints, prompting many to approach equipment services with a cost-first mindset. This often means focusing on what can be minimally delivered, limiting access and speed of provision without fully accounting for broader consequences - ranging from increased hospital admissions and delayed discharges to reduced quality of life for residents and missed opportunities to fulfil statutory duties under the Care Act 2014.

In Kirklees, we recognised the need for a bold and pragmatic rethink. We needed a service that could respond quickly, deliver excellent value for money, and support both users and prescribers across the health and social care system.

A Service Reimagined: What We Achieved

Over two years, we restructured our service model with measurable, high-impact results:

• Reversed a £500k budget overspend in 12 months
• Achieved delivery KPIs exceeding 99.7%
• Delivered £820k in evidenced cost avoidance for FY 2024/25
• Saved £660k through recall and reuse of special-order equipment
• Achieved service user and prescriber satisfaction levels over 99%
• Reduced equipment scrap rates by 38%
• Developed an urgent delivery service projected to save the NHS £5.6M annually, at a cost of just £36k to the service
• Fully integrated the service within the broader health and care ecosystem

These achievements reflect more than just efficiencies - they signify a culture change, where equipment services support independence, reduce dependency, and streamline care pathways across the system.

Understanding What Matters: People, Prescribers, the System

To ensure our reforms were aligned with real-world needs, we began with in-depth listening - through co-production events, Healthwatch engagement, feedback surveys, and strategic dialogue with acute care partners. What we heard was clear:

• People want timely access to modern, effective equipment that enables independence at home. They want to be involved in decisions, receive clear communication, and have equitable access regardless of postcode.
• Prescribers seek a fast, reliable service offering a wide range of equipment. They value responsive communication, opportunities to trial items, and clinical support in decision-making.
• The system requires a service that can act urgently to facilitate discharges, prevent admissions, and improve hospital flow. This demands clear eligibility criteria, up-to-date technology, an expansive and responsive equipment catalogue, and a transparent, clinically led governance model.

The National Picture: Why Change Is Needed

Despite increasing system integration, many local authorities still operate independently and rely on outdated in-house models. This leads to fragmented policies, inconsistent access, and significant variation in what is considered "standard" equipment. Acute care professionals - often working across multiple boroughs - face confusion and delays due to these differences, with decisions frequently driven by short-term cost savings rather than long-term outcomes.

There’s also a troubling lack of communication between stakeholders, professional accountability, and oversight - resulting in waste and inefficiency.

Our Four-Pronged Approach to Transformation

1. Provider Performance and Contract Management

We co-designed a new service specification with users, partners, and our provider. We embedded a robust contract management framework and clear KPI structure to drive quality, foster innovation, and encourage accountability - while building strong operational relationships with depot-based staff.

2. Prescriber Behaviour and Order Appropriateness

We upgraded our ordering platform, introducing new product and speed-specific forms, along with a ‘Professional Statement’ to reaffirm clinical responsibility. Authorisation now sits solely with the KICES clinical team, who ensure consistency, clinical rationale, and financial stewardship. All orders are reviewed by KICES irrespective of the value. Tailored training and active collaboration across hospital and community teams have created a transparent, person-centred process.

3. Sustainability and Cost Efficiency

To minimise waste, we introduced stricter scrappage rules, repair-versus-replace thresholds, and a formal sign-off process for any discarded equipment. We also initiated active recall programs and audits, particularly in care homes, supported by a new trade price catalogue to enable self-purchasing where appropriate.

4. Collaboration and Person-Centred Practice

True partnership is the cornerstone of our model. We commissioned Healthwatch to conduct monthly independent reviews - including ‘ride-along’ days with delivery drivers - ensuring the service remains shaped by lived experience. Strong relationships with stakeholders across the health and care system have reinforced open communication and joint ownership of outcomes. Joint problem-solving is now routine. All partners are committed to shared outcomes - not institutional silos.

The Outsourced Advantage

Our success owes much to our outsourced model, strategically anchored by our internal KICES team. This partnership allows us to:

• Eliminate stock liability while benefiting from a credit-based cost model
• Reduce prices via the provider’s national buying power
• Avoid delays through access to a UK-wide overnight transfer network
• Leverage national-level clinical, procurement, health, and safety expertise - especially valuable in scenarios like MHRA alerts

It’s a dynamic, risk-sharing model that supports innovation, responsiveness, and financial efficiency.

Looking Ahead: A Call for National Reform

I’m incredibly proud of what we’ve achieved at KICES. Our team is committed to acting in the best interest of residents - whether that means delivering simple aids to enhance independence or rapidly responding to end-of-life needs. We act first, resolve the politics later. Policies guide us, but people drive us.

Our catalogue is ever-expanding, and essentially infinite; based on assessed need rather than cost restrictions. We deliver better outcomes at lower overall cost, disproving the notion that good care must come with a heavy price tag.

But we know this transformation can’t stop here.

We urgently need a unified, regional and national approach to equipment service procurement and delivery—one that assures quality, consistency, and value. We must co-produce solutions with all stakeholders, rethink funding models, and move beyond bureaucratic barriers to prioritise what really matters: the wellbeing of those we serve.

The Kirklees model proves that reform is not only possible - it’s essential.