Exactly what is meant by a ‘special’? Quite simply, it is any non-standard community equipment item. Every contract has its own catalogue of standard stock items; some specials may be just slightly different in terms of make, model or size, whilst others may be very bespoke items procured by prescribers to match individual requirements. From a recycling and reuse perspective, many specials are easy to reuse, and others are much more specific, making it more of a challenge for prescribers and providers alike.
In terms of activities, specials represent only a small part of everyday work for a contract. However, the value of these items can be disproportionate, with specialist seating solutions costing in the region of £6,000 and specialist beds up to £10,000. With budgets squeezed in every direction, successfully reusing these low volume, high value assets can make a significant financial contribution.
Specials are owned by the contracts who commission them. They are not Medequip assets, but it is Medequip’s responsibility to ensure best value for commissioners. In many cases, this means not buying in a new item but reusing an existing, reconditioned special, representing best practice.
The challenge for prescribers
For prescribers, there are a number of important considerations when making the decision to buy new versus opting for a recycled special. With a new item, the prescriber knows the item is complete with all accessories, and that it matches the identified requirements, out of the box.
A recycled special, meanwhile, may be held in a depot for a couple of years. Although it will be written up in detail in the catalogue, the prescriber may feel unsure if it will be complete on delivery, or if it may require more adjustments. A combination of competency and confidence is necessary for the prescriber to overcome the perceived variables; skills and experience on behalf of the prescriber, combined with confidence in the Medequip team that catalogued specials are always as described and fit for purpose.
Other variables also come into play, including client expectations of a new item versus the financial implications. In addition, if a new seating solution is purchased for £6000 but fails to meet client needs, this is a big cost to the contract. There is less cost liability involved when prescribing recycled specials.
The challenge for providers
Some CES providers may see specials as a burden, sitting in a corner and taking up much-needed space in a depot. For Medequip, a different perspective is solidly in place.
Fiona Wasdell-Bowyer, Head of Clinical Services and Safeguarding Lead for Medequip, explains more. “At Medequip, we believe in loving our specials,” she stated. “We understand that they come with their own complications. It is vital that they are catalogued correctly to enable prescribers to make an appropriate choice, and it is also critical that prescribers have confidence in their provider where specials are concerned. Love your specials, treat them well, build trust into your relationships with prescribers, ensure your staff have the necessary training and skills to support reuse of equipment and your specials are far more likely to go out of the door again, benefiting people in terms of quick supply of equipment and reducing the cost for the public purse.”
Key advantages of reusing specials
The advantages are multiple. Alongside the important issues of significant cost savings and reducing waste, reusing specials means that people who need equipment to help them lead more independent lives receive this equipment promptly. It is simpler for the prescribers too, with no requirement to source multiple quotes, and easier for the provider depots who can manage a throughput of specials to reduce stockholding and create space.
Managing the reuse of specials
Most contracts do not support individual prescriber authority to order a new special; the request must be passed through approved authorisers. How this is managed at contract level varies significantly and impacts on the rate of specials reuse achieved by each contract.
The highest rates are achieved by contracts where all new specials requests are put to a panel. This ensures best practice and consistency, and requires justification where recycled specials are not prescribed. Contracts with specials panels in place operating strict oversight processes and clear criteria are achieving reuse rates in excess of 70% compared with others where the figure can be as low as 20%.
“Obviously, other considerations also impact on the reuse rates achieved,” explained Fiona. “Contact buy-in and support for the Medequip occupational therapist role in each depot is important, playing a role in building trust and confidence. Also purchase of products that can be more easily reused – so modular or adjustable items instead of fixed or bespoke items - can make a big impact. Templating quality and repairs management is also vital to ensure prescribers know exactly what is on offer and how it can be adapted to meet their individual needs. Consistency and governance are critical to facilitate good reuse rates.”
So the overall success of a specials recycling programme is influenced by a range of different factors:-
- CES depots need to recognise the value of recycled specials
- Prescribers need the knowledge and confidence to use the specials system
- Overall, a ‘whole system’ approach is required for successful reuse; buy in is needed from both contract and provider
Medequip has a range of depot-level training programmes in place to support the reuse of specials, with Specials Champions focused on learning and skills development. With some specials presenting as very similar to existing stock and others completely unique items, Medequip people need real skills and knowledge to make a difference.
The digital product management team
In the drive to maximise available funds and achieve optimum reuse rates, commitment to the supply of comprehensive and accurate information for the assets is one of the most important considerations for providers.
Recognising the importance of good templating, with clear pictures and descriptions of condition to assist prescribers, Medequip has invested in a specialist team based at their Head Office in Middlesex. These digital catalogue managers are now taking ownership of Medequip’s huge library of written specifications on community equipment items, developing and expanding the information and cementing a partnership of clinical knowledge and procurement expertise and governance.
What recycling specials really means in financial terms
At Medequip, specials reuse is closely monitored and reported monthly at board level. To highlight how this work has progressed over the past couple of years, in 2024 total savings achieved by using recycled specials stood at just over £12m (for contacts with Medequip OTs) with total spend on new specials £15.5m.
For the year to date, total savings achieved (for contacts with Medequip OTs) by using recycled specials stands at just over £7.9m, with total spend on new specials just over £8m, approaching parity and demonstrating just how vital the work on improving the use of recycled specials is.
Into the future
Ever reducing budgets means we all need to use assets better, working in partnership. A new willingness to share between contracts is now emerging, particularly for expensive items and neighbouring contracts, tempered by the need to consider savings and values versus logistics and associated costs.
“Medequip is supporting this growing trend, pushing to overcome hurdles, encouraging discussions to achieve agreements in principle,” said Fiona. “We’re passionate about making it work; investment in our community equipment information database, our team of clinical specialists at depot level and our commitment to best practice will all play a role in getting us over the finish line.”