Provision of environmental control systems in the north west of England

Environmental control systems (ECS) enhance the independence of housebound severely physically disabled people and offer them the prospect of a greater quality of life. A Department of Health scheme has provided ECS to severely disabled people. Provision and quality of provision in the North West were examined.

Audit of five years' prescriptions within the North West of England was carried out. Postal questionnaires were sent to 41 voluntary and self-help groups. Additional qualitative data were collected by contacting manufacturers and voluntary group advisors.

Eighty per cent of people referred for assessment received an ECS. However, there was geographical variation in referral rates and a bias toward younger people. There were unexplained variations among the assessors. The commonest diagnoses resulting in referral were multiple sclerosis, motor neurone disease and muscular dystrophy. Many other conditions, such as stroke and arthritis, for which an ECS might produce benefit were under-represented. There were some problems with the quality of the service, especially with the timescale of provision.

It is concluded that doctors and other professionals need a heightened awareness of the categories of person who can benefit from an ECS. Clarification of criteria and training are required if assessors are to be more consistent. Moreover, the mechanism of provision needs review. Public health physicians should re-evaluate their roles in provision, and should concentrate on commissioning an appropriate and good quality service rather than on co-ordination of the scheme.