Environmental Control Services

Specialised NHS Services for EC and AAC

Environmental Control (EC) Services support the independence of individuals with significant physical disabilities using technology to enable them to interact with and operate objects and appliances in their home, including their computer. This guide describes how the commissioning of these services is organised with the aim of improving access to these services for all. It is aimed at anyone who will come into contact with EC e.g. users, families, Social Workers, GPs, Occupational Therapists, Commissioners, Local Authorities, CCGs and Third Sector organisations.

It explains the assessment and provision of EC. A ‘decision tree’ to support referral to specialised EC service can be found here.

What is Environmental Control (EC)?

Environmental Controls offer greater independence to people of all ages with complex disabilities. EC is electronic equipment which enables remote control of home appliances, including personal computers, via a controller which can be accessed by those who are not able to use standard controls, generally due to limited upper limb function. This is usually considered in the main place of residence but may also be used elsewhere.

Examples of activities that environmental controls devices allow users to undertake on their own include:

  • Security: pagers or call alarms, remote access to door openers, door release mechanisms.
  • Communication: intercom systems, hands-free telephones, mobile phones, text messaging. A number of controllers are also able to output speech, either through access to a number of phrases or an accessible keyboard, for those with communication difficulties. Significant communication needs would be dealt with in conjunction with AAC provision/service, following AAC Service Specification https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/guid-comms-aac.pdf
  • Comfort: mains operations of devices such as fans and lamps. Also in some situations infrared light switches, control of the position of a powered chair or bed, curtain and blind control.
  • Computer access: enabling access to a person’s own computer for functions such as internet access (banking, managing care, emails, e-book readers, social media, participation and internet browsing), word processing, spreadsheets and similar.
  • Leisure: Devices such as a television, sound systems, DVD and media players.

Assessments are person centred and so appropriate functions from the above will be assessed for e.g. for children the range of functions or things they want/need to do in terms of computer access, could be different to those of an adult.

Environmental controls can be accessed in a variety of ways. One of the most common ways in which people with physical disabilities are able to access environmental control systems is through switch-based controls. These allow users to scan through a menu of options and select the desired function at the press of a switch. These are switches designed for this application and can be activated by hand, foot, finger, head, chin, mouth, knee, or almost any other body part with which the user can exert sufficient control. Other access methods include touchscreen, eye-gaze, headmouse, alternative keyboards etc.

Enabling people to control these functions improves their quality of life. It offers people new opportunities in their family life, education, social life, friendships and employment. It helps increase independence and promotes equality for people with physical disabilities.

In addition to providing a degree of independence for the user, these systems can also provide support for their family or carers as they are no longer solely responsible for ensuring the comfort of the patient. These systems can be used for attention calling e.g. calling a carer within the house or enabling someone to be able to call a carer if they are out for short periods of time. These systems, however, should not be relied on for emergency calling. We would define emergency calling as calling to mitigate a situation which would cause significant risk to the person’s health or wellbeing e.g. a problem with their ventilator.

Who uses EC?

EC Services are not accessed by a single patient group, but by a wide community of adults and children. Those using EC Services may include people with a congenital disability (such as Cerebral Palsy or Muscular Dystrophy), a progressive condition (such as Motor Neurone Disease or Multiple Sclerosis) or a sudden acquired disability (such as Spinal Cord Injury). Family members, carers and staff may also need to understand EC equipment and services but training will be provided for this. The proportion of the population who are currently users of EC equipment varies considerably between areas and is primarily for conventional home based control functions It is estimated that 0.02% (2 in 10,000) or more of the population may be eligible for EC provision under the NHS England criteria, including that for access to computer technologies.

Commissioning EC Services

In April 2013, NHS England became responsible for commissioning EC Services. This has seen the development of a national service specification for EC, developments in the way specialised services are commissioned and funded and the identification of a number of specialised centres. Services for children and adults who need and use EC are now commissioned as “specialised” services. There are a number of regional “hubs” able to provide specialised services and support to a number of associated centres. Specialised EC Services are now funded directly by NHS England. They provide assessment, review and equipment for those with complex EC needs (including computer access). An individual’s local Occupational Therapist (or other appropriate health or social care professional) will identify the need for EC, ensure that they meet the criteria and refer in to the specialised service. The specialised service works in conjunction with local teams, providing the specialist knowledge and provision of loan equipment where the individual meets the provision criteria. EC equipment is provided on long term loan and maintained by the EC Service, or a contractor working for the EC Service. During and following provision the local team continue to support the individual. The steps that have been taken – with specialised centres across the country working to the same service specification and the development of connections to local services – are helping ensure more equitable access for all patients and reducing variability in the service provided. You can find a list of the specialised services by each NHS specialised commissioning region here.

The Role of Local Community Teams

Local team should: Assess whether an individual can manage mainstream alternatives and either provide these or advise on where they can be purchased from e.g. a big-buttoned remote control/phone, basic accessibility changes on a computer e.g. Sticky Keys. Have a specialised person/s with the knowledge and access to the equipment to be able to assess whether a individual can manage mainstream alternatives (as above. This role may be established with the support of the specialist EC (Hub) service. Refer for local Telecare provision where appropriate, including Community Alarm, which may be subsequently interfaced to EC provision Be aware of EC and how to refer to the specialised service, including the inclusion and exclusion criteria (see section 7 and 8). Collaborate with the Specialist EC service in support of the on-going use of EC provision by the individual user, including extended tuition, especially when an extended trial is required to establish adoption of equipment use Provide on-going support for individuals following provision, with responsibility for re-referral if and when appropriate. If the episode of care with the local team ends they ensure that the individual is aware of who to contact if things change and re-assessment is required. Understand the routes for funding of equipment which is not covered by EC, e.g. door openers/lock releases, window and curtain openers, and where appropriate apply for and coordinate funding and installation of this equipment. Take responsibility for advising on suitability for funding for any necessary minor adaptations ( eg: electrician , locksmith, carpenter) required for EC provision

The remit of specialised EC Services

Specialised EC Services have been commissioned by NHS England in the 5 regions across England. You can find further details and contact information for these services here. The financial resources are allocated by NHS England to these services in accordance with the service specification each financial year. NHS England’s Specialised EC Services aim to provide equipment to adults and children with complex disabilities to improve their independence, quality of life, safety and social participation. They do this by providing a multi-disciplinary assessment of the individual’s needs and collaborating with other health, social care and educational professionals where necessary. Key aspects of the service provided to every service user include:

  • To provide equitable access to specialist EC services
  • To provide a multi-disciplinary assessment of the individual’s needs and collaborate with other health, social care and educational professionals where necessary
  • A short term loan where applicable to confirm suitability
  • A long term loan of equipment that supports the individual’s goals for greater independence
  • Specialist advice, information and training for service users, their carers and professionals involved to maximise the benefits of the equipment. This can include training local professionals to ensure they have appropriate knowledge for local assessment and when to refer
  • Timely reviews and reassessments to address the changing needs of the service user
  • Lifelong maintenance and support with using the equipment

The criteria for referral to a specialised EC service

EC provision will be for people who meet the following criteria:

  • Complex physical disability, such that they are unable to operate standard controls for functioning independently at home.
  • Where simpler, mainstream solutions are not suitable or appropriate.
  • Cognitively and physically able to operate EC equipment consistently.
  • Able to demonstrate sustained motivation to use EC equipment.
  • Individuals requiring multiple control functions integrated into a single means of access as multiple devices are inappropriate, (including also potential for integrating functions for communication, computer access and/or powered wheelchair control).

Exclusion Criteria (for equipment provision by the service):

  • Where simpler mainstream solutions to the identified needs of the patient are available and appropriate for the individual.
  • The individual patient does not have the cognitive ability or motivation to operate the EC equipment. This is normally established through a period of trial of some sample solution of equipment.
  • Provision of equipment is inappropriate due to social, environmental or other circumstances.
  • People can be assessed for computer access with a view to helping them use their own existing computer (as they would their own existing television). If appropriate, access equipment will be loaned. However, the service will not provide the computer itself.
  • Certain EC equipment is based on a computer and has integral computer access functions. This equipment can be provided on a loan basis if the clinical criteria are met i.e. they meet the specification for provision of EC and their requirements are such that a computer based EC system with integral computer control is the most appropriate system.
  • In some circumstances, specialist services may find on assessment that the client does not meet the criteria and therefore make suggestions for local provision. The specialised service may, in some circumstances find that a face to face assessment is the only way to establish if the client meets the criteria

Certain items are outside the funding remit of the specialist service and require further referral for funding and provision by other agencies. If these items cannot be provided , then this may or may not preclude the benefit of provision of the EC equipment, these include:

  • Door, window and curtain openers
  • Replacement door locking mechanisms
  • Page turners
  • Building adaptations
  • Electrical, joiner/carpentry or other minor adaptation
  • Telecare equipment
  • Process of referral

Referral to the specialised service is usually via an individual’s local health professional. The local professional should be aware of the criteria for referral and evidence this appropriately. Individuals may also self-refer. The specialised service would then seek their local OT or relevant health professional and, if they do not have one, look to referring to the local OT team. This is to ensure the individual is supported locally during and after the input from the specialised team wherever possible. If an individual has an EC system in place and their needs change they can self refer or this may be identified by those maintaining the equipment (either the EC service or the contractor). They may not have a local OT in place if they have been discharged. In this situation, a referral to OT will be made by the specialised team if required. If an individual EC service user moves place of residence, between areas, then the services will endeavour to relocate their equipment if suitable and continue the support for it in the new area. In some instances, reassessment and provision of equipment for the new place of residence is more suitable

Useful links

For more details of specialised EC services, see the full NHS England service specification: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d01/ The table below lists further useful links:

NHS England information about commissioning complex disability equipment services NHS England
National Occupational Standards (NOS) for Assistive Technologies: Enter the NOS prefix CHS140 into the search box Skills for Health
Local Services Resource Pack Local Services Resource Pack