Equipment Application Form

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Newlife can either fund the fixed-term loan of equipment or purchase and grant equipment for a child’s long-term use. The vast majority of the services we provide are free. If we grant equipment, you may need to contribute 20% of the equipment value up to a ceiling value of £2,000 depending on whether you receive certain benefits.

The majority of complete applications result in the provision of equipment, and if we offer the loan of equipment we will – where there is a clear health and/or social care responsibility - use this time to secure a statutory assessment of long-term needs and support access to services/funding that meets these needs. We will also help explore options for charitable support that meets long-term needs, when there isn’t a statutory responsibility to provide equipment – ensuring your needs are at the heart of our actions at all times.

Who can access Newlife’s Equipment Services?

If your child meets all of the following criteria for support, and needs an item of equipment listed below to address risks to their safety, health and wellbeing e.g independence and quality of life, Newlife can consider an application for equipment:

  • Under the age of 19 years;
  • Resides in the United Kingdom
  • Has a significant disability, life-threatening/limiting condition or terminal illness

We do not grant equipment to ‘looked-after’ children (LAC) because of a specific legal entitlement to equipment from the local authority. However, we can fund the fixed term loan of equipment that is owned by Newlife. This option is normally only available to children who have a permanent residency in the UK – but we can make individual decisions in the best interests of a child.

What Equipment can be funded?

We can fund an Equipment Grant for most types of essential community equipment which we assess as appropriate to meet the specialist needs of the child using it. It does not have to be specialist, but it does need to be designed to meet the child’s needs.

Most of this equipment can also be funded by the NHS and/or Local Authority so we will ask why they are not funding this equipment in the application form. Please find below a list of different types of equipment that we can consider providing:

  • Wheelchairs: Newlife can fund any type of wheelchair for use in any environment, irrespective of whether it is powered or manual and for one type of terrain or all terrains. We can fund lightweight specifications of manual wheelchair (often referred to as sports wheelchairs because of its active use) but we currently don’t fund wheelchair specifications adapted for sport participation. If the wheelchair is actively involved in sports for lengthy periods regularly, and as such the sports wheelchair is essential to the child/young person’s health and wellbeing – then an application can be accepted and reviewed.
  • Pushchair/Buggy/Reins: Newlife can fund any specification of pushchair/buggy/reins, including double buggies. We can fund all-terrain buggies, but the intended frequency of use will impact on the assessed outcome.
  • Other Mobility Equipment: We can fund walking frames irrespective of whether the child can independently walk using supportive equipment or not. We are aspirational for children and as such as long as the child can weight bear then we will consider an application.
    We can also fund equipment that supports the ability to integrate within any social setting, eg. acheevas
  • Cot/Bed: Newlife can fund any type of cot/bed, as long as the specification will specifically meet the child’s needs. We do not fund double beds to support parents to have the option of co-sleeping, but would consider an application for a double bed if the specification is determined by the child’s exceptional height or weight.
    Transportable cot/beds can be considered but information regarding frequency of use will be needed to determine the extent to which they are essential.
    Safespaces are provided for overnight use, and can be used as part of a behavioural support plan during the day. If intended only for overnight use, then we only fund single bed sized Safespaces, but larger ones can be considered if there are behavioural strategies and support in place.
    Mattresses should have integral incontinence protection if the child is incontinent. Newlife can fund sleep systems to meet a child’s health needs through postural management.
  • Car Seats: Newlife can fund any type of car seat or travel harness, including emergency cutters.
  • Seating: Newlife can fund any type of static functional and/or comfort seating. It is important to understand the extent to which a dynamic seat is needed to correct body shape and postural deterioration or whether comfort is the primary impact of seating. We believe that both are important.
  • Communication Aids: Newlife can fund hardware and/or software that support’s a child’s ability to communicate their needs. The child must be non-verbal (whether this is because of a physical or cognitive/behavioural disability) and the equipment must be designed to help communicate in all environments. Radio aids and communication aids can be considered, but this should have been trialled to demonstrate the benefit before provision. Newlife can fund video/movement sensors to support families to respond to a child’s health and/or safety needs.
  • Mobile Hoist/Handling Aids: We can fund mobile hoists and aids to support transfer between positions (eg. standing frames, temporary ramps and stairclimbers) and equipment to promote independence when completing activities of daily living (eg. neater eater arm supports) but don’t fund manual handling equipment that is fixed to a property or vehicle.
  • Toileting/Bath Aid: We don’t fund fixed toileting/bathing facilities or aids, but can fund mobile supportive aids that make it possible to meet a child’s daily care needs.
  • Accessories: Accessories are items that cannot be used on their own, ie. they attach to other items of equipment. They are not adaptations – they result in a temporary change in specification to meet individual circumstances - but they do play an important role in maximising the ability to use equipment to the point where it can be essential to have it in order to use equipment.
    Wheelchair Accessories cannot change the integral structure of the wheelchair.
    Pushchair/Buggy Accessories, Mobile Hoist/Handling Accessories and Cot/Bed Accessories must be provided to meet the child’s health or safety needs.
    Car Seat Accessories must be provided to meet the child’s health needs.
    Seating and Mobility Accessories can be funded irrespective of the child’s needs.

We do not fund any of the following:

  • therapies, including Second Skins/Splints/Orthotics.
  • weighted blankets/sensory seats or accessories that solely meet sensory needs.
  • scooters, trikes and adapted bicycles.
  • specialist bedding or clothing.
  • permanent adaptations to any equipment that was funded by a Statutory Service. We can consider an application to adapt equipment if it was originally funded by Newlife, in whole or part.
  • adaptations to vehicles.
  • permanent home adaptations.
  • sheds for storage of equipment/medical supplies.
  • holidays/days out.
  • white goods, furniture (that doesn’t fall into one of the other categories) or accessories that would solely improve the home environment.
  • medical monitors that require training to interpret readings.
  • financial grants, in full or part, or reimbursements for items privately purchased.
  • animals to support assisted living or animal therapies.
  • residential placements and/or private community care in the home.

What happens after this application form has been received?

Newlife’s Child and Family Support Team will check whether we have received all the necessary information or not. We will also identify if the need is urgent. Any missing information will be sought at the point of acknowledging the receipt of your application – so please provide an email address. We will then send a website link to the named local supporting professional so that a form can be confidentially and securely shared with us that confirms the details in your form alongside the specification of equipment and it’s appropriateness for your child. This will need to be completed and submitted to us within three weeks to make it possible for the application form outcome to be determined. Please retain a copy of the application form and provide a copy to the named local supporting professional for their reference.

Who should support this application?

All kinds of professionals involved in providing local services to your child can support this application. However, some types of equipment require specialist knowledge to determine the appropriate equipment specification. As such, you should use the guidance table below:

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If you need clarity regarding which professional to approach to support this application, please don’t hesitate to call Newlife’s Child and Family Support Team! Generally speaking, you should consider whether the qualification of the named professional is appropriate given the type of equipment and the need for the equipment. If the need for the requested equipment is to manage a child’s postural needs then a physiotherapist, occupational therapist or nurse involved in providing ongoing care could complete the additional form. If the equipment is predominantly needed to address safety risks then a social worker, portage worker or occupational therapist providing social care support through your local authority could complete the form. Irrespective of who is named as an appropriate supporting professional, please ensure that they are aware you are sharing their details with us.

If there are problems getting a local professional employed by a statutory service to support an application, we can consider accepting a privately funded assessment or assessment completed by a professional employed by a different charity who provides regular support to the child. We do not normally fund private assessments for equipment, but can under exceptional circumstances.

What are the possible outcomes?

In completing this application that highlights the need for equipment, you are accepting that Newlife’s Child and Family Support Team can review the circumstances detailed in the application form and make one of four decisions that will be communicated to you at our earliest opportunity to try and avoid any distress:

  1. Application Outcome – Offer of an Emergency Equipment Loan
  2. You may be offered a fixed-term loan (normally initially for six months to meet short-term urgent needs) and during this loan we will help you explore how to get an assessment and/or secure financial support that meets your child’s long-term needs. The equipment provided belongs to the charity and as such there are different terms and conditions associated with this option. This option is completely free and reserved for children who are at immediate risk of injury without the requested equipment and/or have a life-threatening/limiting condition or terminal illness and need equipment that we have within our equipment loan suite. The child also must be a permanent resident of the UK. Please note that the specifications of Cots/Beds, Buggies, Hoists and Seating Systems and their availability can be found at www.newlifecharity.co.uk

  3. Application Outcome – Offer of an Equipment Grant
  4. Depending on whether you receive particular benefits and therefore are assessed as being on a low-income, and also taking into account whether there is an urgent need for the requested equipment, will determine if you are offered 80% or 100% of the value of the requested equipment. If you are in receipt of certain benefits or the need for equipment is assessed by Newlife as urgent, you will not be asked to contribute to the cost of the equipment. If this isn’t the case, we will ask you to fund 20% up to a ceiling of £2,000 privately or sought from another funding organisation. You must not place the order for the equipment yourself otherwise it invalidates the application.

  5. Application Outcome – A commitment to seek funds for an Equipment Grant
  6. We may be in a position where our assessment identifies that the need for the equipment is comparably less urgent, but we would want to afford a grant if we had the funds. So we will agree the grant ‘in principle’ and then try to secure the funds needed. In this situation, we can work with you and your local community and/or our existing supporters to seek funds specifically for your child. We will keep you up to date with our efforts, and will give you a clear timeframe during which we would hope to secure funds. This timeframe is individual to your application. You must not place the order for the equipment yourself, in the hope that we will commit funds.

  7. Application Outcome – We are unable to commit funds
  8. If, after due consideration, we find that we are unable to offer an emergency loan or an equipment grant, we will write to you as soon as possible so that you can be in a position to make an application to other organisations. We will endeavour to provide signposting information. Our decision not to commit funds, isn’t our way of saying that the equipment isn’t needed. It’s just that demand is high and unfortunately funds may not be available at this time. You can apply multiple times each year.

    The outcome is finalised through a thorough review of each application by the Child and Family Support Team. They will use professional knowledge and experience regarding the needs of children with disabilities, and the impact of equipment provision, to determine the extent to which we have enough information to make a decision. You can expect this outcome to be communicated in a compassionate and transparent way, but if you wish to complain or appeal the outcome, please email the Child and Family Support Team Senior Manager at [email protected]

Who Is Completing This Form?

This form should be completed by someone with parental responsibility and/or the main carer of the child/young person who needs equipment. However, if a child/young person aged 12 or over wishes to be treated as the applicant and is usually regarded as capable of making decisions associated with their own care i.e. they have the mental and emotional development to make sound decisions, then Newlife commits to treating this child/young person as the applicant within the application for equipment.

If the child/young person is to be contacted directly regarding this application, please still complete the section below to provide parent/carer details so that they can be informed and involved in future communications.

Parent/Carer’s Details

The details given below should relate to someone to whom the equipment ownership can be transferred if Newlife can provide the grant. Ownership will be transferred upon receipt of the equipment being acknowledged to Newlife.

Demographic information

This information can help us to shape our services and support communities throughout the UK. We may also use information within our fundraising applications to demonstrate the support we provide. Decision to withhold information will not affect the progress of your application.

We are keen to ensure that parent/carers are accessing appropriate levels of support.

Do you receive any of the following benefits (tick any that apply)?

Child/Young Person’s Details

This section is designed to capture the details of the child/young person who will be using the equipment following a successful application.

In providing this information, our Newlife Nurses will consider the implications of provision on other children/siblings.

Newlife defines a significant disability as being a physical and/or cognitive impairment which affects activities of daily living. A life-threatening condition should be defined as a condition whereby the next period of ill health would make it likely that life sustaining intervention would be needed. Newlife defines a life-limiting condition as a condition that results in a shortened life expectancy, as opposed to having limited life experiences that could affect quality of life. A terminal illness is generally defined as not being expected to live longer than six months and/or a person who has an advanced care plan to meet end of life care needs.

Local Health, Social Care and Educational Services

Health Services

Social Care Services

E.g. direct payments or funding for respite/short breaks.

As an organisation that isn’t directly involved in the child’s care, a historical perspective of safeguarding concerns can be helpful when understanding the reason for this application.

If ‘Yes’, this will be specifically requested and does not need to be provided when submitting this application.

Educational Services

If ‘Yes’, this will be specifically requested and does not need to be provided when submitting this application.

If ‘Yes’, this will be specifically requested and does not need to be provided when submitting this application.

Supporting Professional’s Details

Please be aware that in order to be compliant with the General Data Protection Regulations (2018) then you must have received as a minimum verbal confirmation from the professional, to be named below, that they are willing to have their details shared with Newlife.

It is vital that we have an email address for the named professional so that we can request that an additional form is completed. If this additional form is not completed, an equipment grant cannot be provided.

The quote associated with purchasing this equipment, provided at this assessment, must be provided to Newlife. This can be attached to the application when submitted or emailed to [email protected]

Equipment

Please answer these questions to demonstrate how the requested equipment will benefit the child/young person and their immediate family:

If required, this will be specifically requested and does not need to be provided when submitting this application.

Terms and Conditions




In making this application you are agreeing to:


    1. All the information given in this application process is accurate and representative of the need for this service.
    2. Newlife is not obliged to make provision in respect of this application and all funding decisions are at the discretion of Newlife.
    3. In the process of clarifying the content of this application, it is implicit that we can contact and share personal information and the content of this application form with statutory services.
    4. In the process of arranging delivery of equipment, it is implicit that we must share personal information with trusted third-party companies who deliver this service to your home. Our agreements restrict their ability to use this data outside of the intended purpose for which it was provided.
    5. The equipment requested and supplied must be solely used for the benefit of the child/young person indicated in this application.
    6. The Equipment may be provided to you as a charitable act. We will therefore only be responsible for any loss or damage that you suffer in connection with this agreement, to the extent that we are able to claim for such loss or damage under our insurance.
    7. Following delivery of equipment, we will contact you to gather feedback on the service you received and the difference made by the use of the equipment.



If an equipment grant is offered (long term provision), you are agreeing that:


    1. Newlife may offer new or fully refurbished quality equipment.
    2. Any order placed for equipment prior to Newlife committing funds will invalidate this application and any subsequent grant offer.
    3. After delivery of the equipment, and once you have signed to accept delivery of it, the ownership of this equipment is automatically transferred from Newlife to the named parent/carer for sole use by the named child. If the equipment appears to have been delivered in any state of disrepair please refuse delivery and follow up with Newlife while it remains our order. Signing for the delivery means that it will be your responsibility to raise issues/concerns with the equipment supplier.
    Any equipment delivered and not signed for as accepted under these, or any other conditions, will remain under the ownership of Newlife and may be recalled at any time. Therefore the applicant is required to sign the equipment acceptance form as soon as possible after delivery and ensure it is returned to Newlife.
    4. Newlife accepts no liability for the costs or arrangement of: maintenance, care, adaptation, operation or public liability once the equipment has been accepted by the applicant.



If an emergency equipment loan is offered (fixed term provision), you are agreeing that:


    1. You won’t use the Equipment until you have received the initial training which will be provided by one of our designated agents or a qualified health professional. We need you to agree to always follow all instructions and recommendations provided to you, by us or the manufacturer or supplier of the Equipment. This training will cover, amongst other things, health and safety aspects and guidance for looking after the Equipment during the Loan Period and is necessary to ensure that the Equipment will be safe and without risk to health and safety when properly being used by the child/young person.
    2. The equipment loan is for around 6 months. Within this 6 month period, if you no longer need the Equipment, you should tell us as soon as possible and we will arrange for the Equipment to be collected from your home. This will usually be within 3 working days but we will agree a date suitable for you. If you need it for longer than 6 months we will liaise with you and your professional regarding an extension or change of provision.
    3. If the equipment becomes unsuitable for your child to use due to changes in need or circumstances, you will inform us. We reserve the right to reassess the individual needs of the child, and potentially alter provision to receive an equipment grant rather than equipment loan.
    4. The equipment remains the property of Newlife and we retain the right to recall the equipment. This notice would normally be, but does not need to be, given in writing.
    5. To take all reasonable steps to ensure that the Equipment is properly looked after. If the Equipment is lost or stolen whilst it is in your possession then you must let us know as soon as possible. We need you to agree to contact us directly if something goes wrong with Equipment (including, if the Equipment is damaged) whilst it is in your possession. We will arrange for Equipment to be inspected and repair or replaced.
    6. Newlife will insure against all loss, theft or damage to the Equipment; public liability; and product liability whilst you are in possession of the Equipment. Our insurance covers the Equipment whilst it is in the United Kingdom and for up to 90 days in other countries of the European Union. For use outside of these conditions, you will need to contact us to get approval. Under these circumstances, you may need to personally insure the item. You need to understand that you may also be held responsible, if you seriously misuse the Equipment or use it whilst it is knowingly faulty.


Family Declaration:

Newlife the Charity for Disabled Children are the ‘Controllers’ of the personal data and health information we collect. We need to collect and process certain information to allow us to provide the requested service. To see Newlife’s full privacy notice, please visit  www.newlifecharity.co.uk

If you would like to know more about what we do, or help us in other ways that could help change the lives of disabled children and their families then please tick the boxes below. The permissions associated within this section refer to the applicant’s details rather than anyone else referred to in the application:

If ‘Yes’, we will contact you initially to provide details about all of our Child and Family Support Services and then as we develop and update each individual service.

If ‘Yes’, we will share this information because we know that our supporters are inspired to help again when we tell them about the children we have helped. So it’s important, that we can share some basic information. This is common with most charities who are highly dependent on the public to help them meet the needs of children and their families.

If ‘Yes’, please note that this can be sent by email to [email protected] or by Royal Mail standard delivery.

Would you be happy to speak to our media team to explore using the press to:

If ‘Yes’, we may be able to improve the likelihood of funding the equipment by appealing for support through your local press. You can expect the media team at Newlife to call you to discuss generating and sharing a media story about the child/young person’s need for the equipment and help provide funding for the equipment earlier than if it was not undertaken. Please note that the use of your child’s photograph is essential for use in local media.

If ‘Yes’, we may be able to improve the likelihood of funding the equipment by appealing for support through your local press. You can expect the media team at Newlife to call you to discuss generating and sharing a media story about the child/young person’s need for the equipment and help provide funding for the equipment earlier than if it was not undertaken. Please note that the use of your child’s photograph is essential for use in local media.

Would you be happy to speak with our fundraising team to explore opportunities to engage with supporters and donors to:

If ‘Yes’, there are many different ways we can support you to build up donations towards funding this equipment. Our fundraising team would be happy to share their experience with you and support any future fundraising activities.

If ‘Yes’, there are many different ways we can support you to build up donations towards funding this equipment. Our fundraising team would be happy to share their experience with you and support any future fundraising activities.

In these cases Newlife will remain the Data Controller but will simply share your data for the purpose of data analysis only. In all cases we will use a non-disclosure agreement to ensure that the third party does not misuse any data provided.

(name of parent/carer)

If you need clarity regarding which professional to approach to support this application, please don’t hesitate to call Newlife’s Child and Family Support Team! Generally speaking, you should consider whether the qualification of the named professional is appropriate given the type of equipment and the need for the equipment. If the need for the requested equipment is to manage a child’s postural needs then a physiotherapist, occupational therapist or nurse involved in providing ongoing care could complete the additional form. If the equipment is predominantly needed to address safety risks then a social worker, portage worker or occupational therapist providing social care support through your local authority could complete the form. Irrespective of who is named as an appropriate supporting professional, please ensure that they are aware you are sharing their details with us.

If there are problems getting a local professional employed by a statutory service to support an application, we can consider accepting a privately funded assessment or assessment completed by a professional employed by a different charity who provides regular support to the child. We do not normally fund private assessments for equipment, but can under exceptional circumstances.

What are the possible outcomes?

In completing this application that highlights the need for equipment, you are accepting that Newlife’s Child and Family Support Team can review the circumstances detailed in the application form and make one of four decisions that will be communicated to you at our earliest opportunity to try and avoid any distress:

  1. Application Outcome – Offer of an Emergency Equipment Loan
  2. You may be offered a fixed-term loan (normally initially for six months to meet short-term urgent needs) and during this loan we will help you explore how to get an assessment and/or secure financial support that meets your child’s long-term needs. The equipment provided belongs to the charity and as such there are different terms and conditions associated with this option. This option is completely free and reserved for children who are at immediate risk of injury without the requested equipment and/or have a life-threatening/limiting condition or terminal illness and need equipment that we have within our equipment loan suite. The child also must be a permanent resident of the UK. Please note that the specifications of Cots/Beds, Buggies, Hoists and Seating Systems and their availability can be found at www.newlifecharity.co.uk

  3. Application Outcome – Offer of an Equipment Grant
  4. Depending on whether you receive particular benefits and therefore are assessed as being on a low-income, and also taking into account whether there is an urgent need for the requested equipment, will determine if you are offered 80% or 100% of the value of the requested equipment. If you are in receipt of certain benefits or the need for equipment is assessed by Newlife as urgent, you will not be asked to contribute to the cost of the equipment. If this isn’t the case, we will ask you to fund 20% up to a ceiling of £2,000 privately or sought from another funding organisation. You must not place the order for the equipment yourself otherwise it invalidates the application.

  5. Application Outcome – A commitment to seek funds for an Equipment Grant
  6. We may be in a position where our assessment identifies that the need for the equipment is comparably less urgent, but we would want to afford a grant if we had the funds. So we will agree the grant ‘in principle’ and then try to secure the funds needed. In this situation, we can work with you and your local community and/or our existing supporters to seek funds specifically for your child. We will keep you up to date with our efforts, and will give you a clear timeframe during which we would hope to secure funds. This timeframe is individual to your application. You must not place the order for the equipment yourself, in the hope that we will commit funds.

  7. Application Outcome – We are unable to commit funds
  8. If, after due consideration, we find that we are unable to offer an emergency loan or an equipment grant, we will write to you as soon as possible so that you can be in a position to make an application to other organisations. We will endeavour to provide signposting information. Our decision not to commit funds, isn’t our way of saying that the equipment isn’t needed. It’s just that demand is high and unfortunately funds may not be available at this time. You can apply multiple times each year.

    The outcome is finalised through a thorough review of each application by the Child and Family Support Team. They will use professional knowledge and experience regarding the needs of children with disabilities, and the impact of equipment provision, to determine the extent to which we have enough information to make a decision. You can expect this outcome to be communicated in a compassionate and transparent way, but if you wish to complain or appeal the outcome, please email the Child and Family Support Team Senior Manager at [email protected]

if you have any questions, please contact our care services for free on:

Phone-number0800 902 0095

www.newlifecharity.co.uk

Newlife Centre, Hemlock Way, Cannock, Staffordshire WS11 7GF. Newlife the Charity for Disabled Children - Registered Charity Number: 1170125 in England & Wales

We, Newlife the Charity for Disabled Children are the ‘controllers’ of the information which we collect about you. We are committed to protecting your personal data, whether it is sensitive or not, and we only process data if we need to for a specific purpose. We collect and process data to campaign locally and nationally on behalf of disabled, terminally ill children and their families. To see Newlife’s full Privacy notice, please visit http://newlifecharity.co.uk/docs/general/Resources-and-Documents.shtml