the Application Form PDF

Transcription

the Application Form PDF
To be retained for your
reference purposes.
About Newlife
Foundation for Disabled Children
Newlife is the UK’s largest provider of specialist equipment to help children/young people who are
disabled or terminally ill. We offer care to families through professional support services; practical
support through specialist equipment provision; hope by funding medical research; and we campaign to
get a better deal for families of disabled and terminally ill children/young people.
All Newlife care services are FREE and available nationally.

Newlife’s Care Services Department

National Nurse Helpline

Equipment Grants

Just Can’t Wait Service
Newlife’s Care Services Department consists of health professionals with
specialist qualifications and experiences within childhood disability. The team
will assess each enquiry in confidence and give information, support, and will
signpost families to our services and external organisations.
Newlife operates a confidential and caring Nurse Helpline. Nothing is too
small or too important to discuss with a trusted Newlife Nurse. Please call our
National Helpline on 0800 902 0095 (freephone from UK landlines) or dial
01543 468 400 (normal call charges apply). The lines are manned MondayFriday, 9.30am-5pm or until 7pm every Wednesday. Alternatively you can email
nurse@newlifecharity.co.uk. or go to our website: www.newlifecharity.co.uk to
contact a Nurse using our ‘Live Chat’ service. It’s also easy to connect with us at
www.facebook.com\newlifefoundation or through twitter using @newlifecharity.
Newlife Foundation can provide vital specialist equipment which meets
the child’s current and long-term needs and subsequently changes the
lives of disabled children and their families. Without Newlife many disabled
and terminally ill children would go without vital equipment. Applications
are individually reviewed by our Care Services Team to assess the need, of
children and their families, and urgency of each request. The application
process is simple; the form can be downloaded online and completed by the
family and supporting professional involved in the child’s care.
To ensure that terminally ill children don’t have to wait to get vital
equipment, Newlife offers the Just Can’t Wait Service. Newlife is able to loan
essential professionally-maintained equipment within 72 hours to children
with life limiting conditions and/or palliative needs. This equipment enables
children to be discharged from hospital, access hospice care at home, and
give families the opportunity to build valuable memories. Simply contact
our National Nurse Helpline to enquire about availability of specialist beds,
buggies, wheelchairs, sleeping systems and portable hoists.
continued...
About Newlife Foundation
for Disabled Children (Continued)

Play Therapy Pod Service

Emergency Bed Loan Service

Comfort Capsule Service
The gift of play should not be underestimated. When children have
complicated needs, play and development does not become a priority.
Newlife recognise that the therapeutic effect of play can make a huge
difference to individual children and the family as a whole. This is why Play
Therapy Pods of specialist toys are loaned to children for an average of 12
weeks. All pods are assessed, cleaned and refurbished prior to reloan. The
application form, which can be downloaded online, enables a choice of toys.
It should be wholly completed by the family and doesn’t require support
from a health professional.
Newlife’s emergency service aims to ensure that disabled children aren’t at
risk of injury because they are using inappropriate beds for their medical
and/or behavioural needs. Newlife is able to loan essential professionallymaintained specialist beds within 72 hours. This equipment can prevent
life-threatening injuries and maintain a child’s health, while addressing their
family’s wellbeing. Simply contact our National Nurse Helpline to enquire
about availability of specialist beds.
Newlife’s Comfort Capsules provide practical equipment to meet emotional
needs. When a family is given the news that their child has a terminal illness,
the medical needs often outweigh the holistic needs of the family to have
the opportunity to build and treasure memories. Newlife recognises that
providing equipment can have a therapeutic effect on a child’s quality of
life, and subsequently provide support to the family as a whole. All capsules
are assessed, cleaned and refurbished prior to reloan of items designed for
multiple use. Single use resources are granted to each family. This service
requires support from a health professional involved in addressing the child’s
palliative needs who has regular community contact with the family. Simply
contact our National Nurse Helpline to see how we can help.
if you have any questions, please conTact our care services tEam on:
0800 902 0095
Lines open Monday-Friday 9:30am-5pm
& Wednesdays until 7pm plus 24 hour answerphone
Email: nurse@newlifecharity.co.uk Nurse Chat: www.newlifecharity.co.uk/live
facebook.com/newlifefoundation
twitter.com/@newlifecharity
youtube.com/NewlifeFoundation
Newlife Centre, Hemlock Way, Cannock, Staffordshire WS11 7GF. Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Equipment Grant Application Page 1 of 8
Part 1 - Family Form
For completion by the parent/main carer.
Essential Information - Application notes should be read prior to completion.
Your Details
Please confirm that you are the child/young person’s parent/main carer?
 Yes  No
What is your relationship to the child/young person
Title
 Mr
 Mrs
 Miss
 Ms
 Dr
First Name
Family Name
House No. & Street
Town
County
Postcode
Is the child/young person living at the same address as you?
If ‘No’ please explain further:
 Yes  No
Is the equipment requested, for use at a different address than the child’s home?
If ‘Yes’ please provide the address:
 Yes  No
Does your child/young person live in a:  House
Is this property:  Rented
 Bungalow
 Owned by you/your partner
 Flat/Apartment
 Other (please specify)
 Other (please specify)
Has your home been adapted to meet the child/young person’s needs?
 Yes  No  Not applicable
In order to progress this application you need to give a daytime telephone number and email address that you check
regularly. The other numbers are useful for ensuring timely provision of equipment.
Tel (daytime):
Tel (home):
Tel (mobile):
Email:
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 2 of 8
Can you print documents sent to you by email?
 Yes  No
Can you scan documents to return to Newlife?
 Yes  No
Have you previously used any of Newlife’s services?
 Yes  No
If ‘No’, please circle to indicate how you heard about Newlife:
 Professional
 The Media
 Publication/Leaflet
 Internet
 Other (please specify)
As the child/young person’s main carer, are there any health problems or disabilities, which affect your ability to provide
care e.g. back problems, etc?
How would you describe the child/young person’s family situation?
 Living with both parents (include step-parents)
 Living mainly with one parent
 Living with care given, at different locations, by both parents
 Other (please specify)
Are there any other children or siblings of the child/young person, living in the same home?
If so, please give their gender, ages and state if they have any significant health problems or disabilities:
 Yes  No
Please state who in the household, where the child/young person normally lives, is currently in employment
(exclude brothers and sisters) and say if this is full or part-time:
As the child’s main carer, do you receive:
 Housing Benefit
Do you get DLAm (Disabled Living Allowance mobility component)?
If yes, at what rate is this provided?
 Council Tax Relief
 Low
Do you use this to lease a car/other equipment through Motability?
 Blue Badge
 Yes  No
 Medium  High
 Yes  No
Please state which, if any, benefits you are receiving and say at what rate. Please include all disability and unemployment
related income e.g. Disabled Living Allowance, Carers Allowance, Personal Payments, etc.
Do you have paid carers visit your home to support you in looking after your child/young person?
If yes, how is this care funded? (Direct Payments, Social Care, Personal Health Budget, etc)
 Yes  No
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 3 of 8
Child/young Person’s Details
First Name
Date of Birth
Family Name
DD/MM/YYY
Gender  Male  Female
Is the child/young person fostered, placed in a residential school or residential care?
 Yes  No
Has a public appeal, in the name of this child, been active to fund equipment or other benefits,
in the last 2 years?
 Yes  No
As part of this application, have you enclosed a photograph of the child/young
person with this application form?
 Yes  No
If no, please understand that we will not be able to process the application until this is received - unless details are provided below.
If there is a safeguarding/court order or similar reason why the child/young person’s picture cannot be used by Newlife,
please provide details:
Will you agree to send a picture of this child/young person with the equipment
provided, following a successful application?
 Yes  No
Please note that this could be sent by email to feedback@newlifecharity.co.uk or by Royal Mail standard delivery.
Do you agree to someone from Newlife’s media team contacting you, if they wish,
for an informal chat about this option?
 Yes  No
Please tell us about the child/young person’s condition, diagnosis or disability:
Can the child/young person maintain head control by themselves?
 Yes  No
If they are old enough to do so, can you describe how the child/young person gets about?
If too young to move around independently, do not select an option.
 Walk unaided  Walk using aids  Unable to walk  Crawl  Other (please specify):
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 4 of 8
Can the child/young person bear their own weight?
 Yes  Partially  No
Does the child/young person have: (please tick all that apply)
 any spine, limb or hip problems, which affect their walking or sitting?
 poor muscle control in any part of their body?
 to be hoisted to transfer between positions?
 any difficulties with breathing?
 difficulties with sleeping?
 difficulties understanding danger?
 any type of digestive, stomach or bowel problems?
 problems with their sight?
 problems with their hearing?
Relevant to their age, does the child/young person have difficulty with:
(a) Speech?
(b) Toileting?
 Yes  No
 Yes  No
Would you say, or have you been told, your child has a problem with their behaviour?
 Yes  No
Does the child/young person have any allergies or sensitivities?
If yes please list below:
 Yes  No
Is your child/young person awaiting hospital admission for surgery or tests?
 Yes  No
Is the child/young person currently in hospital?
 Yes  No
If yes, is equipment needed for hospital discharge?
If yes, please provide a discharge date:
 Yes  No  Don’t Know
Does the child use the services of a Hospice?
 Yes  No
Is the child/young person subject to a Medical Negligence Claim or Award?
If Yes, have payments for medical compensation been received or being sought?
 Yes  No
 Yes  No
Does the child/young person attend school?
If ‘Yes’ - what’s the name of the school?
 Yes  No
If old enough to attend a school, does the child/young person go to a:
 Mainstream school.
 Mainstream school and uses a special unit.
 Mainstream school and has support/extra/special lessons.
 Attends a special school.
 Is educated in a different way, please give details:
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 5 of 8
Which professionals have you seen or consulted regarding this child/young person in the past two years (or less if younger)?
Please just give their role, e.g. GP, Physiotherapist, etc (not their name):
Please give the name of the child/young person’s GP, GP’s surgery, their address and their telephone number:
Please tell us about the equipment the child/young person needs:
Please tell us how the child/young person is affected by not having this equipment:
Please tell us how you believe the child/young person will benefit if they had this equipment:
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 6 of 8
Have you already made an application for this equipment to another charity?
 Yes  No
If ‘Yes’ above, please state which charity by name. If you don’t know the outcome yet, please say, if you know, when you
are likely to be told. We often work with other charities to part fund, so this information is important.
Can you make a contribution towards the cost of the equipment?
If yes, how much?
 Yes  No  Unsure
If applying for a wheelchair/buggy, please state if you’ve already been offered vouchers from the local statutory services
department. Please state their name and say how much:
Regardless of the type of equipment being applied for in this application, have your local statutory services offered you
relevant equipment already which you have not felt able to accept? If so, please state the reason for this rejection:
What is the name of the professional supporting this application?
What does this professional do?
What is their telephone number?
What is their email address?
When did you give/send Part Two of this form to them to complete?
DD/MM/YYY
Has a relevant professional carried out an assessment of this child’s needs?
 Yes  No
Is this the same person who you have given Part Two of this form to?
 Yes  No
Has a particular named supplier been involved in carrying out an assessment of this
child/young person’s needs? If ‘Yes’, what is the company’s name (if known)?
 Yes  No  Don’t know
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 7 of 8
Parent/Carer Demographic Information
This information about you can help us to shape our services.
Gender
 Male  Female  Prefer not to say
Age
 0-24 years
 25-64 years
 65+ years
Ethnic background
White
 Prefer not to say
Religion or belief
 English/Scottish/Welsh/NI
 No religion
 Muslim
 Irish
 Christian
 Sikh
 Gypsy or Irish traveller
 Buddhist
 Other religion
 Any other white background
 Hindu
 Prefer not to say
Mixed
 Mixed ethnic background
 Jewish
Asian/Asian UK
 Indian
 Pakistani
 Bangladeshi
 Chinese
 Any other Asian background
Black/African /
Caribbean/
Black UK
 African
 Caribbean
 Any other Black/African/
Caribbean background
Other
 Arab
 Any other ethnic group
Prefer not to say
 Prefer not to say
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 1 - Family Form - Equipment Grant Application Page 8 of 8
Conditions of Grant
In making this application you are agreeing that:
1) All the information given is correct to the best of your
knowledge and belief.
9) You have read, understood and agree to the use of data as
defined under the Newlife Data Protection Policy.
2) The basic information and image provided as described
in the accompanying notes to this form can be used by
Newlife to highlight the work of the charity, seek funds
and thank donors and volunteers.
10) After delivery the applicant will, within 10 days of receipt
of the equipment, sign and return to Newlife the delivery
slip provided. Once the acceptance form is received by
Newlife, the ownership (title) of the product will transfer
from Newlife to the person applying for this equipment
(the owner). 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.
3) Newlife is not obliged to make provision in respect of this
application and all grants are at the discretion of Newlife.
4) Newlife reserves the right to liaise with all parties to this
application with a view to the provision of appropriate
equipment which differs from the brand/make applied
for in the interest of controlling costs.
5) Newlife may offer new or and fully refurbished
quality equipment.
6) Any equipment supplied by Newlife will remain in the UK
or Europe.
7) Newlife may use/share the information provided in
this application and all information given in relation to
this application with relevant statutory and charitable
agencies in pursuing the supply of equipment in
partnership or wholly by others.
8) If Newlife receives a request from Police, the Courts
or other statutory agencies with the power to request
information related to this application, it will be shared.
11) You will offer Newlife the right to ‘buy back’ the equipment
for a nominal £1, within 3 years of the equipment being
provided or when the child/young person no longer uses
the equipment, whichever is the earliest.
12) The equipment requested and supplied must be solely
used for the benefit of the child/young person indicated
in this application.
13) 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.
14) You have read and understood the Terms and Conditions
and accept these conditions in making this application.
Family Declaration
By ticking the statements below and signing this form, I____________________________________(name of parent/carer)
have read, understood and agree to the terms and conditions of the equipment grant, as stated above.
I also confirm that the child/young person is:
 A UK resident
 Has a significant disability which affects their daily life, a life threatening/life limiting condition
or has been diagnosed as terminally ill.
 Under 19 years of age
Signature
Date
if you have any questions, please conTact our care services tEam on:
0800 902 0095
Lines open Monday-Friday 9:30am-5pm
& Wednesdays until 7pm plus 24 hour answerphone
Email: nurse@newlifecharity.co.uk Nurse Chat: www.newlifecharity.co.uk/live
Newlife Centre, Hemlock Way, Cannock, Staffordshire WS11 7GF. Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Equipment Grant Application Page 1 of 4
Part 2 - Professionals Support Form
For completion by the local supporting professional.
Essential Information - Application notes should be read prior to completion.
You may also want to review Part One prior to completion.
Supporting Professional Details
Title
 Mr
 Mrs
 Miss
 Ms
 Dr
First Name
Family Name
Job Title
Professional body registration details
Employer/organisation name and address, inc. Postcode:
In order to progress this application you need to give a daytime telephone number and email address that you check
regularly. The other numbers are useful for ensuring timely provision of equipment.
Telephone Number
Mobile Number
Email Address
(If you have provided an email address, we will copy you into any offer we make to the family).
Preferred Contact Method
Confirming the Child/Young Person’s Details
Child’s First Name
Child’s Family Name
Child’s House No. & Street
Town
Childs Date of Birth
County
Postcode
Childs Gender  Male  Female
Is this child fostered, placed in a residential school or residential care?
 Yes  No
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 2 - Professionals Support Form - Equipment Grant Application Page 2 of 4
Diagnosis and Equipment Details
Can you confirm the diagnosis or effects on the child/young person of this condition/disability?
What is the child/young person’s prognosis?
Are there any reasons why this application should be considered as urgent? Please provide details:
Have you included any additional supporting paperwork about the child/young person’s
condition/disability with this section of the application form?
 Yes  No
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 2 - Professionals Support Form - Equipment Grant Application Page 3 of 4
What is the specific brand name/make and model of the equipment that has been defined as suitable for this
child/young person?
Please note: We would expect any measurements of the child, e.g. leg length, to be accounted for in the quote/specification.
How will this equipment benefit the child/young person?
Were you present at the assessment for this equipment?
 Yes  No
If ‘Yes’, please provide the date of assessment:
Was a particular supplier involved in carrying out this assessment?
 Yes  No
If ‘Yes’, what is the company’s name?
Are you happy that the product meets UK safety standards and applicable British and EU quality standards?
 Yes  No
Please tick one of the following options, as appropriate:
 I am enclosing, with this part of the application form, details of the quote and specification of the equipment which is
suitable for the child.
 I am not enclosing, with this part of the application form, details of the quote and specification of the equipment
which is suitable for the child, as I understand this has already been provided by the family to Newlife.
 I am not enclosing, with this part of the application form, details of the quote and specification as I have not received
it from the supplier/retailer, but will forward it under separate cover as soon as it is available.
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Part 2 - Professionals Support Form - Equipment Grant Application Page 4 of 4
Has anyone who has responsibility for the named child/young persons care, formally
applied to the relevant local statutory body or department to fund this equipment.
 Yes  No
If you answered ‘Yes’ above, please give details of who this application for funding was made to, including the contact
details for that department, and its status/outcome:
If you answered ‘Yes’ above, please give the reason if known, as to why this application was declined:
If you answered ‘No’ to the previous question, can you please say why no application was made, by ticking one of the
following options or stating another reason?
 I know there are no funds available locally for this equipment.
 I know that this type of equipment is not provided.
 I know that locally set criteria would mean the child would not be eligible.
 I know that there are substantial delays in the system of provision locally and I believe this delay could be detrimental
to the child’s health or welfare.
 Other Reason (please give details):
Professional Declaration
By ticking the statements below and signing this form, I_____________________________________________(your name)
declare the information provided in part 2 of this form is accurate and truthful
I also confirm that the child/young person is:
 A UK resident.
 Has a significant disability which affects their daily life, a life threatening/life limiting condition
or has been diagnosed as terminally ill.
 Under 19 years of age.
Signature
Date
if you have any questions, please conTact our care services tEam on:
0800 902 0095
Lines open Monday-Friday 9:30am-5pm
& Wednesdays until 7pm plus 24 hour answerphone
Email: nurse@newlifecharity.co.uk Nurse Chat: www.newlifecharity.co.uk/live
Newlife Centre, Hemlock Way, Cannock, Staffordshire WS11 7GF. Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Equipment Grant Application - Essential Information
Can the Equipment Grant Service
help my child?
The minimum eligibility requirements for an Equipment Grant
- the permanent placement of essential equipment - are that
the child/young person is:
 A UK resident .
 Has a significant disability which affects their daily life,
a life threatening/life limiting condition or has been
diagnosed as terminally ill.
 Under 19 years of age.
If you can answer ‘Yes’ to all three of the above questions, you
should you continue with this application. If you are unsure or
answer ‘No’ to any, please call/contact our Helpline for support.
What is the first step?
Read the notes and then, simply contact a Newlife Nurse on
our National Helpline on 0800 902 0095 (freephone from
UK landlines) or dial 01543 468 400 (normal call charges
apply). The lines are manned Monday-Friday, 9.30am-5pm
and until 7pm on Wednesdays. Alternatively you can email
nurse@newlifecharity.co.uk or go to our website at www.
newlifecharity.co.uk to contact a Nurse, using our ‘Live Chat’
service. It’s also easy to connect with us at www.facebook.
com\newlifefoundation or via Twitter @newlifecharity.
This call will help you to check that Newlife can provide the
sort of equipment needed, inform you which professional will
be required to support your application, and offer support
to complete the application form. Please note that verbal
translation services are available through the Nurse Helpline.
What next?
Newlife’s aim is to make applying for a Grant as simple as
possible. So once you have read the notes and contacted a
Newlife Nurse, just complete Part 1 of the form yourself and
provide Part 2 to the relevant local professional (who the
Newlife Nurse has told you would be suitable to support your
application.) Please understand we will not be able to process
your application until we receive both parts of this form and
a quote from the suppliers that defines the specification and
cost. We are dependent upon the relevant local professional to
define that the specification is absolutely right and safe for the
child/young person.
We can accept the assessment of many suppliers, but this
must still be agreed by the relevant local professional. If you
are not in contact with the appropriate professional that you
need to complete Part Two of this form, a Newlife Nurse may
be able to help you with this matter.
Once both parts of the application form are complete,
please post to: Care Services Dept, Newlife Foundation for
Disabled Children, Newlife Centre, Hemlock Way, Cannock,
Staffordshire, WS11 7GF.
When we have received both parts of the form, along with the
quote/specification paperwork requested, our Care Services
Team will telephone you to have a chat and find out a little
more about the need for equipment.
1
Call a
Newlife
Nurse
regarding
eligibility
2
Complete
and send
application
form and
supporting
letter
3
Newlife
Nurse will
call to assess
the need and
urgency
4
Newlife Nurse
writes with
a decision,
timetable and
conditions
5
If and when
appropriate,
equipment
will be
supplied
Step one: Read these notes and call a Newlife Nurse on the
Helpline 0800 902 0095 to check eligibility and define which
professional can support your application, and if we can
supply the sort of equipment needed.
Step two: Ask the appropriate professional if they will support
your application. If so, give them Part Two to complete and ask
them to send it direct to us with the quote/specification.
Step three: Complete Part One of this form yourself and post it
to us. You can add a covering letter if you wish and photos.
Step four: Once we have receive both parts of this application
form and the written quote/specification, a Newlife Nurse
or one of our other professional staff will call you to find
out more.
Step five: We will write to you with a decision and other
information. If we are able to say ‘Yes’, we will order, pay for
and arrange delivery of the equipment.
Who can benefit?
All our grants (and loans) are for the benefit of an individual
child/young person. We cannot provide equipment for
group use. When reviewing if we can fund equipment we
will holistically assess the combined needs of the child/young
person and family, in terms of safety, health and wellbeing.
Who should complete the application form?
Part One of this application form should be completed
ideally by the parent/main carer. Part Two must be
completed by the appropriate suitable professional. If you
have any problems, please contact the Helpline.
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Essential Information continued...
What types of equipment are funded?
We fund a varied range of equipment, including specialist
seating, wheelchairs and beds, communication aids,
equipment to help with feeding or pain relief, to name
but a few. We will assess if we can help by considering the
impact on the individual and their healthcare, quality of life
and safety.
You or the appropriate professional can indicate the brand/
type of equipment needed. But the professional must
be the one who agrees the specification. On occasions,
Newlife may liaise with you and the professional
to source/purchase the requested equipment from an
alternative cheaper supplier. But we will always ensure the
specification is right and appropriate before doing so.
For operational reasons, we cannot fund adaptations to
cars or properties, therapy/treatment costs, white goods,
holidays or award cash grants. If you need any of these
items, please call our Helpline and we may be able to
signpost you to another organisation. We will consider
funding computers/portable tablets if this equipment is
required to assist with functional speech loss. For more
information, please call our Nurse Helpline.
What is the role of the
supporting professional?
We believe the local professional, who knows the
equipment needs of the child/young person, is best placed
to decide on the specification. This is why we need them
to complete Part Two of this application. The Newlife Care
Services Team relies on their knowledge to underpin and
confirm some of the information the family provide.
If we make a grant, we will place the order, arrange delivery
and installation. Training in the use of the equipment (if
necessary) is carried out by the supplier or by alternative
agreement with a local professional.
Both parts of the form can be sent in together or separately,
but we cannot take action until we receive both parts
and the quote/specification of the equipment requested.
The Professional may, quite reasonably, want to see the
information in Part One, before agreeing to support the
application. So we suggest that, if you send in Part One
separately, you retain a photocopy to show them.
What about the quote/specification?
We will need the specification/quote for the equipment
requested/supported in writing. For ‘non bespoke’
items such as car seats, a print-out from a website will
suffice. In more complex ‘bespoke’ cases, it will likely be
the quote obtained from the equipment manufacturer/
supplier/retailer. We cannot source these ourselves, so the
supporting professional will need to send this to us.
Which professionals can support which
types of equipment?
Qualifications matter, so for instance we need a Paediatric OT
or Physiotherapist to assess for specialist seating, to ensure
postural and any other clinical care needs are considered. But
if the application is for something less tailored, like storage
shed for bulky disability related equipment, we will accept
a wider group of professionals to support these sorts of
applications. It is essential therefore that you confirm which
professionals can support an application to Newlife, by
calling/contacting the Newlife Helpline before applying.
What about local statutory obligations to
provide equipment?
The local statutory services (Health and Social Care) have
certain obligations under Law to assess needs of disabled
children/young people, and make equipment provision
to meet those needs. But many of these statutory services
have locally set criteria/policies which define the basis
on which the provision is made. In considering if Newlife
should make a grant, we ask if an application has been
made by a professional, to these local statutory services and
if not, why not. This helps us to understand the policies and
issues affecting provision. So we will ask a few questions
about this in part two of the form.
In some cases we may contact local statutory services to
establish their criteria/policy and, where possible, request
funding for the equipment in full or part. We believe that
if the local services have an obligation to make funding
available, we should ask them to do this first, before Newlife
agrees to fund. If we do this, we will let you know that we
have tried to achieve this and the outcome.
Who owns and maintains equipment
which Newlife provides?
If Newlife makes a grant, the applicant becomes the owner
of the equipment and is responsible for the maintenance
of the equipment in line with the manufacturer’s
recommendations. For complex equipment, such as
powered wheelchairs, the suppliers often offer a package
at a flat fee to cover this, for which the owner will be
responsible to fund. In the case of wheelchairs, if the local
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Essential Information continued...
wheelchair services department offers vouchers towards
the cost, they may agree to be responsible for maintenance.
Under the terms and conditions of an equipment grant,
Newlife reserves the right to ‘buy back’ the equipment
when the child/young person no longer needs it, for a
token price of £1. This will allow a change of ownership
and make it possible for appropriate equipment to be
refurbished and re-used on behalf of Newlife.
By accepting a grant from Newlife, the applicant will be
agreeing to this arrangement and the applicant accepts the
responsibility of maintaining and offering it back to newlife
when no longer needed.
remember, your details and information on this form are
strictly controlled under the Data Protection Act, so your
general privacy is protected and thousands of families trust
Newlife to ensure this. A copy of our Data Protection Policy
is available via the Helpline on request and on our website
under the Resources section.
In order to process your application, it will be necessary
for us to share your basic contact details with local
statutory services and the equipment supplier to enable
assesment and/or delivery, so they can liaise with you and
us regarding this application.
Data shows that when families have followed our guidance
to contact a Newlife Nurse before applying, the chance of
being successful is good. This is because we can guide the
application and ensure all the information we need to make
a decision is available to us.
We know many families feel that they have to ‘fight’ to get
provision, so we also give families the chance to participate
in helping us raise the funds needed and awareness, by
indicating on this form if you are happy to speak to one
of Newlife’s friendly media staff. We may be able to put
together a media story, for you to approve, to highlight
the need for this equipment. This is often very successful in
raising the funds needed to help your child.
How can I help an application be successful?
Does Newlife part-fund equipment?
What are the chances of a successful grant?
Newlife is dependent upon funds we raise and earn to fund
our grants. That’s why, within the terms and conditions of
this grant application, we ask that you accept that certain
’limited information’ and images you agree to provide
are shared with our prospective and current donors/
supporters/volunteers. If there is a genuine safeguarding
reason why you cannot accept this condition, you need to
specifically advise the Helpline Nurse, before making the
application.
This ‘limited information’ is both written and visual. For
example, the written section could read:
John is 5yrs old, he lives in Lancashire and has complex
disabilities that affect his mobility. He has a heavy
wheelchair at present, but he gets a lot of pain which could
be avoided if he had a lightweight wheelchair, costing £xxx.
We will never publish identifiable data without your specific
consent. This includes the surname/family name, town/
village, or specific condition if rare - as defined by EURODIS.
We need a photo, of the child/young person in need of this
equipment, to be sent with the application form. Once the
equipment has arrived, we also ask that you send a picture
of the child/young person with their new equipment.
Both will only be used, along with the limited information
(as outlined above), to thank our donors/supporters and
volunteers, and to promote the work of the charity. If there
is a safeguarding or similar reason you cannot supply a
photo, there is space in the form to provide details. But
Newlife can fully fund or part fund equipment with a
family or others (such as their local statutory provider or
another charity) to supply the equipment needed. If you
are interested in this, please discuss this possibility with a
Newlife Nurse before applying.
How quickly will my application move forward?
Upon receipt, every part of each application form is
reviewed by Newlife’s Care Services Team which consists
of qualified health and social care professionals. This means
they use their skills to assess the urgency of need. If they
have any reason to believe that the need is urgent, they can
‘fast-track’ the application which means it could be signed
off within a matter of days.
If the application does not need to be ‘fast tracked’, once
we receive both parts of the application form and quote/
specification details, one of the professionals in Newlife’s
Care Services Team will call you to get more information.
Usually within 2-4 weeks.
We always advise families to apply early. So for example, if you
know you child/young person will need certain equipment
to start school or following planned surgery, make an
application ASAP. Months in advance is not too early! Don’t
wait until your child/young person has grown out of their
equipment, think ahead and call the Newlife Helpline.
Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales
Essential Information continued...
Does Newlife fund duplicate equipment?
If you are applying for duplicate equipment, so that it can
be used at another location, we may be able to help in
certain circumstances. Please speak to a Newlife Nurse for
more information before applying.
Will Newlife fund optional extras?
Much of the disability equipment supplied today comes
in optional colours at no extra costs. But if there is a cost,
Newlife will not normally fund ‘optional’ features that for
instance, personalise the equipment, e.g. bespoke colours
or a change of seating fabric. However, this could be met by
the family through part funding and this can be discussed
with a Newlife Nurse before applying.
How often can I ask Newlife to help?
How will we know if the application has
been successful?
Depending on the type and timescale of the need, we will
normally write to you giving one of the following three outcomes:
Outcome 1 - The grant is agreed and a delivery date and
the terms and conditions of the grant are sent to you by
post or email (as per your preference). Please note, we
cannot place the order until you have signed and returned
the acceptance slip. So please act promptly upon receipt or
the offer may be withdrawn.
Outcome 2 - If, we feel the need is comparatively less
urgent, we may write or email, giving you an ‘In Principle’
decision to fund the item and the date on which a final
decision will be made, if funding can be found.
You can apply for equipment through any of our grant and
loan services as often as your child/young person requires
items to meet their needs. Please call the Newlife Helpline
for more information.
Outcome 3 - If, after due consideration, we find that we
are unable to make a grant, we will write to you as soon as
possible so that you can be in a position to make an application
elsewhere. Newlife Nurses may be able to give you information
about other organisations or services that could help.
Has Newlife received my application form?
Is there an appeal/complaints process?
To manage costs, we do not automatically acknowledge
receipt of either part of this form. If you want an update,
please email: careadmin@newlifecharity.co.uk or contact us
via social media or call the Helpline if you don’t have email/
internet access. We advise all families to retain copies of
things they send to us as things can go astray in the post.
Some families choose to send the form as ‘recorded’ or
‘registered’ post so they can track delivery.
Yes, but both should be in writing giving full details to
Newlife’s CEO. We will always respond.
Do you still have questions?
If so please use the following details to contact
Newlife’s Care Services Team.
0800 902 0095
Lines open Monday-Friday 9:30am-5pm
& Wednesdays until 7pm plus 24 hour answerphone
Email: nurse@newlifecharity.co.uk
Nurse Chat: www.newlifecharity.co.uk/live
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Can I provide feedback?
Yes, and this is very helpful to ensure high standards and
to help shape our services. Shortly after you receive the
equipment, you will be actively contacted by email with an
online feedback opportunity or contacted by telephone for
a short interview. Newlife reserves the right to contact you
using either method, and may request permission to seek
feedback from your supporting professional.
How do we get the equipment?
Newlife places the order on the basis of the specification
agreed. It will be delivered direct to your home and we
will liaise with you about the delivery date. If installation
and/or training is required we will liaise with you, the local
professional or supplier to ensure this is carried out.
You don’t need to pay any deposits to suppliers or place
any orders yourself. We do not reimburse costs incurred, so
please don’t personally place an order as Newlife will not
reimburse or honour this order.
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Newlife Centre, Hemlock Way, Cannock, Staffordshire WS11 7GF. Newlife Foundation for Disabled Children. Registered Charity Number: 1001817 in England & Wales