Equipment and Seating Reports: The Criteria the HSE Has Already Published

Who can prescribe, and what the qualifier means

The manual is short on this and worth quoting exactly: "Approved personnel who can prescribe include physiotherapists, occupational therapists, public health nurses, speech and language therapists and clinical engineers with the appropriate skills and competencies."

The last seven words are doing the work. Being an occupational therapist gets you onto the list. It does not get a particular item approved. The HSE wrote the document, in its own words, "to provide clear prescribing criteria to assist prescribers in evidence-based decision making, and to improve the quality and safety of the healthcare they provide." That is a description of a checklist, and the checklist is the part most clinicians have not read.

One thing the manual does not do is say anything about employment status. It names professions. It does not say whether a private occupational therapist outside a Community Healthcare Organisation can prescribe from the list directly, and we are not going to tell you that it does. In the specialised seating pathway, Enable Ireland’s guide says the prescription is sent to the occupational therapist in your Health Service Executive area, who reviews it and forwards it for funding. If you are in private practice, assume your report is an input to an HSE therapist’s decision, and write it for the person who has to sign for the money.

The criteria that apply to everything

Page 17 of the manual carries the Common Prescribing Criteria. Every item in the 150-page list sits under them. The ones that shape a report:

• "The service user has been assessed by a trained healthcare professional, to determine that there is a clinical requirement and absolute necessity for the aid/appliance."
• "Equipment has been selected with regard to the safety and efficiency of both the service user and/or carer(s) who will be using it."
• "Where appropriate the service user’s living environment has been assessed and deemed suitable for use of the prescribed aid/appliance."
• "All clinical and manufacturers contraindications for use have been excluded."
• "Specifications of the prescribed aid/appliance match the service user’s essential clinical need only and any unnecessary higher specification products or features, that are desirable rather than essential, are not prescribed."
• "The aid/appliance has been trialled. The service user and/or carer(s) have been instructed in the use of this item and are deemed safe in its use."
• "All assessment findings and related actions and interventions are fully documented in the service user’s clinical record which is retained locally by the prescriber."

"Absolute necessity" is a higher bar than "would help"

Consent, a demonstration of safe use, the loan agreement, and a check that the person can read the instruction book are on the same page. None of them is hard. What is hard is writing so that a reader can see each one has been met.

Most queried recommendations are written at the level of benefit. The criterion is written at the level of necessity, and the assessor is reading for the second word. "A riser recliner would help Mrs B get up from sitting" is benefit. "Mrs B cannot rise from a standard chair without two-person assistance, her son works days, and she has been sitting on the edge of the bed until he returns because she cannot get out of the armchair. A riser recliner removes the second person from a transfer she makes nine times a day" is necessity. Same clinical picture. Only one of them has answered the criterion.

The condition most reports never answer

Look at how the hoist criteria are built. Standing hoist: "All other non-hoist aids and methods have been considered and cannot be used." Mobile floor hoist: "All other non-hoist and hoisting aids and methods have been considered and cannot be used." Portable overhead gantry hoist: "All other hoisting aids and methods have been considered and are not suitable due to physical or environmental constraints." Three items, one shape. Each one asks you to list what you did not choose.

That is the condition most equipment reports never write, because from inside the assessment it feels like working. You considered the transfer board and the turntable on the visit and they were obviously wrong. The assessor was not on the visit. If the ruled-out options are not on the page, the criterion has not been met on the page, and the page is what gets read.

So write the list. Name the alternatives and say why each one failed for this person: "Transfer board considered; Mr K cannot maintain sitting balance unsupported for the duration of a lateral transfer. Standing hoist considered; he cannot weight bear through either leg since the fracture and the manual states the standing hoist must be withdrawn during any period of complete non weight bearing ability. Mobile hoist is the first option remaining." Four sentences. They turn a preference into a decision the assessor can check against the list.

The same logic runs through the rest of the manual. Appendix 2 says a request for an electric profiling bed "should never be proceeded with until such time as the feasibility of using domestic bed aids is concluded." For adult wheelchairs, prescribers "must fully utilise recycled wheelchairs" from the local loan pool "before proceeding to request a complete wheelchair purchase." Every one of those is a ruled-out list waiting to be written.

Specification, and why "as required" fails

The manual asks that specifications "match the service user’s essential clinical need only". Then it goes further and names the failure mode: features "that are desirable rather than essential, are not prescribed."

That sentence is aimed at the report that says "tilt-in-space wheelchair with pressure cushion as required." It names a category and a wish. It does not name a seat width, a seat depth, a backrest height, a cushion risk band, a user weight, or the interface with anything already on loan. The manual’s own pressure cushion section is sorted by risk band, "At Risk", "High Risk" and "Very High Risk", so a report that does not state which band the person sits in has not told the assessor which page of the list applies.

Be specific to the point of tedium. Name the item, the size, the configuration, the user weight against the product’s limit, and how it fits with what is already there. The sling criteria say it plainly: the sling "is compatible with the hoist product which will be used", and the prescriber "has demonstrated the best practice hoisting process and documented same in the manual handling care plan which is available to carer(s)." That is the same specificity the Irish moving and handling report asks for, and on a home visit it is usually the same document.

The hoist the HSE will not fund

Page 25 has one sentence worth pinning above your desk: "Permanently fixed overhead tracking hoists are not funded by the HSE. They may be funded via Local Council grant schemes."

So a ceiling track hoist is not an equipment prescription at all. It is a works recommendation, and it goes to the local authority through the Housing Adaptation Grant or the Mobility Aids Grant, where an occupational therapist’s report is required. What the HSE will consider is the portable overhead gantry, and only where the person "has a high level of dependency; long term complex needs and/or end of life care requirements, is frequently in bed and requires lifts associated to that level of care."

That is two funding routes, two documents and two readers for what a family experiences as one problem. If you are writing the grant report, the Housing Adaptation Grant guide covers what the council needs. If you are writing the equipment report, do not put the ceiling track in it and expect the HSE to act.

There is a second funding line that catches private clinicians. Citizens Information states: "If you are prescribed aids and appliances, you can get them free if you have a medical card, a Health Amendment Act Card or are on the Long Term Illness Scheme." Your report should say which of those the person holds. Where they hold none, do not imply HSE supply is automatic, because nothing in the published rules says it is.

Custom seating and the national pathway

Postural support cushions and custom seating systems are on the national list, so a local prescription is possible. Complex seating in Ireland also runs through a national specialised service, Enable Ireland’s SeatTech, and its referral gate is narrow and geographic.

In the service’s own words, you can be referred if "You attend an Enable Ireland service in Dublin, Wicklow, Kildare or Kerry", if you attend an Enable Ireland Adult Service Centre, or if "You live in any of the following Health Service Executive Areas: Dun Laoghaire, Dublin South East and Wicklow, and you are referred by the HSE Occupational Therapy Manager in your area." Enable Ireland publishes a referral page for referring therapists. A clinician outside those areas is not a referrer, and a report that promises a SeatTech assessment to a family in Galway has promised something the clinician cannot deliver. Those areas are quoted as published and can change; check the page before you name the pathway to a family.

What a seating report can do anywhere is carry the findings the pathway will otherwise repeat. SeatTech assesses the person while they are sitting in their own chair and while they sit and lie on a plinth. If your report already has the postural findings from sitting and supine, the measured dimensions and the pressure risk band, it shortens the next clinician’s job instead of restarting it.

School seating goes to a different funder

If the seating is for a classroom, none of the above applies. The Department of Education runs its own scheme, and the school applies, not the family and not the HSE. The Department asks for "An Occupational Therapist report which includes a recommendation for SEN furniture and equipment that is being applied for, signed, and dated by the Professional", plus "One supplier quotation, inclusive of VAT and delivery charges". If approved, "the money will be transferred to the school’s bank account." (gov.ie, Special Needs Furniture and Equipment)

So a paediatric OT writing for a child’s classroom chair is writing to a different reader with a different checklist, and a report built on the HSE criteria will answer questions that funder is not asking. Know which desk the report lands on before you write it.

What goes in the file, not just the application

The documentation criterion is not about the form. It says findings, actions and interventions are "fully documented in the service user’s clinical record which is retained locally by the prescriber." The application is a summary. The record is where the justification has to live, and a year later it is the only thing that will explain the decision.

CORU’s code for occupational therapists says the same from the other direction. Records must be "identifiable as being made by you, using your registered name and registration number", "dated and timed", and "completed as soon as practicable following assessment, intervention or treatment". The trial, the demonstration, the alternatives ruled out and the person’s consent all belong in the record with a date, whether or not the application form has a field for them.

The HSE also publishes a one-page prescriber checklist as Appendix 1 to the national list, linked from the same page as the manual. It is the assessor’s side of the conversation. Read it before you write, not after the query comes back.

Writing a report that answers each criterion in turn takes longer than writing a recommendation. Carearoo drafts Irish equipment and seating reports from your assessment notes, on your template or ours, and you review and sign. The first report is free and each one after that is €59, no subscription, on Carearoo for Ireland. If you are also billing the visit privately, the Irish OT invoice guide covers what goes on the invoice.

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