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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 [email protected]. 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: [email protected] 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 [email protected] 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: [email protected] 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: [email protected] 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 [email protected] 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: [email protected] 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: [email protected] Nurse Chat: www.newlifecharity.co.uk/live facebook.com/newlifefoundation 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. 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
