Health and Social Care Committee
One-day inquiry on wheelchair services in Wales
WC 11 North Wales Artificial Limb and Appliances Service, Betsi Cadwaladr University LHB
Introduction
In response to the recommendations of the 2010 Health, Wellbeing and Local Government Committee Report on Wheelchair services a considerable amount of work has been undertaken and is ongoing to achieve the outcomes required. This evidence report will aim to summarise the efforts, achievements and work in progress and will not repeat any evidence provided for the initial inquiry.
All Wales Working
Several workstreams have been established on an All Wales level to progress and monitor compliance with the recommendations. The North Wales service has been actively involved in these workstreams, which have been facilitated via NLIAH and DSU, with performance monitored via the Partnership Board. These activities have been carried out in conjunction with service users and representatives as well as a broad range of clinical referrers and have been monitored using a 45 day cycle method. Joint working is outlined in the table below showing the activity adopted in North Wales and mapped to the recommendations.
Workstream Activity |
Recommendation |
Waiting List Management
|
6
8
6 |
Capacity & Demand
|
11 |
Service User Engagement
|
8 |
Referrals
|
13 |
Training
|
14
3
23 |
Service Specification
|
1
8 |
Partnership Board
|
1, 2, 4, 5 |
Contracts
|
21 |
North Wales Posture & Mobility Service
The North Wales service has been working hard to make improvements in line with the recommendations. In addition to targeting waiting times for children, effort has been focussed on establishing the foundations for improvement (in terms of structure and process) and we expect to realise further benefits over the next 12 months. The following table outlines some additional examples of ongoing work and achievements in North Wales; they are mapped to the recommendations for evidence of progress.
Activity |
Recommendation |
Significant progress with NSF Referral to assessment time of 6 weeks for children achieved. Delivery to fitting time of 8 weeks forecast to be achieved by end of March |
7 |
Implementation of software to allow management of pathways to RTT rules |
7 |
Process mapping of referral and admin pathways undertaken to streamline services and increase capacity (further process mapping planned in March 2012) |
Continuous Improvement |
Organisational restructuring by bringing REU and ALAS into a single Posture & Mobility directorate led by a Clinical Director appointed in Oct 2011 with clear lines of responsibility via the Chief of Staff to the Executive Director of Therapies & Health Science |
4 |
Working with community therapy services to improve integration via regular meetings, rotational posts, secondment opportunities, training, supervision |
3, 12 |
Developing detailed operating instructions and criteria |
Continuous Improvement |
Developing user links e.g. Disability Sports Wales, MS Users Forum |
8 |
Improved communication with Approved Repairer service, monitoring of performance and improving service delivery
|
10
10 20
21 |
Joint clinics established between Rehab Engineering and Wheelchair therapists |
3 |
Daily duty therapist in place to deal with referrals and queries to reduce delays and improve communication |
9 |
Additional clinic sites established |
3 |
97% of standard chairs are delivered within 21 days (target 95%) |
Continuous Improvement |
Maximum referral to assessment time for adults has reduced from 23 months to 15 months and is forecast to be 12 months by end of March |
Continuous Improvement |
Referral to assessment time for powered wheelchairs has reduced from 12 months to 8 months and work is ongoing to ensure further reduction in waiting times |
Continuous Improvement |
Information pack for clients on the website |
8 |
Communication with Whizz Kidz and meeting planned to discuss working better together e.g. on joint funding and training for children |
12 15 |
Reorganisation of admin systems are in progress to streamline the processes and provide better communication with clients |
Continuous Improvement 8 |
All existing clients can be re-referred into the service, children will be seen within 6 weeks whether new or re-referral |
22 |
Assistance provided from CPG Performance team showing evidence of commitment from Health Board to service redesign and improvement |
Continuous Improvement
|
Future Progress Required
It is recognised that we are continuously improving the service and we have focussed our attention on some priority areas initially. The following table outlines areas of the recommendations and general improvement still required.
Activity |
Recommendation |
Additional funding was provided in 2011 for the paediatric service; however, further resources are required to sustain and progress improvements in adult services. Historically waiting times have been longer in North Wales and recurrent funding is required to bring these down to acceptable levels for adults. |
11 |
Further exploring of options for joint funding in relation to equipment for service users |
17 |
Further consideration regarding regular reviews for existing service users, in particular for children and those with changing conditions |
22 |
Work needs to be done to establish and monitor meaningful outcome measures |
5 |
Further streamlining of processes and patient pathways |
Continuous Improvement |
Ongoing development of IT solutions to support improvements and changes |
Continuous Improvement |
Ongoing work on communications via the user engagement workstream and between the service and all stakeholders |
8,9 |
Summary
The overall picture is one of significant progress and achievement; the NSF access targets for children are being achieved and with further resources a similar improvement can be achieved for adult services. There is now a culture of continuous improvement within the service; the foundations have been set to achieve further improvements with the client at the centre of service provision and design. We are proud of the achievements to date and are looking forward to progressing at pace over the next 12 months.