Health and Social Care Committee
One-day inquiry on wheelchair services in Wales
WC 12 Welsh Health Specialised Services Committee (WHSSC)
Response to the National Assembly for Wales’s Health and Social Care Committee One Day Inquiry on Wheelchair Services
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Purpose of Paper
This paper provides evidence to the Health & Social Care Committee’s inquiry into the wheelchair service, on the extent to which the recommendations made by the Third Assembly’s Health, Wellbeing and Local Government Committee’s Report on Wheelchair Services in Wales, have been implemented.
Background
The Welsh Health Specialised Services Committee (WHSSC) is a joint sub committee of the 7 Health Boards in Wales. Health Boards have delegated their responsibility for planning and funding specialised services, including the Artificial Limb and Appliance Services, to WHSSC. WHSSC funds the provision of these services within Abertawe Bro Morgannwg University Health Board, Betsi Cadwaldr University Health Board and Cardiff and Vale University Health Board.
Partnership Board
Following the release of the final report of the All Wales Posture and Mobility Review, the Welsh Government asked the Director of Specialised Services to establish the All Wales Posture and Mobility Partnership Board. One of the recommendations of the review was the establishment of the Partnership Board to focus on the auditing of quality standards and delivery of the key performance indicators, as a measure of the quality service delivery.
The Partnership Board has met on four occasions. It is chaired by Daniel Phillips, Director of Planning, WHSSC. The Terms of Reference and Membership for the Board is attached as Annex (i).
The Partnership Board membership was extended to include the Delivery & Support Unit (DSU) and the National Leadership & Innovation Agency for Healthcare (NLIAH) to ensure that all plans for service improvement for wheelchair services are coordinated through the Partnership Board, although the accountability for implementation of some of the recommendations for the review are outside the remit of WHSSC.
The Partnership Board includes representation from service users, Health Boards, WHSSC, Local Education Authorities and Social Services. It is attended by the Welsh Government policy lead for the Posture and Mobility Service.
Service Improvement Programme
In the Autumn of 2010, the Posture and Mobility Service commenced a service improvement programme, with the support of DSU and NLIAH. The purpose of this programme is to implement specific recommendations of the Review. NLIAH facilitated the selection of priorities for the first phase of this programme.
A detailed progress report against each of the recommendations of the Review was presented to the Partnership Board in October 2011. Some of the key areas of progress include:
· Developments to improve waiting list management:
o Agreement of definitions for measuring referral to delivery
o Systems in place to enter all patients on waiting list within 24 hrs of receipt of referral, ability to actively monitor long waits/early warning systems/trigger points
· Upgrade of IT systems to support waiting list management
· Unification of IT system across Rehabilitation Engineering and ALAS
· Establishing satellite clinics
· Agreement to commence joint assessments with community therapists
· Changes in skill mix/allocation of duties introduced as a result of analysis of duties untaken for capacity and demand analysis
A update was presented to the Partnership Board on the 1st March and a further update will be presented to each future meeting.
Waiting times
The Welsh Government has invested a recurrent resource of approximately £2m from 2011/12 to support improvement in the wheelchair service, with particular emphasis on delivering the waiting times standard in the Children and Young People’s National Service Framework (NSF) (6 weeks referral to assessment, 8 weeks assessment to delivery).
Since February 2011 there have both centres have made significant reductions in waiting times for both adults and children. The improvement for children is notable, as in February 2011 children were waiting in access of 32 weeks for assessment. By the end of March, it is expected that their waiting times will have reduced to 6 weeks.
Waiting Times Definitions
One of the historical challenges to the service was lack of clear definitions to measure waiting times and linked IT system. In the meeting in July, the Partnership Board agreed definitions to apply to the Posture and Mobility Service.
This guidance have been developed by the DSU in conjunction with the Posture and Mobility Service, as part of a work stream of the service improvement programme. The implementation of these definitions has now enabled the service to report robust waiting times, within a framework consistent with those applied to other areas of healthcare.
Service specification
The Partnership Board has established a work stream, led by Clive Sparkes, Chief of Staff, Therapies and Clinical Support Programme Group, Betsi Cadwaladr University Health Board, to make sure that service users are clear on what equipment is provided by the Posture and Mobility Service.
Existing access criteria state that the service will provide equipment to meet essential posture and mobility. The workstream will also explore options for delivering a service that is able to address the broader social and lifestyle requirements of users (noting that with an increasing range of equipment available, there is also an increasing ability and demand to maximise individual potential).
The Partnership Board has recognised that these options must be explored within the context of a fixed budget. Work on this is well advanced, and the final phase is due to conclude in Autumn 2012.
User Representative Engagement
In October 2011, the Partnership Board approved a proposal to take forward the Service User Workstream, with three years funding provided by the Welsh Government. The workstream is overseen by the Partnership Board but reports to the Welsh Government. The aim of the workstream is to develop a system that facilitates improved engagement with service users in order to inform the ongoing and future development of the wheelchair service. The remit of the working group is to:
The Partnership Board has made significant effort, over it’s four meetings, to ensure that the service user representative can contribute effectively to it’s work and that the user experience is at the centre of service provision.
Quality Indicators
Quality Indicators and Key Performance Indicators were developed through the Wheelchair Services Review. A self assessment against the Quality Indicators was completed by both centres, and was presented to the Partnership Board in October 2011.
The self assessments revealed that both centres had already achieved the majority of indicators. The Partnership Board has agreed action plans with both centres to ensure that all of the indicators can be achieved by September 2012.
A report will be submitted to the Welsh Government at year end that sets out the waiting times achieved by 31st March.
Conclusion
Following the Posture and Mobility Review, a significant amount of work has been undertaken by the ALAS service in implementing the recommendations. The net effect of which has been to transform the way in which the posture and mobility services are delivered, most notably through improved data management processes which together with the additional funding from the Welsh Government has resulted in dramatic sustained reductions in waiting times. The development of the Partnership Board has ensured that the services can now be audited against the delivery of quality standards and the key performance indicators, and the coordination of that all plans for service improvement for wheelchair services.
Annex (i)
All Wales Posture and Mobility Service
Partnership Board
Terms of Reference
1.0 Introduction
This paper establishes the All Wales Posture and Mobility Service Partnership Board as an Advisory Group to the Welsh Health Specialised Services Committee (Joint Committee).
2.0 Accountability
The Partnership Board is an Advisory Group to the Welsh Health Specialised Services Committee.
The Posture and Mobility Service is part of the Neurosciences and Complex Conditions Programme Group within the planning structures of the Welsh Health Specialised Services Committee management team. The Partnership Board will provide advice to the Joint Committee through the Neurosciences and Complex Conditions Programme Group.
3.0 Purpose
The Posture and Mobility Service is planned and funded by the Local Health Boards through the Welsh Health Specialised Services Committee (Joint Committee).
The purpose of the Partnership Board is described in the All Wales Posture and Mobility Service Review (October 2010):
It is recommended that a partnership board is established in order to audit the service against the quality indicators and to review and refresh the indicators on an annual basis.
4.0 Terms of Reference
The Terms of Reference of the Partnership Board are as follows:
· To advise the Joint Committee with regard to the Quality Standards and Key Performance Indicators
· To review performance against the agreed Quality Indicators and Key Performance Indicators, and report to LHBs through the Joint Committee
· To revise, as the Board deems appropriate, the nature and target levels of the Quality and Key Performance Indicators, and to advise the Joint Committee of any changes proposed
· To advise the Joint Committee on the scope and eligibility criteria for the Posture and Mobility Service
· To provide advice to the Joint Committee on the specification for the Posture and Mobility Service
· To provide a forum for communication and discussion between the providers of the service and its stakeholders
· To promote understanding between the Posture and Mobility Service and its stakeholders
· To support the provision of a high quality and responsive Posture and Mobility Service for Wales
5.0 Task and Finish Groups
The Partnership Board may establish Task and Finish groups.
6.0 Membership
Membership will be drawn from across the wide range of stakeholders of the Posture and Mobility Service (service users, Third Sector groups, Social Services, Education Authorities, Local Health Boards)
Name |
Designation |
Organisation |
Dan Phillips, Chair |
Director of Planning |
Welsh Health Specialised Services Committee |
Fiona Jenkins |
Director of Therapies and Health Science |
Cardiff and Vale UHB |
Clive Sparkes |
Chief of Staff, Therapies and Clinical Support Programme Group |
Betsi Cadwaladr UHB |
Chrissie Hayes |
Director of Planning
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Powys tHB |
Stuart Davies |
Director of Finance
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WHSSC |
tbc |
Medical/Nursing Director |
to represent all LHBs |
Andrew Fordham |
Flintshire CBC |
Representing Directors of Education |
Mark Jones |
Wrexham CBC |
Representing Directors of Social Services |
Damian Chick
|
Service user representative |
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Emma Reeves
|
Service user representative |
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Rachel Jones
|
Service user representative |
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Michael Butterfield
|
Service user representative |
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Vin West
|
Service user representative |
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Henry Langen
|
Service user representative |
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Karen Beattie
|
Service user representative |
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Lynne Hill
|
Service user representative |
Policy Director, Children in Wales |
Lee Ellery |
Service user representative |
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Pam Mainwaring |
Head of ALAC |
Betsi Cadwaladr UHB |
Helen Hortop |
Head of ALAS |
Cardiff and Vale UHB |
Nigel Shapcott |
Clinical Director of Medical Physics |
Betsi Cadwaladr UHB |
Gareth Atkins |
Head of Rehabilitation Engineering |
Abertawe Bro Morgannwg UHB |
Luke Archard
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Specialised Planner for Neurosciences and Complex Conditions |
Welsh Health Specialised Services Committee |
In attendance |
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Alison Strode |
Therapy Advisor for Wales (and policy lead for posture and mobility services) |
Directorate for Public Health and Health Professions, Welsh Assembly Government |
Liz Singer |
Associate Director |
National Leadership and Innovation Agency for Healthcare |
James Ross / Sue Rowe |
Associate Director |
Delivery Support Unit |
7.0 Partnership Board Meetings
The Role of Chair
The Welsh Assembly Government has asked that the Welsh Health Specialised Services Committee Chair the Partnership Board. The Director of Planning, WHSSC, has been asked to act as Chair.
Engagement
The Chair must ensure that the Partnership Board’s advice on all matters brought before it is given in an open, balanced, objective and unbiased manner. In turn, individual Group members must ensure that their contribution to the Group’s decision making is based upon the best interests of users of the Posture and Mobility Service.
The Partnership Board will be considered quorate when 51% of total membership and at least 3 user representatives are present.
8.0 Secretariat
The function of secretariat to the Partnership Board will be undertaken by the Welsh Health Specialised Services Committee through the Planner for the Neurosciences and Complex Conditions Programme. This will include arrangements for Partnership Board meetings, preparation of papers and coordination of actions agreed by the Board.
9.0 Frequency of Meetings
The Partnership Board will meet at least biannually. The meetings will be held alternately between South and North Wales augmented by video conferencing.
10.0 Members’ Expenses
Members of the Partnership Board who are employees of statutory and third sector organisations, and who attend the Partnership Board meetings as part of their normal working role, should apply to their own organisations for payment of expenses.
Members of the Partnership Board who are not employees of statutory or third sector organisations may apply to WHSSC for reimbursement of out of pocket expenses such as travelling expenses, child care or other care costs, incurred in attending Partnership Board meetings.
11.0 Review
These terms of reference shall be reviewed annually by the Partnership Board.