Health and Social Care Committee
One-day inquiry on wheelchair services in Wales
Additional information - Cardiff and Vale University Health Board – Welsh Health Specialised Services Committee
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Response to the National Assembly for Wales’s Health and Social Care Committee One Day Inquiry on Wheelchair Services |
Purpose of Paper
This paper provides further information for the Health & Social Care Committee’s inquiry into the wheelchair service, following the submission of oral evidence from Dr Cerilan Rogers and Mr Daniel Phillips on the 8th March 2012.
The paper outlines:
• progress achieved with the development of the Service Specification for Posture and Mobility Services,
• delivery plan for achieving the RTT waiting times targets for the assessment and delivery of wheelchairs for adults,
• progress achieved the delivery of the NSF waiting times targets for the assessment and delivery of wheelchairs for children,
• progress achieved against the Quality Indicators for Wheelchair Services following the baseline audit undertaken in April 2011.
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
The Partnership Board met on the 28th June to receive the latest draft of the Service Specification, self assessment audits against the Quality and Key Performance Indicators, update on Welsh waiting times for the assessment and delivery of wheelchairs, and further updates from NLIAH on their ongoing work on stakeholder and service user engagement.
Service Specification
The Service Specification document has been developed in order to specify the current level of service and equipment provision within the existing resources, and to specify the quality and performance indicators for Posture and Mobility services. The document has been developed as a public facing document which provides information for service users, carers and referring clinicians.
The document includes the following information:
• Service Definition
• Service Scope
• Service Model
• Referral and care pathway
• Relationship with other ALAS services and other wheelchair services
• Eligibility criteria
o Specific wheelchairs
o Exclusions
o Exceptions
o Joint Funding
• Quality and Patient Safety
• Key Performance Indicators
The latest draft of the document was reviewed by the Partnership Board on the 28th June. The Board agreed that following further revision to reflect the feedback from the board members, the document would be circulated to the Directors of Therapies and Health Sciences for further comment and feedback. The final draft will then be submitted to the Chief Executives of the three provider Health Boards for approval.
Once the document has been approved, it will be uploaded onto the WHSSC and ALAS website. This should be by mid summer.
Waiting Times Delivery Plan
The Welsh Government 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 delivery to user).
As detailed in the last report to the committee, one of the historical challenges to the service was lack of clear definitions to measure waiting times and linked IT system. Over the last few months the service has made significant progress in developing an interim waiting times report for the Welsh Government using the RTT principles as agreed by the NHS Delivery and Support Unit. The service has now submitted reports for April and May to the Directorate of Operations at Welsh Government. The information returns provide the following information:
• Provider
• Resident LHB
• Standard – Total waiting, up to 26 weeks, over 26 weeks
• Complex – Total waiting, up to 26 weeks, over 26 weeks
• Child
o NSF – Referral to assessment – Total waiting, up to 6 weeks, over 6 weeks
o NSF – Delivery of equipment to user – Total waiting, up to 8 weeks, over 8 weeks
These reports do not yet constitute part of a mandated dataset. In order to take this forward Welsh Government Directorate of Operations are in the process of developing a submission for the July meeting of the Welsh Information Standards Board (WISB) for the approval of a new information requirement from the posture and mobility services.
Once the information requirement has been approved, the waiting times information will be published on the StatsWales website. There will be clear links to this website from both the ALAS and WHSSC websites, in order to ensure that the information is accessible to members of the public accessing those sites.
Waiting Times – May 2012
The following waiting times were reported to the Partnership Board on the 28th June 2012:
Standard Wheelchairs
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Total waiting up to 26 weeks |
Total waiting over 26 weeks |
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BCU |
50 |
0 |
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C&V |
246 |
0 |
Adult Complex Wheelchairs
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Total waiting up to 26 weeks |
Total waiting over 26 weeks |
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BCU – Referral to 1st Asseessment Only |
215 |
54 |
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C&V – Referral to Delivery |
1181 |
55 |
Paediatric Wheelchairs – Referral to Assessment[1]
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Total waiting up to 6 weeks |
Total waiting over 6 weeks |
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BCU |
13 |
0 |
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C&V |
42 |
1 |
Paediatric Wheelchairs – Delivery to User1
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Total waiting up to 8 weeks |
Total waiting over 8 weeks |
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BCU |
14 |
0 |
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C&V |
50 |
1 |
These figures illustrate the significant progress that has been made over the last year, in particular with the reduction in waiting times for children.
At present BCU are unable to report the full pathway for complex wheelchairs, and as such they are only able to report on the wating time from referral to first assessment. Further work is being undertaken in BCU to ensure that they are able to report the full pathway for adult complex wheelchairs. Once this work has been completed it will be possible to accurately identify the number of patients waiting in excess of 26 weeks from referral to delivery of their wheelchair. Following this the Health Board will be able to develop a delivery plan for achieving the 26 weeks RTT target which will be considered by the WHSSC Joint Committee.
Since the meeting, ABMU have provided the following waiting times information for their rehabilitation engineering service:
Adult Complex Wheelchairs
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Total waiting up to 26 weeks |
Total waiting over 26 weeks |
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ABM |
29 |
2 |
Quality Indicators
The quality indicators were developed through the Posture and Mobility Review. A baseline self assessment audit against the Quality Indicators was undertaken by BCU and C&V in April 2011.
All three centres undertook a further self assessment in May 2012 in order to identify their progress against the quality indicators and measure the success of their action plans. The results were presented to the Partnership Board at it’s meeting on the 28th June. The audit indicated further significant improvement against the quality indicators, with progress noted in the following areas:
ABMU
• Single point referral process completed on demand rather than monthly – improved flow
• Improved waiting times information available through introduction of BEST (Bringing Equipment Services Together) software.
BCU
• Improved waiting times for children and adults including the adoption of RTT rules
• Alignment of BEST software
• Improved communication with referrers, service users and across Wales
C&V
• Improved compliance with RTT rules
• BEST software developments in procurement and record keeping
• Most service information leaflets are now translated into Welsh.
• Closer working relationships have been developed with the range of stakeholders via the work led by NLIAH
• User training will be started this year
• Clinical, technical and engineering staff will all soon be depot based which will improve service provision, staff development and career opportunities.
The audit also highlighted that further development was required in the following areas:
ABMU
• Formalised channels of communication with clients
• User engagement – link with consultation project
BCU
• Full pathway software development
• Further communication developments
• Further streamlining of processes
C&V
• Planned Preventive Maintenance
• Capacity review for all groups of staff
• Braille translations for key documents
• Hearing loop for the Depot
• All Wales Oracle link
• Ambulance transport for depot clinics
Regular updates against these areas will be submitted to the Partnership Board. The Board will also be reviewing the quality indicators over the forthcoming months to ensure that they are still fit for purpose.
Conclusion
The Partnership Board continue to review the progress of the Posture and Mobility services in implementing the recommendations of the Posture and Mobility Review. The service specification document is nearing completion, and subject to the approval of the Health Board Chief Executives this document will be available on the ALAS and WHSSC websites from mid summer.
The services are continuing to make significant progress in the reduction of waiting times for the assessment and delivery of wheelchairs. Following the issue of the WISB guidance it is anticipated that the waiting times information will be available on the StatsWales website from late summer.
The self assessment audit indicate that the services are continuing to make progress in achieving the quality indicators, and the Partnership Board will continue to monitor their progress on an annual basis.