Health and Social Care Committee

HSC(4)-08-12 paper 7

One-day inquiry on wheelchair services in Wales – Evidence from the British Red Cross

 

 

Short Term Standard Wheelchair Services in Wales

 

1.       Background         For many years the British Red Cross [BRC] in Wales has lent medical equipment for short periods of time as a charitable service, and the main items being lent have been standard wheelchairs for both adults and children.  Over the past 6 years, however, the number of wheelchairs being lent has increased very significantly [from 4,996 in 2010 to 5,997 in 2011 – a 20% increase over the year], and the overall deficit to BRC budgets has steadily increased [Budget deficit for 2011 was forecasted to be in excess of £300,000].  Accordingly the BRC made representation to the Welsh Government and the NHS in Wales as to the untenable and financially unsustainable situation concerning the future of this service.

2.       Introduction        As a result of the representation made,this short paper addresses the recommendations made in 2010 concerning the provision of a short term standard wheelchair service in Wales.  In so doing it takes forward specifically the recommendations of the National Assembly for Wales, Health, Wellbeing and Local Government Committee[1], and the All Wales Posture and Mobility Review [2] .  For easy reference the recommendations, as germane to Short Term Standard Wheelchairs were:

 

a. Health, Wellbeing and Local Government Committee

 

·         Recommendation 10. We recommend that the Welsh Government should explore with the service, voluntary organisations and charities, options for providing the best possible interim solutions for users who will be waiting for significant periods for delivery or maintenance of a chair.

·         Recommendation 12. We recommend that the Welsh Government should explore opportunities for joint working between ALAS and organisations, charities, community therapists and others, and that this should form a central part of the service’s strategic plan

·          Recommendation 18. We recommend that the Welsh Government should review arrangements for short-term loans of wheelchairs, which are not provided by ALAS, to ensure that this service provision is adequately resourced.

·          Recommendation 19. We also recommend that the Welsh Government should ensure closer joint working between ALAS and those providing short-term loans of wheelchairs, particularly the British Red Cross.

 

b. All Wales Posture and Mobility Review

 

·         There are no forecasts of the number of potential users if the service was freely available to all. 

·         There are no standard eligibility criteria for short term wheelchair loans;

·         The definition of “short term” varies from organisation to organisation;

·         There needs to be clarity in signposting to the service as it is unclear from where wheelchairs can be obtained and how this service is accessed;

 

3.       Way Forward       

It was recognised that progress could be made prior to publication of the report in the area of STWL’s and a meeting was arranged in September 2010 with representatives invited from the ALAS, BRC (Wales), NLIAH, other NHS bodies and WAG. The key areas the group decided to initially concentrate on were to:

·         Look into picking up each other's equipment from users if possible, thereby saving time, fuel and improving turnaround times.

·         The sharing of training.

·         Consider purchasing arrangements to see if we could negotiate a better deal with suppliers for BRC and ALAS.

·         Do some work on facilitating information sharing as initiatives were taken forward.

 

Significant progress has been made with these initiatives and much closer collaboration between the ALAS and BRC has ensued. To take the recommendations the paper “Developing a protocol between NHS Wales and the British Red Cross in Wales” has been presented by the BRC and accepted as a way forwards. In essence this paper takes forward the recommendations under two strands of work:

 

·         The BRC to retain the status quo [Delivery from 11 sites in Wales] and to provide an enhanced short term wheelchair service in pilot sites and collect data to address the recommendations/data requirements above.  Initially these enhanced pilot sites will be the Local Health Boards areas of Hywel Dda, Aneurin Bevan, and Betsi Cadwaladr.

·         To continue and improve further cooperation and joint working ALAS/BRC and examine interfaces and the potential for efficiencies and improving the patient experience.

 

4.      Pilot Sites   In 2011/12 the BRC have agreed with the LHB’s of Hywel Dda, Aneurin Bevan, and Betsi Cadwaladr to enhance the current service provision in those locations as pilot projects.  Work has started on the following:-

 

Since April 2011 KPI data concerning waiting times has been collected by BRC across all LHB areas in a common format and of the 4,950 wheel chairs loaned in the 9 months from April to December 2011 only 94 Service Users (1.9%) did not receive their equipment within 3 days.

 

5.      ALAS/BRC Cooperation The ongoing work by the Short Term Wheelchair Loan Group remains a fundamental building block for the future partnership working with ALAS. Work currently being undertaken by the Society will continue to refine the methods of data capture such that it consistently and accurately reflects existing levels of service and so provides a sound base for more accurately predicting future demands.  This will be especially important in understanding accurately the proportionality of referral pathways, and the seamless data sharing arrangements with ALAS.

 

This work is expected to lead to economies and far better MIS information resulting in:

·         The exchange of basic data to identify shared Service Users ensuring they receive appropriate equipment and do not rely on the STWS

·         Methodologies for enhancing the patient experience when they are shared Service Users i.e. Service Users who use a BRC wheelchair prior to taking delivery of a permanent ALAS chair [ Moving from 4 journeys and 2 chairs to a single chair and only two journeys]

·         The possibility of  common stock purchase arrangements

·         Rationalisation of delivery/collection transport arrangements – BRCS and ALAS are already collecting each other’s equipment for return where this is appropriate

·         The possibility rationalising of storage facilities

·         Sharing of training – BRC medical loan staff have received training from ALAS on the assessment of Service User requirements

·         Sharing of beneficiary impact measurement tools

 

6.      Finance       As identified the projected shortfall in funding by the BRC for this service in 2011 was in excess of £300,000 and this is predicated also on the level of donations and small amounts of LHB/LA funding being protected.  In order to facilitate the 2010 recommendations (Para 2 above) the Welsh Government have put provision in place to fund the BRC £100,000K per annum from 2011 – 2014 this will both limit the BRC deficit whilst facilitating also the pilot schemes.

 

7.      Next Steps  The BRC will continue to engage with LHB’s to move forward with pilot arrangements in order to produce a method of joint working resulting in an overall improvement in service delivery which can be demonstrated.  The “Best Practice” resulting from this can then be incorporated in a Model Service Specification available to all LHBs to adopt if desired.

 

The BRC will also continue to refine data collection methodology to assist both BRC and the NHS (Wales) in understanding the Short Term Loan “business” – e.g. the number of loans issued to reduce DTOC.

 

The Society will also be reviewing stock holdings with a view to “pooling” stocks so that temporary shortages in one area can be remedied by transfers from another.

 

 

8.       Conclusions         In overview the BRC would acknowledge the huge progress made on this subject in the past 24 months especially given a very long problematical history.  On a very positive note the programme of cooperation with ALAS especially continues to bear fruit. 

 

 

 

J A Collins                                                                      March 2012

Director Wales


[1] Report on Inquiry into Wheelchair Services in Wales May 2010

[2] Phase Two Date: October 2010