The Scottish Government

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background and context

NHS Wheelchair and Seating Services provide a wide range of equipment for people with widely varying complexities of need. There are approximately 96,000 registered users of the service who not only need the initial provision of the equipment, but ongoing support; in most cases for their lifetime. ¹ The demands for the service are therefore accumulative and likely to grow rapidly in the next two decades. Chronic lack of profile and under-resourcing in the wider context of the healthcare delivery environment in which they are managed increases the challenges of such a diverse service.

An ageing society that is living longer, with an increasing number of frail elderly people requiring assisted mobility and postural management will need to be supported by a dynamic, efficient and effective service. Given the wider requirements of frail elderly people living independently in the community, a fully integrated assistive technology ( AT) service is indicated. The recommendations presented in this report anticipate this model for delivering assistive technology services. The Steering Group suggests that methods and organisational structures proposed for the NHS Wheelchair and Seating Service be used to pioneer the evolution of a fully integrated assistive technology service for all age groups in the next five years.

There are five wheelchair and seating centres in Scotland based in Aberdeen, Inverness, Dundee, Glasgow and Edinburgh serving a population of over five million people. Host NHS Boards run these centres with income provided by neighbouring NHS Boards. The five centres vary greatly in the size of population that they serve. There are large variations in staffing levels, funding and expenditure per registered user between the centres. ²

The NHS Wheelchair and Seating Service supports:

• young children with disabilities whose requirements have to be closely integrated with other services, including education and paediatric clinical care, and should promote full participation with the child's family members
• young people who make the transition out of children's services at a time when wheelchair and seating become increasingly important for vocational purposes, including employment
• people who acquire a physical disability as a consequence of an accident or who develop a progressive condition, and
• frail elderly people who use a wheelchair to provide mobility outside the home, or in nursing homes, frequently as a primary seating system.

Unlike most services provided by the NHS, NHS Wheelchair and Seating Services are not subject to specific performance standards. Important measures of service quality, such as timeliness of assessment and delivery of equipment, consistency in eligibility of users for the scope of possible services or the expected levels of experience and training of professionals and technicians delivering the service are lacking. Deficiencies in the service have been raised since the 1970s, in many cases through formal reports. ³ The service has not been given adequate priority and has been starved of resources that has resulted in loss of opportunity and quality of life for thousands of its users.

Despite these challenges the commitment of service staff has been extraordinary in providing the best possible support under the circumstances, however this struggle has taken its toll. The service is not perceived by many ambitious and competent clinicians to be an attractive career choice.

Numerous reports and reviews of services for people with disabilities have been published, including at least nine specifically addressing NHS Wheelchair and Seating Services. ⁴ It is widely recognised that these services have failed to keep pace with:

• the increasing aspirations of people with disabilities to participate fully in society and achieve the highest levels of self-sufficiency and independence possible
• advances in technology that can enable and enhance these aspirations
• improvements in the delivery of NHS services by setting basic quality and responsiveness standards as outlined for many services in the NHS Plan "Our National Health. A plan for action, a plan for change", and
• the need for investment in physical facilities and workforce required to deliver services that are local, family-friendly, accessible to people with disabilities and responsive to the requirements and aspirations of users and carers.

On 8 December 2004, Petition PE798 was submitted to the Petitions Committee of the Scottish Parliament by a concerned parent, supported by 1,292 users, carers and staff, within the wheelchair services requesting it to:

• resolve the current critical problems in the provision of wheelchairs and specialist seating services within the NHS by both an immediate increase in funding and through a review, which in consultation with users, will address minimum standards, the scope of equipment provided and the delivery of services, and
• recommend a strategy for the integrated provision of all equipment for people with physical disabilities.

Following the submission of the Petition, the Minister for Health and Community Care requested officials to take forward two pieces of work to:

• progress a wheelchair needs assessment review to be completed by 31 March 2006, and
• to investigate with the service what interim measures could be put in place in the short term to address the unacceptable waiting times.

Immediate steps were taken to address interim issues by an injection of £1.9 million for year 2005/6 to reduce waiting times. The Minister for Health and Community Care commissioned an independent report to review the NHS Wheelchair and Seating Service. A Steering Group, comprising of a wide range of interested stakeholders, chaired by Professor Martin Ferguson-Pell, has steered the review resulting in 40 recommendations outlined in detail in this report.

Following correct tendering procedures, Frontline Consultants were appointed to conduct the independent review of the NHS Wheelchair and Seating Service. Frontline Consultants' independent report is included in Appendix 1. This provides an extensive record of the findings of the consultation processes and comes to a consensus view of the service based on the responses to consultation.

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