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costings for recommendation categories
funding of recommendations
The NHS Wheelchair and Seating Service has, for many years, been seriously constrained in the support and mobility equipment it can offer service users. As a result of the service having a relatively low profile to date, allocation of financial resources has been severely restricted. 44 Further, since 1996 the funds available have reduced in real terms, apparently to meet alternative priorities within the host NHS Boards.
In line with the specification for this review, having prepared the recommendations, the Steering Group requested that Frontline Consultants prepare indicative costs for implementation of the main categories of the recommendations. Table 1 indicates that a substantial increase in funding is required if the service is to be brought up to an acceptable standard to provide users with a service that delivers social inclusion and freedom from unacceptably restrictive eligibility criteria. Given the broader scope of the service proposed in the recommendations, future funding for the service should be on a multi-agency basis, but hosted and managed by the NHS. At present it is common for users and carers as individuals to have to seek multi-agency funding for equipment needs. They are often not familiar with the funding structures of government and frequently fail to obtain the resources they need. It is therefore proposed that multi-agency funding for the service is agreed at Scottish Executive level to reduce this burden on users and carers and to improve equity in accessing multi-agency support for their needs.
The costs give a broad indication of the financial support needed to deliver the recommendations outlined in this document, based on available information, with some input from service providers. However it is important to note that the figures are very much an informed estimate. It will therefore be imperative that allocation of additional money to specific centres or projects would only follow on from the preparation of detailed proposals in the form of fully costed business cases and implementation plans, setting out financial requirements from both capital and revenue streams with the latter split between recurring and non-recurring revenue.
Table 1 summarises the estimated additional revenue consequences of the recommendations, including the recurring revenue effect of potential capital investments. It may be that capital rather than revenue investment will be required to fund specific elements of building development or expensive equipment but pending production of detailed proposals, an assumption has been made for the sake of simplicity that all investment will be of a revenue nature. What is important at this stage is not the source or nature of funding requirements, but the overall amount required.
The phasing suggested for improvements is ambitious, and it is anticipated that it may be constrained by the ability to recruit staff. If implementation takes place at a slower pace, it will be important to ensure that total funds are not lost.
Table 1 - Additional revenue funding required to support recommendations
Recommendation | Short term
< 1 year
full year
(£000s) | Medium term 1-3 years full year (£000s) | Long term/
recurrent annual
(£000s) |
|---|
Year 2 | Year 3 |
|---|
Redesign of service delivery | 1,528 | 2,515 | 2,535 | 2,580 |
|---|
Referral, assessment and provision of equipment | 6,475 | 10,020 | 9,985 | 8,905 |
|---|
Management of the service | 87 | 147 | 147 | 147 |
|---|
Information management and systems | 35 | 110 | 60 | 60 |
|---|
Training | 210 | 560 | 560 | 560 |
|---|
Repair, maintenance and support | 250 | 1,900 | 1,920 | 3,350 |
|---|
Facilities required to expand the service | 100 | 75 | 75 | 75 |
|---|
Particular considerations for children's services | 50 | 130 | 130 | 130 |
|---|
Total (£) | 8,735 | 15,457 | 15,412 | 15,807 |
|---|
Source: Frontline Consultants (Appendix 1)
Notes
1. The current NHS Wheelchair and Seating Service has available funding of £14.2 million per annum. 45 In order to effect the implementation of the recommendations of the Steering Group additional funding will be required. This would be in the order of an additional £8.7 million for the first 12 months of implementation. For years 2 and 3 of implementation, a further additional £6.7 million would be required each year. Then to maintain a steady state after successful implementation of all the recommendations recurrently, an additional £15.8 million would be required from the 2005/06 position of £14.2 million, giving a total of £30 million.
2. Contained within this additional £15.8 million is a funding stream of £6.6 million per annum for additional wheelchairs and powered wheelchairs plus £1.2 million for modernising the existing fleet.
3. The highest cost programmes comprise:
- redesign of service delivery: substantial increase in local access however provided - revenue costs of leasing facilities or the equivalent cost of building and owning them
- referral, assessment and provision: funding for equipment, based on significant increases to the wheelchair fleet in years 1-3 due to the removal of current restrictive eligibility criteria, followed by more frequent replacement and increased demand
- referral, assessment and provision: additional staff time for regular reassessment and full discussion of mobility plans with service users following assessment, and
- repair, maintenance and support: introduction of a PPM programme across Scotland, plus regular replacement of older stock currently in the wheelchair fleet.
4. It should be noted that while costed recommendations specific to the children's service are included, the costs relating to additional staffing and equipment are contained within the recommendations that relate to redesign of service delivery for the service and referral, assessment and provision.
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