« Previous | Contents | Next »
Listen
4. Resources
4.1 Improved Infrastructure
Recommendations Covered
Recommendation 23 - communication links between centres and staff working locally
Appropriate communication links will be established to ensure that staff working remotely from the centre can lead assessments, and access information and advice. Experienced staff in specialist centres ( e.g. spinal injury/head injury, multiple sclerosis, stroke units) may wish to directly assess the requirements of the user and carer who may be based in their facility. They will need to seek approval for supply of the equipment based on the assessment and an agreed mobility and seating plan.
Recommendation 24 - improvements to infrastructure
The infrastructure to provide training on wheelchair and seating needs to be established and accredited. All staff, including reception, administration and technical staff, will receive training in 'customer relations' with an emphasis on the specific requirements of people with disabilities and their carers.
Executive's response
These recommendations support the Joint Future position that staff involved in assessment and care management should have access to shared electronic records. Examples of good use of modern technology exist in Fife, with the use of palm pilot computers and a web based system in the Scottish Borders. Delegation of access to wheelchairs should be as full as possible and should avoid bureaucratic systems for approval. Approximately 80% of chairs are currently issued without the need for specialist intervention. However, relevant training may be required to increase the capacity to assess and issue wheelchairs. Care must be taken to ensure that the point at which further referral is required is clear and easy to implement.
Care should also be taken to include the user and carer in technical discussions during assessment. This could be achieved by telemessaging for example.
Accreditation should encompass the wider equipment and adaptation competency framework and other agendas such as sector skills. Currently all NHS staff are required to undertake disability awareness training, although wider policy issues such as multi-complex needs and equality must also be addressed.
The Executive has recently launched new guidance for improving access to NHS services, to assist all staff within NHSScotland to understand and meet their responsibilities under Part 3 of the Disability Discrimination Act. It covers rights of access to goods, services, facilities and premises for disabled people. Fair for All - Disability is a partnership between the Scottish Executive Health Department and the Disability Rights Commission. The initiative aims to remove the barriers that Scots with disabilities sometimes experience when they use the NHS. The guidance is available to view on line atwww.fairforalldisability.org
There may be scope for addressing the skills/recruitment issues by training existing health/social care staff to undertake some of the work associated with the Wheelchair Service. This has the benefit of increasing people's skills base and may offer a wider pool of people from which to recruit, especially if they are able to work in an area which offers career development opportunities.
4.2 A Career Structure
Recommendations Covered
Recommendation 25 - review career structure for service staff
A review should be undertaken by NHS Education for Scotland ( NES) to ensure that an appropriate career structure exists for clinicians and technicians delivering wheelchair services.
Executive's response
The Executive recommends that career paths should not be confined to Wheelchair services. There is a need to maintain flexibility and movement in and out of the service. The training and development agenda should be seen in the wider health and social care context within Joint Future. Any formal course, however, should include the opportunity for at least six months work experience within one of the five Centres.
NHS Education for Scotland ( NES) has not been formally charged with undertaking such a review. Training needs should relate to existing Local Delivery Plan targets.
Details of the NHS Career Framework have been announced by the Minister for Health and Community Care. It has nine levels and is based on workforce competences at each level of responsibility. The framework can be seen on line atwww.skillsforhealth.org.uk/careerframework
4.3 Reviewing Staffing Levels
Recommendations Covered
Recommendation 26 - review staffing levels throughout the service
A review will be undertaken to determine whether current staffing levels are adequate and whether the most appropriate skill-mixes are in place.
Executive's response
NHS Boards should consider the staffing requirements, including the level and skills mix, to deliver the agreed service model as part of their ongoing workforce planning function and take the necessary steps to implement this. The Review highlighted considerable variations in levels of staffing and skills mix across the five Centres. It is recommended that the service explore which models are proving most effective in terms of service delivery and adopt best practice.
4.4 Staff Training
Recommendations Covered
Recommendation 27 - appropriate training for service staff
Staff referring to the service should receive appropriate training.
Executive's response
The Executive agrees there is a need to increase awareness of the services provided by the Wheelchair and Seating Service, and that simpler and more transparent processes for referral would improve the overall service to users and carers. Consideration should be given to the provision of web-based training and raising awareness levels of procedures in place. A mechanism to check understanding should be built in to such a process for staff likely to refer.
Staff training was essential in the implementation of the Single Shared Assessment. It was one of the difficulties identified in the implementation of Care Management - hence the requirement for the National Training Framework referred to in comments made on Recommendation 10.
4.5 Access to Paediatric Staff
Recommendations Covered
Recommendation 38 - provide access to specialist paediatric clinicians
Clinics will provide access to specialist paediatric clinical expertise as needed.
Executive's response
NHS Boards should ensure that all patients have access to appropriate clinical expertise. Some centres do not, in reality, deal with many children. However, they should have local arrangements in place that allow access to appropriately trained paediatricians when necessary. This recommendation could be addressed in part in the training package (see recommendation 27). There is an opportunity to consider better use of modern technology, such as telemedicine to address some of the issues raised under this recommendation.
4.6 Child Facilities
Recommendations Covered
Recommendation 35 - facilities will be family friendly
All facilities will ensure that they are family-friendly with dedicated waiting areas and clinical facilities for children.
Recommendation 37 - all services for children provided in child-oriented facilities
All services for children will be undertaken in family-friendly, child-oriented, facilities by staff specially trained in the assessment of children with requirements for wheelchairs and seating.
Executive's response
The Executive supports the proposal of providing family friendly facilities, and dedicated waiting areas and clinical facilities for children. The Executive considers this to be best practice and is working with existing hospitals and new builds to achieve this. This will ensure that parents will feel more comfortable bringing young children to the services. Consideration should also be given to the environment in which children are treated. This is an area where national guidelines should be established.
Recommendation 37 concentrates on the aspect of staff being specifically trained to deal with the assessment of children. Boards and professional bodies should consider what additional training needs there may be to achieve this, as well as ensuring adequate service delivery from their existing skills base.
4.7 Teams to Deal with Children
Recommendations Covered
Recommendation 36 - children to have access to a multi-disciplinary team
Children should have comprehensive access to a multi-disciplinary team when being assessed or reviewed for wheelchair and seating systems.
Executive's response
The Executive supports this recommendation and encourages CHPs to consider the particular needs of children at assessment. Everyone involved in the care and treatment of the child, including the child's family, teachers etc. should be aware of the decisions made by service staff and should participate as necessary to ensure a seamless delivery of service.
4.8 National IT System
Recommendations Covered
Recommendation 22 - national IT system to support management
A robust national IT system allowing management of waiting lists and equipment, and facilitating performance comparisons will be established. This will have the facility to link to the electronic patient record and record comprehensive information about each user and the equipment they use.
Executive's response
The Executive is aware that an IT system ( ReTIS) has been developed by the service to specifically meet the needs of the wheelchair service and prosthetists. This has been rolled out and training is ongoing. Building upon this platform to establish a more robust, fit-for-purpose system to monitor performance and aid service delivery is encouraged as an important element to improvement. The Executive looks to ReTSAG to drive this forward.
The eHealth strategy as outlined in HDL(2005)46 requires that there is convergence of systems across Scotland which are web based and that there should be an incorporation of data standards and assessment proformas. Data set development workshops are currently ongoing to work towards multi-professional service delivery, single shared assessment and the single patient record.. (Further information is available on the eHealth websitewww.show.scot.nhs.uk/ehealth).
4.9 Mobility Pathways
Recommendations Covered
Recommendation 6 - establish evidence-based mobility pathways
Documented, evidence-based mobility pathways (similar to 'patient pathways') will underpin all stages of the service provided to users and carers.
Executive's response
The service is currently working towards this model. The Executive notes that the Rehabilitation Technology Information Service ( ReTIS) IT system requires further development to address the wider issues.
The service should develop a set of generic pathways reflecting best practice. The Advisory Group should ensure that this is given priority, and that it includes the performance standards. This pathway should dove-tail into the wider "user pathway" approach, which looks at roles and responsibilities across the equipment and adaptations agenda in community care. The Rehabilitation Framework will also have input into this model. The principles of Single Shared Assessment and Joint Future will be underpinned by developing the ReTISIT model to deliver the data required to monitor the service to users and carers.
The Executive has already issued guidance to NHS Boards requiring them to develop NHS Carer Information Strategies in partnership with local authorities, carer organisations and the voluntary sector. These can be found on the web at: http://www.sehd.scot.nhs.uk/mels/HDL2006_22.pdf
4.10 Multi-agency Links
Recommendations Covered
Recommendation 40 - establish multi-agency links
Centres will establish properly functioning multi-agency links.
Executive's response
The establishment of multi-agency links is a main strand in Delivering for Health. All CHPs should consider meeting the needs of users and carers of the Wheelchair and Seating Service in their Local Delivery Plans and in wider Partnership Agreements.
4.11 More User Information
Recommendations Covered
Recommendation 13 - users and carers to be offered more information about the service
All users and carers will be offered a simple introduction to the NHS Wheelchair and Seating Service so that they understand:
- the purpose of the assessment and associated individual mobility and seating plan
- their right to appeal the specifications of the equipment to be supplied
- how to provide feedback to the service, including the complaints process, and
- procedures for obtaining repairs and preventative maintenance.
Executive's response
The Executive understands that an information leaflet, covering these points, has been developed by one region of the service and will be rolled out nationally. It is important to ascertain the languages it should be available in, the mediums to use and who is the target audience. The Executive recommends that advice is sought from the Scottish Accessible Information Forum and/or the Scottish Consumer Council in preparing this information.
4.12 User Groups at Centres
Recommendations Covered
Recommendation 18 - each centre will establish user and carer working groups
User and carer working groups will be established in association with each centre. The groups will provide advice to the centre and will be supported with basic secretarial services to enable them to confer with other users and carers.
Executive's response
Experience indicates that it can be difficult to actively engage users and carers in shaping the service at local level. It is recommended that existing local networks should be nurtured, including the voluntary sector, and that the support needs of the individual to allow participation should be taken into account. Each regional centre should assign a member of staff to be specifically employed to communicate effectively with users and carers. Boards should undertake an annual review on user and carer satisfaction.
Consideration should be given to representatives of local networks also being a member of the national Advisory Group, to ensure issues of local and national interest are addressed.
« Previous | Contents | Next »