CWHHE Wheelchair Service Redesign Newsletter
For wheelchair service users and colleagues across Barnet, Brent, Central, West, Hounslow, Ealing and Hammersmith & Fulham CCGs
August 2015 – Issue 1
Seven Clinical Commissioning Groups (CCGs) across North West London (NHS Barnet, NHS Brent, NHS Central London, NHS West London, NHS Hounslow, NHS Ealing, and NHS Hammersmith and Fulham) are seeking to jointly commission a high quality, transformed wheelchair service. Central London CCG is hosting this work.
This is the first of a planned series of bi-monthly newsletters to update you on progress and emerging themes with the service redesign and reprocurement process.
- Overall service re-design and re-procurement – we are currently reviewing this and will be making a proposal to the Finance and Performance committees across the CCGs to ensure that we are undertaking a robust and consultative service re-design and procurement process. We will be able to confirm what has been agreed in the next newsletter.
- Governance – We have reviewed governance structures for this work and decided to streamline some of the meetings in order maximise input from clinicians and service users. Over the summer, we will set up a Service Redesign Group which will include commissioners, clinicians and service users. Draft terms of reference will be circulated and its remit will be to review the results of the clinical audits to be undertaken (see below) and advise on the development of the service specification and key performance indicators.
- Benchmarking – We are investigating different types of wheelchair services to inform our commissioning across North West London, Barnet and Brent. The results, including the business case, will be included in programme documentation.
- Finance – We need to thoroughly understand the costs of current services and how best to design the future financial model. Diane Pearson, Assistant Director of Finance for Central London CCG, is leading on this work with input from other CCG finance leads Diane is linking with Department of Health teams developing a national tariff for wheelchair services.
- Process mapping and clinical audits – We are very pleased to have Meg Bodycoat working with us to help us to develop a more detailed understanding of current services and the service user experience. Meg is the Clinical Lead Therapist at Guys and St Thomas’s wheelchair service and has considerable expertise. Meg will be undertaking process mapping interviews with current services in order to understand issues such as local clinical standards, , criteria are and response times. Meg will then design a clinical audit in order to get more systematic information on how services are delivered. This will be agreed through the Strategy Board and internal governance process of each CCG.
Feedback so far
As you will also know, we have undertaken several wheelchair user engagement events over the past months designed to generate feedback and help us identify the important themes for this service redesign and procurement process.
This section summarises the valuable feedback we’ve received from these events, including the following:-
- Service Redesign and Consultation event, Westminster University 18 March
- Process mapping events 24 March & 25 April
- Ealing and Brent Event, Wembley Centre for Health 26 March
- Brent Event 17 March
- There is a need to standardise and update the stock offering. Service users would like the NHS to provide flexibility and a wider variety of equipment that better fits user needs and includes innovative design and colour choice.
- Instructions on safe use, cleaning, and routine maintenance of the wheelchair should be provided upon delivery.
- Wheelchair delivery, set up, and collection of wheelchairs should work concurrently.
- Postcode lottery – differing eligibility criteria across assessment services.
- Logistics for dealing with wheelchair suppliers and maintaining stock need improvement to ensure adequate stock levels. Wheelchair manufacturers should be held accountable for the timely delivery of equipment and parts.
Assessment and delivery
- Services should be easily accessible by public transportation, have sufficient parking (blue badge included) and disabled bays, mobile vans to access people for home visits when needed, and transportation offers to and from service when necessary.
- Assessment service personnel should be able to ask detailed and targeted questions to understand the needs of service users and their goals, aspirations, and levels of independence. Service users expressed the need for a more personalised service that feels supportive of the end user and looks at clinical condition and lifestyle as a whole when determining which wheelchair to recommend.
- The assessment service has a responsibility to assess the carer or parent’s needs in addition to those of the user.
- There is a need for a clearer outline of of the assessment and delivery process – some service users felt this process wasn’t clearly explained. Service users would love to see a map of services as some service users were not familiar with the assessment and , delivery process and voucher scheme.
- A more “just in time model” is needed between the assessment and delivery of wheelchair to the end user. (To reduce spending and improve competitiveness, a business can switch to an alternative method of stock control called just in time. With just in time, a business holds little or no stock and instead relies upon deliveries of raw materials and components to arrive exactly when they are needed)
- Service users would like the opportunity to try out a wide range of equipment or lease equipment for a week or two before committing.
- Flexibility is needed in collection and delivery times with customer focus, in addition to better coordination between delivery and collection of wheelchair.
- Assessment services should work jointly with primary care, GPs, social workers and occupational therapists to ensure the service user’s full needs are known.
Maintenance and repairs
- Acceptable response times, no unnecessary delays, and responsive out of hour maintenance for wheelchairs is needed, similar to Automobile Association services.
- Engineers should be well trained, informed by customer care about the problem, and equipped with appropriate spare parts to repair the wheelchair on their first visit.
- Replacement or courtesy wheelchairs should be provided to cover extended periods of repairs or maintenance. Information should be made available to the public about this service and how to access it, including criteria for the loan period of chairs
- The NRS (hardware and maintenance service) should adopt a more customer-focused model. They have done a poor job in the past of explaining to service users how to use equipment and how to prevent problems recurring.
- Regular maintenance check-ups are required to make service users feel more at ease with the equipment.
Integrated user system
- Service users expressed the view that communication between the wheelchair service, repair service, service user, and all other stakeholders is poor and needs major improvements. A central Information Technology system accessible to the wheelchair service, repair service, and clinical services would ensure proper communication to all parties involved and may be the best way to coordinate all efforts. Local integration of assessment, approved repairer, rehab engineer and special seating services working over 7 days would deliver benefits such as reliability, fewer appointments, more efficient use of time and money, availability, and equity of service. (Communication between call centre and engineers can often be poor at NRS). The engineers should also be able to view the database of the chair each service user.).
- A range of locations for wheelchair services such as community venues, children’s centres, schools and GP surgeries would make the service more accessible.
- No one currently owns the service pathway from assessment to delivery. Someone easily reachable by the service user, who knows who to contact to resolve problems, needs to own it. This role would ensure cases go from problem to solution quickly. A leaflet explaining who and where to go to for help with repairs, complaints, loan chairs etc. should be given to new and existing service users/carers.
- All stakeholders involved need a clear understanding of their roles and responsibilities. The wheelchair service and repair service need a clear understanding of their roles, responsibilities, and expectations. A governance and monitoring system should be put in place to ensure the pathway is working as outlined and services are adhering to the service specification.
- Safeguarding procedures need to be clearly outlined in the service specification and all staff properly trained on the correct processes and procedures. Actions need to be taken quickly and there must be a way to ensure no cases fall through the cracks. Service users should be aware that safeguarding procedures are in place.
- Service users should have a clear understanding of what sources of funding are available to them, what the voucher scheme is, what services are available and when, and what response and delivery times to expect for equipment and repair.
Information supplied by:
Mona Hayat, Associate Director of Service Transformation & Pathways, NHS Central London Clinical Commissioning Group, firstname.lastname@example.org
Alison O’Grady, Programme Manager, Central London CCG, alison.o’email@example.com