HWLG(3)-WS-028 - Gogledd Gwynedd Community Health Council
Health, Wellbeing and Local Government Committee
Inquiry into Wheelchair Services - Written evidence from Gogledd Gwynedd Community Health Council
Gogledd Gwynedd CHC response to Assembly Health & Wellbeing Committee Inquiry into the Wales Wheelchair Service
1. This CHC has been represented on the Posture and Mobility Steering Group of the Wheelchair Service throughout that group’s existence.
(a) While the commitment and integrity of staff within the Service is undoubted it has been impossible to pin down details on how long people have had to wait for wheelchairs despite repeated requests for the information
(b) It is clear that enormous efforts have been made within the Service to live up to the promise of the Five Year Plan but staff have simply lacked the funding or the government backing to do so.
(c) The PMSG itself has been an example of the highest standard of partnership working between all stakeholders, and members were participants in Phase 1of the Review recently. We await the Minister’s response to this
(d) It is not entirely clear why the H&WB Committee felt it necessary to initiate this Inquiry in the middle of the Review process but if the end result is an improved Wheelchair Service that is welcome
2. The MS Society has called for Health Boards to take on responsibility for providing the Wheelchair Service but this could lead to a wide variation of service quality across Wales when what is really needed is a quicker, more responsive service that is the same wherever one is in Wales.
3. Waiting times data was presented to the Phase 1 Review recently but from talking to individual wheelchair users it is clear that the real level of delays that people experience are not captured in any data that is available. People who just need a simple wheelchair probably get a service of reasonable speed but those whose needs are more complex [and therefore potentially more urgent] face almost unendurable delays which, to be fair, are not all due to the Service itself.
(a) Initial waiting periods for a first assessment can be many months, stretching even to years for some people
(b) There then may be further delays of many months for equipment manufacturers to demonstrate their range in order to choose the most appropriate piece of equipment or combination for the individual
(c) Following this there may be a need for a further assessment meeting to decide on which equipment to use
(d) This will be followed by a waiting period for manufacture of the chair and this may mean two or more manufacturers collaborating to provide the necessary configuration
(e) If off-the-shelf components cannot be readily interfaced there may be a need for the Rehab Engineering Units to get involved to custom build something
(f) The wheelchair user or parents or Carers may not have the expertise or experience to spot flaws in the equipment straight away, but over time it may become evident that the design does not fully meet the clinical need of the client and further investigation and re-design may be needed
(g) Throughout all of this the wheelchair user will have their independence severely curtailed: for an adult this is obviously a breach of their civil rights but for a growing child this can be a disaster to their development from which they may never fully recover
4. A wheelchair service should be proactive in order to meet the needs of its clients but the Wales Service does not have resources to monitor and re-assess clients’ needs regularly. It is therefore forced to work on a crisis management basis which is not to be recommended in any area of health
5. Because of this approach the Approved Repairer Service plays a much more crucial rôle in maintaining people’s mobility and this in turn reveals the weaknesses in that organisation.
(a) Service Users [as members of PMSG] were involved in constructing the Approved Repairer Contract and this engendered some hope that rigorous monitoring and control could be used to ensure a high quality of service
(b) Many were disappointed therefore, though not surprised, that such a large international organisation should sometimes be seen to put profit before service standards
(c) Not that all the problems with the Repairer have been due to maximizing profits. Simple poor organisation has been enough to cause distressing delays for some people.
(i) It has not been unusual for repair staff to arrive with no idea what the problem is and therefore no spares to effect an immediate repair
(ii) This approach not only causes continued lack of mobility for the client but wastes limited time and resources to deal with this and other repairs waiting to be carried out
(iii) In one instance the repair agent took three home visits to replace standard inner tubes
(d) As with initial provision of equipment, if the chair is not from the standard range then extra delays are almost guaranteed
(e) In South Wales the decision has now been taken to take the Repair Service back in-house. This decision does not come without financial cost nor huge amounts of work to organise and administer the move but it is welcome nonetheless and hopefully North Wales will follow in due course
6. Many people thought that the Audit Commission Report 'Fully Equipped?’ and the subsequent excellent consultation exercise and five year plan 'A New Wheelchair Service for Wales’ heralded the beginning of a new and bright future for the Service: that was after all why many people contributed time and effort to respond in such detail to the consultation. The Assembly Government’s failure to follow through with the necessary reorganisation was disappointing to say the very least. I think that to understand fully the extent of frustration at failure to deliver it is worth quoting here just the first page of the Five Year Strategy where the Service Philosophy is laid out:
1. Service Philosophy
The philosophy that will underpin the new service is as follows.
The aim of the service will be to maximise ability and minimise disability and thereby to help people attain and maintain as much independence as possible.
Key elements of the philosophy are:
1.1 The wheelchair user will be the focus for the Service.
1.2 The wheelchair user will make a major input into his or her 'statement of need’, which will be agreed in partnership with the service provider.
1.3 The service will support people in the choices they make, providing they are safe and appropriate, and in doing so will seek to maximise the choice of equipment available to the user.
1.4 The service will promote independence and empower wheelchair users.
1.5 The emphasis will be on a lifestyle assessment which takes account of the aspirations and potential capabilities of individual wheelchair users.
1.6 The assessment process will take account of the capabilities and level of support provided by the wheelchair user’s Carer, where there is one. ("Carer” in this respect is defined as an unpaid person who will usually be a relative or partner or a close friend).
1.7 Contact with the wheelchair user will be on-going where appropriate, and will include planned re-assessments as a key feature.
1.8 The service will be forward-looking and pro-active in identifying future needs and responses.
1.9 The service will be equitable throughout Wales, founded on all-Wales service standards, access and service provision criteria and a single service specification.
1.10 Individual needs and agreed service provision will be based on a joint assessment and joint service provision (supporting agreed care plans) by the agencies involved.
1.11 The Service will be "transparent” with a free flow of information regarding the availability of services and the performance of those services.
1.12 Wheelchair users will have input into developing future service change, priorities and the on-going monitoring of service provision.
1.12a The processes involved will ensure that the assessment of clients is separated from the funding arrangements for the service.
[A New Wheelchair Service for Wales - An Action Plan For Improvement Health Commission Wales (S S) April 2004]
The bold text is as in the original. While Service Users and Carers argued long and hard for these thirteen principles this is an official NHS document, approved by the Health Commission Board, and not just some campaigner’s pipe dream and the truth is that on a national scale it is economically and socially wasteful to restrict people’s mobility and independence because you are also restricting their ability to contribute to society and / or to the economy.
Vin West Dec 09
On behalf of Gogledd Gwynedd CHC
