In the past 10 years, wheelchair provision has become more holistic, more affordable, and more personal. How, and why has this happened? What are the benefits for wheelchair users?
Clive Bassant, Millbrook Healthcare’s Community Liaison and Engagement Officer for East Kent and Service User Engagement Lead for the National Wheelchair Alliance, identifies the key changes.
Clear product information and professional clinical knowledge
NHS Personal Wheelchair Budgets and joint funding schemes
Making sure equipment meets individual care outcomes
Feedback and communication
Using service user feedback to improve service delivery
Qualitative outcome reporting
Showing the impact actions taken in response to feedback
A wheelchair user for 30 years, Clive has experienced first-hand the frustration of finding a suitable wheelchair.
“Equipment was old-fashioned one-size-fits-all, so I ended up finding my own equipment primarily on eBay,” says Clive. “When you look at equipment now, it is excellent. I’m using a standard issue chair for our Kent contract, and we have all sorts of options available to meet individual clinical need.”
In Clive’s words, a wheelchair is not just a piece of medical equipment. It’s equipment that gives mobility, and mobility is key to independence.
Millbrook makes it easier for users and prescribers to understand what equipment is available through clear product information and the knowledge and experience of our professional clinical team.
Following the introduction of NHS Personal Wheelchair Budgets in 2019, it’s easier for people to obtain high quality, suitable wheelchairs. Partnerships between service providers and agencies have also led to joint funding schemes for users.
“When someone falls through the cracks of PWB, a panel goes through the case and looks at the assessment,” explains Clive. “We ask, can any of the problems be mitigated by other solutions?”
This compassionate, outcomes-led approach can help to find alternative solutions that fully meet user needs.
“Even in my two years at Millbrook, I’m starting to see a change in assessments,” says Clive. “It used to be entirely down to the clinician to assess medical need. If the individual disagreed, they would have to find their own solution. Now, in line with direction from senior management, we can be more holistic.”
By clearly understanding a person’s health conditions and the relationship between them, Millbrook provides the right equipment, first time.
According to Clive, more awareness of the social model of disability has changed WCS by breaking down the societal barriers that make life more challenging for disabled people.
“Clinicians have come to me and ask me to review their approach with respect to the social model of disability, although Millbrook’s staff are naturally social model minded.”
Millbrook’s case-by-case approach makes sure equipment directly meets individual care outcomes, reducing pressure on wider health and social care services.
Feedback and communication
“We use service user feedback to scrutinise service delivery performance,” says Clive. “Millbrook really prioritise feedback, looking at proper impact on the user.”
Negative feedback, while challenging, presents opportunities.
“Don’t be frightened of complaints. You need to use this evidence to improve services. And,” Clive adds, “if people aren’t telling you, they’ll be telling other people.”
Rather than reacting to feedback and complaints, Millbrook reaches out to users to build relationships and address possible issues early on.
“We have to explain why we do what we do,” says Clive. “The basic reason is to help as many people as possible. Initially, we help people in line with medical requirements, but do the very best we can to build on that. It’s part of a bigger picture and there’s more awareness of that now.”
However, there is a difference between speaking with users and speaking at them.
“Look at the way you communicate,” suggests Clive. “Don’t make assumptions and make sure lines of communication are respectful and meaningful. Once you start communicating, you make that process seamless for everybody.”
To support communication with users, Millbrook has introduced the Community Liaison and Engagement Officer role along with Community Health & Engagement Officer (CHEO) roles which are now being introduced for new contracts. CHEOs go out into the community to speak directly with users, carers, family, and friends, leading to more understanding.
Qualitative Outcome Reporting (QOR) validates the actions taken in response to feedback and communication, evidencing and driving service development.
Clive explains that a robust programme of QOR helps Millbrook understand how equipment impacts service user’s lives medically, socially, professionally, and emotionally.
“Key Performance Indicators used to be just numbers, for example, how many people you assess in a certain amount of time. Now, funders want to see that we’re improving lives, not just hitting numbers.”
The wheels of change
Through improved equipment, better funding, personalised assessments, feedback, communication and outcome reporting, the past 10 years have seen huge improvements in WCS. This has led to more engagement and stronger relationships across health and social care networks.
For Clive, the most important change has been embracing and acknowledging user experience. This means playing a part in the wider community, networking with users and other organisations to understand what is truly needed to meet their complex requirements in full.
“Within our Service Improvement Board in East Kent, we work closely with the CCG. Service users help us raise the temperature on unmet needs, feeding into strategic review,” he says.
“We’ve transformed our service through user engagement. How do you know what your users think if you’re not engaging with them?”