October - November 2015
Consultation response form
Setting the mandate to NHS England for 2016 to 2017
Consultation Questions
1) Do you agree with our aims for the mandate to NHS England?
Whizz-Kidz is supportive of the overall aims of the mandate to NHS England. In order to
meet the overarching ambition of the mandate to improve outcomes, services which have
been demonstrated as unable to deliver consistently good and equitable standards of care
need to be specifically addressed by the mandate.
It is widely recognised that wheelchair services are failing to provide consistently good and
equitable standards of care. If the NHS is to meet the needs of disabled children and
adults and reduce the health inequalities that exist for this vulnerable and often
disenfranchised group, wheelchair services must be overtly referenced.
As a national disabled children’s charity and the largest provider of paediatric mobility
equipment outside of the NHS, we receive between 600 – 900 referrals for children and
young people’s wheelchairs every year through our charitable provision. Most of our
referrals come from the NHS so we know first-hand that wheelchair services are failing to
provide consistently good and equitable standards of care.
We support the work of the Wheelchair Leadership Alliance in asking for wheelchair
services to be specifically mentioned within the mandate.
With the evidence that the Wheelchair Leadership Alliance has been able to collate from
the following sources, it is clear that positive change in wheelchair services is essential if
the aims of the mandate are to be achieved:
The 2 national wheelchair Summits in February 2014 and November 2014
The wheelchair summit service improvement workstreams
NHs England’s wheelchair services tariff, data set and commissioning resources
workstreams
http://www.england.nhs.uk/ourwork/pe/wheelchair-services/nhse-role/
The NHS Improving Quality Wheelchair Services e-Digest
http://www.rightwheelchair.org.uk/index.php/resources/nhs-iq-e-digest
The Wheelchair Charter development and launch
http://www.rightwheelchair.org.uk/index.php/areas-of-work/the-charter
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The Right Chair Right Time Right Now Campaign http://www.rightwheelchair.org.uk
2) Is there anything else we should be considering in producing the mandate to NHS
England?
Include more specific service improvement targets for NHS England within the mandate
which would enable specific steers for CCG improvement programmes; this should include
a need for improvement in wheelchair services.
Overtly referencing the need for improvement in wheelchair services would give a
mandate to NHS England to enable wheelchair users to access a service that meets their
needs, improve health and patient safety, reduce NHS on costs associated with poor or no
provision, enable integration of services and budgets and improve quality of life for
disabling long term conditions and life limiting conditions.
We believe that wheelchair services could be used as an exemplar to demonstrate the aim
of setting a mandate of long term duration, especially in setting budgets for 3 or more
years. It would have huge positive impact on a large, vulnerable and often disenfranchised
health population. Prescribing the right chair and postural support by looking at the whole
lifetime cost of the equipment, cannot be achieved within an annual budget but would bring
efficiencies and significant cost savings over a longer period.
3) What views do you have on our overarching objective of improving outcomes and
reducing health inequalities, including by using new measures of comparative
quality for local CCG populations to complement the national outcomes measures
in the NHS Outcomes Framework?
The overarching objectives are to be commended and using comparative measures to
achieve nationally consistent outcomes is important.
To achieve the objectives, services which have never before been given any priority, need
to come alongside those already in the public domain. It is therefore essential that
wheelchair services are addressed within the mandate.
Significant variation persists in wheelchair service provision and where provision is poor,
significant harm, waste and delays result. Disabled children and young people are on
waiting lists without any equipment or with an ill-fitting wheelchair for too long – on average
its two years, and in many cases longer.
Reformed care pathways for wheelchair services which deliver high quality patient care
and best value for money should be mandated to prevent unintended harm with expensive
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secondary consequences such as pressure sores and fractures, exacerbation of ill health
for the wheelchair users and completely avoidable carer burden.
In expecting NHS England to work with CCGs and other partners to reduce variations in
quality of care and outcomes at a local level, the areas of greatest variation in quality of
care and outcomes should be specified and given priority. One such area is wheelchair
provision. If included in the mandate, then NHS England will be empowered to influence
and guide all CCGS to bring their services in line, ensuring a national quality standard is in
place
4) What views do you have on our priorities for the health and care system?
Q4 : Referencing individual priorities in the mandate:
We agree with the priorities for the health and care system. There is no doubt that within
the priorities, wheelchair services should be specifically mentioned in order that
improvement changes can be effected that work towards all the priorities as described.
Without a national mandate to improve wheelchair services the NHS will fail to meet the
needs of disabled children and young people and the mandate will not meet its objectives.
Preventing ill health and supporting people to live healthier lives
Significant variation currently exists in wheelchair service provision and where provision is
poor significant harm, waste and delays result. Reformed care pathways for wheelchair
services which deliver high quality patient care and best value for money should be
mandated to prevent unintended harm and prevent exacerbation of ill health. Wheelchair
users should be specifically mentioned if this is to happen
Creating the safest, highest quality health and care service
Implementing quality standards and working in a holistic manner with wheelchair users,
their families and carers, social care, education and work could produce improvements in
health, wellbeing and independence as well as have positive effects on NHS budgets and
promote innovation, integration and efficiency.
Ensuring provision of the right chair at the right time is imperative if harm, waste and
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delays are to be avoided. Wheelchair services should be overtly included as a programme
of work to improve patient safety and reduce harm
Making wheelchair services a priority improvement area for CCGs, will bring about huge
improvements in patient and carer experience to what is currently an overlooked and
vulnerable, yet important, group of people.
Maintaining and improving performance against core standards while achieving
financial balance
There a range of long term health and economic benefits to providing appropriate mobility
equipment. For example the right wheelchair can prevent disabled children and adults
from developing pressure sores. It could potentially save hospitalisation at a cost on
average of £4,000, and even spinal surgery that can carry a cost of £40,000.
Whizz-Kidz has worked in partnership with 12 NHS Wheelchair Services nationally in order
to improve the wheelchair service for their customers. Our flagship service is at Tower
Hamlets and we have been collaborating with Tower Hamlets Wheelchair Service since
2007. In our first year of collaboration we saved the service £250K.
Improving wheelchair services can affect major benefits to the economy. A report by
Frontier Economics demonstrated Whizz-Kidz’s Social Return on Investment and showed
that for every £1 spent by the charity on the appropriate wheelchair, between £10 and £65
is generated for the economy as young people gain increased independence and can take
up more education and employment opportunities.
Transforming out-of-hospital care
3.19 ‘objective for NHS England to support the transformation of out-of-hospital
care using whole system approaches to ensure people get the right care in the right
place at the right time. For 2016/17 this would also mean the continuation of the
Better Care Fund’
We would urge demonstrating this using wheelchair services as an exemplar, where
ensuring provision of the right chair at the right time is imperative if harm, waste and
delays are to be avoided.
Include wheelchair services as an improvement programme to improve patient safety and
reduce harm
Driving improvements in efficiency and productivity
We would suggest that Wheelchair services would be a perfect exemplar by using
innovative and flexible budgeting, working with key partners to strengthen integration
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across health, social care, work and education and enabling the accommodation of
individual needs, independence health and wellbeing.
We would suggest that there should be a two-year programme of Quality, Innovation,
Productivity and Prevention (QIPP) activity to deliver quality and efficiency improvements
within wheelchair services.
Supporting research, innovation and growth
By supporting clinicians, manufacturers and independent organisations working together,
innovative, affordable products and solutions can be developed within wheelchair services
Whizz-Kidz has identified some potential and high impact solutions to support the NHS to
deliver better outcomes for wheelchair users and cost savings. This includes online
applications and care plans, a ‘Chair in a Day’ model, innovative procurement and service
provision and mobile assessments and delivery.
5) What views do you have on how we set objectives for NHS England to reflect
their contribution to achieving our priorities?
How the objectives are set inevitably produces general statements and without specifically
directing the mandate, marginalised services will persist with variable standards and a
postcode lottery. If standards are to be driven up, creation of cost efficient and quality
standards have to be mandated and shared throughout the CCGs. This is why it is so
important that wheelchair services improvement must be referenced specifically within the
NHS mandate.
Whizz-Kidz knows first-hand how providing the right wheelchair early enough in a child’s
life can have a massive impact on their development, independence and freedom.
The objectives set in the NHS mandate cannot be met if a vulnerable group of patients
with long term and / or life limiting conditions (circa 1.2 million) is left on the side-lines.
Without inclusion in the mandate CCGs will continue to discount wheelchair services as a
priority and the inequalities in experience of care and outcomes will persist within a
postcode lottery.
Wheelchair services were recognised in the 2014/16 mandate under Mandate 4,
(supporting people with long term conditions) which stated “Develop an outcomes based
specification for wheelchair services by December 2014” and which so far, remains
undelivered. It is imperative that the service continues to be developed to a quality
standard, which will assist CCGs and integrated services in working to achieve quality of
life improvements for patients and carers, whilst bringing significant cost benefit to the
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system.
Wheelchair services could be a superb exemplar of the overarching aims if overtly
included in the new mandate and would bring a service that has been consistently
marginalised up to the standard of care that would be expected of a modern NHS,
reducing health inequalities that impact on a significant sector of the population.
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