All Wales Posture and Mobility Review – Phase Two Project Board
In May 2008 the Minister for Health and Social Care announced a review of wheelchair provision in Wales. The review would encompass long and short-term loans, adult and paediatric wheelchair services. The review was undertaken in two phases. Phase 1 reported to the Minister in October 2009, and described service provision across Wales including how current services are managed. The review recommended changes to improve the experience of service users. Phase 2 took the recommendations of Phase 1 and, through the work of individual workstreams, looked, in closer detail, at the eligibility criteria, quality indicators and key performance indicators together with a range of actions to ensure provision of an efficient and effective service to both established and new users. This Project Board began meeting in May 2010. The Alliance had 2 members of its Executive on the Project Board which reported in October. The NHS has already instigated a service improvement programme, led by relevant LHBs, supported by the National Leadership and Innovation in Healthcare Agency (NLIAH) and the Delivery and Support Unit (DSU). The improvement programme commenced in September 2010, and was built on work already underway in each of the local wheelchair services. It was also recommended that the proposed all Wales specifications be implemented and performance managed through a Partnership Board that would replace the current Posture and Mobility Steering Group. This phase of the review also undertook further detailed assessment of ‘short term’ wheelchair loans, and identified options for how these could be funded and provided. Each of the individual sub-groups provided recommendations for their service areas outlining how improvements could be implemented. In summary, these included: Performance and Quality Workstream * Adoption of proposed eligibility criteria, classification system and quality standards. * Annual self assessment and national audit through a proposed Partnership Board. * A phased implementation of waiting times targets as specified in the performance indicators. Initial phasing to concentrate on reducing component waits, prior to implementing a maximum referral to delivery time of 18 weeks. Waiting List Management Workstream * Immediate transition to the national rules for managing referral to treatment, regardless of whether waiting lists continue to be managed on a component or RTT basis. * A consistent approach to waiting list management. Standardised policy and procedures should be developed to incorporate the current RTT rules and definitions and how they should be applied. * Staff to be trained in the implementation of the procedures to support the changes to RTT reporting. * Whenever possible, the service should ensure that patients are treated in turn, allowing for considerations of clinical priority. * Long waiting times to be actively monitored and all services should ensure that they have early warning systems and contingency plans in place to identify and manage potential waiting list problems. This will require the adoption of a primary targeting list approach. * Routine validation of all waiting lists. Evidence Base and Service Development Workstreams * The findings from this review need to be communicated to the service and stakeholders. The preferred format would be a workshop involving all the service areas. This should focus on the areas for improvement and the development of an action plan. The outputs from this workshop would be subject to a 60-day review by DSU and NLIAH. This is being taken forward by the NHS. * A prospective data collection should be undertaken. The information from this would be used to provide an accurate assessment of the capacity of the service to meet both current and future demands. A prospective study would enable the benefits which would be achieved from implementing other recommendations in this report to be factored into a demand and capacity analysis. This in turn would inform future decisions on priorities and investment. * A detailed study of duties currently undertaken by clinicians should be carried out. This would identify areas where further clinical capacity could be released from administrative tasks. * Information systems should be integrated to enable information sharing across the services. * Current training programmes should be extended to include:- Accredited training for community therapists Basic maintenance training for clients and carers Manual handling training for carers Training for clients in the full functionality of their equipment * A wider review of the procurement process would identify opportunities for improvement across all services. * Extending the range of information collected to include qualitative data such as patient stories and patient diaries would provide an added dimension to assessing service quality. Short term Wheelchair Loans (STWL) * Standard eligibility criteria for the provision of short term wheelchair loans should be developed. Increased user dependence should be factored in to assessments. * There should be clearer signposting for services. Users and carers report current confusion. It is often unclear where wheelchairs can be provided from and what the process is. * The potential increase in demand for STWLs to help support earlier discharging from hospital should be assessed. * A further short study on the demand for STWLs from other commissioned agencies should be undertaken. Once the scale of demand and supply is established, and the provision of STWLs is mapped across Wales, it would be possible to consider additional efficient and effective methods for delivering the service.