NHS South West Wheelchair Review

1. NHS South West Wheelchair Review Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way

2. The current approach to the service is unsustainable • Substantial Growth users approximately doubling every 10 years • increase in numbers of complex patients particularly children who will be life long • 15 years+ of failing reports • Frustration in the community over lack of action • Strategic decisions will have to be made about what the service should be for • Mobility or lifestyle (Current rationing of complex patients) • Universal or focussed • Do we care for carers • We need to improve signposting and assisting people in self care • The service is currently highly complex and requires reshaping and changing the boundaries • There is a need for a collective approach to drive efficiency and outcome improvement Radical transformation of the service is required

3. Users and their Carers High growth increasing expectations Greater complexity Opportunities for earlier / self assessment We are currently not spending our money wisely Supply Base Provide of the shelf or bespoke equipment Wheelchair Service Undertakes mechanical modifications Bespoke fitting and accessories Assemble and fit deliver and handover Hold inventory and spare parts Own maintenance and repair issues Refurbish and recycle The service carries out complex bespoke engineering - manufacturers in the best position to drive efficiency do not, we incentivise them to do the opposite – We need to harness the supply base and use their skills and energies to drive QUIPP The service supply market dynamic needs rebalancing

4. Process and areas of analysis Complex Assessment Referral Screening/ Validation/ Triage Assessment Decision Authorisation Issue/ handover Review Maintenance Repair Modification Rapid issue Areas of consideration • E referral systems to improve process efficiency • Decision support tools to increase complexity that can be directly issued • Inventory reduction • Product design issues • Direct sourcing • NHS chair • Cross agency funding • Life time costing • Common eligibility criteria • Contact centre triage to increase speed of issue improve data • Self assessment • Potential separate route for complex patients • Modification vs using flexible chair and standard accessories • Delivery of completed chair from manufacturer • Direct issue from manufacturer • Requirement for regular review vs strong signposting and patient ownership • Requirement for regular maintenance • Potential for this to be the responsibility of manufacturer • Potential for this to be the responsibility of manufacturer Non process areas of consideration • What elements should be regionally based – procurement, triage procedure, assessment criteria, inventory and pricing. • How do we obtain 24 hour postural care? • Who cares for carers? • How far do we move to a market approach? • Should we introduce personalised budgets? • Do we use an internet decision support to assist customers in selection of service/product • Should we buy chairs outright or lease/rent? • How far should we recycle? • Should we return stock to manufacturers for them to own the recycling with an cost reduction • What is the forecast volume for the service? • How is the split between simple and complex expected to change? Streamlined process will reduce timescales increase time for complex patients and align responsibility for improvement with a capability to do so

5. Assessors • Home Visits • Accredited assessors with decision support • Clinic sessions • Able to innovate solutions • Generic prescribing Contact Centre • Triage Expertise • Information • Appointment setting • home visits • regional clinic • Order processing • Customer servicing Procurement Experts • Outcome based commissioning • Supplier Relationship Management • Contract Management • Customer Feedback process • KPI/Metrics Users Suppliers • Personalised budgets • Choice • Cross agency funding • Feedback driving market • Respond to new service requirements • Assessment • Complete chair provision • Recycling • Total Cost of Ownership model • Developing innovative solutions • Modularisation • Customer Feedback process • KPI/Metrics Our user focused solution requires a regional approach Rebalancing regional and local will improve efficiency and service

6. We need to change the system- Potential alternative for consideration - Contact Centre/ Procurement hub • Triage Expertise • Information support • Appointment setting • home & clinic • Order processing (electronic) • Customer servicing • Outcome based commissioning • Supplier / contract management • Customer feedback process • Catalogue updates • KPI / Metrics / Data management Suppliers Users Local service provision Complex Provision • Personalised budgets • Choice • Cross agency funding • Feedback driving market • Respond to new service requirements • Assessment • Complete chair provision • Recycling • Total Cost of Ownership model • Developing innovative solutions • Modularisation • Customer Feedback process • KPI/Metrics • Personalised budgets • Choice • Cross agency funding • By manufacturer or agent • Personalised budgets • Choice • Cross agency funding • Feedback driving market Specialised localwheelchair service Accredited Assessors • Personalised budgets • Choice • Cross agency funding • Feedback driving market • Initial contact /review • In home / Surgery • Decision support enabled • Able to innovate solutions • Generic prescribing Rebalancing regional and local will improve efficiency and service

7. Challenges and Issues • Data availability to size the current service and the potential solution • Stakeholder management • Risk Aversion incurring substantial costs • Prices in UK higher than Europe • Lack of holistic patient thinking • 24 hour posture care • Cross agency alignment • Lifestyle vs mobility • Breaking new ground • Personalised health budgets • Radical market development work • Long term funding for implementation The radical nature of change requires strong leadership to drive cultural change

8. System Issues, Growth and Complexity In two years there has been a 29% increase in issues for Devon from Exeter rehabilitation centre with growth in complex needs growing at twice the rate of non complex increasing the proportion from 37% to 44.5%, Complex are 10X the cost of simple chairs leading to considerable pressures on cost and service levels The current system with high growth in a cash constrained environment is unsustainable

9. Milestones and Next Steps Next steps • Decision on model shape • Costing of options • Agree decision making process • DH deliverables • Agreement to funding for implementation Jul Aug Sep Oct Nov Dec Jan Feb Mar Data Collection Engagement Business case Common assessment Inventory & Pricealignment Commissioning guidance Contact centre development Market change Personalised budgets Cross agency approach Are we going to deliver the required changes this time?

10. System change Lean or whole system thinking is about putting the citizen at the heart of the design Command and control Systems Thinking System Knowledge System Knowledge Command & control User Knowledge Command & control User Knowledge Application of this approach reduces costs delays and lead times while improving customer outcomes, productivity, efficiency, service quality and VFM. Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way

11. A wide group of stakeholders have involvement in the process Stakeholders Clinicians Procurement Users Suppliers Engineers Carers Social Services Parents Commissioners Work and Pensions Project team & work groups Voluntary sector Education 3rd party providers Councils Regional health authority Other rehab services Tertiary centres Supply chain Dept Health International exemplars GPs Health trusts Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way