Monthly Archives: May 2016
NHS England recently announced that they are introducing personal health budgets for wheelchairs. This new approach to wheelchair commissioning will replace the current voucher scheme. According to NHS England, wheelchair users have found a number of challenges with the existing scheme, now 20 years old, including a lack of information and guidance around maintenance, repair and replacement as well as a limited number of providers where a voucher can be redeemed.
It is claimed that the new personal health budget scheme will offer more choice of where wheelchairs can be bought as well as a detailed care plan that will help users make informed decision about their wheelchair. The care plans will also go beyond purchasing the chair to also include guidance on future maintenance, repair and replacement needs.
It is also claimed that a wheelchair will form part of a person’s wider care, catering for their individual needs and ensuring a more joined-up approach, a key aim of NHS England’s Five Year Forward View. The new approach will also help NHS England collect meaningful data on wheelchair provision that will further help improve services and address variations in provision across the country.
CECOPS’ CEO, Brian Donnelly, says, “Offering personal health budgets for wheelchairs will be useful for some people. Although not a total solution, this will certainly increase choice and hopefully allow people to get access to the equipment they need more quickly.
We included personal health budgets in our Code of Practice for Disability Equipment, Wheelchair and Seating Services last year.
Following the Code will help commissioners, providers and clinicians and will ensure the necessary safeguards are in place where personal health budgets are used.
We would hope to see personal health budgets eventually being used for all disability equipment so that the holistic needs of disabled and elderly people can be met more effectively.”
CECOPS: A New Outcomes Approach to Commissioning and Providing Disability Equipment, Wheelchair and Seating Services
Our innovative approach to commissioning and providing disability equipment, wheelchair and seating services is gaining popularity in the UK, and beyond.
Why is a new approach needed?
The process for commissioning and providing disability equipment, wheelchair and seating services in the UK has generally been the same for many years, very often involving detailed specifications written by commissioners, with which providers are expected to comply.
Stifling innovation and creativity: The process of commissioners writing specifications is time consuming and costly. It has also been found in many cases to be too prescriptive, which can fetter innovation and creativity of providers, and clinical and technical staff. It forces the provider into compliance mode, where they have to work to the exact requirements of the specification and nothing more, meaning that what is set out in the specification is what will be delivered for the duration of the contract.
This approach can prevent frontline staff from making suggestions for better ways to deliver services, making improvements, meeting changing policies, strategies or demands, and it does not often result in improved outcomes for people using the services.
Compliance, not continuous improvement: The current approach to commissioning services does not generally seek for, or encourage, continuous improvement, meaning that people receiving services often have to settle for a ‘just good enough’ service for the duration of the contract. This is largely owing to the fact that the provider is commissioned and paid to comply with the requirements of the specification, and nothing more. This is an inherent weakness in the age long processes currently used.
Outputs, not outcomes: Furthermore, there is often an emphasis on measuring outputs including, for example, the number of activities related to the service. The overall performance of services is often assessed on these outputs, or data sets. Whilst important, outputs only capture one dimension of the service and do very little for influencing or improving quality-related outcomes for people using the services.
When services are commissioned and provided in this way, there is a certain inevitability about the mediocre levels of service that will ensue.
The New Approach
CECOPS and support tools: Recognising the need for change, CECOPS Community Interest Company (CIC), the independent standards body in the UK for disability equipment, wheelchair and seating services, has introduced a new model and support tools for assisting commissioners and providers to help improve services. Already, many health and care organisations are working with CECOPS.
CECOPS CIC has an officially recognised Code of Practice for these services, and offers a registration and accreditation scheme. CECOPS also offers a self-evaluation, compliance management and continuous improvement software tool, iCOPS®.
Outcome focus, not just outputs: The CECOPS Code is made up of forty seven outcome based standards. Some commissioners are already requiring providers and clinical teams to report against these outcomes, meaning that the provider, for the first time, now has the flexibility to choose how best to meet the outcomes, without being fettered or restricted by having to comply with a rigid and detailed service specification.
An outcomes based approach also helps service users to know what level of service to expect. It reduces the need for commissioners to write lengthy and detailed specifications, and ensures all aspects of service provision are comprehensively addressed.
The CECOPS outcomes are service related, and following them ensures the people receiving the service receive safe, good quality and effective care.
Continuous improvement, not just compliance: Whilst compliance with the requirements of a specification or standards could raise the bar in terms of service quality and performance, it can equally breed a culture of apathy i.e. just good enough. Neither should regulation be relied upon for improving quality and performance. Quality and performance management needs to be everyone’s responsibility, and providers should be in control of driving their own improvements. CECOPS has developed a tool, iCOPS®, which helps organisations to self-evaluate their own service, and it cultivates a continuous improvement focus with the view to delivering an outstanding service. This tool also supports compliance and regulatory obligations as it collects all supporting evidence in one place.
Improved contract management: Commissioning services involves a lot more than writing service specifications and tendering services; it includes the day-to-day management of contracts; this requires a lot of time and effort.
To help with this, the CECOPS model includes accreditation; this means that an assessment of the service is undertaken by CECOPS’ assessment team, DNV GL Healthcare (world leaders in quality and risk management).
Accreditation provides (external) assurance that the CECOPS outcome-based standards are being maintained. The assessments are risk rated and weighted, meaning that the commissioner will get a report highlighting any areas that need to be focussed on. This significantly reduces the time and effort of managing these large contracts.
Equally, providers can use accreditation as a means of managing contracts and making improvements.
The simplicity of the CECOPS model and how to get started: Commissioners can simply include CECOPS registration and accreditation in specifications, and require that the provider must evidence continuous improvement year on year using the iCOPS® tool.
Equally providers can directly seek to be registered or accredited and use the iCOPS® tool.
“This is a small change in process, but results in significant change in outcomes. This pioneer approach to commissioning and providing these services is long overdue.” Brian Donnelly MSc, CEO, CECOPS CIC
For further information CECOPS can be contacted here:
T: 01494 863398 | E: firstname.lastname@example.org | W: www.cecops.org.uk