Will Personal Health Budgets for wheelchairs fix the problems?

NHS England recently announced that to give people more choice and control about the care they receive, personal health budgets will be extended to cover wheelchairs from April 2017.

This move is intended to support the government’s target of enabling 100,000 people to benefit from greater control via personal health budgets by 2020/21.

It is proposed that Personal Health Budgets (PHBs) will replace the current wheelchair voucher scheme as part of efforts to improve services for over 1.2 million people that currently use wheelchairs.

NHS England claims the new personal health budget scheme will offer more choice over what wheelchair can be acquired, and will include a detailed care plan to help users make informed decisions about their wheelchair. They claim care plans will not only cover purchasing the chair, but will also include guidance on future maintenance, repair and replacement needs. Without a business case or impact assessment or relevant evidence, it is difficult to assess at this stage exactly how the model will work in practice.

NHS England has been reviewing wheelchair provision over the past 2.5 years, and introducing PHBs would appear to be in response to the findings of that review; however we sincerely hope that issuing PHBs for wheelchair users is not the only outcome of that review, as PHBs cannot possibly be a solution to the numerous problems associated with these services.

As the independent standards body in the UK for wheelchair services, CECOPS welcomes the move to extend personal health budgets to these services, and we have in fact already included the use of PHBs in our Code of Practice. The use of PHBs for wheelchairs will be an area which our assessment processes will cover, for organisations seeking accreditation with us.

Notwithstanding our support of measures to improve wheelchair services and user experience, we do have some concerns which we hope will be addressed before the introduction of PHBs for wheelchairs in April 2017.

We feel that if the areas of concern below are not sufficiently addressed, the roll-out of PHBs for wheelchairs will not achieve its well-intended aims. At this point it is unclear how PHBs will work better than the existing voucher scheme, and this is something we would like to hear more about from NHS England Personal Health Budget team.

Could PHBs exacerbate current difficulties associated with disjointed services?

Disabled people often require a range of assistive technology (AT) related services e.g. communication aids, posture equipment, adaptations. As the different AT services generally operate independently of each other, people usually undergo several different assessments to cover their various and holistic equipment needs.

The current model is costly and is far from being person-centred. Offering a PHB exclusively for one type of assistive technology (i.e. wheelchair) could potentially exacerbate the problem, and would appear to go against the direction of offering more holistic, personalised and person-centred care.

NHS England has indicated that it hopes to start off with PHBs for wheelchairs and then move on to other types of AT. However we feel it would be much better to offer PHBs for all AT needs at the commencement of the initiative; this would help stimulate the drive for more holistic and person-centred assessments, offering real benefits in terms of user experience, as well as improving clinical and financial outcomes.

The following quote from a service user clearly demonstrates current difficulties, and why offering PHBs exclusively for wheelchairs won’t help with wider issues:

“It was great that I eventually got an indoor/outdoor wheelchair, but I couldn’t get in or out of my home because the adaptation hadn’t been done. I was given a communication aid but no-one would agree to mount it to my wheelchair.”

Will PHBs address long waiting times?

One of the main problems associated with many wheelchair services is the waiting times. It is not uncommon for people to wait 18 months for a wheelchair.

PHBs won’t address waiting times, as they are not set up for that purpose. In fact, PHBs could even increase waiting times, for reasons explained below.

The main reason currently for long waiting times is lack of funds. PHBs won’t introduce any new money, and purchasing a wheelchair at retail price under a PHB rather than at bulk contract price will be more expensive. In addition, wheelchairs bought under a PHB belong to the user and will never come back into the wheelchair service to be reissued to another user. This could add significant pressure to current overstretched budgets and increase waiting times for all wheelchairs, whether under a PHB or not.

Will PHBs help people who need equipment urgently?

People with rapidly progressive conditions, such as motor neurone disease or some types of multiple sclerosis, require access to equipment urgently. Sadly, fast-tracking of services for these people is not generally in place.

Providing people with PHBs is not likely to address this serious problem. Presumably there will be a waiting list for accessing PHBs just as there is for loaned equipment, as without new money there will still be funding issues. We feel strongly that this area should be looked at as a priority; it is disgraceful that some people die whilst waiting to receive vital equipment.

One solution could be that the PHB scheme includes a fast-tracking arrangement so that eligible people have access to funds immediately to buy everything they need quickly. Obviously there would need to be clinical professionals involved to facilitate and advise.

Could PHBs for wheelchairs actually be more costly?

As previously mentioned most wheelchairs are purchased by the NHS or out-sourced provider under a bulk contract or framework, in some cases at significantly discounted prices. With PHBs, people will purchase equipment outside of these agreements from retailers at high street prices, which are very likely to be much higher than the prices currently paid by the NHS for wheelchairs. PHBs will have to be of sufficient value to cover the retail price of a wheelchair, otherwise people will not take them up! As this cost is likely to be higher than is currently paid by the wheelchair service, this could strain wheelchair budgets.

In addition, there are significant savings and cost avoidances under the current model where wheelchairs are reissued by wheelchair services. For example, a wheelchair costing £2000 issued 3 times over its life results in a cost avoidance of £4000; whereas 3 of the same wheelchairs purchased using PHBs will cost £6000. Equipment purchased using a PHB will not be recycled within the wheelchair service, and is in effect a sunk cost.

If PHBs for wheelchairs are widely taken up it could have a drastic effect on wheelchair service budgets.

Could wheelchair users be exploited?

There will need to be proper support and safeguards in place to ensure people using their PHBs to buy wheelchairs are not exploited by retailers i.e. being sold something they don’t actually need, or charged an excessive amount. It is recognised that people are consumers in other aspects of their lives, and should be able to make their own choices; however some buyers will be in a vulnerable position, making a large purchase in an unfamiliar market, which could leave them open to exploitation without appropriate guidance, safeguards or support.

When the Department of Health introduced the retail model several years ago for aids to daily living, there were cases reported of people being exploited by retailers, so this is a real concern. 

Could using a PHB compromise clinical needs being met?

A PHB for a wheelchair will only be for a limited amount, although it is currently unclear how this will be set. Wheelchair users will be able to top up from personal funds if they want a higher specification wheelchair. There is a risk that wheelchair users acquire an item which does not meet their clinically assessed needs.

This is a high risk area and it is vital that users get the right wheelchair to avoid problems associated with postural care and pressure, for example. It is difficult to see how it can be ensured that retailers are competent to advise on these matters, some of which require specialist clinical input.

Failure to address the above issue could mean people end up with equipment that doesn’t meet their clinical needs, resulting in further health problems such as a pressure ulcer.

PHBs and Training

As yet no guidance has been made available from NHS England Personal Health Budgets team on training for frontline staff with regards to PHBs for wheelchairs e.g. what training is needed, who needs to be trained, who would carry out the training and who pays for it. It could be a costly and timely exercise for local areas to formulate their own guidance on this, and deliver their own training, which could potentially be a barrier for wider adoption.

Conclusion

CECOPS hopes the above issues will be sufficiently addressed before commencement of this initiative in April 2017; we would be willing to work with the NHS Personal Health Budget team to work through possible solutions.

Many of the areas of concern can be addressed by following our Code of Practice and working with our accreditation framework, which is now formally approved by Care Quality Commission and being adopted by many wheelchair services across the country.

Brian Donnelly, CEO, CECOPS

Addressing the ‘care crisis’ by deploying Assistive Technology effectively

The growing elderly population is a global trend which, coupled with an increase in the number of people living with Long-Term Conditions (LTCs), increases demand for health and care services, with associated fiscal strains, in all societies.

Continuing with the same models of delivery is not going to be sustainable. New approaches and service delivery models need to be found that will deliver more efficient and effective care, whilst maintaining safe and good quality services.

People need to be equipped with the right products and services to help them become more independent and to be better supported in managing their own care. This includes disabled children and adults, to ensure they have the same life expectations, opportunities and outcomes as other citizens. Services also need to be geared toward prevention and early intervention to avoid unnecessary and costlier episodes of care later on.

One method to address some of the concerns above is the better deployment of assistive technologies – from orthotics, prosthetics, walking aids, beds, wheelchairs, and communication aids, through to more advanced electronic assistive technologies such as telecare products and telehealth equipment. If used strategically these can support health and care services significantly and meet a range of government policy aims.

Not only does effective provision of assistive technology improve outcomes for service users, including social inclusion and quality of life, but it can also reduce the burden on the state by enabling independent living, enhancing employment prospects and enabling individuals to take control of their own lives – all of which have a part to play in tackling the worldwide problem of funding longevity.

But a shift towards better deployment of all assistive technologies has not really happened at scale, for a variety of reasons. At strategic level, there is generally failure to appreciate the benefits of this equipment, and as a result there is no overall strategy or vision to integrate the many departments and bodies which currently issue it in such a piecemeal way.

Most assistive technology-related services operate completely separately and independently from one another, resulting in duplication, poor use of resources, and wastage, not to mention the effect on the service user of having to undergo multiple assessments.

One of the results of failing to provide assistive technologies and disability equipment effectively is significant unnecessary cost for the health and care economy, for example through delayed hospital discharges, and unnecessary hospital and care home admissions. Providing services inappropriately is always a false economy.

Incorporating assistive technologies into the delivery of health and care provision is a whole-systems responsibility. It starts with good planning, commissioning and governance. This inevitably flows through to good service provision and clinical involvement. Each of these service areas needs to be clear about their respective responsibilities. There also need to be measurable outcomes and standards in place.

The new UK-wide Code of Practice for Disability Equipment, Wheelchairs and Seating Services

The new UK-wide Code of Practice for Disability Equipment, Wheelchairs and Seating Services is designed to address this, and offers a template for commissioning and providing services; it includes clearly defined and specific standards and measurable outcomes.

Following the Code, in all its parts, will go a long way in overcoming many of the difficulties highlighted above and will significantly improve both clinical and financial outcomes. It will also help to identify where weaknesses are within the whole system and allow root causes to be traced. Following the Code will also enable any equipment-related strategies to be achieved.

The Code, in some or all its parts, relates mainly to disability equipment, wheelchair and seating services. It also applies more generally to other assistive technology-related services; there are certain Code Standards which provide a link to related services, which will assist with integration and offering seamless provision.

The Code is free of charge to organisations registered with CECOPS, or a hard copy or an eBook can be obtained from here: http://www.troubador.co.uk/book_info.asp?bookid=3270 or via the CECOPS website: www.cecops.org.uk

Revolutionary New Self-evaluation & Performance Management Tool now available to Support Planning, Commissioning and Provision of Assistive Technology related services, iCOPS®

In addition to the Code CECOPS has supported the development of iCOPS®, the first ever self-evaluation and performance management software tool for assistive technology related services, including wheelchairs, to complement its scheme.

iCOPS® gives commissioners, providers and clinical staff the ability to evaluate and review services, manage contracts, instil good governance, monitor, assess and manage quality, safety and performance, and drive continuous improvement.

iCOPS® also enables organisations to comply with all their obligations including CECOPS and ISO, for example.

Details about iCOPS® can be found here: www.icops.co.uk. A free one month trial is available.

Find out more about the Code and how it fits with the wider CECOPS scheme here: http://www.cecops.org.uk/2015/03/wheelchair-seating-services-now-covered-by-cecops-standards-uk-and-beyond/

Please get in touch if you would like to discuss any of the points above.

Brian Donnelly

Brian is the founder and director of CECOPS CIC and the author of the Code of Practice.

CECOPS CIC is a not-for-profit social enterprise and is the independent standards body for disability equipment services in the UK.

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Tell us your equipment related stories!

Everyone, at some point in their lives, knows someone who has used disability equipment of some sort. No doubt you will have heard of good experiences, but you will also have heard of the not so good. You may have heard of a child waiting long periods for equipment, or someone not able to be discharged from hospital because of equipment delays. On the positive side you may have heard where equipment has allowed someone to communicate, or to live and lead a relatively normal life.

Our CEO recently wrote a blog post about his next door neighbour, which generated significant interest – see HERE. This blog highlighted the importance of equipment, as well as the lack of integrated working across all care services, waste in administration and money, and an appalling experience received by the end user.

The importance of disability equipment is often not fully understood or appreciated.

We often hear about strategies for early intervention & prevention, hospital discharges, re-ablement and rehabilitation services, moving more care into the community etc., with little reference to the equipment needed to achieve them.

Disability equipment has many purposes and can be used for example as a temporal aid following an operation, to allow people to live independent lives or to communicate, or to be kept alive. If disability equipment is commissioned and provided right, many positive and good quality outcomes can be achieved.

We would like you to share your stories with us – the good and the bad, so that we can generate more evidence to help us in our quest to raise awareness of the importance of equipment, and to improve service standards nationally.

Please post your cases below or to: info@cecops.org.uk and title them ‘Case Examples’. Feel free to anonymise the characters, but it would be helpful to have your name and details. If we want to post your case example on our website, we will contact you beforehand to seek you permission. Thank you in advance.

CECOPS supports aims of ‘Better Care Fund’

Working with us will help the 14 integration pioneer areas, and others, achieve many of the aims of the recently announced Better Care Fund (in England). The integration initiatives intend to transform the way health and care is being delivered to patients by bringing services closer together.

The main aim of the integration pioneer work is to make health and social care services work together in order to provide better support at home and earlier treatment in the community, to ultimately prevent people needing emergency care in hospitals or admissions to care homes. Providing timely and effective disability equipment services is key in supporting these aims.

Working with us will enable your organisation to achieve some of the other aims of the integration pioneer work, including:

• Reduction of avoidable hospital admissions and the length of time people who are admitted to hospital need to stay there
• Supporting people to live well for longer, leading more socially active independent lives
• Achieving better value for money, through cost avoidance savings
• Reducing demand for urgent care at hospitals
• Delivering prevention and early intervention strategies
• Improving outcomes for patients and their experiences of care e.g. right first time
• Reduction in care home admissions
• Supporting workforce with the skills to deliver integrated equipment provision
• Ensuring adults and children experience high quality and seamless care
• Supporting rehabilitative care
• Supporting older people with long-term conditions and families with complex needs
• Providing supportive guidance on integration, joint working and pooled funds

If you are interested in finding out how working with us can support your work on integration, contact us today: info@cecops.org.uk or call us 01494 863398

Not quite ready for CECOPS accreditation? Why not try a Support Visit?

CECOPS Support Visits are provided by our partner organisation, DNV Healthcare, to any organisation commissioning or providing disability equipment. Support visits are designed to help identify areas for improvement in your service, including commissioning, provision, and clinical activities, as well as providing an opportunity to find out more about the Code of Practice and the benefits it can bring. There is no requirement to register with CECOPS or to become accredited before arranging a support visit.

Support visits can be used in a number of ways:

To provide a better understanding of the Code of Practice and the accreditation process
To discuss which parts of the Code of Practice are applicable to your organisation/service provider
To identify key areas for local quality and safety improvements, in line with the Code of Practice
To provide an independent and non-committal review of your disability equipment provision against the requirements of the Code of Practice
To check how ready your organisation is for CECOPS accreditation by identifying gaps and recommending key areas to focus on
To develop an action plan to prepare for accreditation, or as a standalone exercise

DNV assessors will work with you to develop an agenda for the day according to your needs. Download a copy of a Support Visit flyer HERE

To arrange a visit or find out more about what could be covered in a support visit, please contact DNV on 0161 475 6691, or by email at: cecops@dnv.com

CECOPS assessments undertaken by DNV Healthcare, global leaders in quality, safety and risk management

Accredited Users of the CECOPS Code of Practice are given a full assessment every three years with interim annual health checks. World class assessors, DNV Healthcare, carry out these assessments on our behalf.

DNV Healthcare is a reputable organisation with an extensive background in the development and management of large scale assessment and inspection schemes. This includes providing assessments for all hospitals in England on behalf of the NHS Litigation Authority, as well as working with Macmillan Cancer Support to assess the Macmillan Quality Environment Mark for cancer care centres throughout the UK.

James Lawrence, Director of DNV Healthcare UK said:
The CECOPS requirements not only focus on safety but have a strong drive towards improving the quality of life for service users. As a foundation, the work DNV will be undertaking on behalf of CECOPS is therefore closely aligned to our values of promoting safety and quality within healthcare.

CECOPS Chairman, Sir Bert Massie CBE said:
Our aim is to ensure every aspect of the Code of Practice Scheme is robust and credible. By contracting DNV as our preferred provider for assessments we have a much greater chance of realising this aim, especially given DNV’s extensive experience and reputation in this particular field.

About us and how you can work with us…at a glance

We are a not for profit CIC and we manage a registration and accreditation scheme for the unique Code of Practice for disability equipment. We support all sectors in commissioning and providing safe, good quality and efficient services, whilst enabling compliance with legal and regulatory obligations.

We also offer approved training and self-regulation software (iCOPS™), as well as support visits from our accreditation partner DNV Health Care if you don’t feel ready for accreditation.

CECOPS is a self-regulatory model which incorporates indirect regulation i.e. meets other regulatory requirements e.g. HASAWA, CQC Standards, Medical Device Regulations, in one place. Unlike inspections, our model puts you in control of managing your own quality, safety and performance related issues.

 How can I work with CECOPS?

As a Commissioner: Until now there has been little guidance and no specific standards available for commissioning disability equipment services. Our Code includes all the relevant outcomes you would expect from any provider. You can now request that all providers working with equipment, including clinical teams and Care Homes etc., work to the CECOPS Standard, either as Registered or Accredited. This will ensure all quality, safety and performance management issues are addressed in one place, as well as complying with relevant legal and regulatory obligations.

 As a Provider: Do you already provide a safe and good quality service, and want to promote this fact? Now you can opt to become Registered or Accredited with CECOPS as a means of demonstrating to regulators and commissioners etc. that you are working to the highest available standard in this field. This will separate you from the rest and give you competitive advantage. Commissioning authorities up and down the country are already requesting CECOPS compliance…don’t miss out!

 Download a copy of our brochure here

CECOPS or ISO 9001:2008: which one, or both?

ISO 9001:2008 quality management standards make a routine appearance in tender specifications for disability equipment services, which is understandable as for many years ISO has been the only credible standard available. But not any longer! Many of our users are also ISO accredited, and it has been interesting to get their views, and the views of professional quality and risk management assessors, on the CECOPS standards over against ISO.

 The general consensus is that ISO is a good general framework, but CECOPS contains all the specifics for a quality equipment service.

CECOPS’ key advantage is that it is specific to the environment of a disability equipment service, so it covers the nitty gritty issues that crop up every day in real life. CECOPS’ Code of Practice is a uniquely practical tool for making service improvements, in an organisation of any size.

 CECOPS also deals with commissioning and clinical activities which are areas beyond the scope of ISO’s quality framework.

 See the areas covered by the CECOPS Code here: http://tinyurl.com/l3gtazv

 Read the following perspectives on CECOPS and ISO from a CECOPS Accredited User organisation and also a professional quality and risk management specialist.

The Pluss Organisation – Our experience of CECOPS Code Standards as a provider of Community Equipment Services (CES)

 Pluss is pleased to announce that it recently achieved full accreditation status for CECOPS Code of Practice – one of the few in the UK!

 Following our CECOPS Accreditation Status, we would like to share our experience of this journey to encourage other organisations to do so. If you haven’t, or are not thinking of becoming CECOPS Accredited, or expecting your Provider to, then we would seriously ask you to think again. The CECOPS accreditation process is a very worthwhile exercise, especially if you really care about delivering a quality service for your commissioners and more importantly for your service users – you need to be on this journey.

 Pluss has successfully held BS EN ISO: 9001:2008 Quality Management Systems since 1993. Although the ISO quality management system is really good we found the CECOPS Code Standards and the accreditation process to be more multi-dimensional and covers a broader scope that actually fits the service provision.

 The CECOPS accreditation process is not only for providers but for also for commissioners. The CECOPS accreditation process covers all the criteria you would expect for a Total Quality Management System, and more. 

 CECOPS sits exceptionally well within Community Equipment Services, and compliance with the Code of Practice is not very difficult if you are already working to a quality management system – although you do need to have all your ducks in a row.

 For example, you will need up to date evidence that the following is communicated:

• Health & Safety  procedures, risk assessments
• HR policies & procedures
• Company / Corporate procedures
• Operational manuals
• Training  records
• Etc, etc

 So, even though the CECOPS process is a means for getting one’s house in order, Pluss found this process to be a positive challenge – we had all of the above requirements in place but not necessarily in the same place! 

 Our commissioners have comfort and reassurance in knowing that we have met all relevant legal and regulatory requirements in one place and that once a year we will have a CECOPS health-check to ensure we maintain this high level of service.

 We are more confident that our end users will be in receipt of better quality outcomes, as a result of the CECOPS work, and that we will continue to seek to improve a high level of customer satisfaction – and the overall CECOPS process enables us to do so.  

Pluss are now in the process of including its other CES contracts to become CECOPS Accredited and are hoping to become the first wheelchair service in the country to be CECOPS Accredited. Christine Wheeler, Pluss, Equipment Contract Manager

CECOPS and ISO 9001:2008: Disability Equipment Services, UK – by Harriet Smith, Senior Quality & Risk Specialist, DNV Healthcare UK

 What does CECOPS offer in addition to ISO 9001:2008?

CECOPS code standards provide a quality management framework for both commissioners and providers of disability equipment (including clinical staff). The code standards are designed to be specific to disability equipment services; they put unambiguous requirements around the more generic principles of ISO; CECOPS puts flesh on the ISO bones.  They are not in disagreement; CECOPS and ISO fit effortlessly together. The CECOPS code eliminates the need for smaller equipment services to have to interpret the more ‘ambiguous’ generic statements made within ISO, and apply them to their industry. Few other service industries can boast the same luxury.

 Assessment for CECOPS accreditation is more designed around observation and interview, with a greater focus also on outcomes, rather than the checking of the reams of paper that is expected within ISO certification. 

 As time moves forward, the CECOPS Code Standards will evolve as legislation and regulation within the equipment service changes; it is also something that the sector itself can take a degree of ownership over and ‘drive’ its own quality – unlike the large, cumbersome ship of ISO. 

 CECOPS standards are contained within the main principles of ISO, and more, including:

• Customer focus
• Leadership
• Involvement of people
• Process approach
• Systems approach
• Continual improvement
• Factual approach to decision making
• Mutually beneficial supplier relationships

 CECOPS Code Standards are much more service specific and add ‘meat on the bones’ for the disability equipment sector. Unlike CECOPS, ISO does not specifically address the commissioning or clinical aspect of disability equipment services.

 Harriet Smith BSc (Hons) MSc, CMIOSH, Senior Quality & Risk Specialist, DNV Healthcare UK. 

 Harriet Smith has successfully completed the IRCA certified ISO 9000:2000 Series QMS Lead Auditor course, and the ISO 22301 Internal Auditor Course for Business Continuity. In addition to the CECOPS assessments, she regularly undertakes international healthcare assessments against the DNV International Accreditation Standards for Healthcare; she delivers training in Europe on healthcare quality management systems and is an assessor for the Macmillan Quality Environment Mark®, which recognises high standards in cancer care environments.

*NEW* CECOPS for Care Homes and Hospices

*NEW* CECOPS for Wheelchair Services!

We are very pleased to announce that we are extending our work to include wheelchair services!

We are regularly asked whether our Code covers wheelchair services: whilst most of the outcomes in our Code apply to this service area, there are some issues relevant to wheelchairs which haven’t been comprehensively covered in the Code to date. To address this we have been in discussion with the National Wheelchair Managers Forum (NWMF). We are pleased to say that everyone at NWMF is keen to support us in extended the Code to specifically cover wheelchair services. We will keep you up to date on this new and exciting development!