Wheelchair Research Report 2022

An Economic Assessment of Wheelchair Provision in England

The Wheelchair Alliance has partnered on the publication of a vital new report calling for more to be done to enhance the lives of wheelchair users, their families and carers. 

‘An Economic Assessment of Wheelchair Provision in England’ is the first time independently verified research has been published revealing the experiences of wheelchair users. The findings make a series of recommendations on how more work, resources and investment are all required to meet the needs of this often under-represented section of society.

Who is behind the research

The report was undertaken by Frontier Economics and commissioned by the charity Motability in partnership with the Wheelchair Alliance. 

The Alliance has considered the findings and agreed, in partnership with its Wheelchair User Engagement Group, the key priorities to be addressed. This position statement explains the priorities and appropriate actions.

Key Findings 

Wheelchair services in England are not working

Funding levels are unacceptable

The report indicates that Government funds spent on wheelchair users equates to an average of  £125 per person per year, including the cost of a wheelchair, expert support as well as infrastructure costs. This level of underfunding has remained the same for at least five years. If the costs of energy, equipment and staffing are all rising, this figure needs urgent review for wheelchair support to be protected.

Accurate wheelchair user data does not exist

It is only by understanding the true demand for wheelchairs and providers that NHS England can commission appropriate services. Adequate funding requires accurate wheelchair user data so their families and carers can be confident that they will be treated equitably wherever they live in England. This means all types of wheelchair services must offer regular data based on outcomes to ensure accountability and reduce regional differences.

Our recommendations include: 

#1 The adoption of the Model Service Specification for Wheelchair and Posture services to ensure the standardisation of service provision.

NHS England has worked in partnership to develop a service specification for wheelchair services. This is an effective guideline but as its non-compulsory, there are significant variations in structure and delivery between areas of England. This level of inequity must be addressed as the standardisation of provision is vital.

According to the report, wheelchair users are categorised into three levels of assessment/intervention criteria; low, medium and high. There is significant confusion over how these categories are interpreted, with some wheelchair users feeling there could be some discrimination. Ultimately, commissioners should be better educated about wheelchair users in their region and ensure individual needs are considered holistically.

In addition, providers currently interpret the specification to their local community or available budget and this sometimes leads to inconsistencies in provision. A more nuanced and tailored approach is required.

The Wheelchair Alliance will:

• work collaboratively with NHS England and the National Wheelchair Advisory Group to develop the Model Service Specification to ensure it becomes more than guiding principles
• lobby at the highest level, possibly through the development of an All Party Parliamentary Group for Wheelchairs and Postural Management, to ensure wheelchair services have a full understanding of what they need to provide. 

#2 All NHS organisations and contract providers are subject to more rigorous, mandated regulation.

NHS England has worked hard to develop a reporting dataset for wheelchair services. However, this is often inconsistent meaning gaps in service provision are hidden. It is essential that the data includes outsourced providers to ensure that a full picture of service provision is available each quarter. The Wheelchair Alliance believes a more rigorous approach to standards is essential with the need for an independent regulator.

The report raises concerns that wheelchair users may be being exploited due to a lack of clear regulation, independent review body or information about who to approach regarding repairs, complaints or suggestions for service improvements.

The Wheelchair Alliance will:

• work with NHS England and providers to develop a simple system for wheelchair users, their families and carers to help them get repairs, feedback and make suggestions on service improvements. These issues should be led by wheelchair users themselves through wheelchair user groups linked to each service
• discuss the possibility of a regulatory body with oversight for all wheelchair and postural management services, or lobby for a National Institute of Health and Care Excellence (NICE) guideline for wheelchair and postural management.

#3 Reviewing the scale of demand for wheelchair services and enabling the filling of existing and future skills gaps.

It is impossible for NHS England and service commissioners to provide appropriate delivery funding without knowing the scale of demand. Unfortunately, this has been approximated for many years, and is an issue that should be urgently resolved. 

When real demand is known, then appropriate funding can be identified for all aspects of wheelchair services ranging from the recruitment of skilled clinicians to the purchase of high-quality equipment. The report indicates significant uncertainty surrounding the number of wheelchair users in England. Understanding demand facilitates the robust planning of services where the appropriate number of highly skilled staff such as therapists, rehabilitation engineers and technicians can be forecast correctly.

The report highlights the importance of a highly skilled workforce. A community of practice to support the professional development of individuals and raise the profile of roles at education establishments is needed. 

The Wheelchair Alliance will:

• seek to meet with NHS England every quarter to discuss the minimum data set commissioners complete to drive service improvement and address recurrent issues behind poor provision
• aim to develop an online resource hub in collaboration with key organisations where professionals can access and share examples of good practice.