Wheelchair Research Report 2023

Introduction

The Wheelchair Alliance (the Alliance) commissioned a research report to identify the real value of providing the right wheelchair that truly meets the needs of the user to enable them to live the life they choose. The Value of a Wheelchair research was undertaken by two independent research organisations, Frontier Economics and Revealing Reality. It was grant funded by the Motability Foundation and published in December 2023.

The report follows on from the Wheelchair Alliance’s first report which was published in October 2022. This ‘state of the nation’ piece of research highlighted three key areas of concern:

• that wheelchair services in England do not consistently work for service users,
• that NHS provided wheelchair services should be subjected to more rigorous and mandated regulation and
• that the true scale of demand is not known.

A position statement and priority actions were developed to address these challenges with action still needed to be taken to ensure equitable provision across England.

The Value of a Wheelchair report considered both quantitative data and in-depth interviews with wheelchair users across England. It unambiguously shows that the provision of a high quality wheelchair does not only have a significant beneficial impact on people’s lives but also leads to financial benefits for the NHS and society. It highlights that, using conservative assumptions, investment in wheelchair services could result in significant positive economic impact at a ratio of approximately £3 benefit across society for every £1 invested. The report stated that an annual increase of £22million pounds across wheelchair services, with wheelchairs users provided with the right high quality wheelchair realising a conservative annual total of 1% benefit, would result in a societal return of excess of £60 million. Should the annual total benefit be 5%, the same investment would realise benefits to society, including savings to the NHS, of in excess of £315 million pounds.

This report uses a social return on investment methodology however, the Alliance is aware that
‘‘wheelchair users aren’t economic units, and it is not about what a wheelchair user can provide to the economy – it should be about the individual first and foremost”
SM, November 2023

and the Alliance agrees that a follow up report considering the wheelchair users voice, the human impact of the right wheelchair should be the next step.

Findings

The report highlights three key issues.

Local variation: there are clear advantages to locally led provision of NHS wheelchair services. In particular commissioners can provide a service which is tailored to local needs. However, this has led to variation in the standard of care provided and service user experience. This variation has been highlighted in previous studies and our in-depth engagement with wheelchair users reemphasises this inequality. Service users reported that they were often left to navigate the system themselves and had to rely on their own experience and knowledge to access support.

Funding: analysis shows that a relatively modest increase in wheelchair service equipment spend could make a meaningful impact on the budgets of Integrated Care Boards (ICBs) who are currently reporting below average per patient spend on equipment budgets. This increase in spend would deliver significant cost benefits.

Integration of service budgets: there is a need to ensure that current budgets are used in the most effective way possible. This includes the sharing of best practice between commissioners and realising the advantages of joined up working and pooled budgets by statutory bodies for the benefit of wheelchair users, their families and carers.

Wheelchair Alliance action

The Value of a Wheelchair report highlights three policy changes that would enable a significant difference to be made. Under each policy area, the Alliance has indicated the action it will take.

Policy Recommendation #1

NHS England to play a more active role in ensuring that all ICBs prioritise wheelchair services and dedicate sufficient resources to effectively deliver the service. For example, this could be done by mandating that all ICBs adopt the Quality Framework for Wheelchair Provision along with the Model Service Specification when commissioning wheelchair services. This would help to minimise inequality across different services and ensure consistent delivery of a good quality service and provision.

Action One:
We will ensure the voices of wheelchair users are represented during the development of the Quality Framework for Wheelchair Provision.

Action Two:
We will act as a co-producer of the Quality Framework, only signing off the content when it is approved by both the Alliance Board and its Wheelchair User Engagement Group members.

Action Three:
We will lobby the Chief Executive of the NHS to raise awareness and importance of the Quality Framework and expect urgent delivery of an early sign off.

Action Four:
We will ensure the Alliance Wheelchair Charter reflects the expectations of the Quality Framework and provide a wheelchair user friendly guide to the Quality Framework.

Action Five:
We will enable commissioners to provide the best wheelchair services by ensuring the Model Service Specification for Wheelchair and Specialist Seating is brought up to date and ratified.

Policy Recommendation #2

The Department of Health and Social Care (DHSC) and NHS England should explore the possibility of increasing current spending on NHS wheelchair services to help ensure more benefits are realised and the NHS can unlock significant cost savings.

Action Six:
We will lobby at Governmental level, demanding a review of current investment levels into wheelchair services which have not altered in decades and have been severely impacted by both austerity measures and the cost-of-living challenges.

Action Seven:
We will work in collaboration with NHS England, ICBs, other statutory bodies, charitable organisations, manufacturers, providers and wheelchair users to demonstrate the benefits of providing high quality wheelchair services and a choice of wheelchairs to suit a persons identified lifestyle needs. This will be through our APPG for Wheelchair Provision and via an innovation group.

Policy Recommendation #3

Local wheelchair services and commissioners should continue to share best practice and explore opportunities to pool budgets between wheelchair services and other local services. NHS England should consider what support and processes are required to encourage and facilitate greater joined up working and frictionless pooling of budgets.

Action Eight:
We will promote best practice examples through case studies published in our newsletter and on our website.

Action Nine:
We will identify funding opportunities to conduct research to demonstrate the human benefits of shared funding mechanisms as identified by wheelchair users, their families and carers.

Action Ten:
We will continue to monitor the provision of wheelchairs and, should there continue to be inequity of provision and choice across England, have high level discussions exploring the benefits of a national wheelchair service provision funded through health, social care and education contribution.