Wheelchair Service Redesign March 2009

Context Approximately 7400 wheelchair users –(92% Grampian, 4% Orkney, 4% Shetland) Staffing – –4 Occupational Therapists + 1 OTA –2 Bioengineers –8 Technical Staff –2.5 Admin staff Covering Aberdeen, Aberdeenshire, Moray, Orkney & Shetland Area covered = 8700 sq km + Islands Population 556,000

Redesign Event 1 week – late March 2009 All of clinical team + Admin + Technical staff + input from Finance Manager Internally organised – facilitated by NHSG Improvement & Development Manager for Service Looked at Patient Journey – identifying key quality issues “Moving Forward” & Action Plan implementation – Local Action Plan Capacity of service Consistency of service delivery Services to remote areas

Referral Open to registered health professionals Acknowledging referral & informing patient Training of referrers –Basic referral skills, measurement etc –Advanced referrers, capable of specifying basic chair Integration with care pathways in rehab & acute services Electronic route for referral via secure / web form in first instance

Assessment & Delivery Standardised assessment tools –Develop in parallel with National programme –Paediatric / Power / Manual Feedback of Assessment outcome –standardised “tick-list” –develop custom letter based on assessment tools Facilities –Many problems identified but action limited by current building –Clinic store for shared resources

Assessment & Delivery Patient Transport –Most late or over-run appointments due to ambulance transport problems Carer needs –Develop communications with care managers to identify carer needs before assessment –Document carer issues in assessment report Standard documentation packs to be issued at point of equipment delivery –User instructions for pelvic belts etc to be developed Training programme needed for carers on principles of positioning in seats

Capacity Waiting lists currently around 23 weeks! Priorities –Patient safety / breathing / feeding / skin breakdown –1 st issue of wheelchair Waiting list “Blitz” planned for late June Use Bioengineer to cover multiple OT-led clinics Technician on standby for clinic support Create delivery appointment slots – shorter duration than assessments Create third clinic room to accommodate increased staffing Create auxiliary post for clinic support –Personal care / hoisting / user instruction

Equipment Problems with “lightweight” chairs –Durability of components –Rubix / Basix problems –Role of Dash Lite and Action 2NG –Required feature set for occasional user and fleet chairs Configured manual chairs –Action 3 / Rubix Paediatric chairs –Standardise on Action 3 Junior but maintain pressure on manufacturers for alternatives –Cost of harnessing & alternatives to Bodypoint

Equipment High-end Manual –Standardise on K series, XLT, Neon (+Argon if req’d) –Standard specifications agreed Power –Mirage remains main fleet chair –Pride chairs used where mid-wheel drive required (but concerns about some aspects of company) –Spectra Plus and Salsa where tilt / seating / modified controls required –Need for powered recline / powered ELR / riser –Role of attendant controls

Equipment Cushions –Range of types and sizes of stock cushions required –Role of Roho Harmony and Jay Easy cushions Back supports & seating systems –Protech remains most cost-effective system for back support but will look again at Jay 3 –Cost of configured manual chair with back support & cushion is similar to Rea Azalea – review practice –Improve system for storing and recycling Protech components Increase consistency of prescription and control costs

Finance Overview of NHS Grampian financial position, cost pressures and efficiency saving targets – need to control costs Costs of Orkney & Shetland services are disproportionate – increase monitoring & discuss with island Boards SLA with Highland – bring back into Moray clinic Improve monitoring of spend and communication of financial position to all staff –Use ReTIS as purchase ledger until new version implemented

Technical Services Joint working with Aberdeen / Aberdeenshire & Moray Council services to uplift & decontaminate used equipment Training of specialised technicians – setting up seating systems & power chair controls Improve stock management Implementation of PPM – agree protocols with manufacturers and other Scottish services Encourage drop-in repairs

Island Services Improving communications Referral information Scope and implementation of local services Skill set required from local staff and training implications Implementing PPM – local and visiting technicians Clinic facilities required Timescales for island clinics

Other issues ReTIS database issues –Access from peripheral / island clinics –Synchronisation with mobile users –Delays in upgrade to current version Possible use of Tablet PCs for note-taking, preparing assessment reports etc in clinic Develop database of standard CAD drawings

Conclusions Productive exercise to re-examine all aspects of service process Identified many aspects of service which we do well Local Action Plan Follow-up events – late July / November –Include other stakeholders