Assistive Technology Services: Wheelchairs & Seating ‘Sharing the Learning’ Glasgow 2009 Report on

2. NHS Tayside Assistive Technology Services: Wheelchairs & Seating ‘Sharing the Learning’ Glasgow 2009 Report on Rapid Improvement Event April 2008

3. Rapid Improvement Event April 2008 • Background • Scope / objectives • Actions, results, improvements • Future work / sustainability • RIE • National Wheelchair Project • Reflections on RIE / AT service • Thanks • Comments / questions

4. Background • Waiting times out of control • Poor information to users • Service user complaints • Old wheelchairs • Staff morale low • Etc End of CCSF funds Short term SG waiting list funds Agenda for change

5. Scope of the RIE “All patients (adult and paediatric) to meet the 18 week target from referral to provision of safe and usable equipment within NHS Tayside”

6. Management – Team Goals • 95% of new clients to achieve 18 week target by Dec 31st 2008 (Assessment to provision) • Routine follow-up for Paediatrics • Information available for client / carer enquiries • Screening of referrals within 1 working day of receipt • Weekly monitoring by project manager • Standard weekly reporting mechanism • Move towards ‘Moving Forwards’ priorities • Geographical equity of service • Improved service for clients / carers / users • Increased team morale

7. Action Plan – Key Improvements 5 key themes • Pathways defined • Waiting list management • Communication • IT • Staffing issues • Stock / storage / technical

9. Waiting Lists Clients > 18 weeks – assessment to provision of safe and usable equipment (this includes all patient categories) May 2008 - 108 May 2009 - 10 Reduction of 98 Clients!

10. Patients waiting over 18 weeks (Assessment to provision) Number 100 80 60 40 <98% N waiting 20 10 0 July 08 Oct Jan 09 March June Date

11. Assessment Waiting Times Routine assessment – scheduled clinics May 2008 – 67 weeks June 2009 – 10 weeks Priority Assessment – unallocated lists May 2008 – 25 weeks June 2009 – 3 weeks

12. Redesign of services – How? • Cleansing of waiting lists • Removal of ex-employee lists • Removal of team lists • Reduce number of waiting lists - Unallocated + scheduled clinics Packages in progress – individual clinicians • Weekly monitoring by Project Manager • Reporting to Group Manager and Clinical Director

13. Clinic Structure • TORT clinics • May 2008 – 9 clients listed • June 2009 – 146 clients listed • Administrative staff telephone client to confirm attendance • Patient focused booking system • Satellite clinics – • Perth Royal Infirmary • Fairview School Perth • Upper Springlands Perth – February 2009 • Existing clinics • Kingspark School Dundee • ACDC Dundee • TORTC

14. Communication - general • New referral documentation • New screening tool • Standardised letters • New client information leaflets • Information on waiting time now available on enquiry with administrative staff

15. Communication - Staff Weekly meetings – agenda set and minutes recorded TRES meetings – bimonthly Summary of improvements on notice boards Improved use of electronic diaries Visible service by all via database Individual meetings review client lists / actions

16. Communication – staff cont’d • New template for notes to ensure consistency of information • Core team event – July 2008 • Strategy session – January 2009 • Skills maximisation team event – planned for August 2009

17. Staff • Success in filling vacant positions • Temporary staff extended contracts • Trainee Clinical Scientist – May 2009 Technical staff • Long term sick backfill arrangements • Enhanced role consultations • Reviewed job descriptions • Agenda for change issues • PPM – man and a van Proposed new staff – National Wheelchair Project

18. Information Technology (IT) • Database upgraded – New Ways waiting times • Staff trained – external staff training in progress • New PCs – digital radiograph access for clinicians • Stock management module • Van planning module • Website in development

19. Stock / Storage and Technical LEAN principles applied – culling of obsolete stock Mobile workbench Delivery lists (Clinicians work) Redesign of client information – mobile technicians Existing minibus / van replaced with new leased vehicle

20. Stock /Storage &Technical cont’d • New fleet of wheelchairs in progress • New stock of spare parts • Reorganisation of store – identified locations • Storage issues – awaiting space in technical store

21. RIE Way Forward • Continue weekly monitoring • Aim for 100% -referral to provision • Analyse DNA rates • Commence patient focused booking (Repairs / ppm) • Reinstating user / carer group • Repeat service users satisfaction surveys

22. National Wheelchair Project

23. National Wheelchair Project Vision for future of NHS Tayside Wheelchair and Seating Service Based on RIE Moving Forwards, Better Health, Better Care Local delivery Plan…….

24. Vision : Bid to Government • Responsive, local, integrated • Communication, users, other agencies • Efficient, rapid, quality service • Staff levels, skills, clinics, • Safe, continuous, pro-active • Ppm, out of hours, clinical reviews • Modern service • Wheelchair designs, telemedicine • Meeting overall needs • Outdoor power

25. Target Standards (examples) • Referral to provision (direct) : 80% < 14days • 1st Assessment offered < 4 weeks • Assessment to provision, • configurable stock wheelchair: 80% < 21 days • bespoke equipment : 80% < 60 days • Repairs • Routine: 90% < 5 days • Urgent : 75% < 1day

26. Key Performance Indicators Rehabilitation Technology Information Service (ReTIS) • NHS Tayside development • Scottish implementation

27. Project Staffing 1 Clerical officer 1 Trainee technician 2 Mobile technicians ppm, (1.0) 1.2 Technical Instructors (0.6) 1 Stores person 3 Technician upgrades 1 Therapist ( ) = temp staff in post

28. Modern Wheelchairs & spares Year 1 - £360,000 Year 2 - £390,000

29. Scottish Government Funding? • 08/09 £171,000 allocated • 09/10 £600,000 approx • 10/11 as above Note : 2 year commitment

30. Reflections on RIE • Before RIE • Significant improvements made. • Some improvements already planned • Nothing new, but not happening • RIE Catalyst for change • Speed vs Quality ? - outcome measures Home visits, clinics

31. Reflections on RIE • Cost • £ low for NHST (£0 revenue) • Staff time / stress • Benefits • National project • Staff • Team cohesion • Service users

32. Sustainability ? • RIE • National project • 2 years • Afterwards (CCSF!) • Workforce planning • Training / education

33. Future Vision

34. Assistive Technologypotential for development • Electronic assistive technology • Pressure ulcer management (pain) • Seating / ergonomics • Vehicle mobility • Technology for daily living • Etc ….. Independence, Quality of life, Cost savings

35. Thank you • NHS Tayside • Scottish Government • Ross International • Users / associated staff • RIE Project manager (Margaret) • Service staff

36. Comments, Questions ?

37. NHS Tayside Assistive Technology Services: Wheelchairs & Seating • Poster report on • Rapid Improvement Event • April 2008 • Pathway identification • 18 week Referral to Provision

38. Patients waiting longer than 18 weeks (Assessment to provision) <98% 10