Wheelchair Service Redesign March 2009

1. Wheelchair Service RedesignMarch 2009

2. 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

3. 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

4. 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 email / web form in first instance

5. 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

6. 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

7. Capacity • Waiting lists currently around 23 weeks! • Priorities • Patient safety / breathing / feeding / skin breakdown • 1st 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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