NHS South West Wheelchair Review Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at

NHS South West Wheelchair Review

Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way

The current approach to the service is unsustainable

Radical transformation of the service is requiredRadical transformation of the service is required

• Substantial Growth users approximately doubling every 10 years– increase in numbers of complex patients particularly children who will

be life long• 15 years+ of failing reports

– Frustration in the community over lack of action• Strategic decisions will have to be made about what the service should be

for– Mobility or lifestyle (Current rationing of complex patients)– Universal or focussed– Do we care for carers

• We need to improve signposting and assisting people in self care• The service is currently highly complex and requires reshaping and

changing the boundaries• There is a need for a collective approach to drive efficiency and outcome

improvement

We are currently not spending our money wisely

The service supply market dynamic needs rebalancingThe service supply market dynamic needs rebalancing

Users and their CarersHigh growth increasing expectations Greater complexity

Opportunities for earlier / self assessment

The service carries out complex bespoke engineering - manufacturers in the best position to drive efficiency do not, we incentivise them to do the opposite –

We need to harness the supply base and use their skills and energies to drive QUIPP

Supply BaseProvide of the shelf or bespoke equipment

Wheelchair ServiceUndertakes mechanical modificationsBespoke fitting and accessoriesAssemble and fit deliver and handoverHold inventory and spare partsOwn maintenance and repair issuesRefurbish and recycle

Referral Screening/

Validation/ Triage

Assessment Decision

Authorisation Issue/

handover Review Maintenance Repair

Complex Assessment

Modification

Areas of consideration•E referral systems to

improve process efficiency

•Decision support tools to increase complexity that can be directly

issued

•Common eligibility criteria•Contact centre

triage to increase speed of issue improve data

•Self assessment

•Potential separate route

for complex patients

•Inventory reduction

•Product design issues

•Direct sourcing•NHS chair

•Cross agency funding

•Life time costing

•Modification vs using

flexible chair and standard accessories•Delivery of completed chair from

manufacturer

•Direct issue from

manufacturer

•Requirement for regular review vs

strong signposting and patient ownership

•Requirement for regular

maintenance•Potential for this to be the

responsibility of manufacturer

•Potential for this to be the

responsibility of manufacturer

Rapid issue

Non process areas of consideration•What elements should be regionally based –

procurement, triage procedure, assessment criteria, inventory and pricing.

•How do we obtain 24 hour postural care?•Who cares for carers?

•How far do we move to a market approach?•Should we introduce personalised budgets?

•Do we use an internet decision support to assist customers in selection of service/product

•Should we buy chairs outright or lease/rent?

•How far should we recycle?•Should we return stock to manufacturers for them

to own the recycling with an cost reduction•What is the forecast volume for the service?•How is the split between simple and complex

expected to change?

Process and areas of analysis

Streamlined process will reduce timescales increase time for complex patients and align responsibility for improvement with a capability to do so

Streamlined process will reduce timescales increase time for complex patients and align responsibility for improvement with a capability to do so

Our user focused solution requires a regional approach

Rebalancing regional and local will improve efficiency and serviceRebalancing regional and local will improve efficiency and service

Contact Centre Triage ExpertiseInformation Appointment setting

home visits regional clinic

Order processing Customer servicing

Users Personalised budgets

Choice Cross agency funding

Feedback driving market

Suppliers Respond to new service requirements

Assessment Complete chair provision Recycling Total Cost of Ownership model

Developing innovative solutions Modularisation

Customer Feedback process KPI/Metrics

Procurement Experts Outcome based commissioning Supplier Relationship Management Contract Management Customer Feedback process KPI/Metrics

Assessors Home VisitsAccredited assessors with decision support Clinic sessions Able to innovate solutionsGeneric prescribing

We need to change the system- Potential alternative for consideration -

Rebalancing regional and local will improve efficiency and serviceRebalancing regional and local will improve efficiency and service

Contact Centre/ Procurement hub

Triage Expertise Information support Appointment setting

home & clinic Order processing (electronic) Customer servicing Outcome based commissioning Supplier / contract management Customer feedback process Catalogue updates KPI / Metrics / Data management

Users Personalised budgets



Suppliers Respond to new service requirements

Assessment Complete chair provision Recycling Total Cost of Ownership model

Developing innovative solutions Modularisation

Customer Feedback process KPI/Metrics

Accredited Assessors

Initial contact /review In home / Surgery Decision support enabled Able to innovate solutionsGeneric prescribing

Local service provision Personalised budgets


By manufacturer or agent

Specialised localwheelchair service

Personalised budgets Choice Cross agency funding


Complex Provision Personalised budgets



• Data availability to size the current service and the potential solution

• Stakeholder management• Risk Aversion incurring substantial costs

• Prices in UK higher than Europe• Lack of holistic patient thinking

• 24 hour posture care• Cross agency alignment• Lifestyle vs mobility

• Breaking new ground• Personalised health budgets • Radical market development work

• Long term funding for implementation

Challenges and Issues

The radical nature of change requires strong leadership to drive cultural change

The radical nature of change requires strong leadership to drive cultural change

System Issues, Growth and Complexity

The current system with high growth in a cash constrained environment is unsustainable

The current system with high growth in a cash constrained environment is unsustainable

Referral Data Devon

0

500

1000

1500

2000

2500

3000

2008-2009 2008-2009 2010-2011

Year

Wh

eelc

hai

r is

sues

Voucher

Non complex

Complex

In two years there has been a 29% increase in issues for Devon from Exeter rehabilitation centre with growth in complex needs growing at twice the rate of non complex increasing the proportion from 37% to 44.5%, Complex are 10X the cost of simple chairs leading to considerable pressures on cost and service levels

Milestones and Next Steps

Next steps• Decision on model

shape• Costing of options• Agree decision

making process• DH deliverables• Agreement to

funding for implementation

Are we going to deliver the required changes this time?Are we going to deliver the required changes this time?

Jul Aug Sep Oct Nov Dec Jan Feb Mar

Data Collection

Engagement

Business case

Common assessment

Inventory & Pricealignment

Commissioning guidance

Contact centre development

Market change

Personalised budgets

Cross agency approach

System change

Command & control

System Knowledge

UserKnowledge

System Knowledge

User Knowledge

Command& control

Systems ThinkingCommand and control

Lean or whole system thinking is about putting the citizen at the heart of the design

Application of this approach reduces costs delays and lead times while improving customer outcomes, productivity, efficiency, service quality and VFM.


A wide group of stakeholders have involvement in the process

Clinicians

SuppliersUsers

Parents Commissioners

Carers Social Services

Work and Pensions

Education

Councils

3rd party providers

Regional health authority

Health trusts

Dept Health

Voluntary sector

Supply chain

International exemplarsGPs

EngineersProcurement

Tertiary centres

Other rehab services

Project team & work

groups

Stakeholders


Documents

NHS South West Wheelchair Review Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at