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NHS to offer thousands more people a greater choice of care, with more control for wheelchair users over their provision

NHS England today sets out action to help people manage their own health by giving them more choice and control about the personal care they receive.

Three key schemes will be announced at the NHS England Personal Health Budget conference:

  • Personal Health Budgets will replace the current wheelchair voucher scheme as part of efforts to improve services for over 1.2 million people that currently use wheelchairs.
  • The seven sites chosen to develop new ways of delivering choice in maternity care, offering mums-to-be access to services that best suit their needs and preferences.
  • The publication of the Integrated Personal Commissioning (IPC) Emerging Framework, setting out the future model of care for patients and families with the most complex needs

Simon Stevens, Chief Executive of NHS England, said: “We are determined to give people more power and control over their own healthcare rather than just informing people about decisions taken by others on their behalf.”

On Personal Wheelchair Budgets – a new approach to wheelchair commissioning will replace the current voucher scheme. Wheelchair users have found a number of challenges with the existing scheme, now 20 years old, including a lack of information and guidance around maintenance, repair and replacement as well as a limited number of providers where a voucher can be redeemed.

The new personal health budget scheme will offer more choice of where wheelchairs can be bought as well as a detailed care plan that will help users make informed decision about their wheelchair. The care plans will also go beyond purchasing the chair to also include guidance on future maintenance, repair and replacement needs.

It means that a wheelchair will form part of a person’s wider care, catering for their individual needs and ensuring a more joined-up approach, a key aim of NHS England’s Five Year Forward View. The new approach will also help NHS England collect meaningful data on wheelchair provision that will further help improve services and address variations in provision across the country.

Ruth Owen, Chief Executive of Whizz-Kidz, said: “We’re delighted with today’s announcement; it’s a significant step forward, and will give young disabled people, and their families, freedom of choice and control over their own wheelchair provision.

“We know that the families we work with want choice and flexibility; making Personal Health Budgets available for young people’s wheelchair services makes this a reality. This will, at long last, open the door to truly personalised, holistic support for young disabled people.

On the Maternity Choice and Personalisation Pioneers – the seven pioneers, made up of neighbouring Clinical Commissioning Groups, are:

  1. Halton CCG, Liverpool CCG, St. Helen’s CCG, Knowsley CCG, South Sefton CCG, Southport and Formby CCG, Wirral CCG, Warrington CCG, West Lancashire CCG, West Cheshire CCG, South Cheshire CCG
  2. Birmingham South Central CCG, Birmingham CrossCity CCG, Solihull CCG
  3. Salford CCG, Wigan CCG, Bolton CCG
  4. North East Hampshire & Farnham CCG, North Hampshire CCG, West Hampshire CCG, South East Hampshire CCG, Fareham &, Gosport CCG, Southampton CCG, Portsmouth CCG, Isle of Wight CCG
  5. Croydon CCG, Kingston CCG, Merton CCG, Richmond CCG, Sutton CCG, Wandsworth CCG
  6. Newham CCG, Tower Hamlets CCG, Waltham Forest CCG
  7. West Kent CCG , High Weald Lewes and Haven CCG, Maidstone and Tunbridge Wells NHS Trust

Pregnant women living within the pioneer areas will be offered a personal budget and will be able to use it to make choices for each of three stages of the pathway – antenatal, intrapartum and postnatal care.

This means a woman would have a wider choice of who provides the maternity care she would prefer, such as a birthing pool, specialisation in teenage, older, or first time mothers, or a provider with a good reputation for breastfeeding support.

NHS England and other partners will work with the pioneers to develop and test new approaches which can then be rolled out nationally.

Sarah-Jane Marsh, Chair of the Maternity Transformation Programme Board, said: “This is a significant step in implementing several recommendations from the National Maternity Review. Widening and deepening choices across maternity services will enable women to make informed decisions and choices about the care they receive, that’s right for them. Their work will test ways of improving choice and personalisation for women and contribute to shaping world-class maternity services.”

Baroness Julia Cumberledge, who led NHS England’s independent Maternity Review, said: “Congratulations to the seven pioneers who have seized the moment to demonstrate the worth of Personal Maternity Care Budgets, giving more choice to expectant mothers and their families. By being put in control of where the budget is spent, women will have more power to ensure their decisions for their baby’s birth and care are respected and implemented.”

On the IPC Emerging Framework – the launch of the new framework sets out the changes needed to deliver more joined up health and social care and so enabling patients, carers and families to ‘commission’ their own care through personalised care planning and personal budgets.

Based on learning from the first year of the programme, the framework is key to achieving the aim of making IPC a mainstream model of care for people who would benefit from it by 2020/21. This includes people with multiple long term conditions, people with severe and enduring mental health problems, and children and adults with learning disabilities and autism.

The framework sets out an expanded role for communities and peer support, and an embedded personalised care and support planning approach as central part to the model. Further control will be given to patients and families over decisions made about their care, through the option of a personal health budget.

It means the national roll-out of the IPC programme will now begin, with areas being asked to signal their interest to be “early adopters” of IPC through their Sustainability and Transformation Plans.

There are currently around 7,500 people with a Personal Health Budget and today’s announcement is a big step towards achieving the goal of up to 100,000 people benefitting from the greater control they offer by 2020/21.

4 comments

  1. NHS England says:

    Thank you for your comments relating to these announcements and it’s great to see that people are keen to engage and share their views on these new developments. For more information about the work around wheelchair services, please have a look at https://www.england.nhs.uk/healthbudgets/understanding/wheelchair-budgets/. Please do note that the work is at an early stage of development and there will be further opportunities to engage as well as more detailed proposals made available as the work develops. There are two separate strands to the work, one looking at the current wheelchair voucher scheme and another looking at more complex wheelchair needs as part of a wider care package.
    Kind regards,
    NHS England

  2. Teresa Newey, parent/carer says:

    I am a little confused. My daughter is 19, has profound and multiple learning difficulties and health needs. We do not have a voucher system, but she is assessed by an OT for her wheelchair, to ensure good positioning and suitability. I am not an expert on wheelchairs, positioning or suitability. You advise “care plans” to ensure suitability but do not say when and where these assessments take place or by whom, who is accountable and also the fact that needs change. It appears cost saving exercises pose more problems than they solve ( eg-incontinence pads, recently changed to “one product-the cheapest-suits all”, leading to problems that result in higher health costs!!). I believe “managers” make decisions on our behalf, without proper consultation with service users. I do not “do” twitter. How do I get my voice heard? I only came across this information via a facebook group and know many people who do not use social media. A few weeks ago a metal strut broke on my daughter’s chair whilst she was at school, making it unusable. It is her only mode of transport. The repair service came out the same day and replaced her chair We had a wheelchair appointment a few days later to check everything was alright. I was very pleased with the service and the outcome. This potential change to the service was not mentioned at the time and I worry that this level of service will not be maintained.

  3. John bruce says:

    It’s a shame to note that
    detailed proposals are not offered in this consultation or set out on paper that can be posted out in response to requests.
    Personal health budgets should not be considered in isolation, but as part of overall review of nhs wheelchair services
    Nor are detailed proposals, different models considered

    Consultation is only offered by tweeting on a particular day at a particular time.
    Very Difficult if you don’t do tweeting, or unavailable that day!

    The apparatus and commitment to meaningful consultation appears very weak almost frivolous.
    Whilst it may give choice to a few competent people, who know their medical conditions, understand postural and pressure area management very well…
    Presumably they will still need the services of a skilled nhs wheelchair therapist, who will act as both advocate for meeting a wide range of assessed and considered lifestyle needs … office, home, off road, opportunity to engage in and access sporting activity , moving and handling consideration of personal assistants, family members in perhaps pushing a manual wheelchair, considerations of power assisted self propelled designs, vehicles existing and potential, and public transport available to a person……..
    And the tough role of gatekeeper at present limited budgets.
    To the best of my knowledge, nhs England have not ring fenced budgets delegated down to ccgs on the basis of a researched figure per 10,000 or 100, 000 population
    What are the benefits for someone to step out of hopefully a well resourced, skilled, responsive local nhs wheelchair service, with easy access to repairs, easy access to reviews modifications, bespoke adaptations , fit for the 21st century ?
    Many of the current services are starved of cash, advice of nhs wheelchair managers group ignored.
    In the UK cohort of people who would benefit from wheelchair assistance, estimates of 70-80% have needs that can be met by a limited range of well made manual self propelled and transit chairs. There is still great benefit for say a wheelchair therapy assistant to run
    A non complex wheelchair therapy clinic or travel with a van and home assess and leave an appropriate chair, ensure basic home environmental issues ramps , door width recommendations are referred on .
    The power of bulk purchase/ contract call off will or should ensure the unit price is lower than the cost of individual and their being given a voucher/ health budget chitty to go along to boots PLC or even supermarket or Argos store, with the message…. you are now on your own regards hazards of brake adjustment, replacement of worn or broken parts, that have to come from a plethora of factories in China to The UK in slow moving container ships, if they are available at all. Last but not least is the voucher / health budget recipient going to get a good competent support in help training and advice in the difficulties of skills of negotiating kerbs, lifting chair in and out of family vehicle.

    The philosophy seems driven by the any qualified provider for a consumer model which has fragmented paralysed systematic wheelchair service development , even when services are not outsourced.

    I have yet to see evidence of the widespread outcome benefit of voucher or health budget schemes.
    It is an option for a few who are likely to appreciate the flexibility, self determination. For many it is a recipe for poor
    Nhs spending on wheelchairs is some of the most cost effective NHS spending for the outcome it gives to changing lives, promoting independence, maintain engagement in local communities. Yet no targets for waiting times for assessment/ provision of non complex and complex wheelchairs are identified Our local service said in response to request for approx waiting times that they couldn’t share because of ‘ commercial sensitivity!’its a public service and in-house.
    I would be grateful if you could keep me informed of developments

    John Bruce BSc, DipCOT
    Liverpool

  4. Alistair says:

    Where to I go you get more information?