- Why are personal wheelchair budgets being introduced?
- How are personal wheelchair budgets different to the wheelchair voucher scheme?
- Who can get a personal wheelchair budget?
- How much money will people get in their personal wheelchair budget?
- Can people add their own money (contribute) to the money they get from a personal wheelchair budget?
- What are the options for managing a personal wheelchair budget?
- Will personal wheelchair budgets be available to everyone who has an assessment via their NHS commissioned wheelchair service?
- How can CCGs ensure quality and safety if people purchase wheelchairs outside of NHS commissioned services?
- Does a personal wheelchair budget include the cost of assessing someone’s needs?
- Is repair and maintenance included in a personal wheelchair budget?
- Who owns a wheelchair provided by a personal wheelchair budget?
- Does a personal wheelchair budget cover items such as seating cushions, accessories and harness belts?
- Should wheelchair services stop using the voucher scheme now?
- What support is being provided to professionals to help set up personal wheelchair budgets?
Personal wheelchair budgets are being introduced as part of a range of measures to improve current wheelchair service provision, to ensure people have better experiences of care and to give people greater choice over the wheelchair provided.
Personal wheelchair budgets are replacing the wheelchair voucher scheme. They build on progress to offer personal health budgets to more groups of people and ensure people receive care that is right for them.
In 2015 the National Wheelchair Leadership Alliance produced the Wheelchair Charter which highlighted key actions required to support better wheelchair services and improved quality of life for every wheelchair user.
Personal wheelchair budgets support the delivery of two key actions highlighted in the charter:
- A person centred service that works in partnership with service users and their carers and makes the user/carer voice central to any design, innovation and service change.
- Innovative and flexible budgeting working with key partners to strengthen integration across health, social care, work and education, enabling the accommodation of individual needs, independence, health and wellbeing.
Personal wheelchair budgets have been developed by NHS England’s Personalised Care Group, which is responsible for leading a range of programmes that are essential to the successful delivery of the Five Year Forward View. This sets out a clear vision for the NHS to empower people and their families to have far greater control over their own care and break down barriers between health and social care.
Personal wheelchair budgets aim to build and improve upon the wheelchair voucher scheme and are part of a wider programme of work to personalise people’s care.
The personal wheelchair budget model offers a clear framework for clinical commissioning groups (CCGs) to commission wheelchair services that are based on the health and wellbeing outcomes that people want to achieve, as well as care that is integrated around the person and their family. Personal wheelchair budgets enable postural and mobility needs to be included in wider care planning and can support people to access a wider choice of wheelchair. This can be done by pooling the money provided by the NHS to meet all the assessed clinical need with money from a range of health and social care services, as well as Access to Work grants and funding from the local authority to enable one chair to meet a range of needs .
With a personal wheelchair budget, wheelchair users should expect to have:
- a personalised assessment where they are supported to identify the health and wellbeing outcomes they wish to achieve
- a care plan which captures the health and wellbeing outcomes identified, which may be part of any wider care plans the person requires for their care, for example an Education, Health and Care (EHC) plan
- care that is better integrated, meaning that different agencies work together to support their postural and mobility needs and achieve their health and wellbeing outcomes
- information provided upfront about the amount of money available in their personal wheelchair budget and the options available to them locally to use it
- information about the repair and maintenance of wheelchairs, if the option to purchase a wheelchair outside of the NHS commissioned service is taken.
During 2017/18 all CCGs have been expected to develop a plan for providing personal wheelchair budgets to replace the existing voucher system.
The personal wheelchair budget model has been developed to include people who are referred and meet the eligibility criteria of their local wheelchair service, and receive a face to face assessment with a clinician. People who are already registered with the wheelchair service will be eligible when they require a new wheelchair, either through a change in clinical needs or in the condition of their current chair.
Local eligibility criteria for wheelchairs still apply, which CCGs are responsible for and are based on local population needs. Details of local CCGs can be found on the NHS Choices website.
Each CCG will develop local processes to calculate the amount of money in a personal wheelchair budget. The amount will be based upon what it would cost the NHS to meet the person’s assessed postural and mobility needs via the wheelchair service currently commissioned by their CCG.
For people who have additional health and social care needs, the personal wheelchair budget could be pooled with funding from other statutory services. ( if this is agreed as meeting the persons assessed needs by all services involved and is cost effective.)
People can also chose to access non-statutory funding that may be available via voluntary, charitable organisations both nationally and locally.
Can people add their own money (contribute) to the money they get from a personal wheelchair budget?
Yes. The introduction of personal wheelchair budgets does not change the current regulatory framework, which enables people to contribute to the cost of a wheelchair.
A personal wheelchair budget can be managed in the following ways:-
- Notional personal wheelchair budget: This is where the person chooses to use their personal wheelchair budget within the NHS commissioned services and the service purchases and provides the chair. This also offers the option for contributions to the personal wheelchair budget to enhance the wheelchair people can access. This contribution may come from an integrated package with other agencies such as education, social care, a voluntary or charity organisation, or through self-pay. This would have previously been known as a partnership voucher.
- Third party personal wheelchair budget: This is where the person chooses to use their personal wheelchair budget outside of NHS commissioned services. An independent provider receives the personal budget via invoicing the NHS. This may also be contributed to as above. This would have been known previously as an independent voucher.
- Traditional third party personal health budget: where an organisation legally independent of both the NHS and the person holds the money and manages the budget. This could include provision of a wheelchair as part of a package of support.
- Direct payment: This is where the budget holder holds the money in a bank account or an equivalent account, and takes responsibility for arranging the care and support, in line with the agreed personalised care and support plan.
Direct payments are currently not routinely available as an option for managing a standalone personal wheelchair budget. NHS England and the Department of Health and Social Care are currently reviewing existing regulations to establish whether additional contributions are permissible under the Direct Payments in Healthcare Regulations.
Therefore where a direct payment is requested it would either need to meet the whole cost of the wheelchair (which may be appropriate as part of an NHS Continuing Healthcare package), or be part of an integrated package of care and clearly able to demonstrate the health and wellbeing outcome which required a contribution via a separately commissioned service.
The personalised health and care framework explains more about the options for managing a personal health budget or integrated personal budget.
Will personal wheelchair budgets be available to everyone who has an assessment via their NHS commissioned wheelchair service?
Personal wheelchair budgets will not be right for everyone. Once a person has been found eligible for a wheelchair, their healthcare professional will discuss with them the options for how this can be provided. Everyone should have an assessment focussed on the health and wellbeing outcomes and goals they wish to achieve, and have the opportunity to have their wider needs considered.
CCGs should make every effort to provide a personal wheelchair budget to everyone who meets local wheelchair service eligibility criteria and who wants one. CCGs should ensure they have in place all the personal wheelchair budget management options. In some circumstances it is not appropriate to offer all the options for managing a personal wheelchair budget. For example it may not be clinically appropriate for someone with rapidly changing, or very complex needs, to use their personal wheelchair budget outside of NHS commissioned services as regular adaptions and changes may be required which would be likely to require close monitoring and adjustment. They could however be offered a notional budget. Such decisions should be made on a case by case basis, rather than using set criteria that restrict people who have certain conditions or diagnoses from accessing the full range of options.
How can CCGs ensure quality and safety if people purchase wheelchairs outside of NHS commissioned services?
As part of the care and support planning process, the personal wheelchair budget will need to be agreed by the responsible clinician involved in that person’s care. They will need to agree that the wheelchair chosen is the correct specification to meet someone’s assessed clinical needs.
The BHTA (British Healthcare Trades Association) offer an accreditation scheme for independent suppliers which can support people to make decisions about where to purchase their wheelchair.
No. A personal wheelchair budget is for equipment only. It can only be offered after a relevant need has been identified. Personal wheelchair budgets do not change the duty on statutory services to assess a person’s needs for a wheelchair.
Yes. A third party personal wheelchair budget and direct payment (where the money is spent outside the NHS) should include a contribution towards the repair and maintenance costs. If a notional budget is taken, repair and maintenance will be provided via NHS commissioned wheelchair services. If the notional budget includes contributions to the cost of extra features, such as a seat riser, then repair or replacement of these features may not be covered by NHS commissioned services. For example if these features have been paid for by the local authority, local arrangements will need to be put into place to agree how repairs or replacements will be funded. Services should also consider the options for paying for a warranty for specific additional features and including funding in the budget where these costs are incurred.
The original voucher scheme indicated that people who took the independent voucher option (third party personal wheelchair budget) would become the owner of the equipment, whereas wheelchairs accessed via the partnership voucher option (notional personal wheelchair budget) remained the property of the NHS.
Personal wheelchair budgets follow the same principles, with the expectation that appropriate consideration will be given to ownership and responsibilities for repair and maintenance through the personalised care and support planning process, with the decision outlined in an individual’s personal wheelchair budget agreement.. Where there are multiple funding streams involved, the ownership of the wheelchair would need to be agreed locally on a case by case basis.
Does a personal wheelchair budget cover items such as seating cushions, accessories and harness belts?
If someone chooses to use their personal wheelchair budget outside of NHS commissioned services and their assessment indicates the clinical need for accessories (this could for example include specialist seating or pressure-relieving cushions), then the NHS has a duty to provide these either as part of the personal wheelchair budget, or via the commissioned service. Decisions on how accessories are provided will need to be made locally on a case by case basis, based on clinical assessments.
No. Personal wheelchair budgets build on the functionality of the voucher system and all CCGs must ensure vouchers remain available throughout the transition period. During 2017/18, all CCGs are expected to publish the details of their personal wheelchair budget offer as part of their personal health budget local offer, usually available on CCG websites.
NHS England is supporting professionals through a series of events and workshops to share learning and best practice, as well as through online resources and direct support. The latest information is available on the NHS England website or you can find out more by emailing firstname.lastname@example.org
Professionals working in the NHS and local government can access additional resources on the Personal Health Budgets Learning Network.
To find out about local eligibility and wheelchair services, please contact your local CCG.