Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.
Together with the CCG, Martin was involved in the process of designing how personal wheelchair budgets should best be introduced in the East Riding of Yorkshire. Through this process, it became apparent that his current wheelchair was not fully meeting his needs or addressing the things that really mattered most to him. This presented an opportunity to take a fresh look at how health and adult social care could work more closely together to find a better solution.
Martin was really uncomfortable in his existing wheelchair. Management of fatigue and posture were critical for Martin’s daily life to maximise his independence and flexibility.
He enjoyed cooking and baking, but was frequently frustrated by having to rely on others to reach ingredients and equipment from the kitchen. This sometimes meant a lengthy wait for someone to return home to assist.
He was actively involved in outdoor activities – for example geocaching – which had led to repeated repairs to his wheelchair’s wheels.
The revised personalised care and support planning process enabled the local wheelchair service team to work closely with Martin to identify what mattered most to him about his wheelchair. Although this process did take longer than previously, it meant that key needs had been addressed and that all parties understood their own individual responsibilities. For the new the wheelchair, Martin applied for a personal wheelchair budget.
A local authority Occupational Therapist (OT) provided detailed assessment of Martin’s needs to maximise his independence at home, recommending kitchen adaptations. However, this was not really what Martin and his family needed. The addition of a seat riser function to his wheelchair made much more sense to Martin – not only for making life better in the kitchen, but also for shopping, DIY and socialising. This riser function was cheaper than the kitchen adaptions.
Together with the local authority, the CCG negotiated approaching the adaptations via a discretionary grant process that introduced a renewed sense of flexibility. Not only did this better meet the wider health and wellbeing needs of Martin, but it made financial sense to the system too.
With the direct support of the CCG, the provider was able to make the necessary arrangements to draw together the various lines of contribution to a single point and provide the appropriate specification wheelchair.
This morning this wall was just a wall. Because of my new chair I was able to complete this project this morning on my own.
Two weeks ago I could not have achieved this. There are not only physical advantages of having the right chair and being able to do more independently. The mental lift of a little independence cannot be ignored.
A partnership approach between health and social care via more flexible use of resources within a personal wheelchair budget would not previously have been possible. The net effect benefited everyone.
The addition of technology within the new wheelchair set up means that some updates and repairs can be completed remotely by technical support. Martin can plug his chair into his computer and download the necessary fix direct to the chair, with no need for a personal visit from a technician.
It has been really important for the CCG and provider to work closely together with a clear vision for how change was going to be achieved.
Working closely together with people in this way has been key to understanding where we were starting from and bring about changes in ways that were meaningful to them – for example, information resources and support planning.
Sally Smith, Clinical Lead Equipment and Wheelchairs, NHS East Riding CCG
Personal wheelchair budgets are now embedded within local wheelchair services. They are the established local offer in the East Riding of Yorkshire for those requiring a wheelchair. Although the time taken for initial assessment was found to be longer, it is anticipated that follow-ups and alterations to chairs will be reduced. All options are currently available – notional, notional plus contribution and 3rd party. This has been achieved without additional resources being necessary.
Martin’s review of his new chair, and his personal wheelchair budget
My new chair, overall has life changing characteristics for me.
Regarding driving and being a passenger in the car, it is much more stable in the lockdown positions with much less side to side movement, less suspension after-shock and less pitching. Some of this is down to the improved lockdown bracket, but the six wheel configuration and better suspension contribute.
Being able to upgrade the batteries to 2x 73.5 Amp gives me much better range, even allowing for the extra battery consumption of some of the extras on the chair. The motor upgrade also allowed for more speed if needed. Distances travelled are more important to me though. There was the need to allow for this taking the chair into class 3 territory so I needed to register it with the DVLA and pay for the optional road lights.
The touchscreen is very intuitive and simple to use. Being able to swipe and lightly tap, as opposed to pushing down on buttons, has made a difference in how I use the chair and has made life much easier for me. The almost infinite control of speed this system affords is brilliant. There is an option to increase or decrease the area covered by the tap motion. Glove mode can be turned on or off. The brightness of the screen is adjustable. All of the adjustments to the seat are included on the touchscreen.
The gyroscope option has made a huge difference to my fatigue and physical symptoms because I no longer have to fight slopes and cambers all the time. You just point the chair where you want to go and it does it automatically.
The seat appears to be much more adjustable than my old chair in every direction and, when tilting the seat, it is not as necessary to recline the back. The new wheelchair is much more comfortable on all surfaces and when going up and down kerbs and slopes. So far I have been on smooth, cobbled, bumpy, dirt track, grass and gravel. It is more comfortable on all of them.
The general comfort of the chair is superior in every way. The waterfall arms are more deeply padded and softer. There is more padding and adjustability to the thoracic supports. The back cushion being fabric instead of plastic makes them more comfortable on warm days. The calf supports when my legs are lifted are more supportive, though firmer. I am finding the central leg lift and footplates better than the side ones.
The ability to turn on a sixpence and general manoeuvrability afforded by the mid-wheel drive configuration is, to me, much better than rear wheel drive. Despite not having a kerb climber, it tackles them better than my previous chair. Now having central leg lifters and footplates instead of side ones makes moving around less damaging to white goods and skirting boards.
Being able to check on the health of the chair and battery status on the MyLinx app is not Essential, but nice to have.
The seat lifter is amazing, I can now see over sea walls, reach things from top cupboards, walk along with people at eye level, reach items in the supermarket and access the kitchen worktops. The only restriction is whether you can get close enough. I have even managed to reach to clean the car, in stages, throughout the day.
The lights are very handy, especially for the shorter days. They are essential because of the motor upgrade, but they also look quite good.
And the looks. I’ve gone for bright orange shroud and rims but, with the ability to make a special order on top of the standard shroud and wheel insert combinations, you can make your chair very personal to you.
There are a couple of downsides. It is slightly wider, higher and longer than my previous chair. Being a mid-wheel drive (not rear), the reduced amount of chair at the front is brilliant but I do keep forgetting about the casters sticking out at the back.
I have a Drive From Wheelchair/Passenger Upfront vehicle and it’s a bit tight to get into position either side. The mid-wheel drive is a bit trickier for getting in and out both because of size and the functionality of the side entry lift.
However, these things are a small price to pay for the massive benefits of the rest of the chair.
I am very lucky in that I have a very high spec chair to meet my needs. Adult Services have funded the seat riser option. I funded the road lights, the difference between the prescribed manual leg lifter and the powered option and a quick release for the control centre so I can remove it to allow access to the hand controls on my car.