This year I started working as a locum occupational therapist (OT), because I have always wondered how it would impact on my professional practice, and how it might develop my knowledge and skills as an OT. Whilst working at the Guernsey Wheelchair Service, I was grateful to be granted a bursary to attend the PMG Conference 2016 in Birmingham.  It provided an invaluable learning experience, improving my knowledge of mobility equipment and current innovations, as well as the research being conducted by a range of professionals and organisations relating to posture and mobility.

The conference also provided information about current wheelchair service developments in England. The parallel session entitled Personalising wheelchair services – your chance to influence the process particularly caught my attention. It was led by Steven Pruner, Personal Health Budgets Regional Lead at NHS England (NHSE).  The session was packed with professionals from many different services, keen to hear the content of the lecture.  

The presentation included an introduction to Personal Health Budgets (PHBs) and the existing situation, followed by discussion of the wheelchair service budgets, information regarding current proposals, and concluded with the opportunity for delegates to ask questions and to share their concerns. It was quite intense, and numerous queries were raised as to how PHBs will affect the wheelchair service system, its budget and, most importantly, the service users. Pruner explained that PHBs are not new money but a way of spending health funds differently, as well as trying to use the resources more effectively to meet the needs of service users. The idea behind PHBs is to create transparency in order to establish where and how funds are being spent, hopefully giving service users greater choice and the opportunity to work in equal partnership with the NHS.

The UK government has a mandate requiring NHSE to develop a plan with specific milestones for improving service user choice by 2020, particularly through using PHBs. The session emphasised that at the heart of PHBs is a care plan developed by the service user in partnership with their health care professional(s). Pruner described the process of a PHB, which starts out with making contact and gathering information, followed by understanding the person’s needs. Next is calculating the amount of money available, creating a care plan, organising care and support, and finally monitoring and review. This cycle can go back to care planning if needed to ensure that the clinical needs of a service user are met.

Pruner argued that PHBs are part of an effort to help commissioners improve wheelchair services, since not all Clinical Commissioning Groups offer a voucher scheme, and wheelchair service provision varies across the country.  Where vouchers are offered, there is rarely support for making an informed choice about which chair to purchase, and little, if any, provision for maintenance, repair and replacement.  There are usually few retailers locally where vouchers can be redeemed, and voucher value is not related to the cost of the chair.

Reflection

I learned that the stated purpose of a PHB is for service users to choose the health and wellbeing outcomes they want to achieve in partnership with their health care professionals. PHBs allow service users to know how much money they have for their healthcare, giving them the opportunity to create their own care plan, with support if they want it.  They also enable service users to choose how their budget is held and managed. In this way they would have the right to ask for direct payment, and be able to spend money in ways and at times that make sense to them, as agreed in their plan.

As a locum OT I have worked in many wheelchair services, and concur that there are noticeable differences in terms of eligibility criteria and provision of equipment. Wheelchair services have their own individualised range of equipment, which at times may not be the preference of a service user. There are also differing ways of dealing with referral, assessment, equipment provision, as well as maintenance and repair, leading to inconsistency depending on the location or whoever is funding the service.  These differences can create delays in provision and/or with maintenance and repair of equipment, which are the main causes of complaints.

I feel that NHSE’s idea of introducing PHBs to improve service users’ choice is essentially a good one but, if not implemented properly, it could lead to further confusion and conflict.  The implementation of PHBs must be supported by effective dissemination of information, alongside clear model specifications that can be easily understood and are readily available to all those who wish to access the services. It would be helpful to know the pitfalls experienced in the pilots before PHBs come on stream, as well as what choices service users taking part in these pilots have made. Such detail would give professionals like me an understanding of how PHBs are being used, and what impact they are having on people’s health and well-being.

Bibliography

Personal wheelchair budgets

https://www.england.nhs.uk/healthbudgets/understanding/wheelchair-budgets/

Personal Health Budgets

https://www.england.nhs.uk/healthbudgets/

Photo top right, courtesy of Suzie Hunt: Steven Pruner presenting at PMG Conference 2016