Section 1: Introduction
Section 2: General eligibility criteria
Section 3: Purpose of the eligibility criteria
Section 4: Categories of different levels of need and types of wheelchair user
Section 5: Plus size (mediatrics/bariatrics) wheelchairs
Section 6: Options for wheelchair provision
Section 7: Criteria for assessment
Section 8: Right equipment at the right time and place
Section 9: Exclusions
Section 10: Provision of wheelchairs to clients residing in nursing/residential homes/placements/rehab centres
Section 11: Definitions of equipment and additional notes
The Kent and Medway Wheelchair Service provides wheelchairs for child, young person and adult clients with a long-term physical disability that affects their mobility, necessitating a wheelchair and/or specialist postural seating that optimises mobility, comfort and safety in meeting their overall aim of achieving independence and optimal function related to activities of daily living.
The service is provided for patients who are registered with a General Practitioner (GP) within the catchment area of the eight Kent and Medway Clinical Commissioning Groups (CCGs)
The definition of long-term is a period of more than six months. The service is also provided to clients who are terminally ill with a short life expectancy.
The wheelchair service comprises the following key components:
- Purchase/provision of equipment
- Equipment delivery and collection
- Repair service
- Service user training on equipment provided where indicated
General Eligibility Criteria
Clients will be supplied with a wheelchair providing the following criteria are met:
- The client has been referred to the service by their GP, registered community nurse, occupational therapist, physiotherapist or other allied health or social care professional;
- The client has a long-term physical condition that significantly restricts their mobility;
- The client has a long-term illness that restricts their mobility; and/or
- The client is terminally ill and requires a wheelchair to aid their mobility
Long-term is defined as a period of more than six months.
- If a CHC or neuro-rehab patient assessment identifies the need for a wheelchair, the CCG CHC team will contact the service to make them aware.
- If the assessment meets the usual service eligibility criteria, then a wheelchair will be provided.
- If the assessment falls outside of the usual eligibility criteria, the service will then provide a cost estimate for the chair and maintenance and agree this with the CCG CHC team. If agreed, an invoice will be sent to the CCG and the wheelchair will be provided.
- This process will be reviewed annually to ascertain its success.
Purpose of the eligibility criteria
The eligibility criteria has been developed to:
- provide transparency and clarity for clients and their parents/carers requesting, or currently receiving, a service from the Kent and Medway Wheelchair Service;
- support the service provider to deliver a person-centred service for individuals who have long-term impairment to their ability to walk. This will be realised through a holistic multidisciplinary/multi-agency assessment of their needs (where this is appropriate);
- support the prioritisation of provision of wheelchairs, specialist seating and associated equipment to clients with the greatest clinical needs within available resources;
- support equity of provision to the population of Kent and Medway;
- ensure that when demand exceeds supply, waiting lists are addressed in a fair and transparent manner, according to clinical need and other risks;
- promote multi-agency commissioning of wheelchairs and specialist seating systems through using funding streams from within the NHS and other agencies where appropriate;
- promote the participation of the clients in choice of wheelchairs and specialist seating linked to their assessment needs;
- signpost referrers to alternative sources of provision where appropriate.
The wheelchair service, when carrying out an holistic assessment of the client’s and carer’s needs in partnership with other agencies, will prioritise the clinical needs of the client, whilst also taking into consideration the needs of the parent/carer. Where there is a conflict between the assessed needs of the client and those of the parent/carer, a creative solution will be developed. However, the primary client for the wheelchair service remains the wheelchair user.
Categories of different levels of need and types of wheelchair user
Plus size (mediatrics/bariatrics) wheelchairs
For the purpose of this document, the definition used for clients with bariatric needs is that the wheelchair is designed and construction to carry clients who weight 25 stone (159kg) or more.
The client will:
- exceed the manufacturer’s weight limit for a standard wheelchair;
- have their weight accurately measured and recently recorded (within one month of assessment);
Where the wheelchair is to be used within the home environment, this will be assessed by a suitable representative from the wheelchair service to ensure accessibility and manoeuvrability within the dwelling and have adequate storage for the wheechair.
Whilst the lead agency for funding all forms of equipment as defined in Table 1 (Categories) is the NHS, there is an underlying principle that on a case-by-case basis there may be a need to jointly commision a piece of equipment to maximise the client’s and their parents’/carers’ independence and quality of life. There may also be occasions where the lead agency is a school or college or a local authority to fund a piece of equipment, but it is prescribed and procured via the wheelchair service.
Options for wheelchair provision
There are four options for the provision of wheelchairs for clients and their parents/carers.
With reference to the Table 1 (Categories), to accept an assessment and prescription by an appropriately qualified professional followed by loan of an NHS wheelchair, maintained and repaired by a provider commissioned through NHS Kent and Medway.
Part NHS provision via a voucher scheme (the voucher scheme may shortly be replaced by personal wheelchair budgets (PWBs) by NHS England:
Independent voucher: Following assessment and prescription by an appropriately qualified professional, the client and their parent/carer has the option to contribute to/top up the cost of a more expensive wheelchair of their choice from an approved supplier. The client will own the wheelchair and be responsible for its maintenance and repair; however, the wheelchair service will signpost the client to reputable wheelchair suppliers on the NHS voucher scheme suppliers.
Partnership voucher: Following the assessment and prescription by an appropriately qualified professional, the client and their parent/carer has the option to contribute to/top up the cost of a more expensive wheelchair from an approved supplier (the choice of wheelchair is more limited with this option as it needs to be from within the range maintained by the approved repairer). The NHS will purchase and own the wheelchair and be responsible for its maintenance and repair. In addition, the client or their parent/carer must agree in writing to the conditions of the loan.
The vouchers are expected to last five years for the Kent and Medway Wheelchair Service.
The expectation is that the Kent and Medway Wheelchair Service will take into consideration changes in the assessed clinical needs of the client and their parent/carer and that the demand on the wheelchair will vary from user to user. Where the independent voucher option has been chosen and a replacement is requested within the five-year period due to being beyond repair, the client or their parent/carer will be expected to provide evidence of previous maintenance records.
If a client or their parent/carer wished to approach a registered charity for a wheelchair and/or specialist seating system, it would be expected that the equipment’s maintenance would form part of the purchasing agreement. The wheelchair service will not have a responsibility to maintain a wheelchair purchased through a charity.
If a client or their parent/carer wished to purchase a wheelchair and/or specialist seating system solely through private funds, the responsibility for maintaining the wheelchair and/or specialist seating system will remain with them.
Criteria for assessment
The assessment process will have identified that the client has a long-term significant impairment to their ability to walk and requires the use of a wheelchair and/or specialist seating system to promote their independence and quality of life.
Right equipment at the right time and place
It is essential the wheelchairs and specialist seating systems are designed to meet the specific needs of the client, whilst also taking into account the assessed needs of their parent/carer.
It is essential that a flexible and age appropriate range of wheelchair, buggies and specialist seating systems are available that promote age appropriate independence and quality of life, rather than learned helplessness and dependency.
As part of an agreed care plan, a multi-agency approach to commissioning wheelchairs, buggies and specialist seating systems could be considered as part of a creative approach to meeting the assessed needs of the client and their parent/carer.
It is essential that the Kent and Medway Wheelchair Service is able to respond promptly and effectively to the potentially rapid deterioration of a client’s condition; this will also include those clients who are at the end of their life, or who may be prevented from requiring hospital admission through their interventions.
Wheelchair and associated equipment are NOT provided by the wheelchair service under the following circumstances:
- For short-term need (CAT4 in Table 1 (Categories), e.g. leg fracture, rehabilitation or operations which lead to a short-term requirement for a wheelchair). Short-term needs will be supplied by a short-term loan provider. Best endeavours will be made by the wheelchair service to meet the needs of existing service users who require provision in these instances;
- For part-time (less than 3 days a week) transit use only (CAT 3 in Table 1);
- In a care home setting when required for transit only (i.e. NOT enable independent access around the home or to support access to the community);
- Where a wheelchair has already been provided (except in a case of the provision of a standard manual chair to act as an emergency back up where an electrically powered indoor/outdoor chair is issued);
- Electrically powered outdoor chairs – clients requiring outdoor only provision would only be assessed for a manual wheelchair;
- Wheelchairs/buggies will not be provided as a static chair;
- Pressure relieving cushions will not be provided for use in static seating/armchairs in either a client’s home or in a care home situation;
- The provision of mobility scooters is not included;
- The service will not provide wheelchairs for the purpose of restraint owing to a behavioral or mental condition if the patient has the ability to walk;
- Additional batteries will not be supplied for EPICs or EPIOCs. The client/carer is responsible for ensuring their wheelchair battery is placed on charge;
- Wheelchairs will not be provided as part of a programme of rehabilitation, whether in hospital or at a specialist rehabilitation centre, as these should be provided by the hospital or rehabilitation centre as part of the ongoing treatment process. Once the long-term clinical need of the client is known and the environment in which the wheelchair will be used on discharge, the provider will conduct an assessment as part of discharge planning with the hospital or rehabilitation centre.
- Wheelchair will not b eprovided for use solely in a work environment or solely in a school or other educational establishment; however, the service will work with ‘Access to Work’ and/or educational establishments to specify and facilitate provision through alternative funding streams;
- The wheelchair service does not normally provide equipment to children under the age of 36 months, as it is excepted that in most cases a normal commercial buggy will be suitable. However, if the child has complex postural or medical needs (as identified through the assessment process), consideration to provide a specialist buggy will be directed to the relevant CCG for consideration to fund on an individual basis. In all cases, the buggy will be age appropriate for the child;
- Rain covers and sunshades are not supplied by the service; information regarding private purchase can be provided where applicable;
- Lap straps, harnesses and head supports are not supplied for transport use only;
- In those instances where the client is unable to be seated in a wheelchair; this will be discussed with the client and their carer at assessment.
Provision of wheelchair to clients residing in nursing/residential homes/placements/rehab centres
The Kent and Medway Wheelchair Service provides on loan, wheelchairs for individual use for clients who meet the following criteria:
- The client requires a wheelchair to be independently mobile, e.g. by self-propelling or foot propelling. NB: Independence means that the client can independently operate the wheelchair; and/or
- The client requires significant postural support to minimise postural deterioration and to maximise function. In some instances, it is more suitable for those residents requiring significant postural support to be provided with a suitable static seating system rather than a wheelchair. Therefore, the nursing/residential/rehab centre will be responsible for provision.
- It may not always be possible for severely disabled residents to be able to be appropriately seated in a wheelchair, in which case a wheelchair would not be appropriate for their needs.
- It is not desirable for residents to sit immobile in a wheelchair for long periods.
- It is at the discretion of the assessing therapist whether a wheelchair will be provided following referral, even if the client appears to meet the above criteria. If there are concerns about tissue viability and/or posture in the wheelchair, and it is felt that the client would be more comfortable in an armchair/bed, then this recommendation will be made.
Definitions of equipment and additional notes