Community equipment and wheelchair services - our response to service user feedback

Published on 20 Mar, 2017

The following stakeholder comments relate to both community equipment and wheelchair services. Also provided are the details of how we have worked to address this service user feedback throughout the procurement exercise which resulted in a change in service provider for both Community equipment and wheelchair services from 1 December 2016.

Service users told us

We did

Patients said that equipment is often delivered with no information on how to use it.

Commissioners re-procured these services, with a focus placed on improved patient literature concerning how to use equipment.

The new service providers are commissioned to set-up all equipment and demonstrate its use to patients in their home, with literature left with patients as supporting information.

Patients and health professionals raised concern that patients do not know equipment is loaned to them and that they can return equipment when it is no longer required.

Concerns were raised that hundreds of raised toilet seats and walking frames are issued and used for a short time and are then lost in garden sheds/cupboards – when items should be returned and reused.

The new providers of the newly commissioned services label clearly all equipment items with the telephone number that patients should ring when they no longer require their equipment and require collection.

The new services are commissioned to collect equipment within 5 working days. There are recycling targets applied to the contract to encourage re-call of equipment and recycling. Equipment amnesties are also planned in the near future.

 

Patients and health professionals want more information regarding the equipment available and how equipment is selected for provision on the catalogue. Is it good quality equipment?

 

The new community equipment provider is commissioned to provide quarterly Equipment Review Groups with clinicians from all hospitals across North Yorkshire.

The Equipment Review Group is the forum for checking equipment on the catalogue is suitable and for considering national best practice.

The new Community Wheelchairs provider has many wheelchair contracts across the country and therefore has the expertise and knowledge to bring to this local area and our local clinicians with regards to suitable equipment provision.

 

Patient said “I don't know how to engage to improve the service”.

 

Commissioners acted on this feedback quickly and have established a service user forum for Equipment and Wheelchair services working with Healthwatch York and North Yorkshire. The forum meets monthly and is a forum where patients/service users can feedback on the experiences of services.

Patients, Healthwatch and Councillors said that commissioners need to involve service users in the procurement and on-going monitoring of services.

Two local service users who regularly attend the service user forums (above) were asked to participate in the evaluation of bids when the re-procurement was undertaken.

Patients therefore assisted with the selection of the new service providers. Service users will also be actively involved in the monitoring of contracts and service improvements as we move forward.

Patients and prescribers of equipment, asked how do you know who has what equipment and when it needs to be collected?

A bar code tracking system has been implemented by both services. Both services utilise clever IT systems which log all equipment allocated to patients.

Patients and carers advised that there were lots of different providers for Equipment and Wheelchair Services, for example for repairs an alternative provider had to be contacted because the contract was sub-contracted. This created a lot of confusion.

Commissioners previously commissioned equipment and wheelchair services from multiples providers/repairers.

There is now just one service provider in place for Community Equipment Services and one provider for Community Wheelchair services.

There is one contact number for each service to ensure that patients and carers know who to call.

Patient and carers raised concern that providers did not always fully listen to the patient and take their needs into account.

 

Wheelchair services have been commissioned to provide a full assessment of patient’s holistic needs in order to determine treatment and care plans.

Treatment/equipment available must be explained to patients and carers in a clear, consistent manner.

In addition, both services are commissioned to actively collect and act on patient feedback and share feedback/learning and resulting developments with commissioners. The service user forum also provides the opportunity to feedback on services directly with commissioners.

Patients and carers raised concern that they often ring into services and are unable to speak to staff who know about products / clinical matters or are in fact unable to contact the service at all, because phones are not answered.

The new community equipment service has a dedicated customer services line, manned 8am-8pm Monday to Friday and on Saturdays.

The helpline can be used to discuss equipment products and assist with repairs/enquiries. The new community wheelchair service has one central number which can be called.

The new community wheelchair service provides an on-duty clinician who is always available at the end of the phone to discuss any clinical matters and/or answer enquiries regarding wheelchairs/equipment.

Patients, councillors, providers and local charities raised concern that there is a lot of waste in the system. Patients/carers are often not told where to hand equipment back in – can it be recycled?

Approximately 80% of equipment if returned to providers can be refurbished, decontaminated and re-issued to other patients.

There are recycling targets on new contracts, with patients advised to return equipment when it is no longer in use.

Equipment is clearly labelled with the telephone number to ring to request collection.  Equipment amnesties are also planned in the near future; for example recycling bins will be placed across North Yorkshire so that patients/carers can drop off equipment.

Patients advised “we don't know how to access these services”.

Information has been shared across provider / commissioner websites, key stakeholders and GP practices with regards how to contact these new services.

 

Patients and carers raised concern that they have previously asked community equipment and wheelchair providers to collect equipment and this has taken weeks to be collected.

The new service providers are commissioned to collect equipment within 5 working days of the request for collection being made.

If collection is due to bereavement, equipment will be collected within 2 working days of the request.

Patients, prescribers and referrers advised that services need to be accessible with extended hours commissioned to support need

The Community Equipment service is commissioned to provide services 8am-8pm Monday to Friday and on Saturdays to facilitate hospital discharges.

The wheelchair service operates 8am-5pm, Monday – Friday, with Saturday clinics also commissioned to facilitate improved access for patients who work full-time. Both services provide an out of hours, 24/7 repair service.

Patients requested time slots for delivery of equipment/wheelchairs. Patients felt that there was an expectation that they would always be home because of their disability, when this should not be the case.

The community equipment service is able to advise of the date of delivery and whether an AM/PM delivery slot. The community wheelchair service is currently working to provide this service element in early 2017.

Patients suggested that drop in sessions for advice on keeping well and pressure sore relief should be offered.

This is a request that shall be explored fully with providers going forwards.

Patients requested improved waiting times for both services, as historically there have been long waits for Community Equipment and Wheelchairs.

Commissioners worked with national providers to discuss and review suitable waiting times. Within the specification for new services, the following best practice waiting times have been commissioned:

Equipment:

  • Urgent delivery of equipment within 4 hours
  • Routine delivery of equipment within 3 working days
  • Collection of equipment within 5 working days
  • Urgent repair within 4 hours
  • Routine repair within 5 working days

Wheelchairs:

  • Patient assessment within 6 weeks of referral
  • Equipment provision within 12 weeks of assessment
  • Collection of equipment within 5 working days
  • Urgent repair within 4 hours
  • Routine repair within 5 working days

Providers from across the country advised that we should consider alternative financial models to incentivise providers to recycle equipment and also save commissioners money in the long-term to reinvest within services.

Commissioners explored alternative models available and have applied a ‘credit model’ to the community equipment contract. NHS Vale of York has won an award from the Yorkshire and Humber HFMA for application of its innovative financial model and also for joint working between commissioners across North Yorkshire.