NHS England recently announced that Personal Health Budgets (PHBs) will be extended to cover wheelchairs from April 2017, replacing the current voucher scheme. New PHBs aim to offer more choice over what wheelchair can be acquired and a detailed care plan to help users make informed decisions. CECOPS, the independent standards body in the UK for wheelchair services, welcomes the move to extend personal health budgets; however there are concerns.
How will PHBs work in practice?
It’s claimed that care plans will not only cover purchasing the wheelchair, but also include guidance on future maintenance, repair and replacement needs.
Could PHBs make the user assessment worse than it currently is?
A wheelchair user often needs other equipment such as communication aids, posture support, or adaptations. They may have different assessments from different independent services:
“It was great that I eventually got an indoor/outdoor wheelchair, but I couldn’t get in or out of my home because the adaptation hadn’t been done. I was given a communication aid but no-one would agree to mount it to my wheelchair.”
Will wheelchair users’ clinical and other needs be met?
A PHB for a wheelchair will only be for a limited amount – how much this will be is currently unclear. Wheelchair users will be able to top up from personal funds if they want or can afford a higher spec wheelchair. However there’s a risk that users may acquire an item which doesn't meet their clinically-assessed needs. If people end up with the wrong equipment, we know that pressure ulcers, personal stress and extra costs to the NHS can result.
Could the wheelchair user be exploited?
Proper safeguards are needed to ensure people using their PHBs to buy a wheelchair are not exploited by retailers, for instance being sold something they don’t need, or being overcharged. When the Department for Health introduced the retail model for aids to daily living several years ago, there were reported cases of people being exploited by retailers.
Will PHBs address long waiting times?
In some areas, waiting times can be up to 18 months. However there are 2 reasons that PHBs could actually increase waiting times: no bulk purchasing and no re-issues.
- Currently, the main reason for long waiting times is lack of funds. PHBs won’t introduce new money.
- Wheelchairs bought under a PHB belong to the user and won’t come back into the wheelchair service to be reissued to another user.
Under the current model, wheelchairs are reissued by wheelchair services. For instance, a wheelchair costing £2000 issued three times over its life results in a cost avoidance of £4000; but three wheelchairs purchased using PHBs will cost £6000.
Could PHBs for wheelchairs actually be more costly?
Most wheelchairs are purchased by the NHS or an outsourced provider under a bulk contract or framework, often at significantly discounted prices. With PHBs, people will purchase equipment outside these agreements from retailers at high street prices, higher than the prices currently paid by the NHS for wheelchairs.
Will PHBs have fast tracking for people who need equipment urgently?
People with rapidly progressive conditions, motor neurone disease, or some types of MS require equipment urgently.
PHBs and Training
There’s currently no guidance from NHS England PHBs team about training. That raises these questions:
- What training is needed?
- Who needs to be trained?
- Who would carry out the training?
- Who pays for it?
It could be costly for local areas to formulate their own guidance and/or deliver training, which could potentially be a barrier for wider adoption of PHBs.