Since Personal Health Budgets (PHBs) were introduced by the NHS in 2017, they have helped more than 54,000 people two years ahead of schedule.
Launched as part of a strategy to improve care for individuals while allowing commissioners to be more flexible in how they spend tight budgets, PHBs have generally been praised by health professionals and patients alike.
Included as part of PHBs are Personal Wheelchair Budgets (PWBs), which replace the old wheelchair voucher system and allow service-users to use money from commissioners to purchase more suitable mobility equipment privately.
While PWBs have largely been welcomed across the industry and in NHS circles, the new system still requires tweaking and greater publicity to encourage greater take-up.
One commissioning group, NHS East Riding of Yorkshire Clinical Commissioning Group (CCG), recently ran a session designed to increase awareness of PWBs in the community and collect feedback from trade and health professionals.
Sally Smith, clinical commissioning lead equipment and wheelchairs at East Riding CCG, confirms that the organisation has been working hard to spread the word.
Describing how, she says that PWBs are offered to every person who attends a wheelchair clinic appointment and a support form is sent out with every appointment letter.
The CCG has also trained all of its wheelchair approved referrers in the community on what the offer is, as they are best placed to discuss PWBs with service-users. But Smith notes that the wheelchair service for the area receives “very few” completed forms, which has been identified as an area that the team plans to work on.
So far, the CCG has received positive feedback from service-users in regards to PWBs, unsurprisingly because many have been able to access a chair that better meets their clinical and importantly, their social needs. But Smith adds: “As the chairs on the NHS catalogue still meet a large majority of peoples’ needs and are very cost effective a lot of people still choose to have the NHS chair offered. If a support plan has been completed and the options have been discussed these are counted as a notional budget.”
Some of the most popular pieces of equipment among people using the new PWB system include powerchairs that allow users to raise the height or to come into a standing position.
For manual users it has been more about the battery pack and lighter or sportier chairs, Smith says. Most mobility providers initially responded well to the introduction of PWBs, which meant for an uptake in privately purchased equipment.
And Smith says that so far, commissioners in Hull and East Riding have not found there to be much resistance from the mobility industry. However, she notes that it has been acknowledged that the cost of an NHS chair and a private purchase chair can be “insurmountable”.
While PWBs represent an obvious opportunity for service-users, for Smith, they also present a number of key benefits for commissioners. She comments: “Purely giving the wheelchair users of East Riding choice and control can improve their and their carers’ quality of life. Savings can be made in other areas such as social care. For example, providing a chair with a small wheelbase that fits through a domestic door as opposed to the cost of a housing adaptation to widen a number of doors or providing a raiser instead of adapting a kitchen.”
PWBs mean that people can access higher-spec mobility equipment from private providers, but Smith says that in Hull and East Riding, commissioners have tried to look at every other option first. For example, access to work, education, adult social care, housing assistance policy and charities. It has had some cases where people just want to pay any extra cost and not look at any other funding.
As it stands, commissioners in Hull and East Riding do not recommend particular, trusted providers to individuals wanting to spend their PWBs. Although, the wheelchair services operator is able to offer advice based on experience and may also signpost end-users. NRS Healthcare is the contracted wheelchair provider in Hull and East Riding and is in the process of employing a wheelchair user to work alongside the service to look at improving the service. They will also be involved in assisting with the outcomes measuring tool the CCG is using.
Smith concludes: “Often the chair of choice is available from the NHS catalogue, although this may not be what the individual would be entitled to based on their needs. However, with the use of PWBs, wheelchair services are able to suggest the alternative, sometimes at an extra cost. If the person chooses to take a third party option they are provided a prescription and as long as their choice meets that prescription they can purchase the chair from any provider of their choice. As PWBs become embedded in other CCGs and wheelchair service providers, I envisage the different providers and options available to be more common knowledge. We had nine providers coming to our wheelchair event so there is certainly an interest.”
As PWBs become increasingly mainstream, it is hoped that more users will take them up, thereby easing pressure on social care services. As Smith outlines however, the challenge currently is to make PWBs common knowledge among wheelchair users. Perhaps individuals in the mobility sector can play their part here and in turn help oil the wheels of a process which may in turn lead to more demand for high-end equipment.