Our wheelchair services team in Hull & East Riding have been working with Centre for Health Economics and Medicines Evaluation (CHEME) at Bangor University to implement a tool to capture Person Centred Outcome Measures for wheelchair users to help make decisions about what is important to them.
Dr Lorna Tuersley and Dr Nathan Bray from Bangor University developed the Wheelchair outcomes Assessment Tools for Children (WATCh) to allow patients, clinicians, and therapists to identify, score and monitor individuals’ most important outcomes before and then after wheelchair provision. The tool helps providers understand the differences that wheelchair provision has made in the most important areas for each individual child. They are now researching its use for adults through the WATCh-Ad variation of the tool on behalf of NHS England to see if it should be adopted across the NHS within personal wheelchair budget pathways.
The WATCh measurement systems allow wheelchair users across a wide range of ages and clinical needs to:
• Select the five outcomes most important to them from a curated list,
• Give their current level of satisfaction in that area, and give an example of what achievement looks like to them.
• Three months after they have received their wheelchair, a follow up survey asks for their current satisfaction scores against each of their chosen criteria.
The clinicians on the team use the tool in their appointments to help open up discussions around what the wheelchair user sees as key issues. In turn this leads to wider holistic discussion centring on the choices available to the person around their wheelchair and funding for it.
Our Hull & East Riding team were one of four services who took part in the research to identify how well the tool works in practice. The team completed their part of the research despite the challenges faced during the pandemic. They have recently been asked to share how they’ve achieved their success to NHS England at their National Personal Wheelchair Budget (PWB) meeting.
One of the biggest challenges implementing the new system was how to incorporate it into the team’s day-to-day work; how to administer it and properly monitor and act on the results – with no action, the results have no value. For the tool to work accurately, follow up is key. The team arranged for a dedicated member of staff to contact the wheelchair users 3 months after receiving their equipment. They would discuss with the wheelchair user their initial responses to the questionnaire and how their equipment was helping towards their desired outcomes and aims. If the aims are not met any lack of success is identified early, and the person can be referred back into clinic to review their equipment solution.
The initial results of the surveys undertaken have been submitted to Bangor University for their use in assessing the long-term success of the tool within the personal wheelchair budget pathway. The introduction of the questionnaire tool has been positively received by clients of the service with comments such as:
"I didn't realise that a wheelchair would affect all these areas of my life, I thought I was just coming for a wheelchair and be told what I would get".
"I think filling this in at home helped me remember what was important to me when I got to my appointment as I don't always remember everything I want to talk about".
NRS Wheelchair manager Heather Gray said:
“The trial of the Wheelchair outcomes Assessment Tool provided a platform for wheelchair users to think about what is important to them and find out what goals they have in relation to their wheelchair, it also helped clinicians and therapists to tailor interventions with the individual and be more creative in how those goals can be achieved. This fits perfectly with Personal Wheelchair Budget (PWB) offering more flexibility and opportunity for people to access a wheelchair that meets their health and wellbeing needs and goals.”
By putting scores against each level of satisfaction (very dissatisfied = 1 to very satisfied = 5), and adding up these scores for the 5 chosen outcomes before the assessment vs 3 months after receipt of the wheelchair, the team have been able to analyse the overall impact of their provision. The majority of the NRS Healthcare wheelchair service users who took part in the trial had a positive change from initial review to follow up. The average increase, from our service point of view, in satisfaction scores of the trial group was approximately 50%, with half of those surveyed very satisfied with all their 5 priority outcomes after they have had their wheelchairs for 3 months.
Following this success, the team have continued with the use of the WATCh and WATCh-Ad tools, and we are introducing outcome-based assessments in other areas of the business.
For further information about our Clinical Division and how we can help local authorities with their provision of wheelchair services please see our dedicated pages here or contact our clinical team on 01530 232330 or by email.