1. NHS South West Wheelchair Review Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way

2. The current approach to the service is unsustainable Radical transformation of the service is required Substantial Growth users approximately doubling every 10 years –increase in numbers of complex patients particularly children who will be life long 15 years+ of failing reports –Frustration in the community over lack of action Strategic decisions will have to be made about what the service should be for –Mobility or lifestyle (Current rationing of complex patients) –Universal or focussed –Do we care for carers We need to improve signposting and assisting people in self care The service is currently highly complex and requires reshaping and changing the boundaries There is a need for a collective approach to drive efficiency and outcome improvement

3. We are currently not spending our money wisely The service supply market dynamic needs rebalancing Users and their Carers High growth increasing expectations Greater complexity Opportunities for earlier / self assessment The service carries out complex bespoke engineering - manufacturers in the best position to drive efficiency do not, we incentivise them to do the opposite – We need to harness the supply base and use their skills and energies to drive QUIPP Supply Base Provide of the shelf or bespoke equipment Wheelchair Service Undertakes mechanical modifications Bespoke fitting and accessories Assemble and fit deliver and handover Hold inventory and spare parts Own maintenance and repair issues Refurbish and recycle

4. Referral Screening/ Validation/ Triage Assessment Decision Authorisation Issue/ handover Review Maintenance Repair Complex Assessment Modification Areas of consideration E referral systems to improve process efficiency Decision support tools to increase complexity that can be directly issued Common eligibility criteria Contact centre triage to increase speed of issue improve data Self assessment Potential separate route for complex patients Inventory reduction Product design issues Direct sourcing NHS chair Cross agency funding Life time costing Modification vs using flexible chair and standard accessories Delivery of completed chair from manufacturer Direct issue from manufacturer Requirement for regular review vs strong signposting and patient ownership Requirement for regular maintenance Potential for this to be the responsibility of manufacturer Rapid issue Non process areas of consideration What elements should be regionally based – procurement, triage procedure, assessment criteria, inventory and pricing. How do we obtain 24 hour postural care? Who cares for carers? How far do we move to a market approach? Should we introduce personalised budgets? Do we use an internet decision support to assist customers in selection of service/product Should we buy chairs outright or lease/rent? How far should we recycle? Should we return stock to manufacturers for them to own the recycling with an cost reduction What is the forecast volume for the service? How is the split between simple and complex expected to change? Process and areas of analysis Streamlined process will reduce timescales increase time for complex patients and align responsibility for improvement with a capability to do so

5. Our user focused solution requires a regional approach Rebalancing regional and local will improve efficiency and service Contact Centre Triage Expertise Information Appointment setting home visits regional clinic Order processing Customer servicing Users Personalised budgets Choice Cross agency funding Feedback driving market Suppliers Respond to new service requirements Assessment Complete chair provision Recycling Total Cost of Ownership model Developing innovative solutions Modularisation Customer Feedback process KPI/Metrics Procurement Experts Outcome based commissioning Supplier Relationship Management Contract Management Customer Feedback process KPI/Metrics Assessors Home Visits Accredited assessors with decision support Clinic sessions Able to innovate solutions Generic prescribing

6. We need to change the system - Potential alternative for consideration - Rebalancing regional and local will improve efficiency and service Contact Centre/ Procurement hub Triage Expertise Information support Appointment setting home & clinic Order processing (electronic) Customer servicing Outcome based commissioning Supplier / contract management Customer feedback process Catalogue updates KPI / Metrics / Data management Users Personalised budgets Choice Cross agency funding Feedback driving market Suppliers Respond to new service requirements Assessment Complete chair provision Recycling Total Cost of Ownership model Developing innovative solutions Modularisation Customer Feedback process KPI/Metrics Accredited Assessors Initial contact /review In home / Surgery Decision support enabled Able to innovate solutions Generic prescribing Local service provision Personalised budgets Choice Cross agency funding By manufacturer or agent Specialised local wheelchair service Personalised budgets Choice Cross agency funding Feedback driving market Complex Provision Personalised budgets Choice Cross agency funding Feedback driving market

7. Data availability to size the current service and the potential solution Stakeholder management Risk Aversion incurring substantial costs Prices in UK higher than Europe Lack of holistic patient thinking 24 hour posture care Cross agency alignment Lifestyle vs mobility Breaking new ground Personalised health budgets Radical market development work Long term funding for implementation Challenges and Issues The radical nature of change requires strong leadership to drive cultural change

8. System Issues, Growth and Complexity The current system with high growth in a cash constrained environment is unsustainable In two years there has been a 29% increase in issues for Devon from Exeter rehabilitation centre with growth in complex needs growing at twice the rate of non complex increasing the proportion from 37% to 44.5%, Complex are 10X the cost of simple chairs leading to considerable pressures on cost and service levels

9. Milestones and Next Steps Next steps Decision on model shape Costing of options Agree decision making process DH deliverables Agreement to funding for implementation Are we going to deliver the required changes this time? Jul Aug Sep Oct Nov Dec Jan Feb Mar Data Collection Engagement Business case Common assessment Inventory & Price alignment Commissioning guidance Contact centre development Market change Personalised budgets Cross agency approach

10. System change Command & control System Knowledge User Knowledge System Knowledge User Knowledge Command & control Systems Thinking Command and control Lean or whole system thinking is about putting the citizen at the heart of the design Application of this approach reduces costs delays and lead times while improving customer outcomes, productivity, efficiency, service quality and VFM. Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way

11. A wide group of stakeholders have involvement in the process Clinicians Suppliers Users Parents Commissioners Carers Social Services Work and Pensions Education Councils 3rd party providers Regional health authority Health trusts Dept Health Voluntary sector Supply chain International exemplars GPs Engineers Procurement Tertiary centres Other rehab services Project team & work groups Stakeholders Integrated independent living service providing a holistic approach to an individual’s needs :- the right solution at the most appropriate time for the individual in a cost effective way