Agenda item

This report and attached appendix sets out a response to an issue, raised by Councillor Purdy, relating to the Kent and Medway Wheelchair Service.

Discussion

Councillor Purdy introduced her Member item. She had requested inclusion of the item on the agenda due to the length of time that some people were having to wait for a wheelchair to be provided or for repairs to their wheelchair. The item would also provide Members with the same opportunity to consider the matter as the Kent Health Scrutiny Committee, which had previously considered reports on the Kent and Medway Wheelchair service.

Representatives from the East Kent CCGs and Millbrook Healthcare introduced the report. This showed steady and continuous improvement in performance of the service but it was recognised that there was still significant further work to be undertaken by the CCGs and Millbrook Healthcare in order to provide the required service. Service users were being closely involved in this improvement journey. A Service Improvement Board was being established that would include a service user representative. Three events to engage with service users were due to take place in April and May and the information collected at these would feed into a Service Improvement Plan. The waiting list for assessment and equipment provision had reduced from 3,369 in August 2018 to 2,386 in January 2019. These figures included new referrals of around 120 clients a month. There had been a waiting list reduction for the fifth consecutive month. The average waiting time for repairs had reduced from 5.6 weeks in November 2018 to 2.9 weeks in February 2019 while the number of patients waiting for repairs had fallen steadily until January 2019 when it had stood at 132. It had then increased slightly in February due to staff vacancies. This was being addressed by Millbrook.

Questions asked by Committee Members were responded to as follows:

Activity level included in contract – A Member asked why the contract with Millbrook Healthcare had not correctly forecast demand and why in-depth work had not been undertaken to ensure that demand was correctly forecast. The Committee was told that this had been caused by Millbrook having inherited a bigger waiting list than was known about during procurement. Many of the patients on the waiting list were amongst those with the most complex needs. The data available from the previous nine contracts covering Kent and Medway had not been detailed enough. The CCGs had commissioned an independent audit to review the procurement process with the CCGs now acting upon those recommendations. All the Kent and Medway CCGs had agreed to provide additional funding to enable Millbrook to address the waiting list.

Available data, Medway specific data, Complaints Review and training – A Committee Member asked why adequate data had not been available ahead of the tendering process and said that the need for additional funding demonstrated that the commissioning process had gone wrong. The Member would have liked to have seen Medway specific data included in report. He also asked when the Complaints Review would be completed. Concern was expressed that the review of eligibility had not been undertaken earlier and also that staff were only now undertaking Disability Equality Training. The Committee was advised that the Complaints Review would be completed by 15 May and it was agreed that data would be provided to the Committee after that. It had been important for extra funding to be provided to Millbrook in order to clear the waiting list backlog. Lessons had been learned from the procurement process. Procurement had been undertaken by one CCG with another CCG having subsequently taken on responsibility. This had presented challenges. The audit programme had made a number of suggestions regarding the procurement. Equality training was already in place at the CCGs and Millbrook but there had been a request from a service user for particular training to be commissioned. 

Information Sharing – A Member highlighted the need for different departments within organisations to communicate better with each other. He highlighted an example where Millbrook had been contacted to say that a wheelchair was no longer needed following the death of its user. The wheelchair had been collected but Millbrook had subsequently made contact to arrange an annual maintenance visit.

Replacement Wheelchair – It was confirmed that, where appropriate, a loan wheelchair would be provided to a user in the event that their chair had to be taken away for repair. This was relatively rare as 99.7% of wheelchairs were repaired at the patient’s home on the first visit. Those with complex needs also tended to already have a backup wheelchair. New patients requiring wheelchairs would be assessed by an occupational therapist and prioritised according to their needs.

Staffing numbers and performance standards – A Committee Member asked how many people were employed by Millbrook to deliver the Kent and Medway Wheelchair service and what performance targets were associated with the service. They considered the length of the waiting list to be unacceptable, particularly in relation to children. It was also questioned what arrangements were being put in place to cover the work of a staff member on long term sick leave. The Committee was advised that the aim was to provide all children equipment within the specified 18 week timescale. It was expected that this would be achieved in the near future. In relation to adults, demand and capacity modelling was being undertaken in order to set a clear standard for the following year. The staff member on long term sick leave had now returned to work. Staffing figures would be provided to the Committee separately.

Engineer availability and training – Committee Members asked what work had taken place to increase the number of engineers working within the wheelchair service and whether any work had been undertaken to boost training opportunities locally. Nine technicians had been recruited to do collections and deliveries. This would reduce engineer workload. Work was undertaken with specialist engineers to support the repair process. Consideration was being given to development of an apprentice scheme. A training scheme would also be established to educate and certify engineers. The average number of repair requests a week was currently 108, with 101 being completed each week. Delays could be caused by the wait for spare parts to be provided and by patients being admitted to hospital. 

Cause of waiting list – It was questioned what had caused a waiting list to develop and what was being done to ensure that a similar situation was avoided in the future. The Committee was advised that the audit report had confirmed that the waiting list had been significantly longer than had been known at the time of procurement and that patients on the waiting list tended to have the most complex needs. Work had been undertaken with Millbrook to ensure that detailed data was available. This was significantly more in-depth than the data that had been available under the previous provider contracts. Weekly improvement meetings now took place and there was good engagement with Millbrook staff.

Decision

The Committee:

i)     Noted and commented on the Member item and the report provided by Thanet NHS Clinical Commissioning Group.

ii)    Requested that further information be provided to the Committee in writing, including:

a.    The number of Millbrook Healthcare employees who were delivering the Kent and Medway Wheelchair service.

b.    Data in relation to the Complaints Review due to be completed in May.

iii)   Requested that a further report be presented to the Committee at a future meeting.