Nottingham and Nottinghamshire Wheelchair Services Review
Executive Summary
Background
There are historic differences in wheelchair services provided across Nottingham and Nottinghamshire due to changes in commissioning bodies across the area. A review of Nottingham and Nottinghamshire wheelchair services was conducted to assess whether the difference in services create inequity across Nottingham and Nottinghamshire.
Aims
The aims of the engagement were:
- To understand what works well in Nottingham & Nottinghamshire wheelchair services for citizens/carers and professionals.
- To understand what citizens/carers and professionals would like to change about Nottingham & Nottinghamshire wheelchair services.
- To understand any barriers to citizens/carers in accessing wheelchair services.
- To understand barriers experienced by professionals in working with or within wheelchair services.
- To identify any inequity in wheelchair provision across the Nottingham & Nottinghamshire area.
Methods
Engagement activities were conducted to include citizens/carers and professionals from any sector that work within wheelchair services, refer into wheelchair services, or interact with wheelchair services to share their experiences of wheelchair services currently being provided within Nottingham and Nottinghamshire. The approaches used to capture the responses included the following:
- Online surveys
- Focus groups
- Group discussions
- Individual conversations
- Conversations during service visits
Findings and Recommendations
Findings and recommendations aligned with the following themes:
- Efficiency of wheelchair services
- Personalised care
- Positive attitude and capability of staff
- Consistency of servicing, maintenance, and assessments
- Accessibility of wheelchair services
- Inequity of wheelchair services
- Information sharing and education about wheelchair services
- Integration of wheelchair services within the wider Nottingham and Nottinghamshire system.
Feedback collated in this report will help inform the rest of the system wide review of wheelchair services across Nottingham & Nottinghamshire.
Recommendations
Conclusion 1: Increase efficiency within services.
Recommendation: Whilst there was some positive feedback about current efficiency within services, waiting times for initial appointments and delivery of equipment after assessment was one of the most common themes in this engagement activity. There is some residual impact from the pandemic and supply issues i.e., importation issues caused by circumstances such as Suez Canal and Brexit. Efforts are being made to reduce inefficiencies and services should continue their efforts to reduce wait times for service users.
Conclusion 2: Encourage personalised care and recognise positive staff behaviour
Recommendation: Personalised care that is already taking place should be supported and where it is not taking place successfully it should be encouraged. The positive attitude and behaviour of staff was highlighted by both professionals and citizens & carers, and this should be recognised and praised.
Conclusion 3:Increase consistency for servicing, maintenance, and assessments.
Recommendation: Servicing and maintenance arrangements were highlighted as working well and as something that needed to change. This indicates an inconsistency with the level of service provided in each interaction. There was also a theme to support wheelchair services to carry out more thorough assessments/interactions, in clinical settings and when repairs are required.
Conclusion 4: Increase accessibility into services.
Recommendation: Services should support and advise citizens to be able to physically access services, but recommendations are not limited to physical accessibility. A common theme was the difficulty of the review and referral process; services should implement self-referral pathways so known services users can contact the service directly rather than going through a GP or HCP. Services should remain contactable and responsive to queries made by professionals and citizens.
Conclusion 5: Reduction in localised disparity of service provision.
Recommendation: Inconsistencies should be reduced across the Nottingham & Nottinghamshire area. Where possible, service specifications, eligibility criteria, variety and type of equipment offered to service users should be harmonised.
Conclusion 6: Increase information sharing and education about wheelchair services.
Recommendation: Both professionals and citizens would benefit from increased transparency of processes and waiting times to provide context. Training should be implemented more consistently to support carers with manoeuvring wheelchairs safely and to educate professionals on how to refer for better standards of referral. Clarity on referral routes and criteria should be established and support should be given to service users to understand the wheelchair assessment process and keep them informed.
Conclusion 7: True integration of wheelchair services.
Recommendation: Joined up care and collaboration with other services should be increased to allow smoother transitions between services. Mitigations should be established for the lack of access to systems that allow different services to share patient information, and communication with other services should be improved.
Conclusions and next steps
The engagement activity carried out will help inform the rest of the system wide review of
wheelchair services across Nottingham & Nottinghamshire, which should conclude later
this year. Feedback and recommendations based on feedback will be used to identify
areas of improvement or service change where appropriate.
The Community Transformation Team would like to thank everyone who supported and/or
were involved in this engagement. If there are any queries, please contact us via our
shared inbox at nnicb-nn.communitytransformation@nhs.net.
Background
There are historic differences in wheelchair services provided across Nottingham and Nottinghamshire due to changes in commissioning bodies across the area. A review of Nottingham and Nottinghamshire Wheelchair services was conducted to assess wheelchair services and whether the difference in services create inequity across Nottingham and Nottinghamshire.
Wheelchair services across the Nottingham & Nottinghamshire area are provided by 4 different providers.
2.1 Aims and Objectives
The aims of the engagement were:
- To understand what works well in Nottingham & Nottinghamshire wheelchair services for citizens/carers and professionals.
- To understand what citizens/carers and professionals would like to change about Nottingham & Nottinghamshire wheelchair services.
- To understand any barriers to citizens/carers in accessing wheelchair services.
- To understand barriers experienced by professionals in working with or within wheelchair services.
- To identify any inequity in wheelchair provision across the Nottingham & Nottinghamshire area.
Engagement Exercise
The outputs of the engagement exercise will be used to inform the system wide review and develop recommendations for Nottingham and Nottinghamshire wheelchair services.
Engagement Methods
Engagement activities were conducted to include citizens/carers and professionals from any sector that work within wheelchair services, refer into wheelchair services, or interact with wheelchair services to share their experiences of wheelchair services currently being provided within Nottingham and Nottinghamshire. The approaches used to capture the responses included the following:
• Online surveys – One for citizens and carers (appendix 1), and one for professionals (appendix 2)
• Focus groups – One for citizens and carers, and one for professionals (notes can be found in appendix 3)
• Group discussions
• Individual conversations
• Conversations during service visits
Online surveys were available from Friday 29 February 2024 and concluded on 25 March 2024. In total 111 surveys were completed, 66 were completed by citizens/carers and 45 by health and care professionals. The option to request paper copies of the survey was available. No paper copies were requested.
A combination of multiple choice, short answer, satisfaction scale and long answer questions were used. Multiple choice and short answer questions allowed for quantification of the scope of the engagement across the different Nottingham and Nottinghamshire services and identified the types of professionals that had responded. Satisfaction scales were utilised to highlight the satisfaction with specific elements of the services. There were three open questions in each survey, to provide qualitative data to support the understanding of the lived experience of individuals accessing and working for/with wheelchair services.
Distribution methods
Surveys were distributed virtually across communication channels for example:
- Community groups.
- Meetings that bring together health and care professionals.
- General Practice (GP) bulletins.
- Community and Voluntary Sector (CVS) newsletters.
- Social media.
- NHS Nottingham and Nottinghamshire ICB Website.
- Newsletters
Further methods were used to support engagement with professionals, citizens, and carers. These were:
- Visiting each service
- Two focus groups: one for professionals and another for citizens and carers
- Individual and group conversations with professionals
Survey Findings
Survey Respondents: Professionals
There was a total of 45 responses collected from professionals. All the professionals that responded were happy to proceed knowing the survey contained questions where you can write freely, and their response may be shared with other services. Details of the background of professionals who completed the questionnaire can be found in the tables below.
| Nottingham University Hospitals NHS Trust | 13 |
| Nottinghamshire Heathcare NHS Foundation Trust | 9 |
| Nottinghamshire County Council | 8 |
| Other NHS Organisations | 6 |
| General Practice Organisations | 3 |
| Organisations Providing NHS Services | 3 |
| VCSE Organisations | 2 |
| Education Organisations | 1 |
There was at least one respondent from three of the four organisations providing wheelchair services to Nottingham and Nottinghamshire citizens. There were no respondents from the long-term loan service in the Mid-Nottinghamshire area (Mansfield, Ashfield, Newark and Sherwood), provided by RossCare.
| Work in wheelchair services | 7 |
| Refer into wheelchair services | 33 |
| Other | 5 |
There were 5 respondents who did not work within a wheelchair service or refer (or support referral) into wheelchair services. These 5 respondents have a mix of clinical and non-clinical roles that involve interacting with wheelchair service users in various ways. This included providing transport to wheelchair users, working in educational settings with children that use wheelchairs, and supporting management of long-term complex conditions.
| Bassetlaw | 12 |
| Rushcliffe | 20 |
| Nottingham City | 24 |
| Gedling | 18 |
| Broxtowe | 19 |
| Newark Sherwood | 14 |
| Ashfield | 14 |
| Mansfield | 16 |
Out of the 45 respondents to the professional survey, there were at least 12 respondents working in each geographical district in Nottinghamshire. There were 27 respondents that worked across multiple areas. 2 of the respondents specified that they also worked in areas outside of Nottingham/Nottinghamshire.
Response to Survey: Supporting Patient Choice
Professionals that work within wheelchair services were asked what extent they agreed with two statements. Statement A: ‘I feel supported to provide patients and service users with the right information regarding the personal wheelchair budget and related funding they can access.’ and statement B: ‘I support patients to think about the choices they have in relation to their wheelchair and/or related funding.’ One respondent disagreed with both statements, one respondent agreed to statement B and answered neutrally to statement A. The remaining 5 respondents agreed or strongly agreed with both statements.
Response to Survey: ‘What do you think works well in wheelchair services for patients and service users?’
43 professionals responded to this question. There were 4 individuals who responded to this question by identifying improvements that could be made, these responses have been included in section 4.4. The main themes identified of what works well in wheelchair services in Nottingham & Nottinghamshire were:
- Efficiency of the service (6 responses)
- Personalised care is demonstrated within the service (12 responses)
- Accessibility of the service, including physical accessibility, ease of access for referrals and ability to contact the service (15 responses)
- Existence of a service that caters specifically to wheelchair users. (4 responses)
- Positive behaviour and attitudes of staff (9 responses)
- Servicing and maintenance arrangements (4 responses)
- Thoroughness of assessments. (3 responses)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“Efficiency of the wheelchair team to provide an effective level of Patient care within current budget restraints”
“Holistic approach in empowering our clients to make decisions in their best interests and promoting independence. Providing postural assessments to ensure health and wellbeing and where possible prolonged quality of life.”
“The referral system is easy to use and standard wheelchairs are actioned and sent out relatively quickly. The staff working at Wheelchair Services are accessible to discuss more complex cases.”
“A dedicated service to assess and measure for wheelchairs”
“Experienced, skilled, approachable staff. Good facilities at Mansfield Community Hospital.”
“Provided with a free wheelchair that is serviced and repaired if broken”
“The chairs people receive are well assessed for.”
Response to Survey: ‘If you could change anything about wheelchair services, what would you change for patients and service users?’
42 professionals responded to this question. The main themes identified of what professionals would change in wheelchair services in Nottingham & Nottinghamshire were:
- Efficiency of the service (24 responses)
- Joined up care between wheelchair services and other services to provide personalised care (15 responses)
- Accessibility of the service, including physical accessibility, ease of access for referrals and ability to contact the service (4 responses)
- The transparency and quality of eligibility criteria, pathways and assessments (6 responses)
- Disparity between wheelchair services across the Nottingham & Nottinghamshire area (3 responses)
- Servicing and maintenance arrangements (3 responses)
- The variety and quality of equipment provided (4 responses)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“The wait times, my pupils seem to wait an extended amount of time for a wheelchair, many many months. This has impacted on their attendance and as a result their education and progress…”
“…Having a clear agreement that facilitates good joint working with HCP’s who know a service user/patient well, so that clinician can support the appointment if it is in the person’s best interests, (or when the patient has capacity, that the patient is in agreement). Relevant mainly for people with complex needs. This would allow more effective problem solving and best interests’ decisions…”
“Availability with Patient Transport to allow part time wheelchair users to access it – they are more likely to need a wheelchair for long or stressful days such as visiting hospital…”
“…Less restrictive criteria for power chair provision. Improved signposting and support to other providers if criteria not met. Improved communication / shared access to electronic records for better outcomes”
“Make provision of certain equipment/range of equipment the same across all areas to prevent confusion for clients and other health professionals/referrers”
“Prompt repair if a problem occurs with a user’s wheelchair.”
“Wider range of chairs to be available- lighter weight, more customised, tilt in space wheelchairs to be provided before patients have left hospital to support rehab, seen sooner…”
Response to Survey: ‘Is there anything else you would like to tell us?’
25 professionals responded to this question. Many of the responses echoed the themes of previous questions, while providing further context. The main themes identified were:
- A need for increased training and education for healthcare professionals, service users and carers (5 responses)
- A desire for improved referral processes and relationships with referrers (7 responses)
- A need for increased variety in equipment or clearer signposting for service users to appropriate alternatives (5 responses)
- Positive behaviour and attitudes of wheelchair service staff (3 responses)
- A need for improved efficiency through increased resources and joined up care (6 responses)
- Provision of wheelchairs in the wider region is not equitable (1 response)
- The importance of physically accessible services (1 response)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“We would welcome shared training on postural management to ensure that all professionals working towards these goals within the ICB have the same understanding…”
“I think the referral and re referral process is laborious… It also wastes my time to fill in the entire referral form again to re refer a patient that is still on your system whose wheelchair needs reviewing…”
“…Ideally, would like to have the cost of provision eliminated for the likes of battery packs for carers who struggle to push.”
“When I have made referrals to the Mobility Centre, staff are always very friendly and quick to resolve my queries.”
“Increase funding. Increase staff to enable more appointments. More specialist adaptations are needed – need more specially trained staff and resources to do this”
“Patchy provision across the East Midlands. For out-of-area patients (Derbys, Lincs, Leics, and North Notts), we’re unable to lend them one of our NUH interim wheelchairs so they sometimes have to go home just transferring between bed and commode until their long-term wheelchair is delivered.”
“Currently the British Red cross offer a valuable service to users… The service is currently under consultation to close down all physical locations across the country… I believe this will impact service users in Nottinghamshire but is inevitable considering the financial situation in the service and the lack of support from external partners.”
Demographic Profile of Respondents: Citizens and Carers
Demographic information was not collected from the survey targeted to professionals. The demographic profile detailed is based on the information provided by citizen and carer respondents.
Gender
62 respondents chose to answer this question. Of those, 62% described themselves as female with 33% describing themselves as male. The remaining 3% (2 individuals) described themselves as trans masculine and non-binary.
Relationship status
61 respondents chose to answer this question which related to their relationship status. 44% described themselves as single, 41% described themselves as married, 7% described themselves as living with their partner, 6% described themselves as widowed and 2% described themselves as divorced.
Sexual orientation
56 respondents answered this question which related to their sexual orientation. 82% described themselves as heterosexual or straight, 9% described themselves as asexual, 7% described themselves as bisexual and 2% described themselves as lesbian or gay woman.
Pregnancy and maternity leave
60 respondents answered the question relating to pregnancy and maternity leave. Only 1 (2%) respondent was noted as being pregnant, on maternity leave or returning from maternity leave.
Ethnicity
60 respondents answered this question which related to their ethnicity. 80% described themselves as White (73%: English, Welsh, Scottish, Northern Irish or British; 7% any other white background). 17% described themselves as Black, Black British, Caribbean, or African (10%: African; 7% Caribbean). 2% described themselves as Mixed or Multiple ethnic groups: White and Black African, and 2% as Asian or Asian British: Pakistani.
Religion
57 respondents answered the question relating to their religion. 49% described themselves as having no religion, 47% as being Christian, 2% as being Spiritualist and 2% as being Buddhist.
Disabilities and health conditions
There were three questions relating to disabilities and health conditions.
61 of the respondents answered this question. 18% described themselves as having no disability, 52% described themselves as having multiple types of disability and 30% described themselves as having one type of disability. Relating to the type of disability reported: 75% had physical disabilities, 18% had a disability relating to a mental health condition, 13% described themselves as neurodivergent (including autism), and 10% had learning disabilities.
63 respondents answered the question relating to whether they had any physical or mental health conditions expected to last 12 months or more. 83% of respondents reported that they did and 17% of respondents did not.
59 respondents answered the question about the extent to which their conditions or illnesses reduce their ability to carry out day-to-day activities. 58% reported their illnesses/conditions impacted their ability to carry out daily activities a lot, 22% reported it impacted them a little and 20% reported that their illnesses/conditions did not impact their ability to carry out daily activities.
Carer
62 respondents answered the question relating to whether or not they were a carer. 53% said they were not a carer, 40% described themselves as a carer providing unpaid support and 7% described themselves as paid carers.
Age
62 respondents answer the question relating to their age. The data collected is shown in the table below.
| Age band | Number of respondents | Percentage of respondents |
| Under 16 | 6 | 10% |
| 16-24 | 4 | 6% |
| 25-34 | 14 | 23% |
| 35-44 | 14 | 23% |
| 45-54 | 12 | 19% |
| 55-64 | 5 | 8% |
| 65-74 | 5 | 8% |
| 75-84 | 2 | 3% |
Question: ‘How satisfied are you with the arrangements in place to collect your views?’
60 respondents answered this question. 57% were satisfied, 28% were neither satisfied or dissatisfied, 8% were dissatisfied and 7% were not sure.
Survey Respondents: Citizens and Carers
There was a total of 66 responses collected from citizens and carers. 63 of the citizens and carers that responded were happy to proceed knowing the survey contained questions where you can write freely, and their response may be shared with other services. Details of the background of the citizen and carer respondents who completed the questionnaire can be found in the graphs below.
| Parent | 52 |
| Relative | 4 |
| Carer (Paid or Non-paid) | 7 |
Of the 63 respondents, 34 (54%) completed the survey on behalf of themselves and 29 (46%) completed the survey on behalf of someone else. 24 of the respondents completing the survey on behalf of someone else were the parent of the wheelchair user, 2 were a relative other than a parent and 3 were carers (paid or non-paid).
There were 41 survey responses about wheelchair service users that access adult clinics and 22 responses about wheelchair service users that access child clinics.
At least 3 citizens or carers responded from each of the Nottingham & Nottinghamshire areas. In terms of wheelchair services, the wider Nottingham & Nottinghamshire area is split up into 3 distinct sections: Bassetlaw, Mid-Notts, and South Notts & Nottingham City. Mid-Notts comprises of Ashfield, Mansfield, Newark, and Sherwood. South Notts & Nottingham City includes the Broxtowe, Gedling, Rushcliffe, and Nottingham City Districts.
| Bassetlaw | 3 |
| Rushcliffe | 11 |
| Nottingham City | 17 |
| Gedling | 4 |
| Broxtowe | 2 |
| Newark Sherwood | 7 |
| Ashfield | 6 |
| Mansfield | 13 |
Most respondents (52) accessed a long-term wheelchair loan service, with only 9 accessing short-term loan services. There were 3 respondents that were unsure of whether they had a short-term or long-term loan wheelchair. The locality of the respondents suggests that there were at least 2 respondents that access each of the four different wheelchair services across Nottingham & Nottinghamshire.
| Long-term | Short-term | Unsure | |
| Nottingham City | 2 | 14 | 1 |
| Mansfield | 6 | 2 | |
| Ashfield | 1 | 4 | |
| Rushcliffe | 11 | ||
| Gedling | 4 | ||
| Broxtowe | 2 | ||
| Newark and Sherwood | 7 | ||
| Bassetlaw | 3 |
According to the loan-term length and GP postal code area, 33 of the respondents access NUH wheelchair services with at least 2 of these accessing the short-term loan part of the service. 18 respondents likely access RossCare, 3 likely access STH and 7 likely access ICELS. Of the 2 respondents that were unsure of their wheelchair loan term, 1 most likely accesses NUH services and the other likely accesses either RossCare or ICELS, depending on loan length.
To be issued with a wheelchair, individuals must be assessed to ensure they receive the correct type of wheelchair. Most respondents (44) were issued with a wheelchair after an in-person assessment, 6 after a virtual assessment, 5 were not sure how they were issued with their wheelchair and 3 were not issued with a wheelchair at all. 5 respondents described their assessment type as other and listed: a mobility scheme, being an in-patient in hospital, self-funding, and urgent upgrades after malfunctioning, as the circumstances that led them to be issued with a wheelchair.
28 respondents were issued with a wheelchair that is self-propelled (pushed by the person in the wheelchair), 22 were issued with an attendant propelled wheelchair or buggy (a buggy or wheelchair that requires someone else to push it), 9 respondents were issued with an electric powered wheelchair and 4 respondents were not sure what type of wheelchair they were issued with.
In addition to the type of wheelchair issued to them, respondents were also asked if their wheelchairs had any specialised seating for postural needs or additional modifications that required them to attend clinic. 40% of respondents reported they had specialised seating for postural needs and 51% reported they had additional modifications to their wheelchair such as trunk supports, leg supports or a head rest. These answers were not mutually exclusive 32% of respondents reported having both and 46% of respondents did not have either specialised seating or additional modifications.
Response to Survey: Satisfaction of Service Users
Respondents were asked to rate their satisfaction of seven factors of their experience with wheelchair services within Nottingham & Nottinghamshire. For each of the factors, the ratings they could choose from were ‘Dissatisfied’, ‘Somewhat dissatisfied’, ‘Not sure/Not applicable’, ‘Somewhat satisfied’ or ‘Satisfied’.
33 respondents were satisfied or somewhat satisfied with the amount of time it took to receive their first appointment after their referral to wheelchair services, 7 answered not sure or not applicable and 23 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with the time took to receive their first appointment had a GP in the Bassetlaw area. 2 (66%) respondents from the Bassetlaw area were satisfied or somewhat satisfied. 13 (50%) out of the 26 respondents that likely access Mid-Notts wheelchair services were dissatisfied or somewhat dissatisfied and 12 (46%) were satisfied or somewhat satisfied. 10 (30%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 19 (58%) were satisfied or somewhat satisfied.
55 respondents were satisfied or somewhat satisfied with the accessibility of the clinic and waiting room areas of Nottingham & Nottinghamshire wheelchair services, 11 answered not sure or not applicable and 7 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with the accessibility of the clinic and waiting room areas had a GP in the Bassetlaw area. 2 (66%) respondents from the Bassetlaw area were satisfied or somewhat satisfied. 4 (15%) out of the 26 respondents that likely access Mid Notts wheelchair services were somewhat dissatisfied, and 22 (85%) were satisfied or somewhat satisfied. 3 (9%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 21 (64%) were satisfied or somewhat satisfied.
41 respondents were satisfied or somewhat satisfied with their involvement in decisions about the wheelchair users care, 8 answered not sure or not applicable and 14 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with their involvement in decisions about the wheelchair users care had a GP in the Bassetlaw area. 2 (66%) respondents from the Bassetlaw area were satisfied or somewhat satisfied. 6 (23%) out of the 26 respondents that likely access Mid Notts wheelchair services were dissatisfied or somewhat dissatisfied, and 18 (69%) were satisfied or somewhat satisfied. 7 (21%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 21 (64%) were satisfied or somewhat satisfied.
26 respondents were satisfied or somewhat satisfied with the discussion had with them about the personal wheelchair budget or other funding options, 17 answered not sure or not applicable and 20 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with the discussion had with them about the personal wheelchair budget or other funding options had a GP in the Bassetlaw area. 1 (33%) respondent from the Bassetlaw area was satisfied or somewhat satisfied. 9 (35%) out of the 26 respondents that likely access Mid Notts wheelchair services were dissatisfied or somewhat dissatisfied, and 13 (50%) were satisfied or somewhat satisfied. 11 (33%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 12 (36%) were satisfied or somewhat satisfied.
27 respondents were satisfied or somewhat satisfied with the time taken to receive their wheelchair, 9 answered not sure or not applicable and 27 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with the time taken to receive equipment had a GP in the Bassetlaw area. 2 (66%) respondents from the Bassetlaw area were satisfied or somewhat satisfied. 15 (58%) out of the 26 respondents that likely access Mid Notts wheelchair services were dissatisfied or somewhat dissatisfied, and 11 (42%) were satisfied or somewhat satisfied. 12 (36%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 14 (42%) were satisfied or somewhat satisfied.
26 respondents were satisfied or somewhat satisfied with the arrangements in place for servicing and maintenance of their wheelchair, 17 answered not sure or not applicable and 20 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied the arrangements in place for servicing and maintenance of their wheelchair had a GP in the Bassetlaw area. 1 (33%) respondent from the Bassetlaw area was satisfied or somewhat satisfied. 12 (46%) out of the 26 respondents that likely access Mid Notts wheelchair services were dissatisfied or somewhat dissatisfied, and 11 (42%) were satisfied or somewhat satisfied. 8 (24%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 14 (42%) were satisfied or somewhat satisfied.
31 respondents were satisfied or somewhat satisfied with their overall experience of Nottingham & Nottinghamshire wheelchair services, 6 answered not sure or not applicable and 26 were either dissatisfied or somewhat dissatisfied. None of those dissatisfied with their overall experience, had a GP in the Bassetlaw area. 2 (66%) respondents from the Bassetlaw area were satisfied or somewhat satisfied. 12 (46%) out of the 26 respondents that likely access Mid Notts wheelchair services were dissatisfied or somewhat dissatisfied, and 12 (46%) were satisfied or somewhat satisfied. 13 (39%) out of the 33 that likely access South Notts & Nottingham City wheelchair services were dissatisfied or somewhat dissatisfied and 17 (52%) were satisfied or somewhat satisfied.
Response to Survey: ‘What has gone well in your experience with Nottingham/Nottinghamshire Wheelchair Services?’
48 citizens & carers responded to this question. There were 3 individuals who responded to this question by identifying improvements that could be made, these responses have been included in section 4.10. The main themes identified of what works well in wheelchair services in Nottingham & Nottinghamshire were:
- Efficiency of the service (5 responses)
- Personalised care is demonstrated within the service (8 responses)
- Accessibility of the service, including ability to contact the service (2 responses)
- Existence of a service that provides wheelchairs (7 responses)
- Positive behaviour and attitudes of staff (11 responses)
- Servicing and maintenance arrangements (3 responses)
- Quality and variety of equipment. (5 responses)
- Everything (5 responses)
- Nothing (5 responses)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“Wheelchair services have been lovely, very fast turn around”
“My son has been quadriplegic since birth, he got his 1st wheelchair aged 2yrs when a standard pram couldn’t support his postural needs. He is now 23yrs old and has always had a tilt in space wheelchair frame and a moulded seat with a specialist headrest support, all provided from SOS (Specialised Orthotic Services ) through the NHS. The service we have received over the years has always been excellent…”
“Usually able to contact relatively easily.”
“I have a wheelchair which means I can be independent”
“Excellent staff who go above and beyond to advise and make my child feel at ease in the appointment.”
“Repairs are quick and easy to arrange at home. I was able to change to a better wheelchair for my needs.”
“…The quality of the wheelchair is very good and meets dads needs”
“Everything really. I had little stress with their services”
“Nothing really”
Response to Survey: ‘If you could change anything about your experience with Nottingham/Nottinghamshire Wheelchair Services what would this be?’
50 citizens & carers responded to this question. The main themes identified of what professionals would change in wheelchair services in Nottingham & Nottinghamshire were:
- Efficiency of the service (17 responses)
- The service should make care more personalised (12 responses)
- Accessibility of the service, including physical accessibility and ability to contact the service (4 responses)
- Nothing (4 responses)
- Servicing and maintenance arrangements (12 responses)
- Education and information shared with citizens and carers (5 responses)
- Suitability and quality of eligibility criteria and/or equipment issued (7 responses)
- Suitability of facilities (2 responses)
- Increased resources (2 responses)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“I have been referred twice by my GP surgery and measured twice (by my GP surgery) and then I’ve never been contacted. The surgery said there was a long wait due to covid. That was in 2020/2021. I don’t understand what has gone wrong…”
“Yes I should have been treated with respect, my personal circumstances should have been taken into account, so that I did not feel a ‘Reject and a Nobody!’”
“A home visit please there’s no certainty of being able to park.”
“Everything is okay”
“I have had 4 visits for the same breakdown having to take time away from work to be at home fore them to fix it and could not be fixed as they brought the wrong part. Then they rounded off a bolt and it can not now be fixed without being taken into the workshop which means I will not be able to drive my car and will have no means of transport.”
“Improved communication with people who need a wheelchair on services offered including a flowchart with rough timelines for assessment and provision of equipment…”
“Change eligibility criteria so that semi-ambulatory/not paralysed people can receive an appropriate electric or lightweight/active self propelling wheelchair…”
“The service doesn’t seem very child friendly, in both location/setting – first time we accessed the service our child was quite young and felt a bit uneasy in such an adult focussed environment…”
“More funding to allow more clinics and staff.”
Response to Survey: ‘Please use the box below to tell us anything else that you would like to share’
32 citizens & carers responded to this question. Many of the responses echoed the themes of previous questions, while providing further context. The main themes identified were:
- Changes to servicing and maintenance arrangements (5 responses)
- Approachable staff (2 responses)
- The need to promote personalised care (10 responses)
- Increasing communication and information sharing with citizens & carers and between wheelchair services and other services (4 responses)
- Difficult review and referral processes (3 responses)
- Inflexible appointments (2 responses)
- A need to increase efficiency in wheelchair services (2 responses)
- A need for more resources for wheelchair services (2 responses)
Open questions were used in this section of the survey and more than one theme may have been present in each response. Quotes of responses to this question are shown below to provide context to the themes outlined.
“The engineers doing repairs don’t seem to have much knowledge, and it often takes 3-4 weeks for a repair to be completed. I’ve lived in 4 other parts of the UK and all 4 of those wheelchair service provisions were miles better than Nottinghamshire who just don’t seem to care if the wheelchair is causing pain or is broken leaving an otherwise independent adult housebound and unable to get out to work.”
“The staff themselves were knowledgeable and kind, and answered my questions.”
“…I feel that I would actually benefit from being able to move myself independently. Giving me an even better quality of life as I would gain some independence. I do appreciate the fresh air .”
“Feel that there is no communication between the clinicians and the wheelchair service… There is not much discussion with carers to help understand the world of wheelchairs. It would be ideal to have that conversation to help understand clearly how wheelchair world works”
“Process for reviewing unclear, who should we contact if we feel chair too small now etc”
“They cancel appointments and don’t reschedule, they don’t answer the telephone and people are left in limbo.”
“18 months to wait for a wheelchair that isn’t suitable isn’t fair or acceptable. I can’t live without my wheelchair so i have to make do but I’m wrecking my arms and back in this broken chair and it’s not suitable. But until they sort the new chair out I have little choice”
“More clinics, more regular reviews, more staff.”
Additional Engagement to Survey
Focus Group: Professionals
In addition to the online surveys, professionals also had the opportunity to take part in a virtual focus group. 5 professionals were in attendance from Notts Fire and rescue service and RossCare. Technical issues meant that some professionals were not able to attend, but they were offered the opportunity to share their views separately. 1 additional professional shared their views and they are included in the focus group summary. The areas of focus were:
- What works well?
- If you could change anything about wheelchair services, what would it be?
- Opportunities to make any further comments.
The main themes mirrored the themes in other areas of the engagement and included:
- Resource limitations in wheelchair services making engagement with service users more difficult.
- Accessibility to services are limited by referral processes and the need to be referred by a GP/HCP.
- Importance of creating and sustaining dialogue between services to support joined up care.
- Personalised care and knowledgeable staff are often highlighted in positive feedback received by wheelchair services.
Focus Group: Citizens
Citizens and carers also had the opportunity to take part in a virtual focus group. 4 citizens and carers attended the focus group. Two of the citizens who attended the focus group contacted the ICB to share further comments, which are captured in this focus group summary. The areas of focus were:
- What works well?
- If you could change anything about wheelchair services, what would it be?
- Opportunities to make any further comments.
The main themes mirrored the themes in other areas of the engagement and included:
- Information transparency and availability should be improved.
- Education on wheelchairs and wheelchair service processes would be helpful for citizens.
- The repair service and maintenance arrangements should be more thorough.
- Wheelchair services should communicate well with other services to provide joined up care.
- Some additional parts must be paid for, this can complicate organising equipment to be ready at the same time.
- Waiting times could be improved even when services are aware of a need for a wheelchair in advance. Some parts of the service are very efficient e.g. cushion reviews
- Approachable, helpful, and knowledgeable staff
- Eligibility criteria makes services less accessible sometimes.
- Importance of personalised care was highlighted.
Service Visits
In addition to virtual focus groups and online surveys, each of the four services providing wheelchairs to citizens across Nottingham & Nottinghamshire were visited. As part of these visits conversations were had to support understanding and provide context to other engagement findings. The main themes mirrored the themes in other areas of the engagement and included:
- Inequity between service provision across Nottingham & Nottinghamshire. This includes large differences in service size and wheelchair service team size, and differences in equipment provided.
- Service user feedback for servicing and maintenance arrangements is inconsistent.
- All services are planning on implementing self-referral pathways in the near future.
- There is a recognised need for wheelchair services to provide education to professionals.
- Efficiency of services was impacted by the COVID-19 pandemic and various supply issues in recent years.
- Services have or recently had issues with recruitment.
- ICELS are an equipment loan service and wheelchair provision is only a small part of their service
- Lack of access to systems for sharing patient data creates barriers to joined up care.
Group discussions
Further to the above engagement methods a discussion was held with a group of Local Authority occupational therapy leads. The main themes mirrored the themes in other areas of the engagement and included:
- Inequity between service provision across the county, this makes it difficult for professionals to know which service is relevant for a particular individual.
- Accessibility to services is limited by referral processes and the need to be referred by a GP/HCP.
- There is a need for wheelchair services to provide training and education to professionals.
- Efficiency of services – some wheelchairs cannot be provided until adaptations are made to homes, even when adaptations are planned.
Glossary
| Acronym | Term | Explanation |
| – | Professionals | A person who works for health, local authority or VCSE services. |
| – | System | A group of organisations working together as an interconnecting network |
| VCSE | Voluntary, Community and Social Enterprise | The voluntary, community and social enterprise (VCSE) sector is an important partner for statutory health and social care agencies and plays a key role in improving health, well-being, and care outcomes. VCSEs range from small community-based groups/schemes through to larger registered Charities that operate locally, regionally & nationally. |
| – | Wheelchair Services | Services that provide wheelchairs on a short-term or long-term loan |
| – | Short-term loan | |
| – | Long-term loan | |
| HCP | Healthcare Professional | |
| STH | Sheffield Teaching Hospitals | |
| NUH | Nottingham University Hospitals | |
| ICELS | Integrated Community Equipment Loan Service | |
| ICB | Integrated Care Board | |
| CVS | Community and Voluntary Sector |
