Wheelchair Services, EPIOCs & the Voucher System

Jennifer Trust Information Leaflet N° 0007.

Often at Central Office we receive requests for information about the provision of powered wheelchairs, the responsibility of the NHS and the wheelchair voucher scheme. In order to answer this adequately we contacted the Department of Health, who came up with the following information. (for information regarding powered wheelchairs for children see fact sheet 002).

WHAT IS THE NHS WHEELCHAIR SERVICE?

The NHS provides wheelchairs to anyone who has a clinical need for one due to limited mobility. People who need a wheelchair are usually referred to the NHS Wheelchair Service by their General Practitioner, Physiotherapist, Occupational Therapist or other health care professional. Decisions about which type of wheelchair is appropriate are made by Wheelchair Therapists following assessment and consideration of the individual's needs and their mobility requirements. If a wheelchair is prescribed it is provided free on loan.

There are currently 145 NHS Wheelchair Services Centres in England with the majority being based in NHS trusts. Some centres also act as Regional Disablement Services Centres, which include the NHS artificial limb service and offer specialist support to severely disabled people who require complex wheelchair and seating support systems.

KEY FACTS/INFORMATION

In 1996 the then Government announced two separate but related initiatives on wheelchair services. An additional UKP 50 million was made available over four years to enable them to provide electrically powered indoor/outdoor chairs (EPIOCs) to those severely disabled people who would benefit from them, and to introduce a voucher scheme to give manual wheelchair users the choice of contributing to a more expensive wheelchair of their choice.

Detailed guidance on both these schemes was issued to the NHS in 1996 with priority being given to the more straightforward introduction of EPIOCs. Voucher schemes were to be introduced over a two-year period with health authorities having to have a scheme in place by 1 April 1998. Initially it was not intended that vouchers should be used for EPIOCs but some health authorities have now extended the voucher scheme to EPIOCs.

On 29 March 2000 the Government confirmed that it would make UKP 14 million available in 2000-01 for the powered wheelchair and voucher schemes.

In 1998 the Government announced a review of the schemes and commissioned an evaluation study of the implementation and operation of the two initiatives. The study, undertaken by York Health Economics Consortium, would:

Critically examine the performance of health authorities and wheelchair service providers in meeting the objectives of the two initiatives.
Identify the features of successful implementation
Identify where problems are occurring; and
Make recommendations on any further action, which may be necessary either in relation to the objectives or to improve implementation across the NHS.

The Consortium's report was made publicly available on 29 March 2000. It confirmed the success of the powered wheelchair initiative. In contrast, it confirmed that it has taken longer to establish wheelchair voucher schemes and that take-up has been variable around the country. However, the numbers of disabled people now taking advantage of vouchers is accelerating.

GOVERNMENT POLICY

The responsibility for the provision of NHS wheelchairs rests with individual health authorities. Health authorities are also responsible for setting local criteria for the provision of EPIOCs. These are based on the broad national criteria that the severely disabled person is:

unable to propel a manual wheelchair outdoors;
able to benefit from the chair through increased mobility leading to improved quality of life; and
able to handle the chair safely.

All applications for EPIOCs from both adults and children involve an assessment, which takes into account these three factors. The safety factor is particularly important since the NHS would be liable if the wheelchair user sustained injury through unsafe handling of the chair, or injured a third party because the user was not fully in control.

GOVERNMENT FUNDING

The Department of Health has awarded the Research Institute for Consumer Affairs (RICA) UKP 50,000 for 1999/2000 for its Wheelchairs - Mapping Consumers' Needs project.

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