Effectiveness in Wheelchair Service Provision

Abstract

Services that provide wheelchairs to permanently disabled people have undergone fundamental changes following the recommendations of the McColl report in 1986. The devolution of centralised wheelchair services to the National Health Service (NHS) health districts in 1991 coincided with the implementation of the government's proposals for NHS reforms and community care initiatives. This paper describes a four-part research study, undertaken to identify and investigate key factors which propose effectiveness in the post-devolution wheelchair service. The sample comprised 125 wheelchair therapists as service providers and a total of 130 service users. The user sample consisted of 84 people issued with NHS manual wheelchairs, 27 indoor powered wheelchair users and 19 special seating users. An integrated methodology was employed, including questionnaires, interviews, participant observation and case studies. The research identified the development of client-centred referral and assessment procedures for wheelchairs and seating, and highlighted the need for increased therapist training. Close links between wheelchair services and local therapists were found, providing greater access to assessment for wheelchair users. An increased demand for wheelchairs outside the NHS range and a rising number of referrals for elderly people were recorded, although the management of finite resources resulted in eligibility criteria designed to control supply and provision variations between districts.