3. Mrs U complains about the ICB’s decision to not give funding for a specialised wheelchair to help E access the community safely.
4. Mrs U says her daughter has been left without a safe way to access the community. She feels the ICB have discriminated against her daughter as she is seen as a high risk because of her behaviour.
5. She would like the ICB to reconsider its decision.
6. E has autism spectrum disorder (ASD), epilepsy and physical problems like poor co-ordination, rigid muscle tissue and she gets tired easily. She has a severe learning disability and is non-verbal. E’s ASD behaviour causes her to rock back and forth and she sometimes shows aggression. E has broken a number of wheelchairs while being out in the local community.
7. E is not eligible for NHS funded continuing healthcare (to pay for care costs). She gets some funded hours of care. This is known as a joint package of care because E’s needs are the responsibility of the local authority adult social care.
8. In January 2021, the clinical lead occupational therapist told Mrs U her daughter did not meet the Northamptonshire Wheelchair Service eligibility criteria for assessment and a wheelchair.
13. We first look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.
14. Mrs U told us she disagrees with the ICB’s decision and it did not consider all the evidence she gave.
15. NHS England gives support to ICBs to commission effective, efficient and personalised wheelchair services by: establishing a national wheelchair dataset • developing a national wheelchair tariff • publishing a model wheelchair service specification • introducing personal wheelchair budget model and legal rights.
This offers a clear framework for ICBs to use so its services are outcome focused.
16. NHS England works with a national advisory group to co-produce wheelchair policy. This includes representation of a wide range of stakeholders from providers, commissioners, industry, charities and people with lived experience (people who use wheelchairs).
17. The Wheelchair Leadership Alliance (the Alliance) is a group committed to improving wheelchair services across England. Representing wheelchair users, their families, carers and other organisations the Alliance works to strengthen connections between key groups to bring about positive, lasting change and shape NHS wheelchair services into a system that works better for its users.
18. NHS England introduced Personal Wheelchair Budgets in 2019. The budget model has been developed to include people who are referred to and meet the eligibility criteria of their local wheelchair service and who have had a face-to-face assessment with a wheelchair clinician.
19. People who are already registered with a wheelchair service will be eligible when they need a new wheelchair, either through a change in clinical needs or because of the condition of their current chair.
20. Local eligibility criteria for wheelchairs still applies and ICBs are responsible for this and should consider the needs of the local population. Each ICB has developed local processes to calculate the amount of money in a personal wheelchair budget. The amount is based on what it would cost the NHS to meet the person’s assessed needs through the wheelchair service currently commissioned by their ICB.
21. For people who have additional health and social care needs, the personal wheelchair budget can be added to funding from other statutory services. People can also choose to apply for non-statutory funding that may be available from voluntary, charitable organisations, either nationally or locally.
22. A personal wheelchair budget is for equipment only. It can only be offered after a relevant need has been identified by an authorised wheelchair clinician. Personal wheelchair budgets do not change the duty on statutory services to assess a person’s needs for a wheelchair.
23. We reviewed the ICB guidance on wheelchair eligibility. Point 2.2 of the criteria states wheelchairs will not be provided for children, young people and adults for outdoor use only. Users are directed to other forms of support including charitable organisations.
24. Mrs U explained to the ICB the reason she needed funding to purchase a wheelchair was for her daughter to use outdoors to access the community. The wheelchair was not going to be used indoors.
25. Point 3.2 of the criteria states bespoke and non-standard wheelchairs are only available after an assessment and recommendation by a wheelchair clinician and when the individual’s primary clinical needs cannot be met by standard equipment.
26. Our adviser says the ICB had not identified a primary need for E to have a specialised wheelchair. The wheelchair clinician, a physiotherapist, said they were concerned about E’s safety of using a wheelchair in the community. E had broken the backs of wheelchairs before because of her forceful rocking, she had broken a lap strap placed for her safety and had scratched people who were there. The physiotherapist considered the safety risks to E, the carers and the public to be too high.
27. Mrs U told us E had a wheelchair assessment and the report was sent to the ICB to consider along with her request for funding. Mrs U believed a specialised wheelchair could allow E to safely access the community and it would not easily break. Mrs U also provided the ICB with a letter from an organisation to support her request.
28. Point 7.8 of the criteria for Safety and Restraints states wheelchairs are not provided for children, young people and adults with safety or behavioural needs and individuals should be directed to voluntary organisations and private providers who can help find other solutions. It also states risk assessments are needed for children and young people who need restraints. This assessment should be done by the clinical lead and the national clinical lead.
29. The ICB’s complaint response says because E’s behaviour is unlikely to change, = a heavier chair could make outings less safe for her, her carers and the public. The ICB considered the supporting letter but found it supported the concerns of the ICB. A comment in the letter said, ‘the wheelchair would offer the staff and public the added security of restricting E’s ability to reach out and make contact with them’. Our adviser explained this letter not only supported the ICB’s decision but would also breach the Court of Protection Deprivation of Liberties Safeguarding Guidance, because it says care should be given in the least restrictive way.
30. We asked the ICB to see if Mrs U was directed to another organisation or charity. The ICB told us it could not confirm if Mrs U was contacted or directed to other organisations. We asked Mrs U and she told us she was not pointed to other organisations.
31. Having considered the evidence, the ICB’s decision to not award E funding for a specialised wheelchair was made in line with NHS England and local authority guidance. Although we have seen no evidence of whether the ICB directed Mrs U to another organisation or charity, this does not mean the ICB did not follow the correct process when making its decision. We have not seen that anything went seriously wrong.
32. We understand Mrs U wants the best for her daughter. We thank Mrs U for bringing her complaint to us.
1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs U’s complaint about Integrated Care Northamptonshire (the ICB) made on behalf of her daughter, E. We are sorry to hear about her concerns and the distress they caused her.
2. We understand Mrs U wants the best available equipment for her daughter. We have seen the ICB’s decision to refuse funding to purchase a specialised wheelchair for E was made in line with guidance. We explain our reasons below.