Norfolk Community Health and Care NHS Trust

6. Mrs T says that between October 2019 and January 2020 the Trust removed Mr T’s wheelchair without notice (for adjustments to be made) and provided a temporary one that did not meet his needs.

7. She says the Trust was slow to meet Mr T’s needs and it needed him to attend different appointments where nothing was achieved. Mrs T also complains that the Trust did not resolve issues after investigation and she does not feel her concerns were taken seriously.

8. Mrs T says Mr T was in the temporary wheelchair for over six months. She says Mr T lost his independence as he was unable to move himself out of the temporary chair. She says the temporary chair did not give Mr T enough support for his back. She says Mr T lost muscle tone and his annual hip X-rays from 2019 and 2020 showed a deterioration in his hip placement. She explains he has been put on the list for hip surgery. She says since being back in his existing wheelchair, Mr T’s annual hip X-ray from September 2021 showed no further deterioration of his hips.

9. Mrs T says Mr T was inconvenienced due to difficulties moving around at school as the temporary wheelchair was not appropriate and he missed school to attend appointments. She says Mr T was frustrated with his replacement wheelchair and this led to him being upset and the experience caused the family distress.

10. Mrs T wants the Trust to accept its failings and to make service improvements.

11. Mr T has cerebral palsy (a condition that affects movement and coordination) and relies on a wheelchair to support his posture.

12. The Trust did an assessment on 30 January 2019. Mr T’s existing wheelchair was adjusted and a prescription for a new footplate, brakes and harness was made.

13. On 14 October 2019, the Trust kept Mr T’s wheelchair for brake and footplate adjustments. It provided a replacement temporary wheelchair the same day.

14. Mr T attended more appointments on 18 and 25 October. On 25 October, a different clinician found that Mr T’s existing wheelchair was no longer suitable as he had grown. His back rest could not be mounted in the correct position in his existing wheelchair. But, the backrest was correctly positioned in the temporary wheelchair. The records note the clinical reasons why Mr T needed to stay in the temporary wheelchair. It was providing more effective support as the back rest did fit correctly.

15. On 4 November, the Trust did a new assessment for a wheelchair prescription. Mr T had an appointment on 5 November.

16. A handover of Mr T’s new bespoke (specially made) wheelchair was arranged for 20 January 2020. But, Mr T’s new wheelchair was the wrong size because it was unable to provide the back support needed.

17. The Trust did another assessment on 4 February. On 27 March, the Trust received Mr T’s new wheelchair, but found faulty brake cables.

18. New brake cables were fitted to Mr T’s wheelchair and the handover took place on 7 April.

22. Mrs T says the Trust removed Mr T’s wheelchair for adjustments to be made and gave him a temporary one that did not meet his needs. She says the Trust was slow to meet Mr T’s needs and he needed to attend several appointments where nothing was achieved.

23. Our adviser helped us understand the process for the completion of wheelchair referrals and adjustments.

24. The ‘NHS Operational Planning and Contracting Guidance 2017 – 2019’ says the national target for non-emergency care, including wheelchair services, from referral to getting a chair was 18 weeks for children and adults.

25. The national wheelchair data collection collects and reports the data for each commissioning area. For context, national data collection from NHS England in 2016/17 reported that around 25 per cent of children waited over 18 weeks for a wheelchair. This shows there were some national delays in the provision of children’s wheelchairs.

26. There are several stages before a wheelchair handover. A referral is made which leads to an assessment for a prescription. A wheelchair is made based on a prescription and then handed over to the patient. The expected wait for each stage depends on the type of assessment and equipment needed.

27. NHS England guidance on model service specification outlines the wheelchair assessment and prescription process:

‘Assessment

• the holistic assessment is co-produced by appropriate members of the multidisciplinary/multiagency team, in which the Service User, Carer and/or family are equal members of the team.

• the assessment considers the objectives all parties wish to achieve, with clear and agreed individual outcome measures.

• the assessment is carried out, and equipment and/or training provided, by a member of the Provider’s staff with the required level of competency.’

‘Prescription

The Provider will prescribe wheelchairs and specialist seating ensuring that:

• the Service User/Carer must be aware of all options for wheelchairs and specialist seating at the beginning of the prescription process.

• the prescription that generates the product order must be produced by an appropriately trained and authorised clinician.

• the prescription must be suitable to the Service User’s/Carer’s needs as defined in the assessment and must facilitate and encourage safe independent mobility where appropriate.

• a collaborative approach to decision making should be employed to produce individuals’ prescription and wherever possible, service user choice should be included within the prescription.’

28. A referral is triaged by a clinician to decide what type of assessment is required. There are a range of potential assessments for a standard, active, or powered wheelchair, postural assessment and specialist seating.

29. After triage, the referral is placed in an appropriate clinic for assessment by a clinician with the skills and knowledge to complete the assessment and prescription. The assessment should include a postural assessment and measurements. Based on the outcome of the assessment, a prescription for a wheelchair should be agreed with the patient and carer.

30. If the prescription is for a standard wheelchair this may be a stock item, but if a bespoke prescription is needed that needs to be ordered specifically for a patient, the assessment to handover timescale will be different.

31. Mr T needed an active user wheelchair with added postural support. This needed to be ordered and made individually for Mr T with the postural support fitted afterwards.

32. Suppliers and wheelchair services should provide patients and carers with a guide to the expected time from assessment and prescription to the chair being available. This timeframe will vary depending on the complexity of the bespoke wheelchair prescription.

33. On receipt of the wheelchair by the wheelchair service, if more fittings are needed, fitting and handover of the wheelchair may need specialist clinicians, a rehabilitation engineer and the wheelchair supplier to be present. In this case, the postural support for Mr T’s wheelchair needed more fittings.

34. The requirement for several experts to be present can increase the time from delivery to handover. Wheelchair services may need involvement from wheelchair supplier representatives for handovers when the equipment is bespoke. This was the case for Mr T’s wheelchair.

35. The causes of the delays in the handover of Mr T’s new wheelchair are quite straightforward. First, the Trust caused an 11-day delay between 14 and 25 October 2019. At the appointment on 14 October it should have been clear to the Trust, as it was on 25 October, that Mr T’s wheelchair was now too small and his existing prescription was now unsuitable. Secondly, the Trust’s wheelchair prescription of 4 November was incorrect. It did not include consideration for fitting the added postural support Mr T needed. This was not clear until the handover on 20 January 2020 when Mr T’s new chair could not provide his back support. The Trust noted the error was on the part of the wheelchair supplier representative. But for our purposes, the Trust was responsible for delivering a wheelchair that was fit for purpose. We find the Trust failed to act in line with NHS England service specification guidance. The prescriptions were not suitable for Mr T’s needs.

36. This caused a delay because a new prescription and handover was needed. The need for a second prescription caused an added wait of just over two months from handover of the first new wheelchair on 20 January 2020 to the Trust getting the new wheelchair on 27 March. There was then a further slight delay due to the replacement of faulty brakes. While that may have been an unavoidable complication, which the Trust fixed quickly, the fact remains that the wheelchair should have been ready on 20 January. But, the Trust did not provide it until 7 April.

37. We find there were no further delays by the Trust between 25 October 2019 and 20 January 2020. As we have explained above, the process for suppling bespoke wheelchairs can be complex. The Trust was reliant on the supplier for the completion of the order and handover of the wheelchair, which is the case with bespoke wheelchairs. The records show the wheelchair service was proactive in contacting the supplier regularly for the order delivery date. Excluding for now the delays that the Trust did cause, the timeframe of 12-and-a-half weeks was within the 18-week target in the NHS Operational Planning and Contracting Guidance.

38. Overall, we find the Trust’s failings meant Mr T was in his temporary wheelchair for almost 13 weeks longer than he should have been.

39. We asked our adviser if the temporary wheelchair Mr T used met his physical needs.

40. Mr T’s wheelchair requirements were complex due to the need for an active wheelchair and added postural support using a different back support and other features. Prescriptions for complex wheelchair solutions like Mr T’s can be challenging and further alterations can be needed once the wheelchair is ready for handover. It is not uncommon for more adjustments to be needed at handover or after handover of the wheelchair.

41. As Mr T’s original wheelchair and postural support were made for him, an exact replica (copy) would not be available as a temporary wheelchair. The Trust tried to provide a temporary wheelchair as near to Mr T’s own wheelchair as possible.

42. Our adviser explained the temporary wheelchair was an active wheelchair and was fitted with a matrix back (a type of back support) the same as Mr T had on his own wheelchair. While the temporary wheelchair was a different style and make to his permanent one, our adviser explained it provided the same level of postural support as Mr T’s own wheelchair. It was fit for purpose and met his postural needs.

43. We find we cannot link the impact Mrs T told us about on Mr T’s physical health, with the Trust’s failings. While it was not the same as his permanent wheelchair, the evidence suggests the support the temporary wheelchair gave to Mr T was suitable for his needs. We also note that half of the time the temporary wheelchair was used, was not down to any delays by the Trust.

44. That said, we did find the delays caused some distress to Mr T and his family. We have no reason to doubt Mrs T’s account that the temporary wheelchair caused Mr T difficulties and that he was incredibly frustrated. We do realise Mr T would always have needed to be in the temporary wheelchair for some time, and that in itself would have been frustrating. But, the Trust caused that frustration to last 13 weeks longer than it should have. The Trust’s failure to provide prescriptions that met Mr T’s needs also meant he did have to attend extra appointments meaning he needed to miss things like school. We find the Trust has not done enough to acknowledge the extra difficulties Mr T faced. We partly uphold this part of the complaint.

45. We note the Trust has taken steps to improve its service since this complaint. The Trust has accepted the service provided from the supplier was not good enough and it has now changed to a different supplier. It says it has made changes to its service provision to make sure full assessments by skilled clinicians are available at appointments. We acknowledge the service improvements the Trust has made as a result of Mrs T’s complaint. We are satisfied these are enough to reduce the risk of a future problem with a prescription.

Complaint handling

46. Mrs T says the Trust did not resolve issues after an investigation into her complaint about the delays with Mr T’s wheelchair and she says she does not feel her concerns were taken seriously.

47. Mrs T complained to the Trust on 4 November 2019 and it responded on 20 January 2020. The response covered the error of 14 October, but not the incorrect prescription of 4 November which no one was yet aware of. The response noted Mr T’s appointment on 14 October had not had an appropriate skill mix of clinicians to look at Mr T’s chair and apologised for the delay this had caused. It set out the improvements it would make to give appropriate support in more complex cases like Mr T’s.

48. The same day as the Trust’s response of 20 January 2020, Mr T had the failed handover appointment. On 22 January Mrs T emailed the Trust to complain. She said she did not feel the outcome of the Trust’s investigation was good, that the Trust had not taken her concerns seriously enough and that she would be coming to us. Mrs T came to us that week and we started investigating her complaints.

49. Our Principles say organisations should be customer focused and listen to and consider the complainants views. They should be open and accountable when things have gone wrong and explain what they will do to put matters right.

50. We find the Trust did take Mrs T’s concerns seriously. Its complaint response of 20 January 2020 reflected her concerns, took accountability for what went wrong and set out what it would do to improve in the future. That was in line with our Principles.

51. Unfortunately, on the same day as the Trust’s response Mr T experienced more problems with his wheelchair. We have explained how the Trust’s failings caused that problem, but that does not mean there was anything wrong with the Trust’s response on that day. At that point no one knew about the further mistake, so we cannot say the Trust’s response was incomplete in any way because of that. After that, Mrs T came to us to deal with her complaints so the Trust did not respond further.

52. While Mr T’s experience at the Trust did not go as smoothly as expected, our decision is the Trust did take Mrs T’s concerns seriously and it acted in line with our Principles. We do not uphold this part of the complaint.

1. Mrs T complains on behalf of her son, Mr T. Our decision is that Norfolk Community Health and Care NHS Trust (the Trust) should have completed a re-assessment for a larger wheelchair for Mr T on 14 October 2019. It did not do this until 4 November. In this assessment the Trust did not take into consideration the addition of the postural support back into the wheelchair. This caused an extra delay from 20 January 2020 when the first new wheelchair handover should have been completed, to the handover of the second new wheelchair on 27 March. At handover, the brakes were faulty which added another week’s delay in Mr T getting his completed new wheelchair on 7 April.

2. If the Trust had not delayed matters, this would have reduced the amount of time Mr T spent in the temporary wheelchair. Mr T’s temporary wheelchair was an active wheelchair like his existing wheelchair. It was fitted with the same back support Mr T had in his own wheelchair. We found the temporary wheelchair was fit for purpose and met Mr T’s needs. We partly uphold this part of the complaint.

3. The Trust has accepted the delays Mr T experienced. It has made changes to its service provision and it has also changed the wheelchair supplier for children’s active wheelchairs. We consider the improvements the Trust has made is enough to reduce the risk of a problem in the future.

4. We recognise how upsetting and frustrating it was for Mr T to stay in the temporary wheelchair for longer. We understand this meant he missed school to go to extra appointments. The inconvenience he experienced due to difficulties in him using the temporary wheelchair caused him and Mrs T distress. We recommend the Trust apologises to Mr T and Mrs T for the distress the delays caused them both. We partly uphold this part of the complaint.

5. Finally, our decision is the Trust did take Mrs T’s concerns seriously. The problems with the adjustments to Mr T’s wheelchair were unfortunately delayed further after the Trust replied to Mrs T’s complaint. We cannot say the Trust’s investigation into Mrs T’s concerns was not good enough because of this. We do not uphold this part of the complaint.