Health and Social Care Integration
The Public Bodies (Joint Working) (Scotland) Act 2014 (the Joint Working Act) establishes the legal framework for integrating health and social care in Scotland. The Act requires each Health Board and Local Authority to delegate some of their statutory functions, and associated budgets, to their Integration Authority.
Regulations that underpin the Act set out which health and social care functions must be delegated. The provision of equipment and adaptations are functions which must be delegated to the Integration Authority.
Power of Ministers to Issue Direction and Guidance
Under the Joint Working Act Ministers have the power to issue Directions and Guidance to Health Boards, local authorities and Integration Authorities in relation to carrying out their functions.
This advice note is issued as statutory guidance under the terms of Section 53 of the Joint Working Act, and as such Health Boards, local authorities and Integration Authorities must have regard to the advice provided.
It should be read in conjunction with other statutory guidance and advice issued under the terms of the Act, alongside the Guidance on Providing Equipment and Adaptations (CCD 5/2009), and subsequent guidance on providing children's equipment (DL 01 (2015)) which detail the overarching principles for the assessment for, and provision of, community equipment and adaptations.
This guidance has been developed in response to reports from the British Red Cross which highlighted inconsistency and gaps in the provision of standard wheelchairs for temporary, short-term loan.
Evidence shows that historical arrangements for short-term provision of standard wheelchairs has been inconsistent, unclear, reliant of the third sector, and staff are often left to problem solve the gap in provision leading to frustrations and delays.
Red Cross Reports and Research
Over recent years the Red Cross has worked to explore the problems and solutions associated with the provision of short-term wheelchair loans. In 2015 they published a report outlining the argument for a statutory duty to be placed on the NHS to provide wheelchairs for short-term use.
Everyone who needs a wheelchair should be entitled to quickly and easily get one that is right for them, for as long as they need it.
In addition to this, the Red Cross undertook UK-wide research to gather the experiences of people who had borrowed a wheelchair from them. This included an economic impact assessment, based on the data provided. It found that overall health and social care savings ranged from £469 to £4,607, with an average saving of £1,676.
The impact of a short-term wheelchair loan
The Red Cross' Maintaining Mobility Report highlighted the benefits to individuals of the short-term use of a wheelchair. The report presents research from face-to-face surveys of over 4,000 people across the UK. In depth interviews were also carried out with eight people across the UK who had experienced a short-term unmet need. Healthcare professionals across the UK were also interviewed.
The benefits of short-term use of a wheelchair were widely felt, with 72% seeing the value of a wheelchair in preventing further injury, and almost half (49%) stating that using a wheelchair aided their recovery time.
For those who were not provided with a wheelchair, the majority (65%) felt a significant negative impact on their quality of life. A number of common themes and issues appeared in their responses, including:
- Emotional wellbeing
- Weakened physical health
- Inability to manage everyday life
- Affected employment
"Some people do get to the point where they get so socially isolated that they don't feel that they could possibly get out of the house, even to see a doctor"
The short term loan was to facilitate outings to hospital appointments for a patient with a family member while she progressed through her rehab goals. The outcome was favourable to the patient who was recovering from major surgery. Although in the process of improving her mobility, there were limits to the distance she could walk making it difficult to attend appointments.
The patient received her wheelchair within a few days of the request being made and this was a pleasing factor of overall service provision to the patient.
The team has not experienced any delays receiving a wheelchair, and believe the service is very well run and tailored to suit the needs of those who need them.