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WQ.466/2019
WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.P. SOUTHERN OF ST. HELIER
ANSWER TO BE TABLED ON TUESDAY 22nd OCTOBER 2019
Question
Will the Minister state what budget and staff are in place to ensure that medical equipment available for loan from his department are well maintained and fit for purpose; and will he state whether this budget has been altered over the past 5 years?
Answer
The following is a summary of the loan medical equipment provided in Jersey from Occupational Therapy and Physiotherapy. The equipment includes aids of daily living, wheelchairs, and care equipment such as hoists, slings and mechanical bath lifts from Occupational Therapy. Physiotherapy provides mobility equipment in the form of crutches and walking frames as well as prosthetics.
There are 29 qualified Occupational therapists and 40 Physiotherapists employed within Health and Community Services and there are 4 technical staff employed within the Occupational Therapy Wheelchair Service, including 1 Rehabilitation Engineer and 2 wheelchair services technicians. An additional post for a technician has been funded through the HCS modernisation programme (P82).
The assessment and prescription of equipment is undertaken by a qualified practitioner such as an Occupational Therapist or Physiotherapist. The assessment and prescription of some small aids is delegated to therapy assistants who have been through a competency-based assessment to undertake this.
Aids of daily living are purchased from accredited suppliers which are members of the British Healthcare Trades Association and which adhere to its codes of practice, which are approved by the Trading Standards Institute (TSI).
The Occupational Therapy wheelchair services have been developed to provide essential mobility and associated postural management based on the needs of our clients. The service provides clinically-based assessment and prescription of manual and powered wheelchairs, specialised seating and cushions, modifications and accessories. Due to the nature of the client base, the wheelchair service also provides equipment maintenance facilities and client review programmes.
Every assessor for the prescribing of wheelchairs is a qualified Occupational Therapist with appropriate current experience in wheelchair assessment. All equipment purchased for the wheelchair service complies with the essential requirements of the CE marking regulations.
All newly prescribed wheelchairs are serviced and checked by the wheelchair service technicians prior to being issued to the client by the Occupational Therapist. In 2018, a total of 453 wheelchairs were prepared for issuing to clients by the wheelchair service. Handover of the equipment is the responsibility of named qualified staff who undertake the client/carer training content, complying with the original manufacturer's instructions, and meeting risk management and controls assurance requirements as developed during the assessment \ prescription stages.
All necessary information is provided on use, adjustment and limitations of the wheelchair, including the manufacturer's handbook, (reconditioned equipment is issued with appropriate documentation) and client responsibilities regarding due care of equipment. As part of the handover process, the client or authorised carer is advised on how to obtain repair and maintenance for the equipment, including details on ongoing support from the wheelchair service. The client is required to sign to agree the completion of the handover, which is in the form of a loan document.
All repairs and annual services for wheelchairs are undertaken in the workshop based at Overdale. In 2018, the workshop undertook 1,463 routine services of manual and powered wheelchairs. The workshop is overseen by a qualified Rehabilitation Engineer who is a member of the Institute of Physics and Engineering in medicine and monitors the work undertaken by the technicians. This is completed through periodic audits of work. Staff have annual appraisals where any training needs are identified. The Rehabilitation Engineer attends the yearly Postural Management Group conference and then runs in-service training with staff to ensure they can maintain and update their skills.
The workshop also undertakes bespoke adaptations of wheelchairs to ensure they fully meet the needs of clients with more complex postural needs. All adaptations are fully risk assessed (using a risk matrix developed by Department of Mechanical Engineering, Kings College, London), use parts and accessories from accredited suppliers, and are regularly reviewed by both the Rehabilitation Engineer and the qualified therapist. In 2018, the workshop provided 298 adaptations to basic wheelchairs to ensure they met the needs of their users, increasing clients' quality of life by providing a stable and supportive seating system to allow them to access the community.
The prescription and maintenance of hoists, slings and mechanical bath lifts falls within the Lifting Operations and Lifting Equipment regulations (LOLER) of 1998 as part of the Health and Safety at Work Act.
The LOLER regulations protect users and handlers of lifting equipment and the regulations apply to any establishment with such equipment. The requirements state that all equipment must be examined before it is put into place for use for the first time or moved to another location. The equipment must then be maintained and reported upon by users – it is the responsibility of users to immediately report any problems or wear and tear. Products should be inspected by a competent person every six months and maximum load tested every 12 months. Records and examination reports must be kept by the employer so that any accident investigation is fully supplied.
The equipment owned and issued by the Occupational Therapy Service is compliant with the LOLER regulations and all equipment is serviced 6-monthly by a local medical equipment provider and independent third-party checks are undertaken by a local engineering company.
The budget for Occupational Therapy aids of daily living has increased from £122,501 in 2012 to £126,800 in 2019.
The budget for the Occupational Therapy Wheelchairs and Postural Management Service has increased from £105,000 in 2012 to £107,500 in 2019.
As the complexity, cost and demand for equipment to assist people to remain in their own homes increases, these budgets are becoming a cost pressure and will continue to do so into the future.
The Physiotherapy Department has processes in place to review and valet all loaned walking aids – crutches, frames and sticks – when they are returned to the department or at a client's request. Those that are not fit for purpose are removed from circulation and disposed of.
The Physiotherapy Department has a budget for equipment totalling £22,550 for equipment for patients. This includes the budget for walking aids, which cost approximately £5,000 per year. This is the only equipment that is loaned to patients.
The Physiotherapy budget has not been altered in 5 years for this, but there is so much effective recycling that only minimal budget is required. Therefore, the department does not have any cost pressures to replace equipment needed.
The Physiotherapy Department works with a UK company to provide prostheses to patients with amputations. The prostheses are reviewed by the visiting prosthetist, and changes or replacements are made as required for patient comfort, safety and functionality. The budget for this has significantly increased during the past 5 years, due to an increase in the number of patients needing prostheses after amputations.