Wheelchair provision - short-term loans: guidance

Estimated Demand and cost

The British Red Cross conducted a survey of 1,105 people in Scotland, and found that 12% (130) people had experienced a serious short-term mobility need at least once in the past two years.

• These 130 people were then asked if they had had issues with everyday living during their most recent experience of need, and 105 people reported they did
• These 105 people were then asked if they had access to mobility aids during this time, and:
  • 31 people reported they had not had access to any mobility aids
  • 9 people reported they had access to a wheelchair
• Therefore, 96 people out of 105 had not had access to a wheelchair
• 17 (17.7 per cent) of these 96 people thought that having a wheelchair would have helped them with everyday living (1.53 per cent of respondents)

Based on the above it could be projected that around 1.5% of the population of Scotland's adult population (around 68,000) may have had an unmet need for a wheelchair in the last two years.

Joint Community Equipment Store

During 2019/20 the EquipU joint equipment store made 54 individual wheelchair loans to facilitate hospital discharge and support people in the community. Of those, 33 were recycled.

• New wheelchairs were charged at £154 each, with a total expenditure of £3,234 for new, and £528 for the recycled, and an overall total cost of £3762.
• Recycling and reissuing of chairs in the future will ensure minimal costs going forward – in Equipu these are recharged at £16 per chair.
• Early figures from 2020/21 indicate that in the first 6 months there have been 45 wheelchairs provided by Equipu, which evidences that the service is increasing its scope and responsiveness in the pandemic. These have been provided to avoid admission to hospital, maintain people in the community, support hospital discharge, and end of life.

Savings through recycling

Effective recycling of wheelchairs can result in significant cost efficiencies. For example, the EquipU partnership report the cost of issuing a recycled chair at just £16 per chair. A saving of £138 per loan.

In response to the wheelchair survey they stated "Standard wheelchairs are very cheap and very recyclable. We have found that very few new chairs have been purchased and we have been able to deliver this service with recycled chairs. This is cost effective and responsive and saves staff time in trying to problem solve this type of provision in other ways."

Savings through Prevention

The Red Cross's economic impact assessment found that overall health and social care savings ranged from £469 to £4,607, with an average saving of £1,676 to the health system in the cases presented.

Economic Resource Savings Example^[3]

Peggy is 89 and lives independently in a bungalow. At the end of 2014, she broke her ankle. Social Services recommended initially that she go into a care home to recover following her discharge from hospital, with her ankle in a cast. She did not want to do this and the local authority found her a wheelchair. With this and the support of friends, she was able to return home.

£4,607

Avoided community rehabilitation unit care home costs
£1,913 cost saving to Community Rehabilitation Unit ¹

Avoided ambulance call-outs for two A&E incidences for resetting her ankle, and return trip home in plaster plus two additional follow-up hospital appointments
£1,864 resource savings for ambulance service ³

Faster recovery by one week, plus avoiding 3 weeks of increased homecare
£468 resource savings for social care services ²

Avoided A&E attendance as an outpatient, from likely fall at home if she had been without a wheelchair during recovery
£129 resource saving for Accident & Emergency ⁴
£233 resource saving for ambulance service ⁴

1. Based on £1,913 per typical low-cost episode, in purpose-built units for older people requiring recuperation after an illness, fall or temporary difficulty managing daily living; PSSRU 2014. Note: this is equal to approximately three weeks' recovery period with the Red Cross wheelchair, therefore consistent with timeframes of this case, as the weekly cost is estimated at approximately £637; PSSRU 2014.

2. Based on £117 difference between £397 per week 'critical' level homecare, and £280 per week 'Substantial' level care.; PSSRU, 2014.

3. Based on £233 per incidence of ambulance call out: see, treat and convey; PSSRU 2014

4. Based on NHS National Tariff of £129 per A&E incidence with category 2 investigation and category 3 treatment, i.e. plaster removal or application, bone fracture

5. Based on £233 per incidence of ambulance call out: see, treat and convey; PSSRU 2014