OUR REPORTS

The report indicates that Government funds spent on wheelchair users equates to an average of £125 per person per year, including the cost of a wheelchair, expert support as well as infrastructure costs. This level of underfunding has remained the same for at least five years. If the costs of energy, equipment and staffing are all rising, this figure needs urgent review for wheelchair support to be protected.

It is only by understanding the true demand for wheelchairs and providers that NHS England can commission appropriate services. Adequate funding requires accurate wheelchair user data so their families and carers can be confident that they will be treated equitably wherever they live in England. This means all types of wheelchair services must offer regular data based on outcomes to ensure accountability and reduce regional differences.

NHS England has worked in partnership to develop a service specification for wheelchair services. This is an effective guideline but as its non-compulsory, there are significant variations in structure and delivery between areas of England. This level of inequity must be addressed as the standardisation of provision is vital.

According to the report, wheelchair users are categorised into three levels of assessment/intervention criteria; low, medium and high. There is significant confusion over how these categories are interpreted, with some wheelchair users feeling there could be some discrimination. Ultimately, commissioners should be better educated about wheelchair users in their region and ensure individual needs are considered holistically.

In addition, providers currently interpret the specification to their local community or available budget and this sometimes leads to inconsistencies in provision. A more nuanced and tailored approach is required.

NHS England has worked hard to develop a reporting dataset for wheelchair services. However, this is often inconsistent meaning gaps in service provision are hidden. It is essential that the data includes outsourced providers to ensure that a full picture of service provision is available each quarter. The Wheelchair Alliance believes a more rigorous approach to standards is essential with the need for an independent regulator.

The report raises concerns that wheelchair users may be being exploited due to a lack of clear regulation, independent review body or information about who to approach regarding repairs, complaints or suggestions for service improvements.

It is impossible for NHS England and service commissioners to provide appropriate delivery funding without knowing the scale of demand. Unfortunately, this has been approximated for many years, and is an issue that should be urgently resolved.

When real demand is known, then appropriate funding can be identified for all aspects of wheelchair services ranging from the recruitment of skilled clinicians to the purchase of high-quality equipment. The report indicates significant uncertainty surrounding the number of wheelchair users in England. Understanding demand facilitates the robust planning of services where the appropriate number of highly skilled staff such as therapists, rehabilitation engineers and technicians can be forecast correctly.

The report highlights the importance of a highly skilled workforce. A community of practice to support the professional development of individuals and raise the profile of roles at education establishments is needed.

There are clear advantages to locally led provision of NHS wheelchair services. In particular commissioners can provide a service which is tailored to local needs. However, this has led to variation in the standard of care provided and service user experience. This variation has been highlighted in previous studies and our in-depth engagement with wheelchair users reemphasises this inequality. Service users reported that they were often left to navigate the system themselves and had to rely on their own experience and knowledge to access support.

Analysis shows that a relatively modest increase in wheelchair service equipment spend could make a meaningful impact on the budgets of Integrated Care Boards (ICBs) who are currently reporting below average per patient spend on equipment budgets. This increase in spend would deliver significant cost benefits.

There is a need to ensure that current budgets are used in the most effective way possible. This includes the sharing of best practice between commissioners and realising the advantages of joined up working and pooled budgets by statutory bodies for the benefit of wheelchair users, their families and carers.

This could be done by mandating that all ICBs adopt the Quality Framework for Wheelchair Provision along with the Model Service Specification when commissioning wheelchair services. This would help to minimise inequality across different services and ensure consistent delivery of a good quality service and provision.

The Department of Health and Social Care (DHSC) and NHS England should explore the possibility of increasing current spending on NHS wheelchair services to help ensure more benefits are realised and the NHS can unlock significant cost savings.

The Wheelchair Alliance will lobby at Governmental level, demanding a review of current investment levels into wheelchair services which have not altered in decades and have been severely impacted by both austerity measures and the cost-of-living challenges.

The Alliance will also work in collaboration with NHS England, ICBs, other statutory bodies, charitable organisations, manufacturers, providers and wheelchair users to demonstrate the benefits of providing high quality wheelchair services and a choice of wheelchairs to suit a persons identified lifestyle needs.

Local wheelchair services and commissioners should continue to share best practice and explore opportunities to pool budgets between wheelchair services and other local services. NHS England should consider what support and processes are required to encourage and facilitate greater joined up working and frictionless pooling of budgets.

The Wheelchair Alliance will promote best practice examples through case studies published in our newsletter and on our website. As well as this, the Alliance will identify funding opportunities to conduct research to demonstrate the human benefits of shared funding mechanisms as identified by wheelchair users, their families and carers.

The report highlights that there is no centralised director of wheelchair services which is impacting the development and delivery of high-quality wheelchair Services.

Report findings also show that there is currently no standardised eligibility criteria across all services to help ensure that every wheelchair user is entitled to the exact same standard of care and equipment, regardless of where they live.

The report highlights a stark lack of data regarding the true scale of wheelchair demand which severely limits the insights that stakeholders can draw from the information that has been provided. It calls for strengthening the National Wheelchair Dataset to optimise central oversight, service tracking, and benchmarking.

Its findings also stresses that this data is crucial in order to ensure that this information is used to drive improvements in wheelchair services.

The report also recommends shifting away from ‘lowest-cost’ purchasing models toward value-based procurement and efficient supply chains, improving retail practices so users get reliable, high-quality equipment.

A critical finding of the report is the severe gap in meaningful patient feedback. It highlights that wheelchair users do not currently have adequate mechanisms to provide feedback to service providers and communicate with ICBs.

This is compounded by the fact that current issues like long delays in assessment, reliance on unsafe temporary equipment, and a total lack of clear repair pathways is affecting the user experience.

Currently some of the data required as part of the National Wheelchair Dataset (NWD) is either incomplete or entirely missing. This is severely limiting the insights that stakeholders can draw from the information that has been provided including information relating to provision of Personal Wheelchair Budgets. The report recommends that NHSE should undertake discussions with ICBs who do not submit data or are providing inadequate data. NHSE should then identify and address barriers to ensure that the NWD can serve its purpose and allow for benchmarking of local area services.

The report highlights the need to create an NHSE Senior Responsible Officer (SRO) role, that is responsible and accountable for the overall development and ongoing delivery of high-quality wheelchair services. To achieve meaningful change, it is recommended that this role is sufficiently senior e.g. equivalent to National Clinical Director. The report also recommends that the SRO would be responsible for ensuring that insights from national data is used to drive improvements in wheelchair services.

The report recommends that NHSE mandates a set of standardised eligibility criteria across all services to ensure that all wheelchair users across the country are entitled to the same care regardless of where they are located. To avoid duplication, this set of criteria should draw heavily on existing efforts to articulate what a ‘good’ service looks like (e.g. NHSE’s own Wheelchair Model Specification and the Wheelchair Quality Framework). However, the criteria need to be clearly described and implemented as mandatory rather than optional guidance.

To ensure this is successful, local commissioners should receive dedicated centralised training on the new set of standardised eligibility criteria.

The introduction of the 'Not in a Class' category in the Department for Transport's 2024 guidance has significant discriminatory effects on powered wheelchair and mobility scooter users. Individuals whose devices exceed certain weight, width, or speed thresholds are required to hold a driving licence and are restricted to using roads only, excluding pavements and public areas. This disproportionately affects children, people with complex needs, and those unable to obtain a licence due to age or disability. As a result, many users may be unable to leave their homes, access education, work, or leisure activities, and risk legal penalties for using essential medical equipment. The report highlights that these changes may breach the UN Convention on the Rights of Persons with Disabilities and the Chronically Sick and Disabled Persons Act 1970, and were implemented without adequate consultation or an Equality Impact.

The report identifies that the current legislative framework, particularly the Use of Invalid Carriages on Highways Regulations 1988, is outdated and ill-suited to modern technology and user needs. The use of derogatory terms like 'invalid carriage,' unclear VAT and import rules, and ambiguous requirements for insurance, registration, and licensing create confusion for users, manufacturers, and providers. Technological advancements in powered mobility devices are not reflected in the legislation, leading to barriers in prescribing appropriate equipment and potential discrimination against those needing heavier or more advanced devices.

A major finding from the report is the widespread lack of awareness among powered wheelchair users regarding the new guidance and their legal obligations. A survey of 434 users revealed that 62% were unaware of the UK government’s guidance on where powered wheelchairs can be used, and 79% had not received any information or advice about the rules. Furthermore, 69% did not know which class their wheelchair belonged to. This lack of communication from authorities has left users at risk of unintentionally breaking the law, facing penalties, or being denied access to public spaces.

The report strongly recommends eliminating the requirement for certain powered wheelchair and mobility scooter users to hold a driving licence and to use their devices only on roads. This policy disproportionately affects children, people with complex needs, and those unable to obtain a licence, effectively restricting their independence and access to public spaces. Instead, the report advocates for allowing these users to access pavements and pedestrian areas, aligning with practices in other EU countries. This change would reduce the risk of injury, prevent social isolation, and ensure compliance with disability rights legislation.

The report recommends a comprehensive legislative review, modernisation of terminology, and alignment with international best practices to ensure disabled people’s rights and independence are protected.

This includes a review and update of the outdated 'Use of Invalid Carriages on Highways Regulations 1988’ to replace derogatory terms like 'invalid carriage' with modern, respectful language. It also calls for clarification on ambiguous rules around VAT, import duties, insurance, and registration.

By updating the legislation to reflect technological advancements and current social values, the government can remove confusion for users, manufacturers, and providers, and ensure that disabled people are not unfairly penalised or excluded from essential mobility aids.

The report calls for urgent improvements in communication and the development of clear, accessible information for all stakeholders to avoid unintentional non-compliance and increased risk.

It suggests creating a central, user-friendly resource – developed in collaboration with people with lived experience – to ensure all stakeholders, including users, carers, and providers, have accurate and up-to-date guidance. This would empower users to make informed decisions and reduce the risk of legal or safety issues.

The findings indicate widespread concerns regarding inconsistencies in interpretation along with significant variations in reporting. Data is misleading and could negatively influence any procurement process Respondents reported that the data offers little support for service planning, budgeting or quality improvement and does not adequately capture patient experience, repairs, maintenance, complexity of need or workforce pressures.

The findings strongly suggest that the quarterly dataset does not demonstrate service quality. Eight of nine commissioners (89%) said it failed to reflect the quality of commissioned services, while all five provider respondents agreed it did not accurately represent their services. The dataset records activity but lacks patient feedback, outcomes and evidence of the effect of wheelchair provision on daily life. Without these qualitative measures, commissioners cannot distinguish high-performing services from those needing support or assess whether provision delivers meaningful benefits for wheelchair users.

The findings reveal a significant gap in the quarterly dataset: it captures no direct feedback from wheelchair users or their carers. Consequently, the data cannot show whether services meet individual needs, achieve agreed outcomes or improve daily living. Providers also confirmed that patient experience is absent from current reporting. Without measures of satisfaction, quality of life and functional outcomes, commissioners cannot fully assess service quality or value. Introducing standardised patient-reported experience and outcome measures should therefore be central to any redesigned dataset.

The overwhelming message from the survey is that the dataset is not fit for purpose and urgently needs to be reviewed. The NHS 10-year plan stresses the need to move from analogue to digital use and the recent publication of the Wheelchair Quality Framework could provide the NHS with a significant opportunity to devise a dashboard based on the Framework that looks across both qualitative and quantitative data. A revised dataset would drive up service quality and minimise the current ‘postcode lottery’ experienced by wheelchair users.

The findings demonstrate the need for clear, standardised definitions so that every provider and commissioner interprets and reports information consistently. Agreed outcome measures should also be introduced to capture service-user experience, satisfaction and the effect of wheelchair provision on daily life. Combining these qualitative measures with existing activity data would enable meaningful comparisons between services, improve accountability and give commissioners a stronger evidence base for planning, funding and service improvement.

Aggregating returns across multiple providers obscures important differences in performance, demand and service quality. More granular reporting at individual service-provider level would enable commissioners and NHS England to identify high-performing services, recognise those requiring support and investigate unexplained variations. It would also strengthen accountability, improve comparisons and reduce the risk that poor performance is hidden within wider ICB-level figures. This clearer oversight would support better-informed commissioning, funding and service-improvement decisions.