Eligibility criteria for wheelchair users

Standard transit and Self propelling Wheelchairs

Standard Wheelchairs from within our locally agreed range will be supplied following triage of received self-referral or professional’s referral form.

Equipment will be ordered and delivered direct to the client where the request is for standard, equipment and there is no indication of a need for Dorset Wheelchair Service clinical assessment.

NB: a standard transit wheelchair is provided as back up to powered provision, where the client is eligible for this additional provision.

Wheelchairs and all paediatric buggies that require further assessment

This range of wheelchairs and buggies offer more adjustability and range of size options than available in the standard wheelchair range.

An assessment for this type of wheelchair/ buggy is always undertaken by the Wheelchair Service Therapist and / or Rehabilitation Engineer in clinic. External manufacturers may also be involved.

Self-propelling configurable manual wheelchairs

Assessment for this type of wheelchair is undertaken by the Wheelchair Service Therapist and / or Rehabilitation Engineer.

Referrals for this type of manual wheelchair will be considered for provision when:

• The main service criteria for self-propelled wheelchairs are met.
• The clients clinical and mobility needs cannot be met by a standard wheelchair of a lower specification within the Wheelchair service range.
• The client requires adjustments in wheelchair set up to meet their clinical and mobility needs

High specification energy efficient manual wheelchairs

Assessment for this type of wheelchair is undertaken by the Wheelchair Service Therapist and / or Rehabilitation Engineer. External manufacturers may also be involved.

Referrals for this type of manual wheelchair will be considered for provision when:

• The main service criteria for self-propelled wheelchairs are met.
• The clients clinical and mobility needs cannot be met by another wheelchair of a lower specification within the Wheelchair service range.
• The client is a full-time wheelchair user, and lifestyle needs, and ability is such that maximum independence and mobility will be gained by provision of an energy efficient wheelchair.
• The wheelchair user has demonstrated adequate control of static and dynamic stability of the wheelchair necessary for their likely environment and planned usage.

Manual wheelchairs and buggies with a tilt in space and / or recline facility

These will be supplied where the client requires postural support and regular changes in positioning within their wheelchair and their needs cannot be accommodated in any other wheelchair type with the addition of accessories.

NB: Suitable indoor seating provision should be in place for clients as well as wheelchair provision.

One arm lever of dual rim self-propelling chairs

These types of wheelchairs will only be issued following a full assessment with the client for this type of wheelchair. It will be undertaken by the Wheelchair Service Therapist and / or Rehabilitation Engineer. External manufacturers may also be involved.

Double buggies

The main responsibility of the Wheelchair Service is the provision of appropriate seating and mobility within a single buggy/wheelchair required by the child meeting the criteria.

Provision of a double buggy will only be considered where both children meet the main criteria for the provision of wheelchair service equipment. This will be in the place of individual buggies for each child.

Where only one child meets the criteria, a Personal Wheelchair Budget (PWB) can be used as an option to obtain a double buggy in place on an individual buggy. The PWB buggy chosen by the family must meet the postural needs of the disabled child requiring wheelchair provision and accommodate the weight of both children.

Provision for this type of equipment will be assessed by the wheelchair service clinical team and will involve a full clinical, functional and environmental assessment.

An EPIC may be supplied under the following circumstances.

• The person meets the Service general criteria for the provision of equipment.
• The person is unable to walk, or the walking is not functional within the home environment, or there are medical and / or functional contra-indications to them continuing to do so e.g. high risk of falls etc.
• The person is unable to manually self-propel a wheelchair or there are medical issues that limit the consistent ability to self-propel or provide a significant risk of injury to the person when mobilising indoors.
• The person has a residential environment that is compatible with the use of an EPIC; and they have adequate space for the movement of the EPIC including leg rests/foot plates within the home; and have a suitable area with power supply for charging the batteries.
• The person must demonstrate an ability of reasonable potential with further training to safely control the EPIC independently within the home.
• Agreement to the EPIC annual planned preventative maintenance programmes to be completed, giving full access to the equipment when requested.
• Agree to Wheelchair Services conditions of supply, including the annual review process.

Assessment

The person’s home environment and their ability to manage the chair safely within this setting will be assessed by the clinical team. An EPIC is not intended for outdoor pavement use. However, the chair may be suitable for use within the confines of a private garden, and this will be discussed and assessed for at the time of assessment by the clinical assessment team.

The Wheelchair Service will seek advice from the clients GP or other healthcare professionals, if, prior to or at assessment, actual or potential risks to the health and safety of the client and others are identified. This will be done with the consent of the client.

EPIC provision for children

EPIC’s will be issued to children who are unable to walk or self-propel functionally and have been assessed as being capable of independently controlling a powered wheelchair safely.

A full assessment will be undertaken before supply.

Dorset Wheelchair Service will not consider provision of an EPIC for school use only.

All EPIOC supply through the NHS has a limited maximum speed of 4mph and is for pavement use only.

Provision for this type of equipment will be assessed by the our clinical team and will involve a full clinical, functional and environmental assessment.

Referrals must meet all the criteria for supply of EPIC above AND additional criteria before they can be considered eligible for provision of an EPIOC.

Additional criteria

• Have safe and easy access to the outdoors from their home environment.
• Have a local environment which is accessible and compatible within safe EPIOC use.
• Be able to demonstrate that they have the potential to benefit from an EPIOC and will derive significant benefit to an improved quality of life through increased independent mobility.
• Be medically fit to independently control a powered wheelchair both indoors and outdoors and be free from conditions causing loss of consciousness and / or epileptic seizures within the last 12 months, in line with the DVLA requirements for motor vehicle drivers.

See www.dvla.gov.uk for more information on medical requirements.

• Be able to demonstrate during a driving assessment on a specified indoor and outdoor route that they have the insight, intellectual capacity and dexterity to operate an EPIOC both safely and responsibly on their own, without assistance (consideration is given to all age-appropriate skills). Completion of an outdoor driving assessment is compulsory in ALL CASES.

Assessment

Assessment will involve a review of current manual / power chair use within the home, a visit to the client’s home to review environmental suitability for EPIOC use if this is appropriate and an indoor and outdoor driving assessment.

Additional information

• Powered wheelchair provision is not considered to allow mobility solely for use within Education establishment or the workplace; for this usage the client should contact Education Department for their locality or the Department of Employment ‘Access to Work’ for advice respectively.
• An annual planned preventative maintenance check will be carried out by the Wheelchair Repair Service on all power wheelchairs supplied. These must be agreed to by the client on signing the conditions of supply.
• All accidents involving powered wheelchairs supplied must be reported immediately to the service for a review of the equipment to be carried out.
• Any changes to a person’s medical condition must be reported immediately to the service for further assessment and consideration to ensure continued safe use of the equipment.

There are certain items which we are not commissioned to provide, which includes the following.

• Wheelchair / Buggies to be used as an aid to restraint.
• Wheelchairs to be used in place of an armchair.
• Powered assisted units that can be attached to the chair e.g. power packs and power assisted hand rim systems.
• Rain covers or sunshades where they are not supplied as a standard part of the model of buggy
• Equipment specifically required to meet work, education or sporting needs.
• Pressure care cushions for armchair or other seating use.
• Powered wheelchairs with the following powered features: elevating leg rests, seat risers.
• Attendant only controlled powered wheelchairs.
• Powered wheelchairs used outdoors only (EPOC).
• Mobility scooters.
• Trike attachments.

Special Seating may be in the form of either ‘off the shelf’ equipment or individual bespoke systems that are fitted to a wheelchair or buggy chassis.

Full assessment will be carried out by the wheelchair clinical team and may involve contractors from manufacturers. The provision of special seating will be considered where the client meets all the Standard Dorset Wheelchair Service criteria and has a postural positioning need that cannot be addressed through the provision of standard equipment.

Please note: Special seating is provided for use within a wheelchair to meet mobility needs and is not supplied to replace armchair provision or solely to provide a school seating or transport system.

Provision of a pressure relieving cushion is considered where:

• the client meets our criteria for provision of equipment.
• the client is using NHS supplied wheelchair, either a transit wheelchair, a self-propelling manual wheelchair or a powered wheelchair as their main means of mobility.

Pressure relieving cushions will not be provided for use:

• in armchairs or any other form of seating.
• in a transit wheelchair which is used as an alternative to appropriate armchair provision.
• in a privately owned wheelchair where it assessed that the addition of the cushion compromises safety.
• in a private wheelchair where the standard criteria for NHS provision and use of equipment is not met, or the client is not already known to the service.

The resident must meet the standard Dorset Wheelchair Service criteria for the provision of equipment.

Wheelchairs will not be provided where there is no suitable provision of alternative seating.

Self-propelling wheelchair provision to residents of nursing and residential homes

Self-propelling wheelchairs and accessories; including pressure relieving cushions, may be issued to meet criteria to any resident who.

• Has a permanent disability, which prevents him/her from mobilising independently within the home.
• Is physically fit and able to self-propel a wheelchair.
• Is motivated to use the equipment for independent mobility.

Transit and wheelchair-controlled wheelchair provision to residents of nursing and residential homes

This type of wheelchair will only be issued for the purposes of taking a resident out of the nursing/residential home (including the grounds) on a regular basis (at least 4 days a week) by a named relative or friend:

• The Dorset Wheelchair Service is not responsible for provision of transit chairs within the nursing home / residential home setting. It is the responsibility of the nursing / residential home to supply equipment to transfer residents around the home in order to socialise, access meal facilities, access the immediate care home environment, garden etc.
• The Dorset Wheelchair Service is not responsible for seating within the nursing / residential home setting. It is a nursing / residential home responsibility to ensure that the client has a suitable armchair or dining room chair to manage their comfort, postural and pressure case requirements.
• The Dorset Wheelchair Service will not provide wheelchairs to take residents out of the care setting by staff only on an infrequent basis. For these occasions the British Red Cross short term loan facilities could be utilised.
• Equipment currently on issue to clients moving into nursing / residential home will be exempt from these rules. However, these chairs are on temporary loan for use by the named resident only and must be returned when no longer required. By that resident.
• It is the responsibility of the care home staff to inform the wheelchair service if the equipment is no longer required by the named individual.
• If the user requires a re-assessment of their wheelchairs needs within the care setting, Standard Dorset Wheelchair Service criteria applies.
• Pressure relieving cushions are not issued for use in armchairs or non-NHS supplied wheelchairs. Nursing and residential homes are expected to provide this equipment.

Indoor power chair (EPIC) provision to residents of nursing homes or residential homes

The resident must meet the Dorset Wheelchair Service criteria for the provision of equipment and the main EPIC criteria.

In addition, an EPIC may be supplied if the person is:

• Able to control a powered wheelchair to enable them to be independently mobile.
• Able to operate the chair with regard to their safety and the safety of other residents.

Electrically powered indoor / outdoor wheelchair (EPIOC) provision to resident of nursing home or residential homes

Our criteria for EPIOC provision applies (See EPIOC criteria). Individual cases will be carefully assessed to establish if EPIOC provision is appropriate. There must be a need for the client to access the local environment independently.

Modifications are custom made additions or changes to a wheelchair or buggy. Modifications are considered where standard accessories are not suitable and there is a clear clinical need for provision. A rehabilitation engineer will complete an assessment and all documentation required for these client specific, bespoke items.

Accessories are generally off the shelf parts that are readily available from the manufacturer. These will be supplied following an assessment and recommendation from an accredited referrer, Wheelchair Therapist or Rehabilitation Engineer. Accessories must be supported with clear clinical reasoning for their provision.

Head supports

• We provide head supports for clients sitting in wheelchairs or seating systems where it is a clinical need e.g. to meet postural needs.
• They are not supplied to meet transport needs alone and are not a legal requirement.
• Most head support provided for postural support are not crash tested. It is the responsibility of the transporter to consider provision of the head support as part of the safe transportation of a client in a wheelchair.

Trays

• The supply of trays to fit wheelchair service supplied equipment will be considered in the following situations
• To assist postural support management (i.e. to support client’s arms, to encourage trunk extension or to facilitate fitting of anterior trunk support).
• To allow mounting of NHS supplied power chair controls to facilitate independent management of the power chair.
• It is advised that the tray should be removed from the wheelchair and stored for transit if the client is transported in a vehicle (refer to wheelchair manufacturers guidelines on transporting the wheelchair and occupant).

Trays are not supplied in the following instances:

• To carry a communication aid supplied by the communication aid service.
• To carry food or drinks
• Where school tables are neither accessible nor suitable. It is the responsibility of the school to provide suitable working surfaces to meet education needs within the school environment. These needs should be detailed in the child’s statement, formulated, agreed and reviewed within the school.

If a tray is privately purchased and fitted, then its use is the responsibility of the clients or their advocate.