I have been a qualified occupational therapist since 2002 working within the NHS. I recently joined the Northamptonshire Wheelchair Service as clinical lead for Millbrook Healthcare. Attending the PMG Conference 2018 enabled me to develop my knowledge, with a view to implementing my learning within the wheelchair service.
Caroline Desjardins, clinical lead for wheelchairs and specialist seating at Blatchford Clinical Services in Leicester, talked about her research and implementation of One Child One Chair. This pilot was a service development project carried out over an 18-month pathway. The service development focused on children with complex physical disabilities who have mobile and static seating at home or school. The children selected for the One Child One Chair (OCOC) project were identified as functioning at Level 4 and 5 on the Gross Motor Function Classification System (GMFCS) for Cerebral Palsy (CP).
Caroline (photo above) advised that often these children can have up to five seating solutions, financed by a mix of funding from wheelchair services, community equipment and private purchases or charities, and the seating solutions do not always meet the child’s clinical and postural needs. It was agreed that the Leicestershire Partnership Trust paediatric children's physiotherapy team, wheelchair service and Blatchford’s specialist seating team would work together to jointly fund one chair that would aim to meet all of the child’s postural and seating needs. The project was approved and supported by the commissioner whose involvement was highlighted as a major contributor to its success.
Caroline advised that the pilot included 10 young people from 3-18 years old; from there, over the 18 month period, it was extended to 76 children who were referred through the OCOC pathway. Of the 76 -
- 57 completed
- 8 completed after study period
- 11 not appropriate for the pathway
All the children who met the inclusion criteria completed a postural management assessment, including evaluation of sitting, lying and joint range of movement. Inclusion criteria also required children to have a 24-hour postural management programme in place. It was necessary to establish that clients did not have commercial static or mobile seating which met their clinical needs and therefore new provision was required. Also assessed was the level of need for the client to have an appropriate vehicle or method of travel to accommodate the new seating.
Following selection, clients were assessed with the support of specialist seating manufacturers, and a customised seat was identified that could meet the child’s postural needs. These customised seats were fitted onto mobility bases. All parties involved in the child’s care worked closely to agree on the customised seating, which was then jointly funded as part of the One Child One Chair project. Once the equipment was issued, outcome measures were used to identify the effectiveness of One Child One Chair. The outcome measures included asking family and clinician to score the child on comfort and posture in existing and customised seating at handover. A telephone interview with the family was conducted one month after the equipment was issued to ensure the chair remained suitable for comfort, posture, activities of daily living, manual handling and support when used in different environments. A questionnaire was also completed with school/educational establishments.
The project identified a gap in the provision of static seating for children with complex postural needs. The financial cost was significantly reduced through the jointly funded pilot. The previous cost of equipment was £380,280.25 and the cost saving was identified as £181,041.08 (47.6%). Moreover, the findings reported significant improvements in posture and comfort. Families and education gave positive feedback; for example, the reduction of accompanying equipment with the customised seating meant there was more space within the home and in educational settings. Families and carers also highlighted reduced manual handling due to fewer transfers from one seating solution to another.
Caroline did highlight that there were some challenges during the pilot scheme; however, the overall One Child One Chair project was very positive. The pilot led to improved partnerships among the key stakeholders and the increased involvement of the wheelchair service proved to be of significant value to the scheme. It was certainly accepted that the outcomes collated had changed the approach to best practices for specialist seating provision. The success of the One Child One Chair service development has led to additional funding being granted for adults with complex postural needs.
As it resulted in a reduction in financial cost to the NHS, I have discussed the pilot with the Northamptonshire Wheelchair Service clinical team, and we have continued to develop our collaboration with the paediatric team who work with children both at home and within the educational setting. The universal benefits shown by the One Child One Chair project stand as a source of motivation for the staff at the children’s occupational therapy service and Northamptonshire Wheelchair Service.
I found attending the PMG Conference 2018 to be a highly educational experience and an excellent networking opportunity. I would like to thank PMG for providing me with a bursary to attend and look forward to implementing all the knowledge gained within the Northamptonshire Wheelchair Service and in further service development.