Reflective Article on a free paper presented by Amie James and Rhian Davies. This article was submitted as a condition of the author receiving a bursary place at PMG2025

Introduction

One of the presentations at PMG2025 that particularly resonated with me was delivered by Amie James and Rhian Davies from the South Wales Posture and Mobility Service: “Improving service efficiency and quality – issuing a manual tilt-in-space wheelchair on first contact to service users.”

The talk explored how first-contact provision of manual tilt-in-space (TIS) wheelchairs can reduce delays, improve outcomes, and streamline service delivery. For me, the relevance was immediate. As a rehabilitation engineering professional working at the National Electronic Assistive Technology (NCEAT) service, South Wales, the principle of equipping staff with the right tools at the earliest point of contact has strong parallels with my own work.

This reflection explores what I learned from the session, how it relates to wider conference themes, and what it might mean for future practice—particularly in relation to communication aids and mounting systems.

Key Messages from the Session

The South Wales team’s project centred on two pressing challenges: delays in wheelchair provision and inefficiencies caused by multiple appointments before a suitable chair is issued. Their solution was pragmatic: develop a process whereby appropriate users could receive a manual TIS wheelchair at their first appointment, rather than waiting for a later prescription and fitting.

The presenters emphasised several benefits of this approach:

• Improved service efficiency, with fewer repeat visits.
• Enhanced patient satisfaction, since users left with appropriate equipment immediately.
• Better outcomes, as early provision of TIS supported posture management and pressure care from the outset.

The project also required careful management of risk, ensuring that clinicians were trained to assess suitability quickly and safely, and that standardised stock was available without compromising individualised provision.

Resonance with NCEAT Practice

Listening to this presentation, I was struck by the parallels with our work at NCEAT. In our service, repeat visits are often caused by delays in providing standard communication aids or mounting equipment. Just as the South Wales team sought to avoid sending service users away without a wheelchair, we too often face situations where a patient leaves their first appointment without the communication equipment they need.

The idea of having “first-visit ready” resources—whether TIS wheelchairs, communication aids, or mounting kits—has clear benefits in terms of efficiency and patient experience. Indeed, my team already bring a range of adaptors and mounts “just in case,” but this session challenged me to think more strategically about how we could formalise and expand that practice.

Wider Lessons from PMG2025

This session also connected to wider themes from the conference.

• Teamwork in Complex Cases: The presentation “Team work actually does make the dream work! Providing powered mobility for double upper limb amputation” highlighted the importance of multidisciplinary creativity. Similarly, first-contact provision of TIS chairs only works if therapists, engineers, and suppliers collaborate effectively.
• Context-Sensitive Innovation: The talk on postural management in Mexico emphasised how solutions must fit local context. In Wales, geographical spread and varied health board systems present unique challenges. Having equipment ready at first contact could be a particularly effective way to reduce travel and duplication of appointments across the country.
• Efficiency and Safety: Both the TIS session and the draft wheelchair stability guidelines reminded me that efficiency must never compromise safety. The South Wales approach balanced speed of provision with robust assessment, an ethos that is equally critical for us when prescribing mounted communication aids.

Application to My Practice

Reflecting on this session, I see two main areas for potential application:

1. First-Contact Communication Aid Provision
   Just as a TIS wheelchair can be provided on first contact, I believe that standard communication aids (such as widely used AAC devices) could be held in stock for immediate trial or temporary provision. This would reduce delays for patients and allow us to begin customisation and mounting sooner.
2. Field-Based Mounting Assessment
   Building on both this session and the draft stability guidelines, there is scope to explore whether portable assessment tools (e.g. weighing devices) could help us determine wheelchair stability in the field when mounts are added. This would allow us to make safer decisions earlier, rather than deferring until a laboratory test can be arranged.

Both areas align with the principle championed by the South Wales team: equip clinicians to deliver safe, effective solutions at the first possible opportunity.

Challenges and Considerations

The presentation also prompted me to reflect on potential challenges in adapting this model to NCEAT:

• Resource Management: Holding equipment in stock requires funding, storage, and processes to ensure availability and traceability.
• Training and Competence: Just as clinicians needed training to issue TIS chairs safely, staff must be supported to feel confident in first-contact provision of communication aids and mounts.
• Collaboration Across Health Boards: As an all-Wales service, we face the additional difficulty of fragmented patient management systems. To succeed, first-contact provision would require robust cross-board communication and record keeping.

Despite these challenges, the benefits in terms of efficiency and patient-centred care make this a valuable goal.

Conclusion

The session on issuing manual tilt-in-space wheelchairs at first contact was both practical and inspiring. It demonstrated that efficiency improvements are possible when services are willing to adapt processes, train staff, and manage resources creatively.

For my own practice at NCEAT, the lessons are clear: prepare standard resources for first-contact provision, explore field-based stability assessments, and embrace a culture of teamwork and pragmatism. If adopted, these approaches could significantly improve service efficiency and quality, while maintaining the safety and individualised care that remain at the heart of what we do.

References and Resources

• PMG Conference 2025 Programme: PMG Website – Conference
• Draft Best Practice Guidelines – Wheelchair Stability Evaluation (PMG, 2023 draft)
• PMG Standards and Resources: PMG Standards