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

I would like to thank the Posture and Mobility Group for allowing me to attend the PMG Conference 2025 with the bursary opportunity. As a new therapist in this field, I have gained invaluable experience and knowledge from professionals presenting over the three days. I found all themes and discussions thought-provoking, helping me to reflect on my practice. Even though I have only recently started working for a wheelchair service, my years of experience in healthcare have made me aware of the crucial role of service quality improvement. The presentation from the South Wales Posture and Mobility Service, which won the Best Free Paper at the end of the conference, was a great example of how we can improve efficiency in a time when the NHS faces constant time constraints and budget concerns.

Amie and Rhian explained their concept on how issuing a manual Tilt-In-Space wheelchair on first contact to service users can benefit both service users and providers at the same time. Following a long period of a streamlined screening process and data collection, the service identified that a certain group of users had similar needs, which could be anticipated with a stock of highly supportive and adaptable chairs. They established the "Grab and Go" scheme, storing these specific chairs in 2-3 most frequently needed sizes, and could take them to first assessments with the potential of allocating and fitting the chair on site. After the implementation in April 2024, they evaluated the scheme’s efficiency in January 2025, resulting in a significant estimated time (151 hours) and financial savings (approx. £597). While mainly the travel time and fuel costs were considered for the outcome measures, the less measurable reductions in visits and waiting times were also mentioned as potential benefits of this scheme, with 69% of assessed users in this period having their episode of care completed without a need for follow-up. The implications of this scheme for their particular wheelchair service were evident due to the extensive coverage area of South Wales, where a home visit could take place up to 3 hours away from the clinic or stock location. However, reflecting on the method and process of this successful implementation made me consider what other factors contributed to the trial's success, which could be transferred to the quality improvement of other wheelchair services, regardless of size or geographical location.

The service could only identify a specific group with similar wheelchair needs after an extensive data collection period, during which they recognised the patterns such as age, conditions, or mobility needs. While larger services with a diverse population of service users may take longer to recognise these connections, especially if referrals are spread over time, it is also notable that more data is available to underpin implementations. It needs to be acknowledged that in smaller services, there might be a scarcity of similarity between service users during a shorter timeframe, or they already specialise in an area of posture and mobility support. Nonetheless, to gain the practical details that can provide more recurrent patterns, the referral form and screening process need to be appropriately informative.

While building a stock from one type of highly adaptive wheelchair can be a good solution for saving time and money compared to waiting for new orders, it can potentially lead to a more generalised thinking or over-prescription. However, I think awareness of these risks can reduce the chance of compromising the prescription for the individual. Wheelchair users have the right to receive equipment that meets their clinical needs to enable functional participation to the best of their abilities. [1] It also needs to be acknowledged that posture and mobility services have not been able to meet the 92% goal within the 18-week time frame based on the last quarterly data between April and June in 2025. [2] While multiple hindering factors could have contributed to the statistics, which are not detailed in the report, it should be considered in decision-making how schemes like the “Grab and Go” stock could assist services with getting equipment sooner to the clients. The suitable chair would ideally be versatile and easily adjustable to meet various needs and manageable by multiple professionals in the multidisciplinary team. In some cases, there is a high risk of deterioration, which further challenges the balance between time and equipment choice.

While I am aware of the essential technical requirements, such as storage and accessible vehicles for this scheme, I acknowledge that these issues are more difficult to resolve and require organisational changes that might not be in the scope of the wheelchair services. On the other hand, the previously described factors could not only help the services acquire usable information for service efficiency and quality, but also provide a foundation for discussions regarding potential investments in improvement.

Altogether, this session allowed me to consider reviewing the referral and screening process of our service. The presentation also opened my eyes to the opportunity to find structured ways in a highly individualised care setting, without compromising on the solution for service users. Therefore, I would like to thank the presenters for bringing their hard work to light with this impressive scheme and congratulate them again on winning the Best Free Paper of the Conference.

[1] National Wheelchair Data Collection Classification: Official National Wheelchair Data Collection Quarter 1, 2025-26 Statistical Briefing (no date). Available at: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2025/08/National-Wheelchair-Data-Collection-Statistical-Briefing-April-June-2025.pdf (Accessed: 5 October 2025).

[2] England, N. (2025) NHS England» Wheelchair quality framework, England.nhs.uk. Available at: https://www.england.nhs.uk/long-read/wheelchair-quality-framework/.