Reflective Article on a parallel session presented by Holly Pulham on Wheelchair Skills for Clinicians. This article was submitted as a condition of the author receiving a bursary place at PMG2025.

I would like to thank PMG for the opportunity to attend the 2025 conference with the bursary. As someone who is relatively new to the world of postural assessment and wheelchairs, I found the talks informative and thought provoking. Attending has encouraged me to reflect on my own practice as an NHS wheelchair service clinician.

The presentation on wheelchair skills in NHS services brought to light an often overlooked yet crucial component of client care—how we equip wheelchair users with the skills necessary to maximise their independence and quality of life. At the heart of the presentation was a simple yet important question: “Do you show your clients how to use their wheelchair when you issue it?” As service providers, we sometimes assume or hope that once a wheelchair is issued, the client will develop skills intuitively and with practice. However, the skills required for real world functionality go far beyond basic propulsion and negotiating doorways. Skills such as carrying drinks, negotiating curbs, and navigating uneven terrain are vital and directly impact a user’s independence, safety, and confidence.

Reflecting on my own practice, I realise that while I might demonstrate some basic manoeuvres when issuing a wheelchair, formal training or systematic teaching of these essential skills is often not addressed or inconsistent. This gap is partly due to a lack of formal training among clinicians themselves, as well as time constraints and the pressure of large waiting lists. The presentation highlighted that many professionals have not received dedicated wheelchair skills training and therefore may lack confidence in teaching these skills effectively, or even awareness of the skills required for someone to live as independently as they can from a wheelchair. This creates a cycle where training is not prioritised, perpetuating gaps in client support and reduces quality of services.

Often, assessments focus heavily on physical needs, comfort, and suitability of the device itself, with an inadequate focus on the user’s ability to perform functional skills with the wheelchair. This oversight can lead to prescribing wheelchairs that, while technically appropriate, may not always be the best match for the user’s environment or lifestyle. On reflection, it is obvious that wheelchair skills should be a core component of the assessment process. Understanding a client’s baseline skills, their goals, and the challenges they face can inform better prescription decisions and interventions. Integrating wheelchair skills assessment also aligns with a more holistic, person-centred approach to care.

The presenter Holly, described wheelchair skills in NHS services as an “open secret.” It reflects a shared understanding among professionals that wheelchair skills training is essential, yet due to constraints like time, resources, and lack of training, it remains largely unaddressed. The reality is that NHS services are already over stretched with heavy caseloads and limited time for in-depth service user training. This systemic challenge means that many wheelchair users are left to learn through trial and error or informal support, potentially increasing their risk of injury and reducing their independence and confidence. I applaud Holly’s honesty and open approach in acknowledging and highlighting this issue in a none- judgmental way. The presentation genuinely encouraged reflection and open discussion around this issue, encouraging professionals to acknowledge and confront this gap rather than accept it as inevitable or failing to acknowledge this is a fundamental issue.

The World Health Organisation (WHO) provides guidelines that emphasise wheelchair skills as a fundamental part of service provision. Yet, the presentation highlighted a disconnect between these guidelines and everyday practice in NHS settings. Meeting even the minimum WHO standards requires firstly acknowledging the issue before addressing barriers such as insufficient training, limited time for client education, and lack of accessible resources.

Reflecting on this, it’s clear that teaching wheelchair skills to clinicians is an essential component of high-quality service delivery and should be prioritised to bring NHS practice in line with WHO standards. This could involve developing dedicated wheelchair skills training modules, integrating skills assessment into routine practice, and developing partnerships with external training providers and charities, to expand client and clinician options. More importantly, collaboration with wheelchair users, their families and carers should be central in developing appropriate services/training that is relevant and truly client centred, identifying and addressing the real-world difficulties people face day to day.

The presentation highlighted an obvious and essential aspect of wheelchair assessment and provision. However, is unfortunately often neglected and overlooked for various reasons.  It has made me reassess how I approach wheelchair provision and client education. It has examined the need for teaching essential wheelchair skills, rather than assuming and hoping clients will learn independently. I recognise that taking steps such as prioritising teaching of wheelchair skills during assessments can make a difference and can maximise a person’s independence, confidence and engagement in meaningful activities. It will also drive a higher standard care delivered to service users.

It has prompted me to acknowledge gaps in my own knowledge and skills and review formal training opportunities available to build my own competence and ability to incorporate more teaching into my assessments. By enhancing my confidence and knowledge, I can better support clients to navigate their environments safely and independently.

Finally, I am reminded of the value of advocacy and discussion. Highlighting these issues within my team and professional networks can contribute to broader changes in how wheelchair skills training is valued and resourced within NHS service. By embracing better teaching of wheelchair skills as an essential component of assessment, prescription, and client education, healthcare providers can significantly enhance the independence, safety, and quality of life for wheelchair users, which should be at the heart of what we aim to achieve always, as clinicians.