Assessing the economic conditions of wheelchair provision in England

Assessing the economic conditions of wheelchair provision in England

Motability and The Wheelchair Alliance commissioned Frontier Economics to review the economic conditions in the provision of wheelchairs and how these conditions impact end-users.

Our work provides an evidence-based articulation of current issues and quantifies variation in geographic service provision.

Wheelchairs profoundly impact the quality of life of thousands of disabled adults, children, families and carers. Wheelchairs and associated seating are fundamental to safely facilitating independent living and social inclusion, and access to education and work. 

Current provision 

A user has four different options for receiving wheelchair equipment: direct NHS provision, NHS provision through personal wheelchair budgets, charity funding, and private purchase.

Figure 1

In 2018-19, we estimate that there were between 688,000 and 860,000 users in England, with a central estimate of around 780,000 users. The estimated range is very large to reflect the uncertainty due to the lack of robust evidence to back our assumptions. 

Inconsistent user experience  

Our report finds clear concerns among stakeholders over service quality, equity and user fairness. In terms of service quality, we found evidence of significant delays in receiving timely intervention and wheelchair equipment. Our quantitative analysis found significant variation across CCGs in meeting the 18 week waiting times standard. Some services achieved this target in the third quarter of 2021-22 for all their new and re-referred high need users, while others met those timescales for less than 25% of their high need users. We found examples of where users are left without adequate equipment, leading to self-funding of permanent or temporary equipment. We also found examples of users being unaware of how and where to access services. Further, users are unsure of where to report feedback and wider concerns with wheelchair provision. Together, these impacts can have significant implications for users of wheelchairs and their carers, leading to a reduction in independence and reduced quality of life. 

In our report, we summarised specific issues and their underlying economic drivers including: 

  • Economies of scale: Economies of scale are generally limited in NHS wheelchair provision due to each local area developing their own unique wheelchair service independently from one another.  
  • Asymmetric information: The fragmentation of services across CCGs has led to limited transparency about costs paid for equipment and other aspects of wheelchair services across CCGs.  
  • Market power: Stakeholders suggest that the manufacturing of wheelchairs is dominated by a small number of firms, with some smaller manufacturers providing more niche specialised equipment.  
  • Innovation: We found mixed evidence on the extent that innovation occurs in wheelchair provision and the extent that innovation ultimately results in improvements to the experiences of wheelchair users.  
  • Incentives: Stakeholders identified a number of critical gaps in services received by users. These gaps, alongside questions of service quality and waiting times, have incentivised users to self-fund permanent or temporary equipment.  

How to address the challenges in wheelchair provision  

We have drawn together all the evidence gathered, to highlight interventions and recommendations that could be adopted in order to address the challenges in wheelchair provision. Our research finds that there are clear opportunities for beneficial change and empowerment of users. These include: 

  • Additional support for NHS Wheelchair services: NHSE&I played a more active role in ensuring that all CCGs prioritise wheelchair services and dedicate sufficient resources to them, the outcomes for some wheelchair users may be improved.  
  • Regulation: All NHS services (both those provided by NHS organisations and those tendered out) need to be subject to a consistent and appropriate level of regulation. 
  • Role of charities and social enterprises: Charities have a crucial role to play in enabling individuals to access appropriate equipment and supporting users more generally. Currently, the charity market is somewhat fragmented, and multiple charities have remits that are partially overlapping.  
  • Data and information: We recommend that further work be undertaken to estimate the scale of demand for wheelchair services, and their provision. This will help inform the configuration of services and identify individuals who are currently not receiving adequate support.  

To find out more about the research you can download the full report from the Wheelchair Alliance website here. 

For further information please contact or call +44 (0) 20 7031 7000.