The case of the missing wheelchair
Suffer a serious, immobilising injury in England and you almost certainly won't get a wheelchair. Surprised? Read on.
In other words, break your leg and you’re on your own.
Getting a wheelchair
How it works (and why it sometimes doesn’t)
If you come a cropper and need support, your best bet is to either get injured just a little or quite a lot. Confused? Here’s an explanation:
1. If you twist your ankle or get a small mobility injury, hospitals in the UK have to provide you with a ‘minor aid’ – such as crutches or a walking frame.
2. If you have a serious illness or injury that will mean long-term use of a wheelchair, hospitals are similarly obliged to provide the equipment. But…
3. If you need a wheelchair for a ‘short-term’ ailment (officially, anything lasting less than six months), then good luck.
No official body has any responsibility to help.
Why this is a problem
Put simply, there are a lot of good reasons why someone might really need to borrow a wheelchair for less than six months.
> Broken leg or ankle.
> Recovering from an operation.
> Terminal illness.
Every year, thousands of people find themselves in just such a situation, only to discover their local hospital can’t provide a wheelchair.
…but what can you do?
In short, look for help from a charity, such as the British Red Cross.
We’re the biggest national provider of short-term wheelchair loans – and often the only option for people who’d otherwise be facing months stuck on the sofa.
Wheels of history
So how did the Red Cross become the go-to organisation for wheelchairs? Here’s 100 years in four quick steps.
1. During World War One (long before the NHS even existed), the Red Cross started providing short-term loans of wheelchairs – both to injured servicemen and the general population.
2. It was an immediate success. Over the next 20 years, the service grew rapidly.
3. By the time the NHS was established in 1948, we were already the go-to organisation for wheelchair loans. Having plenty of other priorities, the NHS largely left this job to us.
4. Since then, the Red Cross and other voluntary organisations have continued to deal with the overwhelming majority* of people temporarily needing a wheelchair.
(*By 2012, only 24 out of 151 NHS wheelchair services made any provision at all for short-term need – and that was almost always only for terminal illness.)
Fast forward to now…
Today, the Red Cross loans out 83,000 wheelchairs each year in the UK.
Our wheelchairs are loaned free of charge (though 80 per cent of users make a donation).
In 2014, we spent more than £1 million on providing our mobility aids service.
Two reasons why this is a big deal
1. Thousands of people – who might otherwise endure a miserable time – get the help they need.
Having a wheelchair means you’re not stuck in the house. You can get out to the shops, visit friends, make hospital appointments, lead a semi-normal life. And here’s another thing…
2. Red Cross wheelchairs save the government (and taxpayers) a lot of money.
That’s because, when someone is suddenly immobilised, it usually triggers a whole raft of knock-on effects – medical, social and personal – which end up making claims on public money.
The wonder of wheels
Wheelchairs (as opposed to crutches) have what’s called a ‘preventative value’.
In plain English, this means they can stop problems before they even happen – and that’s good news for the public purse.
How we save the government (and you, the taxpayer) money.
The wonder of wheels
Wheelchairs have what is called a ‘preventative value’.
In plain English, this means they can stop problems before they even happen – and that saves public money.
How it works
Imagine two identical twins – Tim and Jim –sustained exactly the same injuries, but then one was given a wheelchair and the other crutches.
Here’s how a lot of research suggests they’d get on, and what they would need from the state
- Longer stay in hospital
- Needs ambulance for hospital visits
- Nurse home visits
- Risk of further injury
- Stuck at home
- Delayed return to work
- Leaves hospital early
- Visit hospital independently
- No home visits
- Safe and secure
- Goes out and socialises
- Early return to work
Life without wheels
So far, we’ve looked at the big picture and the thousands of people affected. But how must it actually feel – as an individual – to be stranded by illness or injury?
Imagine for a moment you’ve badly broken your leg.
You fell. It broke. And that was that.
Now there’s just you and your tibia bone, sitting in three separate, pinned pieces under a bulky plaster.
You’re going to be in the cast for four months.
It’s pretty sore: a constant, low throbbing. You can’t really move.
All you have for support is a pair of crutches, and the bad leg swings painfully when you move on them.
Besides, you’re terrified of falling. The doctor has warned that another knock could mean further surgery.
You’re stuck in the house. The weather’s lovely, but there’s no question of going out. You’re so bored you could scream.
Days yawn on. It’s miserable. The calendar ticks off a succession of things-you-were-looking-forward-to but will now have to miss.
Your loved ones have taken unpaid leave to look after you, so money’s a bit tight.
And there’s a tense atmosphere at home. None of you are used to being cooped up like this, and it shows.
So on top of the pain and discomfort, there’s also a sense of guilt. This is all happening because of you.
You can’t wait for it to be over.
A TALE OF FOUR WHEELCHAIRS
You're about to meet four people who had almost nothing in common – apart from a pressing need for a wheelchair to get through very tough times.
When Ashleigh fell and badly broke her ankle, she had more than just pain to contend with.
After a gruelling operation, the trainee nurse was told she’d face seven weeks in plaster with just a pair of crutches for support.
She immediately knew what that meant: having to postpone and re-sit her final year of nursing qualifications, at a cost of £1,500. Ashleigh was devastated by the news.
But then fate intervened: a neighbour mentioned the Red Cross.
She recalls: “Without the wheelchair, my partner would have needed more time off work to care for me, so we’d have been crippled financially. And with just crutches, I’d have become really depressed.
£469 = extra night and day in hospital
£233 = ambulance call-out following a fall
£129 = attending A&E as an outpatient following a fall
a massive difference to Dad's recovery.
Despite his failing heath, World War Two veteran Ron desperately wanted to join the 70th anniversary Armistice parade in central London.
This would be a final chance for Ron to remember his fallen comrades. And as a member of the Normandy Veterans Association, it was unthinkable that he should miss out.
Then shortly before the event, Ron was hospitalised. For a while it looked like he would miss the big day after all.
But he rallied in time. And Ron’s family believe that knowing he had a guaranteed wheelchair for the event was a big motivating factor in his recovery.
£486 = hospital stay
£685 = hospital day care
£233 = ambulance transport
Holly’s first shock was discovering she needed surgery on both her hips – it meant her legs would have to be elevated and splayed for four months.
The second shock was learning the NHS does not provide wheelchairs for this type of case.
Without a Red Cross wheelchair, six-year-old Holly (who has developmental dysplasia of both hips) faced being stuck at home for weeks on end, and missing a full term at school.
Instead, she went out almost every day. She regularly saw her friends. She even attended school two afternoons a week – where her unusual injury made her a star in class.
The wheelchair also meant Holly didn’t have to use the hospital’s ambulance service to make an X-ray appointment.
£932 = ambulance service
£102 = nurse home visits
£400 = cost of family support worker
‘Prisoners’ across the country
How many people needed a wheelchair last year but had to go without?
Nobody knows. That kind of information simply isn’t out there at the moment.
Certainly, the Red Cross loaned out 83,000 wheelchairs each year. We know that those people, at least, do get help.
But it’s very likely that thousands more – ‘prisoners’ hidden away in their homes – had to struggle on without extra support.
Laura’s experience probably offers a clue to the true picture.
The 20-year-old, who has a chronic knee condition, was recently given a Red Cross wheelchair following an operation. So far, so good.
But her story’s not so straightforward.
On two earlier occasions, before she learned about our service, Laura twice had to endure six agonising months on just a pair of crutches.
During both these periods, she was scared to leave home, completely dependent on her mother, and at constant risk of falling again.
Altogether, that’s a full year of pain and misery. And all because she didn’t know help was out there.
Why is it so hard to get a wheelchair?
Part one: the perfect storm.
1. The Red Cross and other charities have traditionally dealt with most wheelchair loans. But with an ageing population, demand is soaring. We just can’t keep up.
2. At the same time, the NHS in England (which, remember, has no clearly defined duty to help) is facing historically tough cuts – £22 billion from its budget by 2020.
So: increased demand; less money; no obligation to help.
Any one of these factors would make life very difficult. Together, they make a perfect storm of over-reaching need and inadequate supply. And that’s bad news for anyone needing a wheelchair.
Why is it so hard to get a wheelchair?
Part two: confusion reigns
Big bureaucracies bring big headaches, and the NHS is a massive organisation. With so many policies in place, the picture isn’t always clear.
So, for starters, the important distinction between ‘long-term’ need (Yes, have a wheelchair!) or ‘short-term’ need (Sorry, you’re on your own) can be horribly blurred and contentious.
Things are confused even more by a fuzzy distinction that’s made between ‘clinical’ and ‘social’ need. (In short, clinical need is taken seriously by the health service, but social need is seen as much more wishy-washy.)
The NHS consistently links short-term wheelchair loans with social need, which essentially offers a handy get-out clause.
‘Look,’ NHS managers can say. ‘If Edith only needs that wheelchair for a trip to the shops rather than a serious medical condition, how can you expect us to help?’
But such an argument doesn’t stand up to scrutiny. Here’s why:
Three important points
1. Most people using short-term wheelchairs absolutely have a ‘clinical’ need.
The majority of those helped by the Red Cross are recovering from operations, struggling with broken and fractured limbs, or living with long-standing medical conditions.
2. Even when people do primarily have a ‘social’ need, we’d argue that’s still worthwhile.
Getting out and about in a wheelchair does bring tangible benefits – especially since social isolation is proven to have a negative impact on physical health. Besides, no-one deserves to be shut at home alone.
3. People tend not to fit neatly into categories.
Most of the time, those we help have a mix of clinical and social needs. One tends to evolve into the other over time. Even in the most straightforward cases, the line between the two is often very blurred.
Still, there is room for optimism. Just a few months ago, the NHS published this encouraging statement:
And in June 2015, a Department of Health spokesperson added:
The Red Cross – and other voluntary organisations – will be watching very carefully to see if there is substance behind such warm words.
What is the Red Cross doing?
‘Everyone who needs a wheelchair should be entitled
to quickly and easily get one that is right for
them, for as long as they need it.’
This is the British Red Cross’ message about wheelchairs. That’s what we’re fighting for, and we’re unapologetic about it.
In 2015, there’s no good reason why an 80-year-old or vulnerable child should have to be a prisoner in their own home for months at a time. We should be better than that.
The way ahead
We’ve published a report – Putting the wheels in motion – which offers some hard, common sense advice to the government. Here are our main calls:
1. We’re calling on the government to change the NHS Mandate (which enshrines the health service’s core goals) so it includes short-term wheelchair loans.
2. Basically, we’re shouting from the rooftops about our wheelchair service, so more health care professionals will know about how it can help patients.
3. No-one has an idea how many people might need a wheelchair at any one time in England – the research simply hasn’t been done. So we’re asking the government to investigate this.
(Note: There are seven more calls, but they’re a bit more in-depth and technical, and we don’t want to test your reading patience.)