Wheelchair and Community Equipment Strategy
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Lord Hunt of Kings Heath
To ask His Majesty’s Government what plans they have to publish a strategy for ensuring high-quality and equitable wheelchair and community equipment provision by NHS and social care services.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to all noble Lords who are taking part in the debate. I particularly welcome the noble Baroness, Lady Gerada, who is making her maiden speech. She has been an absolutely brilliant president and chair of the Royal College of GPs, but more than that, she has been an excellent GP and brilliant champion of primary care and the NHS. It is a pleasure to welcome her to this debate. I should inform the House of my patronage of the Wheelchair Alliance and the Health Care Supply Association, and my daughter Phillipa works for Back Up, which supports people with spinal injury.
The provision of wheelchairs and community equipment for disabled people is, to put it bluntly, a disgrace. The nub of the problem was described in the Guardian on 2 December by the distinguished academic Dr Paul Sagar. He was paralysed in a climbing accident and described how inconsiderate, illogical and incompetent many of the current wheelchair providers are. He talked about the bureaucratic barriers, organisational inflexibilities and patchiness of the services he encountered. Particularly telling for me were the words he quoted of a physiotherapist who has been working with people with spinal cord injuries for more than 20 years. He said:
“Many of her clients are discharged from hospital in heavy manual wheelchairs that an able-bodied person would struggle to push. Frequently, they are the wrong type or size, and are at the very least uncomfortable. ‘Often,’ she said, ‘people who have impaired function in their upper limbs cannot push these wheelchairs themselves, and become effectively housebound, in some cases confined to their bed. Sometimes, they develop complications from poorly prescribed wheelchairs, and it lands them back in hospital’. On average, she adds, people have to wait at least 10 months between being discharged and being assessed, let alone getting the wheelchair that is right for them”.
Unbelievably, some local wheelchair services refuse to assess a patient until they have left hospital. So much for integrated care, which I thought integrated care boards were established to achieve.
Dr Sagar’s experience is not unusual, of course. The Wheelchair Alliance has produced convincing evidence to show how inconsistent and under-resourced wheelchair services are. Over 50% of providers come from the private sector and there are real worries regarding the financial frailty of many of them, with a system that prioritises lowest initial cost over long-term value and reliability. There are no consistent national standards, no independent regulation and few clear paths for users seeking repairs, reporting faults or making complaints. As a result, many disabled people experience long waiting times, delays in hospital discharge, loss of independence, social isolation and, tragically, avoidable deterioration in health and well-being.
It is the same dismal picture with community equipment, embracing hoists, grab rails, harnesses, medical beds and a wide range of essential medical products. The All-Party Group for Access to Disability Equipment recently reported on the systemic crisis in this sector, saying that 63% of carers and 55% of equipment users feel that services are getting worse, not better. The all-party group concluded that the system is inconsistent, under-invested, fragmented and lacking leadership.
The Government state that at present, local authorities and integrated care boards share responsibility for community equipment. In practice, this means fragmented and inconsistent delivery. Equipment providers describe a landscape in which “every authority works differently,” without alignment or accountability. The consequence is a postcode lottery, with 74% of equipment providers being aware of patients experiencing delayed hospital discharge due to unavailable community equipment. I would argue—and I am looking forward to the speech of the noble Baroness, Lady Brinton, on this—that community equipment is the silent crisis at the root of the challenges we face in providing community and social care. The tragedy is that it would be so easy to sort this out if there were a will to do it.
In April, the Government published the Wheelchair Quality Framework to assist integrated care boards and wheelchair service providers to deliver high-quality provision. I have read it and it is welcome, but the problem is that, first, it is guidance. It lacks binding universal standards, does not guarantee equitable provision across the whole country and does not address systemic underinvestment. It does not mandate robust data reporting. It lacks external oversight or performance management, so there is no statutory, legally guaranteed entitlement ensuring that every person in need receives the right wheelchair or community equipment in a timely fashion.
What is required? I am absolutely convinced that we need a national strategy, underpinned by the appointment of a national clinical director accountable to Ministers and backed up by strong performance management. The remit of the director should embrace community equipment as well as wheelchairs. This needs to be underpinned by a vision—a national, comprehensive vision of what high-quality wheelchair and community equipment provision should look like. The Government should embrace the report by the All-Party Group for Access to Disability Equipment by introducing a dedicated national strategy for community equipment and wheelchair provision. Users must be around the top table with a real input into policy.
We need a nationally defined eligibility and quality standard for wheelchairs and community equipment that is uniform across all regions and removes the current postcode lottery; a legally guaranteed entitlement to appropriate equipment for all those assessed as needing it; a long-term funding model that accounts for the rising costs of equipment, manufacturing, maintenance, energy, staff and supply chain resilience; and a simple, user-friendly service for wheelchair users and carers to report issues, request repairs, make complaints, give feedback and be heard. We need to shift from lowest-cost procurement to value-based procurement. This is happening in general in procurement and ought to be extended to wheelchairs and community equipment. For community equipment, we need national training standards for clinicians, commissioners, OTs and other professionals and suppliers involved in equipment provision.
I do not think anyone in this debate will argue that wheelchair and community equipment is absolutely woeful. The tragedy, as I have said before, is that it would be so easily sorted if the Government were prepared to say that they will do what I have suggested and have national leadership. So many of the issues and blockages in community care would be dealt with if this were really taken seriously. We all know what happens: neither the NHS nor local authorities regard it as at all serious, and many people suffer as a result.
Lord Shinkwin (Con)
My Lords, it is a great pleasure to follow the noble Lord, Lord Hunt of Kings Heath. I thank him, first, for securing this important debate; secondly, for his work on improving health outcomes, which he has been involved in for probably far longer than he cares to remember; and, thirdly, for choosing to champion wheelchair services, of which I should declare an interest as a user.
I trust his noble friend the Minister will bear in mind the noble Lord’s tenacity in her response, which we look forward to hearing, as we do the maiden speech of the noble Baroness, Lady Gerada. None of us will ever forget the trepidation with which we each faced the prospect of addressing your Lordships’ House for the first time. There may be issues which divide us, but the nerve-wracking experience of making our maiden speech, seared into each Member’s memory, surely unites us. I have no doubt that we will all be rooting for her.
I referred to the noble Lord’s tenacity. It is much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money—money it cannot afford to waste. So, in the little time I have, may I put three questions to the Minister?
The Minister will no doubt be familiar with the finding of the APPG for Access to Disability Equipment’s report that the community and medical equipment system is “in crisis” and with the Wheelchair Alliance’s recent report Wheelchair Provision: How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision, as the noble Lord, Lord Hunt, mentioned. These include delays in hospital discharge, loss of independence, social isolation, with the inevitable impact on mental health, and, of course, avoidable deterioration in health and well-being—a point that the noble Lord made in his excellent speech. Would the Minister agree with me that “avoidable” is the key word here? Would she further agree that, if it is avoidable, then we are cutting our nose to spite our face if we allow ICBs to misrepresent as a saving what is actually in the strategic big picture a completely false economy, which is costing the NHS and indeed the taxpayer far too much money?
My third and last question is this. The second of three reports by Frontier Economics, The Value of a Wheelchair, estimated the potential value—I would say saving—that high-quality wheelchair provision could provide to wheelchair users and, crucially, society. Will the Minister undertake to put that thinking at the heart of any strategy? The current situation is untenable because it does not make economic sense. That is why the noble Lord’s call for a strategy deserves to be heard and acted upon urgently.
Lord Rennard (LD)
My Lords, I declare my interest as the conference chair of the National Association of Equipment Providers for the last five years. Before that, for 10 years I was director of communications for the British Healthcare Trades Association, representing manufacturers and suppliers of wheelchairs and assistive technology, upholding industry standards, promoting innovation and supporting purchasers and users through a code of practice.
My personal interest in this began as a teenager pushing my mother in a second-hand wheelchair bought through an advert in the Liverpool Echo. There was no assessment, training or support in the 1970s. Much has improved in the 50 years since, yet the Wheelchair Alliance report in December 2023 showed that wheelchair provision varied widely. It said:
“Wheelchair users … in some areas receive an excellent service whereas users in other areas may experience significant delays, inappropriately tailored equipment, a lack of training and/or slow response to breakdowns”.
The report also showed how high-quality provision can improve lives and deliver financial benefits. Wheelchairs are not just medical devices; they are gateways to independence, inclusion, work, education and activity.
Poor provision restricts life chances, limits employment and can harm the health of carers. Pressures in wheelchair services are mirrored across community equipment—from hoists and specialist beds to bathing aids and home adaptations. The problems are systemic, not just localised. The APPG for Access to Disability Equipment found that delays are driven by staff shortages, particularly of occupational therapists; supply chain and recycling constraints; and wide inconsistencies between local authorities. At the root of this crisis are weak oversight and blurred accountability between local authorities and integrated care boards, driving wide regional variation. Provision is fragmented and inconsistent, so I also hope that the Government will now drive forward a national strategy with clear structures for provision.
I agree with the Wheelchair Alliance that all integrated care boards must adopt the quality framework for wheelchair provision and the model service specification when commissioning services. I also support the call by the APPG for Access to Disability Equipment for a dedicated national strategy for community equipment, alongside a dedicated DHSC Minister to oversee delivery. This would ensure that needs are appropriately and fairly met everywhere. I welcome the Government’s wheelchair quality framework, but it does not go nearly far enough. I also welcome increased use of personalised budgets, but providers and users really need to understand these budgets to ensure real choice and best provision, giving users more control over their daily lives.
Fundamentally, what we need to address is balancing the costs of the provision of wheelchairs and community equipment with long-term benefits, including preventing accidents, reducing the need for healthcare intervention in future and enabling people with disabilities to work, pay taxes and reduce their dependency on benefits, while at the same time significantly increasing emotional well-being for many families.
Lord Harries of Pentregarth (CB)
My Lords, I thank the noble Lord, Lord Hunt, for introducing this debate, which is of great importance. I am the main carer for my wife, who is severely disabled, and I have calculated that we probably need at least nine pieces of equipment to lead any kind of reasonable life. She has a hospital bed to stop her having sores, a hoist to get her out of bed, a commode wheelchair to wheel her to the stairlift, a turner to get her on to the stairlift to take her downstairs, another turner to get her onto the commode lift and a commode lift to take her into the bathroom, in addition to a lifting armchair. In addition, there are special adaptations in the bathroom, with rails and so on, and there are both powered and hand wheelchairs, because we can get into the GP only with a small hand wheelchair. There are at least three ramps to get her out of the house.
We are very fortunate; this is a good story. We have what we want to lead a decent life. It is partly provided and partly purchased by us. However, it brings to my mind the total nightmare of those who do not have that equipment, or if equipment breaks down and they are not able to get emergency help to mend it. As we have heard from the noble Lord, Lord Hunt, and others, there is widespread dissatisfaction among those who need equipment because of frustrations, delays and bureaucracy, and I will not repeat those figures. I was particularly moved, as others were, by the story of Rhys Porter, who has cerebral palsy and was without essential equipment, including a hoist and home adaptations, for two years. Apparently, during this time, his parents had to help him use a commode seat in his bedroom and drag him into the family bathroom on a towel once a week, putting them all at risk of injury. When he needed surgery, there was no immediate help to have a hoist to get him out of bed. Such equipment, for Rhys and countless others, is critical, not only to support day-to-day activities but to ensure that essential medical treatment can take place, avoiding further complications.
Such delays are not just occasional. The crisis impacting community equipment, causing months—sometimes years—of delay for assessment and medical kit, is systemic rather than down to individual actors. The main reason, as we have already heard but it is worth repeating, is that there is a lack of national oversight. Statutory responsibilities are left to local authorities and ICBs, which creates inconsistent and patchy provision, and confusion over who ultimately is responsible for this essential service. Moreover, the situation is likely to get worse; with an ageing population and the rise of chronic health conditions, the demand for mobility aids of various kinds is going to increase. It is vital that the Government act now before the situation deteriorates even further.
In the light of the APPG for Access to Disability Equipment’s finding that there is no national strategy, no coherent commissioning framework and no single accountable Minister for community equipment, will the Government now commit to developing a national strategy for both community equipment and wheelchair services, overseen by a named Minister with clear responsibility for delivery?
Baroness Gerada (CB) (Maiden Speech)
My Lords, I rise for the first time with gratitude, humility and, if I am honest, a certain amount of surprise, until I remember how hard it is to see a GP these days—and having me in the House at least solves that problem. It is a great honour to stand here, particularly in such a significant debate that concerns dignity, fairness and independence. I thank the noble Baroness, Lady Kennedy of The Shaws, and the noble Lord, Lord Patel of Bradford, who so kindly introduced me. I also thank the staff of this House for their warm welcome, their patience with my many questions and their kindness.
Here is a little bit about me. I have Maltese heritage and was born in Nigeria, where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service. My father became a general practitioner in the NHS. His surgery was the front room of our home and patients have therefore been part of my life from a very early age. As a young girl, Dad would take me on home visits in communities still bearing the scars of the Second World War. Through him, I learned what general practice truly involves: not only medicine but community, continuity and compassion, and that the measure of a doctor lies not only in what they know but in how he or she cares.
I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy. In 1990, after completing my training in psychiatry, I became a GP in Kennington, and I have lived and worked in the community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit; the next day, it was returned to the surgery with a note reading, “Sorry, doc. It won’t happen again”. Of course, it can never happen when I visit this House, as my little Brompton has two armed policemen guarding it every day—thank you, officers.
My patients have included the great, the good and, given that I work in the Division Bell zone, occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change. We observe how illness is linked to housing, poverty, work and the myriad pressures of everyday life. This is not the soft end of medicine; it is its foundation: the undramatic, continuous care that underpins the entire National Health Service. GPs carry out more than 300 million patient consultations every year—80% of all NHS contacts—for less than 10% of its budget. Most of our encounters end without referral, admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed and saves money, and it is where the story of our NHS begins anew every day.
It is a privilege to be among the very few GPs admitted to this noble House, and now that I have completed my maiden speech, my first surgery is tomorrow—10 minutes only and only one problem allowed. Thank you very much.
Baroness Lane-Fox of Soho (CB)
My Lords, it is great honour to listen to the noble Baroness, Lady Gerada, and to have enjoyed a small sample of the immense knowledge that she will bring to this House. It is, however, somewhat ironic that I am asked to talk about her in a time-limited debate when it is clear it is possible to fill a whole hour with her public achievements and contributions to public life.
As we heard, the noble Baroness qualified as a doctor in 1983 and trained in psychiatry in the Maudsley and Bethlem and then as a GP in south London. Her career has consistently sat at the intersection of general practice and mental health, including addiction, gambling harm and, critically, the well-being of the healthcare workforce itself.
From 2008 to 2022, the noble Baroness founded and led the NHS Practitioner Health Service. It is now the largest confidential mental health and addiction service for health professionals in the world, supporting nearly 50,000 clinicians across England and Scotland. From 2019 to 2025, she co-chaired the NHS Assembly, helping to bridge policy and patient experience at a national level. Ever the entrepreneur, she co-developed eConsult, now used by around a third of GP practices. She continues to lead the Primary Care Gambling Service and serves as patron of Doctors in Distress. As if all this was not enough, she has been chair and president of the Royal College of General Practitioners, only the second woman to hold both roles.
Before I end, I must mention perhaps the noble Baroness’s most remarkable career high: her stint as a stand-up comedienne in the show that she co-wrote, “Fifty Minutes to Save the NHS”. This should have been a clue to how effective she would be in a time-limited debate on an important subject. The noble Baroness, Lady Gerada, brings not only deep knowledge but wit to this House. I have no doubt that she will make an important and exceptional contribution.
We often file wheelchair and community equipment services under “health” or “social care”. In reality, they ought to be part of our national employment infrastructure. When those services fail, people lose not just mobility but their ability to contribute. The numbers tell the story starkly. Only around 53% of working-age disabled people in the UK are in employment, compared with 82% of non-disabled people. It is even wider for young disabled people, as a recent House of Lords report on the transition to work made clear. Some 1.2 million people rely on a wheelchair and many more rely on other equipment. When these systems fail, we are not talking about just inconvenience but large parts of the labour market losing the tools that make work possible.
For many disabled people, daily life and work depend on reliable access to the right equipment—wheelchairs, seating, mobility aids, home adaptations, assistive tech. When systems slip, when assessments take months and repairs take weeks, the consequences are immediate. Parliamentary inquiries have described these failures as “systemic”, as we have heard. Charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply has not arrived. Services designed to enable independence become gatekeepers to one’s ability to work.
This has an economic cost that we rarely acknowledge. If someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They are less likely to earn, pay tax or progress in their career. They are more likely to draw on welfare and to need avoidable support. Independent assessments show that timely wheelchair provision produces substantial net fiscal benefits over a lifetime. This is not charity. It is investment in people, productivity and public finances.
What can we do? The private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work or access equipment and the responsiveness of service providers and the basic accessibility of buildings and bathrooms.
Employers can change that. They can partner with local social care services and use procurement to demand guaranteed repair times, loan equipment or minimum quality standards. They can appoint a senior sponsor for end-to-end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data to track how many dates slip because equipment is not in place, how many job offers fall away and how many days of work are lost to broken or missing equipment. They can work with unions and disabled staff networks to design no-detriment policies when external equipment failures prevent people from working.
Government and commissioners must stop treating equipment services as a marginal welfare line. They are essential economic infrastructure. Outcomes should be judged not just clinically but in terms of employment, education and participation. Services should publish transparent data on waiting times for assessment, delivery and repair, broken down by age, region and employment status. As a minimum we must know how many working-age disabled people are delayed or denied work because of delays to equipment. Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end.
This is the core point. Mobility, accessibility and equipment are not optional extras. For many disabled people, they are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year. However, before my own experience, I learned from another Lane-Fox, who terrorised the halls of this building in her electric wheelchair—my great-aunt, Felicity Lane-Fox. If we are serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy, not have it marooned on the edge of the health system.
Lord Blencathra (Con)
My Lords, I am delighted to be the first Conservative to congratulate the noble Baroness, Lady Gerada, on an excellent maiden speech, as one would expect from such a distinguished doctor. How wise of her to speak today and not step into the maelstrom of assisted dying tomorrow—although there will be plenty more days and opportunities for her to give a view on that as a distinguished former president of the Royal College of General Practitioners. We shall also expect her to singlehandedly save the NHS and solve the serious problems of general practice moving patients into hospital care. We all look forward to hearing from her again.
I also congratulate the noble Lord, Lord Hunt of Kings Heath, on securing this debate and on his excellent contribution. NHS wheelchair provision has been widely criticised for inconsistency, long delays and poor suitability of equipment. Costs are driven up by inefficiencies and the false economy of supplying inadequate wheelchairs. A cost-effective strategy would focus on standardising services, improving assessments and investing in fit-for-purpose equipment to reduce downstream health and social costs.
What are the key criticisms of NHS wheelchair provision? First, it is a postcode lottery, as services vary significantly across regions, leading to inequitable access. Secondly, there are long waiting times. Delays in assessment and delivery leave users without mobility support for months. Third is the poor suitability of equipment. Many wheelchairs provided are heavy, cumbersome or not tailored to users’ daily lives, forcing some to buy their own. Fourthly, there is limited user involvement. Assessments often fail to consider lifestyle needs, reducing independence and social participation. Fifthly, standards are inconsistent. NHS England acknowledges variation in service quality and outcomes. Putting it simply, NHS wheelchairs are dirt cheap and for that you get big, heavy, ugly things which appal young people who may need to use them. The wheels may not detach. Car transport can be difficult, if not impossible.
Noble Lords have seen my sophisticated wheelchair parked around the corner. It is similar to that of the noble Baroness, Lady Brinton. However, these wheelchairs are of a 10 year-old design. They are on a solid steel frame and very heavy, no doubt designed for 40 to 50 stone Americans. A replacement these days would be lightweight aluminium. Lightweight aluminium wheelchairs have been taking over the scene in the last few years. That is what people want and need, but there is a higher cost.
That cost could be contained if there was a national NHS strategy. First, it would standardise provision nationally, implement the NHS wheelchair quality framework across all ICBs to reduce variation, and appoint a senior NHS England lead to oversee wheelchair services. Secondly, it would improve assessments and user involvement, ensuring that assessments consider lifestyle, employment and education needs rather than just the medical factors, and co-design services with wheelchair users to avoid unsuitable provision. Thirdly, it must invest in fit-for-purpose equipment, providing wheelchairs that meet individual needs, reducing downstream costs from poor health outcomes as they get worse in the future with bad wheelchairs, and expand personal health budgets to allow choice and flexibility. Fourthly, it must streamline procurement and maintenance, centralising purchasing to leverage economies of scale and introducing rapid response maintenance contracts to minimise downtime. Fifthly and finally, it must measure outcomes, not just costs, tracking independence, employment and health outcomes as key performance indicators—the value added—and using data to demonstrate long-term savings from better provision.
While upfront costs of better equipment and services may rise, the long-term savings in health, social care and productivity would make this a cost-effective strategy. Standardisation, user-centred assessments and investment in suitable wheelchairs are the most impactful reforms. I beg your Lordships to support this.
Baroness Brinton (LD)
My Lords, I congratulate the noble Lord, Lord Hunt of Kings Heath, on securing this important debate. I too congratulate the noble Baroness, Lady Gerada, on her excellent maiden speech. From these Benches, we look forward to her many future contributions.
I too am a member of the All-Party Group for Access to Disability Equipment, which published a forensically detailed report in October on the systematic barriers that prevent millions of disabled children and adults across the UK from accessing the medical and community equipment, including wheelchairs, that they need to live safely and independently and that are holding back the sector from supplying the equipment that is needed.
The noble Lord, Lord Shinkwin, helpfully set out a wider social picture, because community equipment is the backbone of social care. It is key to removing barriers for disabled people.
Fourteen years ago, I was referred to my local wheelchair services. They told me that, as I could walk slowly with a stick from my sitting room to my kitchen, I did not qualify for an electric chair. But the very reason that my physio had recommended me was that I was doing around 10,000 to 12,000 steps a day in travelling to, from and around your Lordships’ House; the damage that was doing to my already damaged joints was significant. I had to buy my own chair. Even this week, I have heard people say that they face the same inconsistent decisions, based not on actual needs but on rules to keep costs down, because that is what it is all about. That is why the Wheelchair Alliance was right to say that services should be patient focused first.
The APG report found that 63% of carers and 55% of users said that services are getting worse. Over half of equipment users reported that they do not have access to the medical equipment they require for their long-term needs. As the noble Lord, Lord Blencathra, said, there are widespread reports of users being let down by the current system, so it was also good to hear from the noble and right reverend Lord, Lord Harries, that the system has worked for him and his wife. My family’s experience in requiring emergency equipment for end-of-life care was absolutely wonderful, but I note that the Kent end-of-life service bypassed the usual wheelchair and equipment service to get things done. There are lessons to be learned from that.
My noble friend Lord Rennard’s contribution was so important: we need to hear from the equipment sector and to understand its problems too. One key issue in the medical equipment supply sector is that contracting of services from the sector by local authorities is not strategic. As the APG report shows, most local authorities became very dependent on one supplier that was cheaper than all the others. When it went bust earlier this year, the sector, the commissioners in local authorities and, above all, wheelchair and equipment users found that they were left high and dry. I am pleased to report that the sector has come together with local authorities to try to remedy this, but that is a strategic fault.
The Government need a national strategy that is different from a voluntary framework, as the noble Lord, Lord Hunt, outlined, and that serves the needs of disabled people and their families, while offering value for money to commissioners and the public purse. What we have at the moment is the exact opposite. Would the Minister agree to meet with the All-Party Group for Access to Disability Equipment to discuss these issues?
Lord Kamall (Con)
My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for securing this valuable debate. I also thank all noble Lords who have shared their own valuable experiences. I also welcome the noble Baroness, Lady Gerada—I hope I have pronounced that correctly—who, in her maiden speech, shared her valuable background, which we know will contribute hugely to this House.
At its heart, this is a discussion about people’s freedom, dignity and independence. Wheelchairs are, for many, the difference between participating in daily life or being excluded, by enabling people to leave their homes, to see loved ones and to access work and education. However, the reason for today’s debate is that the current system faces serious problems. NHS England’s 2025 wheelchair quality framework recognises this, while the APG for Access to Disability Equipment describes the system as being “in crisis”.
We welcome and acknowledge NHS England’s initial steps to improve wheelchair services, such as a national wheelchair dataset and personal wheelchair budgets. These steps are welcome and should be acknowledged, but data from the British Healthcare Trades Association shows that only around 80% of users received a wheelchair, or a much-needed modification, within 18 weeks, which is below the 92% national target, while people with complex needs can wait significantly longer. A delay in receiving a wheelchair is not simply an inconvenience or a statistic; it is a barrier to living a fuller life.
Also, we find that where a person lives determines how their wheelchair services are assessed, whether they qualify, their level of support, how clearly the process is explained, and what kind of equipment they ultimately receive. NHS England’s own national dataset shows significant regional variation between integrated care boards in meeting the 18-week standard. There is also a wide variation in eligibility criteria. In north Bristol, the threshold for regular use is at least 4 times weekly, on a regular basis. In Oxford, regular use is defined as at least three days per week. In Wirral and west Cheshire, regular use is worded as “more often than not”. For powered wheelchair assessment, we find that in west Suffolk a person must demonstrate indoor need and appropriate home accessibility, get GP clearance and pass a driving assessment, while north-west London uses a tiered categorisation system of need, with detailed thresholds and criteria for the effects that denying access to certain items could foreseeably have.
When noble Lords discussed this topic last month, the Minister said that
“integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population”.—[Official Report, 24/11/25; col. 1089.]
I appreciate the need for such flexibility, reflecting local populations, but could the Minister tell the House whether the Government believe there should be better co-ordination on eligibility and communicating the criteria, and what plans they have for achieving this?
The noble Lord, Lord Hunt, shared an article from Paul Sagar about his home experience. While he was on his hospital bed, distressed and worried about his future, he was phoned by the wheelchair service when he was obviously unable to speak. He assumed that he would be called back. Instead, a letter was sent to his home address: an upstairs flat which he would never access again. I thought that showed just how Kafkaesque a situation some users find themselves in. What is the recourse for patients where local ICBs offer such poor and unempathetic services? What is the accountability mechanism for that and, while respecting local differences, what is the department’s thinking on making them accountable for allowing such poor services? Do the Government have any plans for regular reviews of wheelchair service providers to make sure that they are all meeting standards?
I appreciate that noble Lords have asked a lot of questions, but I hope the Minister, who we know cares deeply about patients, will appreciate that we see this not as a party-political issue but as one which all Benches can agree touches directly on people’s independence, dignity and everyday lives.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to my noble friend Lord Hunt, not just for securing this important debate on a vital issue, as the noble Lord, Lord Kamall, said, but for his campaigning, along with other noble Lords, groups and individuals outside your Lordships’ House over many years. I am also grateful to noble Lords not just for their contributions but for sharing their experiences, some of which are painful to relate and to hear.
On the maiden speech of the noble Baroness, Lady Gerada, I welcome her experience and approach. I welcome her to your Lordships’ House. The noble Baroness spoke of choosing to speak in this debate because of its featuring, among other things, dignity and fairness. I was touched by her description of what and who a GP really is within their community. I know that we all look forward to hearing more from the noble Baroness. Perhaps I might say that the Government have promised more GPs—and we are delighted to have more GPs sitting on our red Benches.
This has been an affecting debate, not least as people described the impact of services not being, as they should be, in the right place. I am sure we would all agree that there is more work to do, but I will take this opportunity to outline what the Government have done and are doing. We are focused on ensuring that disabled people have access to the services and support that they need to lead a fulfilling life. My ministerial colleague, Zubir Ahmed MP, is the relevant Minister and I look forward to sharing the points and questions raised in this debate with him.
Integrated care boards are responsible, as the noble Lord, Lord Kamall, just quoted, for the provision and commissioning of local wheelchair services based on the needs of their local population. I am glad that the noble Lord, Lord Kamall, recognised the importance of flexibility. However, flexibility cannot be an excuse for not providing—a point I have heard rightly and repeatedly today.
There are no plans to publish a national strategy for wheelchair provision. I know that will be disappointing to noble Lords, but NHS England has developed policy guidance and legislation to support ICBs, which are crucial in this, to ensure the commissioning of effective, efficient and personalised wheelchair services, including the wheelchair quality framework, published in April, in collaboration with the NHS England national wheelchair advisory group.
Local authorities have a statutory duty to arrange for the provision of community disability equipment to meet the assessed care and support needs of people in their area. Our 10-year plan for health gives that freedom and autonomy to serve local people to local commissioners. In this regard, it is important that we are giving systems a greater degree of control and flexibility over how funding is deployed to get this done.
I have heard about delays to wheelchair provision. I say this not as any excuse at all, but the pandemic continues to have an impact on wheelchair services, not least because some providers have not only reduced their services—with the inevitable outcome—but now face a backlog of referrals. I was interested to explore that some services have also experienced lower referral rates during the pandemic. This of course led to a surge in referrals later. It has meant that waiting times for both adults and children have fluctuated, as services have worked to recover.
However, we need action to address waiting times and I absolutely recognise the impact that delays have. To that point, in October, we published the NHS Medium Term Planning Framework, which requires all ICBs and community health services to actively manage and reduce waits over 18 weeks, and to develop a plan to eliminate all 52-week waits.
The noble Lord, Lord Blencathra, rightly referred to the need to focus on measuring outcomes. The community health services situation report will be used to monitor ICB performances against waiting time targets in 2026-27, and currently monitors waiting times for children, young people and adults under wheelchair, orthotics, prosthetics and equipment. These targets will guide systems to reduce the longest waits. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments have to take place in the most suitable environment, including hospitals, the key thing here being that they are based on the need of the individual.
My noble friend Lord Hunt and other noble Lords rightly spoke of delays in discharge being linked to temporary or short-term loan wheelchairs rather than long-term provision. Access to temporary wheelchair provision to support hospital discharge is determined locally by ICBs; it does not fall within the remit of NHS wheelchair services, which provide services to people of all ages with long-term mobility needs. I heard the point made very clearly about the technology and quality of wheelchairs, which is one of the things I will be raising and discussing with Minister Ahmed.
Reducing waiting time is part of improving the quality of wheelchair services, but it is not the whole story. The quality framework, which the noble Lord, Lord Shinkwin, asked about, is very much designed to assist ICBs and NHS wheelchair service providers to get it right. I have heard, from the experience of noble Lords in the Chamber and also from those outside, that this is not always the case, and I understand that. However, the quality framework sets out the quality standards relevant to all suppliers and aligns with the CQC assessment framework. To the point raised by the noble Lord, Lord Blencathra, and the noble Baroness, Lady Brinton, this is about aiming to tackle the inequalities that we know exist—I acknowledge that—in outcomes, experience and access.
NHS England statutory guidance sets out how ICBs should be working with people, communities, key partners and local authorities. That is why each ICB must have executive leads who work closely with local authorities and who promote integrated working for the benefit of people, including those with a learning disability, autism, Down’s syndrome, and children and young people with special educational needs and disabilities.
As was referred to in the debate, NHS England introduced personal wheelchair budgets in 2019 and gave a clear framework for ICBs to commission personalised wheelchair services, focusing on outcomes and also on integrated care, giving people greater choice over the wheelchair provided—and I have heard what noble Lords have said today.
The noble Baroness, Lady Lane-Fox, spoke quite correctly about the impact of the quality of services on the ability to be in the employment market. That is about quality of life as well as the economy, and I share her views.
The noble and right reverend Lord, Lord Harries, and the noble Lord, Lord Rennard, discussed dissatisfaction with services; I heard that mentioned a number of times. NHS bodies and local authorities must arrange for dealing properly with complaints.
The approach of the 10-year health plan identifies disabled people as a priority group. Our neighbourhood health service will support disabled people, and the 10-year plan focuses on choice and control over their care. I have heard what noble Lords have said, and I will take that back. I hope the steps we have made will make a difference, but I recognise that there is so much more to do.