Assistive Technology in the UK - a clinician's perspective

The MSc in Disability, Design and Innovation and my work since with the GDI Hub team has really pushed me to think critically about the design and delivery of Assistive Technology (AT) services at home in the UK. This blog shares some of these personal and professional experiences and asks the reader to think about how it could be and should be better.

My work:

Since qualifying from my BSc in Physiotherapy in 2013, life has taken me to work in a variety of locations and clinical settings; from busy NHS wards, Accident and Emergency, Specialist Rehabilitation Centres and Community Teams offering short and long-term care for patients.

I work closely with Occupational Therapists and other members of the multi-disciplinary team and am very regularly responsible for ordering, fitting and prescribing mobility aids that enable a person to interact with the world around them. This can be anything from walking frames to commodes, wheelchairs and falls sensors.

Of course, with the sophistication of our health service and the direct and free access people can get to assistive devices through the NHS there is much to be celebrated.

But, we could do better! We need to do better, because we are all getting older and the demand for AT is only set to grow.

I, like many, really feel the shared vulnerability of what it is to be human and the underlying fact that at some point, every-one of us might need to source and use a piece of AT - if we don’t already. I fundamentally believe that this is not something to shy away from but embrace and prepare for; because having access to AT means a million and one things:

AT is a walking frame or a pair of crutches that enables you to get back on your feet after an injury, to take your first steps, leave hospital and return to your home.

AT is a mobility scooter that means you can go to the shop, restaurant and connect with your friends.

AT is a well fitted wheelchair that enables you to sit comfortably, navigate the space around you and participate in whatever is meaningful to you.

AT is a communication device that means you can hear, see or speak - engage with the world and offer your opinions.

AT can be pressure relieving equipment (to prevent pressure sores) – that is quite literally lifesaving.

And AT might mean you can take your dog for an outing...

Although I can celebrate the progress within the UK, I also can see paths towards improvement. Because at the face of these issues are the service users who could be seriously, adversely affected - and that might just include you.

Key challenges:

• Procurement and Processes – services can be fragmented and different pieces of AT available dependent on where you live and who the supplier is. There are supply chain issues that mean certain pieces of AT may take significant time to get to the user. This can mean unnecessary days spent in hospital.
• Staffing - There is not enough staff who can confidently and comfortably prescribe, deliver and repair the devices that are needed.
• Inequality – Those who live in certain parts of the UK will have access to different devices and AT dependent on how the local funding structures and health boards work. Also, those who have received an education, or who have more access to money, a family, transport, the English language and/or the internet will be able to research, trial and buy cutting edge devices.
• Lack of choice – Patients are left with off the shelf products that are often very undesirable, problematic and ultimately abandoned.
• Waste – there are no systems in place for recycling devices. This existed even prior to COVID-19. There is no robust returns and re-use policy which means unwanted and unneeded devices sit in cupboards of people’s homes - or in charity shops. And the AT itself arrives in huge amounts of plastic that the NHS then has no means of recycling.
• Long waits – if you need a specialist piece of equipment from an expert, from a specialist centre, there is a really, really, really long wait – oh and if something breaks, repair is a complete hassle.

But in order to target these overarching ideas, that are anecdotal and based on my experience, we need to understand the AT landscape in the UK in more depth so we can get to the root of the problem and know exactly what can be done to make it better.

So, what's stopping us?

Oh and one last thought as a matter of urgency...

Please, somebody re-design the commode with the people who use them. I have lost count of the amount of people who have asked me the same.