Policy context Section 3 of the same Act provides (f) such other services or In England, there is no clearly more ambiguous language within facilities as are required for defined duty for statutory provision which short-term wheelchair the diagnosis and treatment of short-term wheelchair loans. Yet provision may fit. The Section of illness.” the policy and legislative framework holds that the Secretary of State “Illness” is understood as: “includes is focused strongly on promoting the “must provide…to such extent as mental disorder within the meaning wellbeing of individuals, achieved he considers necessary to meet of the Mental Health Act 1983 through integration of services all reasonable requirements… (c. 20) and any injury or disability and prioritisation of preventing such other services or facilities for requiring medical or dental treatment and reducing need in order to the prevention of illness, the care or nursing” (NHS Act, 2006: 275). prevent, reduce and delay any loss of persons suffering from illness A “disabled person” refers to “a of independence. This resonates and the after-care of persons person who has a physical or mental with recognition by the NHS that who have suffered from illness impairment which has a substantial wheelchairs aren’t just a piece of as he considers are appropriate and long-term adverse effect on his equipment (NHSIQ, 2014: 37). as part of the health service” ability to carry out normal day-to- (NHS Act, 2006: 2). This language day activities or who has such other In this section of the report we lends itself to the experiences of disability as may be prescribed” discuss policy considerations individuals who require short-term (NHS Act, 2006: 256). This definition relating to wheelchair provision wheelchairs, but does not explicitly seems to incorporate a person with 8 within England. We examine include them. In particular, they a long-term condition – such as the provision of short-term may be recovering from an illness Parkinson’s, asthma, diabetes or wheelchair loans within relevant or ailment for which short-term multiple sclerosis – but, elsewhere policy and legislation, focusing use of a wheelchair is an essential within NHS literature, having a long- on the ambiguity of statutory part of their after-care, as well term condition is considered to be responsibilities to provide short- as preventing further injury or quite distinct from being a disabled term wheelchair loans. And we deterioration of health. person. Indeed, having a long-term consider key policy drivers within While Section 3 of the NHS Act condition is identified as being a the health and social care systems, 2006 empowered the Secretary of potential cause of disability, rather exploring the opportunities these State to act through the NHS, the than the two being synonymous or present for change. Health and Social Care Act 2012 the former incorporated within the Policy landscape amended this, placing the duty to latter (NHS, undated). The National Health Service Act meet all reasonable requirements The NHS’s lack of clarity as to the 2006 refers to wheelchairs in upon clinical commissioning interpretation of “frailty” poses further Section 5 (schedule 1), stipulating groups (CCGs). CCGs, while ambiguity with regard to whom the that the Secretary of State overseen by NHS England (“the CCGs’ duties extend. Professor John “may provide vehicles (including NHS Commissioning Board” Young, NHS England’s Director for wheelchairs) for persons appearing within legislation), have significant Integration and Frail Elderly Care, to him to be persons who have a devolved powers. In particular, the argues: “we must recognise frailty physical impairment which has a amendments made by Section 13 as a long-term condition”, reasoning substantial and long-term adverse of the 2012 Act to Section 3 of the that: “frailty behaves just like a long- effect on their ability to carry 2006 Act provide that: term condition. It is progressive, it out normal day-to-day activities” 1. “A clinical commissioning group impacts adversely on life experience (179; italics added). This explicitly must arrange for the provision of and – if unmanaged – it can cause excludes short-term wheelchair the following to such extent as the sufferer to become very sick, very provision. it considers necessary to meet quickly” (Young, 2014). However, this the reasonable requirements interpretation does not seem to have 8 Information about the policy context within of the persons for whom it has been adopted formally within the Scotland is available within the British Red responsibility: NHS. Cross report Making a move: increasing choice and independence for people with short-term mobility needs, which is available … As in the 2006 Act, the duty to online: http://www.redcross.org.uk/~/media/ provide a wheelchair for short-term BritishRedCross/Documents/About%20us/ (e) such other services or Scotland%20mobility%20aids%20report.pdf facilities for the prevention of use is ambiguous in the 2012 Act. Information about the policy context within CCGs need only meet “reasonable Wales is available within the National Assembly illness, the care of persons requirements” in providing services; for Wales Health and Social Care Committee suffering from illness and the report Wheelchair services in Wales: follow-up the terms of which are not defined inquiry, which is available online: http://www. after-care of persons who and are therefore susceptible to assembly.wales/Laid%20Documents/CR- have suffered from illness LD9028%20-%20Health%20and%20Social%20 inconsistent interpretation, or, as is Care%20Committee%20Report%20on%20 as the group considers are presently the case, are interpreted Wheelchair%20Services%20in%20Wales%20 appropriate as part of the Follow-up%20Inquiry%20-13082012-237712/ by the NHS to preclude short-term cr-ld9028-English.pdf health service, wheelchair provision. 4