MOBILE STAIRCLIMBER SURVEY RESULTS

The answers below are a summary of the replies received from the questionnaire. The questionnaire was sent to 31 London Boroughs and replies were received from 21 of the boroughs.

1. Do you issue mobile stairclimbers? if no, could you provide further details?

• 11 boroughs said they do not issue mobile stairclimbers.
• 2 said they had never issued one, but would consider it if there were no other options.
• 8 boroughs had issued mobile stairclimbers.

The reasons given for not providing mobile stairclimbers were mainly about lack of control over who is in charge of it and whether the carer will always be capable of using it. It was felt this type of equipment was too risky. Safety concerns were mentioned for the carer and user. One borough said they did not feel able to meet the regulations that go with providing this type of equipment. Another borough felt it may not be possible to make blanket statements in future provision of equipment and that each request would need an individual risk assessment.

The boroughs that had issued mobile stairclimbers said they were only issued as a last resort and were very rarely provided. Examples were given of issuing them for paediatric cases when waiting for a stairlift or other adapts to be fitted, also for terminally ill service users. One borough had a stock of 3 Scalamobil stairclimbers and 1 Baronmead stairclimber, which were issued regularly. Another borough had one stairclimber in stores that had not been issued for many years.

2. What is your criteria for issuing mobile stairclimbers? if you have a written criteria, would it be possible to have a copy?

• 2 boroughs had specific written criteria for mobile stairclimbers.
• One of the above boroughs had specific written criteria for the Scalamobil stair climber by Simorg.

Boroughs without written criteria commented that the requests for mobile stairclimbers were decided on an individual basis. They were issued as the very last resort and in extreme circumstances. All boroughs agreed they were only considered when there were no other possible options of facilitating access to and from a property or to basic amenities.

• The written criteria included the following factors: The service user is a full time wheelchair user, minimum of 3 hours per day. One of the boroughs required this as a standard).
• The service user is able to sit safely in a wheelchair or integral chair and does not have ataxic movements.
• An attendant must be willing and available to assist and must be a regular carer.
• An attendant must be trained to use the equipment by a recognised trainer.
• The company representative has confirmed that the style, length and condition of the staircase is suitable for the use of the equipment.
• Legislation relating to manual handling and health and safety and local guidelines must be followed.
• There must be a suitable storage and battery charging area.
• A team manager or major adaptation panel must be consulted and agree issue.
• The service user is added to a monitoring system for a regular six monthly review.

Contra indications included a maximum weight limit of 16 stone, anxiety conditions (service user or attendant); dementia, mental health conditions, learning disabilities (i.e. may cause the service user to act in an unsafe manner); epilepsy and irregular carers.

3. Do you have a detailed risk assessment document to use when issuing mobile stairclimbers? if yes, would it be possible to have a copy?

• 6 boroughs said they would do a general risk assessment, i.e. as used for manual handling assessments.

One borough suggested the following areas for a thorough risk assessment.

"The Risk Assessment would cover the 4 main areas:

"Task - You would have already considered all the other possibilities to perform the task (getting a disabled person up and down stairs) and found them to be impossible for whatever reason. You also need to consider how the disabled person is going to transfer onto the stair climber (not necessary for the wheelchair climbers). You also need to consider whether it is essential for the disabled person to use the stairs.

"Individual - a lot depends on the skill and aptitude of the operator controlling the equipment. During the demonstrations, the company representatives were highly skilled at making it look easy! All the companies offer training to the operators of the equipment, but you would need to assess whether this was sufficient at the end of the training. In my experience you do need a fair amount of strength and fitness (possibly more than I have!). They would also need to be able to make a risk assessment each time the equipment is used to ensure that conditions are favourable (environment, the operators physical condition, and disabled person condition). It requires a high level of skill and concentration. It is probably not suitable in situations where there are several carers as they would all need training and be able to practice using the equipment regularly.

"Load - the load is unpredictable as it is a heavy bit of machinery with a person strapped to it! It is an unstable load when in use. You would need to assess how compliant the disabled person is, and whether they have uncontrolled movements which can unbalance the machine and the operator.

"Environment - this is a high risk procedure as it occurs in an environment Where the floor surface is uneven (if outside), and there are steps or stairs. Conditions are often cramped, and the floor surface could be wet, slippery, dark, or dazzling. There may be other distractions that cannot be controlled (dogs, noise from traffic, wind etc). Invariably the stairs/steps are not straight, but have a winder or bend, adding to the environmental hazards.

"If you can address all these issues and feel confident that you have covered them all, then I think you would have done a good assessment of the risks. Fortunately, we do not use them very often, but I would be circumspect in providing one now, and would need to be very clear that it was essential, and the only possible solution to be worthy of the risks involved."

4. Are mobile stairclimbers classed as mobility equipment or moving and handling equipment?

• 5 boroughs said they would class stairclimbers as moving and handling equipment.
• 4 boroughs implied it would be classified as moving and handling equipment.
• 1 felt it was general equipment.
• 1 did not categorise but felt it was in line with major adaptation criteria.

5. Are you aware of any reasons why the use of mobile stairclimbers do not fall within current moving & handling guidelines, or any other concerns regarding health & safety issues?

• No answers suggested any of the mobile stairclimbers available did not fall within current moving and handling guidelines.
• 6 boroughs raised safety concerns around the issue of mobile stairclimbers.

Replies included the following comments:

"I know there have been serious worries concerning the safety of stairclimbers in other boroughs."

"The Manual Handling Operations Regulations do not give specific rules, but guidelines based on the assessment of risks. You need to be sure that the benefits outweigh the risks."

"Concern over the amount of effort needed to operate the item, how to stop it going downstairs uncontrollably, concern for safety of service user."

"There was an incident, some years ago where there was an accident a stairclimber falling on a staircase."

"The (wheelchair) stairclimber type of transportation has many disadvantages for infrequent use. I have heard from the Medical Devices Agency that there have been two deaths from this type of transportation, both put down to user error. However, an MDA warning has not been released because there was no mechanical failure. I would like to point out that the MDA and other sources did not specifically mention product makes with regards to the accidents, but simply that there have been human error accidents with chairs based on this principle.

"The main disadvantages from infrequent use is the capacity for simple errors from the user resulting in potentially very serious consequences. For example:

• "The type of stair climber used by the Borough needs to be tilted BEFORE reaching the top step to descend. Otherwise it will fall down the stairs.
• "The user positioning on the stair is crucial. During a training session there was a repetitive error from all users to stand one step too far away from the chair. This results in the users centre of gravity drawing them slightly forward, this combined with a 'kick forward' motion from the chair (with client) as it grips the stair could potentially take the user off balance with a result of user and client and chair falling down the stairs. From what I gathered from the MDA, this was the error, which caused at least one death. There is an additional risk of this occurring if the client is confused / frightened / non co-operative and tries to move their bodyweight forward as the chair grips the stair. From personal experience with this type of chair, I found an excessive amount of exertion was required during the procedure (despite the company representative supporting the bottom of the chair!)."

"The opinions of the potential risks stated were originally from myself, however, I have taken this to the Back Exchange for an equipment review and my colleagues were of the similar opinion, in that there was a significant potential for human error if the technique were not perfected and used frequently."

"The Back Exchange also reviewed a 'caterpillar' type stair climber, which was simple to use, the error potential was very small and the potential consequences for the human error were that the machine would not function. The product was very stable both on and off the stairs and the level of exertion required was that the chair needed to be tilted back in a 'cantilever' fashion on the flat. On the stairway, I managed to operate the product with two fingers and felt very stable. The seating arrangement was such that the manufacture claimed that the client could have a seizure on the stairway and the product would remain stable. My own experience of being transported in this was that I was not able to unbalance the equipment"

"I have concerns about them i.e. re transfer issues as the user has to be transferred in /out at top and bottom of stairs. Also they just look enormous and sure there'd be storage issues etc."

" We did not have the confidence that we could provide all the necessary support or have the capacity to provide such support within our service."

6. What are your general considerations & concerns when you are requested to issue mobile stair climber?

• 7 boroughs raised concerns about the safety and ability of the carer.

Replies included the following comments:

"General considerations are that the controller of the stairclimber must be very competent. I have issued them in the past - but am not convinced that they are safe and would only issue again as a last possible option, and only for a few stairs - say up to 6 at a front entrance."

"We used Scalamobile - I used this many times very successfully -need a regular operator to be trained in using it but very useful in situations where stairs were unadaptable; for terminally ill people, it's very portable and recyclable and no transfer issues i.e. as the user remains in own wheelchair throughout."

"We have one stair climber that is not issued unless the company Baron Mead has been out and completed an assessment of the environment, established that the seat and harness is suitable for the client."

"Ability of carers to operate -Risk assess. to judge this. Sitting balance and any cognitive issues re: client-OT to assess this."

"The carer's ability to use the item. The stairclimber is tailored made for an individual wheelchair and so cannot be readily used for another."

"Property layout, client compliance, where step climber will be used, over what distance. The health of the carer/'s surface, ease of use, life of battery, charging requirements, and portability."

"Safety and care of service user and carer, including psychological effect of being moved in this way."

"The shape and depth of the stairs and configuration of the staircase is also important and may increase the difficulty of use"

"I would only say, that unless it is used all the time and a really skilful technique is developed (such as the rep demonstrates!) I felt that they were potentially very dangerous both in terms of injury to the operator (jerking, strain to the hands, arms and shoulders, and in the potential for accidents to the occupant (at worst falling down the stairs)."

"I would only consider issuing one for straight stairs with very physically and cognitively able carers and a small client with reliable posture and co-operative behaviour."

"Environment/carer safety/user safety....any other way of resolving the problem."

"Carers ability to use the stairclimber safely, who is responsible if an accident does happen?"

"Risk assessment of user/carers. Maintenance contacts. Training and monitoring to meet H&S satisfactorily."

7. What arrangements have you come to for maintaining mobile stair climbers?

"We pay for a service for the equipment and lessons for the carer".

"A contract is set up via our private contractors".

"This will be maintained through the joint funding scheme. 6 month review".

"Stairclimbers are inspected and serviced before issue. They are then serviced on an annual basis".

"All our equipment maintenance is the responsibility of our Contractors...however I would have thought that there is a real issue of the OT having to review care needs on a regular basis".

"They are maintained by our stores (external contracted in company)".