Mobility Support

Mobility support needs, preferences and risks must all be understood as part of the assessment process.

Mobility needs and preferences must be recorded on the person's individual care or support plan and any relevant risk assessments must be completed.

Records should include:

1. Mobility aids the person uses, when and how they use them and any support they need from staff to use and maintain them safely;
2. Moving and handling equipment used, when used, support preferences, and routine maintenance required;
3. Risks to staff and to the person and measures to manage them;
4. The details of any professionals or services the person is involved with to access or maintain mobility aids or moving and handling equipment.

Everyone is personally responsible for making sure they understand the mobility needs of a person before providing them with mobility support.

If support involves moving and handling nobody must carry out such tasks until they have received appropriate training, supervision and been deemed competent.

Mobility assessments are normally carried out by an Occupational Therapist (OT). This is usually in the community, but if a person is ever admitted to hospital, a hospital-based OT will also routinely assess mobility needs prior to discharge.

With the person’s consent a referral to OT services should be made when:

1. They have a mobility need that has not been formally assessed;
2. Their mobility needs were formally assessed previously, but their needs have changed e.g., they are more unsteady or have started to fall;
3. Mobility or moving and handling equipment provided by OT services no longer seems effective e.g., a rotator is in place, but the person can no longer bear weight.

For guidance around consent, see: Consent.

Following assessment

Following assessment, the OT will recommend any mobility equipment to meet the person’s mobility needs.

People living in the community

If the person lives in the community, this will be provided by community equipment services, normally at no charge or minimal cost.

People living in a care home

If the person lives in a care home, the responsibility for arranging and/or funding equipment may belong to the care home, under the ‘fit for purpose’ requirement of the Care Standards Act 2000.

For example, it is normally the responsibility of a care home to provide equipment and basic structural adaptations that will benefit more than one resident:

1. Basic moving and handling equipment (e.g., a self-propelling wheelchair);
2. General mobility equipment (e.g., appropriate seating);
3. General lifting equipment (e.g., hoists and banana boards);
4. Communal area structural adaptations (e.g., doors widened to accommodate wheelchairs/grab rails in hallways).

Equipment that is specialist and will only ever benefit a single person is normally eligible for local authority or NHS services and funding (depending on whether needs have been assessed by a community-based or hospital-based OT). The only time when they would be the responsibility of the care home is if either the Statement of Purpose or individual contract commits them to doing so.

Mobility support needs must be reviewed as part of any individual care or support plan review. However, because mobility needs can change regularly staff must also be mindful of any changing needs each time that mobility support is provided. This could be a sudden change or a slow deterioration over time.

Any potential changes in need observed by staff should be recorded and brought to the attention of a manager or the registered person.

Professional advice should be sought swiftly, and any advice given recorded. This could be from the person’s GP or an OT.

Individual care or support plans and risk assessments must be updated in line with advice given, new equipment, new risks etc. Changes must be communicated to all staff before they provide mobility support again.

Moving and handling equipment must always be used safely in line with individual care or support plans, risk assessments and relevant regulations.

There is a full chapter of this Handbook dedicated to safe moving and handling. This includes maintenance of moving and handling equipment.

See: Moving and Handling

Buses, coaches, trains, and trams

Under the Public Services Vehicle Accessibility Regulations 2000 all vehicles that have capacity to carry more than 22 passengers must allow people with mobility aids to board. Low floor vehicles with ramps and lifts should be provided to facilitate this.

The only exception is scooters.

Passenger assistance

If using a train, Passenger Assistance can be used to help people with mobility support needs or visually/hearing impairments plan their journey, purchase tickets and carry out their journey safely. This includes supporting people to board and alight safely and at the right station, and to get from the platform to a taxi safely.

To find out more see: Passenger Assistance

Bus passes

Older people and most disabled people are entitled to a bus pass.

See: Apply for a disabled person’s bus pass 

See: Apply for an older person’s bus pass 

Disabled Persons Railcard

For a cost of £20 per year, the Disabled Persons Railcard gives disabled people and any adult travelling with them 1/3 off the cost of normal rail fares at any time of the day, week or year.

The following people are eligible to have a Disabled Persons Railcard:

• Anyone receiving PIP;
• Anyone receiving DLA;
• People with a visual impairment;
• People with a hearing impairment;
• People with epilepsy;
• Anyone receiving Attendance Allowance or Severe Disablement Allowance;
• Anyone receiving War Pensioners Mobility Supplement;
• Anyone receiving War or Service Disablement Pension for 80% or more disability;
• Anyone buying or leasing a vehicle through the Motability Scheme.

To find out more or apply online see: Disabled Persons Railcard

London Freedom pass

The London Freedom Pass only applies to people living in one of the 32 London Boroughs. Anyone living in London that is over the age of 66 or has a disability is eligible for a pass. It enables free travel on public transport across London.

See: Freedom Pass

Taxis 

Many taxi firms have accessible vehicles with lifts or ramps. Anyone supporting a person to book a taxi should let the taxi company know that you need such a vehicle when booking.

Community transport schemes

Community transport schemes can be used by people that do not have (or cannot use) their own transport and find it difficult to access public transport. This includes people that live in areas where public transport is limited.

Community transport schemes include:

• Community car schemes where volunteers use their own cars;
• Door-to-door dial-a-ride minibus services;
• Community bus services.

The local authority information and advice service or pages of their website will be able to provide information about any local schemes and how to access them.

Local authority funded transport

If a person is accessing a day service or other service that has been arranged by the local authority, they may be able to access local authority transport, or be able to use some of their personal budget to pay for a taxi or community transport service.

The person’s allocated social worker or the duty social work team will be able to advise on this.

Transport to get to and from hospital

Some people are eligible for non-emergency patient transport services (PTS):

1. People whose condition means they need additional medical assistance during their journey; and
2. People who find it difficult to walk.

If you are supporting someone to arrange PTS, this will need to be arranged through the GP or whichever health professional made the referral to hospital.

If PTS isn’t provided, the person may be able to claim back the cost of travel expenses through the Healthcare Travel Costs Scheme. Normally this is only the case if the treatment or tests are specialist.

For more information, see: Healthcare Travel Costs Scheme (HTCS)

ShopMobility schemes help people with mobility needs that do not have their own equipment to shop in town centres by lending wheelchairs and scooters.

ShopMobility UK coordinates a network of local ShopMobility schemes.

To find out more and see where your local ShopMobility scheme centre is located see: ShopMobility.

Note: Many supermarkets and out-of-town-retail parks also have their own mobility hire independent of the ShopMobility scheme.

If a person receives the highest rate of mobility allowance, they can use this to access the Motability Scheme.

This is a national scheme that allows the person to use their mobility allowance to lease a new car. This could be a standard car, a wheelchair accessible vehicle or an adapted vehicle. It can also be used to lease an electric mobility scooter.

Powered wheelchairs can also be leased through the scheme if:

1. The person has been formally assessed as needing a wheelchair; and
2. The person has been assessed as able to use a powered wheelchair safely.

The scheme includes a change of vehicle every 3 years, insurance of named drivers, servicing, and breakdown cover.

Important things to know

• The vehicle can only be used for the benefit of the person;
• Only people named on the insurance can drive the car;
• The person must meet the fuel costs;
• Anyone driving the vehicle must have a full and clean driving license;
• Records of mileage use must be kept.

Under no circumstances must staff use a vehicle for their own personal use, even if the person says it is OK. It is unlawful.

If any member of staff believes that a vehicle provided through the Motability Scheme is being used inappropriately this should be recorded and brought to the attention of a manager or the registered person. For example, if a family member seems to be using the vehicle as their own primary mode of transport.

The individual using the vehicle inappropriately may not be aware that their action is unlawful so the first step should always be to make them aware of this. If the activity continues, the Motability Scheme should be advised.

Depending on the circumstances, misuse of a mobility vehicle could be an act of financial abuse.

For further information about the Motability Scheme, see: Motability

The blue badge scheme allows people with reduced mobility to park closer to their destination than they would otherwise be able to do.

Vehicles that display a blue badge can:

1. Park for free with no time limit in a disabled parking space (unless signage specifies otherwise); and
2. Park for free with no time limit at pay-and-display parking meters on the street.

They also allow the vehicle to be parked on yellow lines for up to 3 hours.

Note: The above rules apply apart from parking spaces in The City of London, The City of Westminster, The Royal Borough of Kensington and Chelsea and parts of Camden. If the person is supported to park in these areas, it will not be free.

Access to a blue badge is subject to an eligibility test. Some people will be automatically eligible, and others will need to have their individual circumstances assessed.

Automatic eligibility

1. Anyone that receives the higher rate disability mobility component;
2. Anyone that receives a Personal Independence Payment (PIP) because they cannot walk more than 50 metres;
3. Anyone that receives a PIP because they are unable to undertake any journey due to overwhelming psychological stress;
4. Anyone registered blind;
5. Anyone that receives a War Pensioners Mobility Supplement;
6. Anyone that has received a lump sum benefit from the Armed Forces and Reserve Forces Compensation Scheme.

Eligibility subject to assessment

The following people may be eligible for a blue badge, pending assessment:

• Someone that cannot walk at all;
• Someone that cannot walk without help from someone else or using mobility aids;
• Someone that finds walking difficult due to pain, breathlessness, or the time it takes;
• If walking is dangerous to a person’s health and safety;
• Someone with a terminal illness that makes walking difficult or impossible;
• Someone with a severe disability in both arms who drives but cannot operate pay-and-display machinery;
• Someone that is constantly a risk to themselves or others near vehicles, in traffic or in car parks;
• Someone that struggles to plan a journey;
• Someone that finds it difficult or impossible to control their actions and lacks awareness of the impact of this on others;
• Someone that regularly has intense and overwhelming responses to situations that cause temporary loss of behaviour control;
• Someone that frequently becomes anxious or fearful of public/open spaces.

Applying for a blue badge

If someone being supported wants to apply for a blue badge, they may need support to do so, and this should be provided.

If staff think that someone may be eligible, they should tell them about the scheme and support them to access it.

Applications can be made online or to the local authority.

See: Apply for or renew a Blue Badge

There are over 9,000 accessible toilets around the country. Most are locked and can only be opened with a RADAR key. RADAR keys can be purchased by anyone and it is good practice for staff going into the community to always have one with them. This ensures that people who need to use an accessible toilet can do so in a timely way and reduce the risk of continence incidents that reduce dignity.

To buy a RADAR key and see a list of accessible toilets in the area, see: Disability Rights UK. 

Changing Places accessible toilets are accessible toilets with additional features for people with specific mobility needs. They can contain a changing table, a hoist and are much bigger than standard accessible toilets.

To find a Changing Places toilet see: Changing Places toilet map

Wheelchair assessments 

Wheelchair assessments are completed by an Occupational Therapist, consultant or by a company who has clinical expertise in this area.

A wheelchair assessment measures the person’s clinical needs to determine whether a wheelchair is the best form of mobility support. If the professional assessing clinical need does not feel a wheelchair is appropriate, they will not arrange for one to be provided.

If a wheelchair is appropriate, a prescription will be prepared. This will set out the type of wheelchair that the assessor thinks is best for the person to both meet their mobility needs and maximise their independence and control. This will consider the person’s lifestyle, the environments they live in and spend time in, their physiology (posture, weight, strength, size, dexterity, eyesight etc.). The prescription will also set out any supplementary aids to make wheelchair use more comfortable or manage the risk of pressure areas. For example, head support or a pressure relieving cushion.

If a powered wheelchair is to be used, the assessing professional should further assess the person’s ability to use the powered wheelchair safely and avoid risks to themselves and others.

Types of wheelchairs

There are indoor and outdoor wheelchairs as well as manual and powered wheelchairs.

Manual wheelchairs: Can be self-propelled or pushed by staff.

Powered wheelchairs: Battery powered and controlled by the user with a joystick with no intervention from staff.

A powered wheelchair is classed as a type of vehicle by the DVLA. If the person uses a powered wheelchair, when using it in the community they must abide by dedicated Highway Code rules or have staff support to manage risks.

See: Rules for users of powered wheelchairs and mobility scooters

If a person has complex physical or health needs, the wheelchair may need to be specifically made for them and several professionals may need to be involved in its design. The design could allow for the inclusion of things like a head support, pressure relieving cushions or a tray to support with eating and drinking or activities.

Wheelchair care or support plans and risk assessments

If anyone being supported uses a wheelchair, staff will need to think about support they need with storing, charging, accessing, and maintaining the wheelchair. A wheelchair risk assessment will also need to be carried out. All support to be provided must be recorded in the individual care or support plan and followed at all times

Wheelchairs should be used in line with instructions given by mobility professionals and specific manufacturers.

Temporary unassessed wheelchair use

If a person is doing an activity that is beyond their normal mobility level, with their consent a wheelchair can be hired for a small fee on a short-term basis from a charity organisation, such as the British Red Cross. For example, if the person is being supported to go on holiday, there will be long days out and they can only normally mobilise short distances at a time before getting tired.

Scooters can be purchased by anyone, but if someone wants to use their mobility allowance to lease one a professional assessment of mobility needs must take place first.

There are 3 types of scooter available:

1. Small scooters for indoor and pavement use only;
2. Medium scooters, designed to travel further and carry more weight;
3. Large scooters, classified by the DVLA as Class 3 vehicles and can travel extended distances.

Medium and large scooters can be registered for use on the road. When used on the road, the user must abide by dedicated Highway Code rules.

See: Rules for users of powered wheelchairs and mobility scooters

If anyone being supported uses a scooter, staff will need to think about support they need with storing, charging, accessing, and maintaining the scooter. A scooter risk assessment will also need to be carried out. All support to be provided must be recorded in the individual care or support plan and followed at all times.

Following assessment, if the OT believes that a home adaptation is beneficial, they will work with the local housing authority to carry out the changes.

As part of this process, the local housing authority will carry out an assessment of the person’s finances to determine whether they are eligible for financial assistance towards the cost of the home adaptations. This is called a disabled facilities grant (DFG). Most people are eligible for financial assistance.

If the person lives in a care home, the responsibility for arranging and funding adaptations belongs to the care home. There is no funding available to make adaptions in a care home and no legal requirement for local authority, NHS, or housing services to carry out the work.

The registered person and anyone else that manages the business' finances will need to consider whether it is financially viable to make the structural changes.

If the person is likely to remain in the care home for some years, a decision may be made to make the changes. These will need to be arranged by the care home, who is responsible for making sure they are carried out in line with the OT assessment.

If the service decides not to make the changes, it is likely that the service is no longer suitable and alternative support will need to be found to meet the person’s needs and manage mobility risks.