This post is also available in: Nederlands (Dutch)
Around the turn of the year it is customary to look back at what has happened in the past year and what the perspective for the coming year may be.
The beginning
On May 26, I started the website arenlezen.nl out of concern about the Dutch Code Safe Transport of Wheelchair Occupants, opens in a new window(Code VVR SFM from 2017).
For the first time in the history of the Code VVR, this code assumes a dichotomy of people with disabilities who use a wheelchair as a seat for their transport:
- Users of a wheelchair who have passed an ISO7176/19 crash test are allowed to take taxi as passengers in the wheelchair.
- People with disabilities who do not have such a wheelchair are refused as wheelchair passengers by the driver.
In the transitional situation, until this Code comes into force, people from the second category are still allowed in the taxi. However, the driver says they should take care of a wheelchair that has passed the crashtest, as soon as possible.
For a number of people with disabilities, this is unfeasible, because they use a unique individually customized wheelchair. For them, the Code VVR platform has figured out that they should be transported individually. Unfortunately, despite all the consultations, the Code itself has remained unchanged since 2017. Exclusion of transport is therefore still looming!
Consequences
This paragraph marks the beginning of the introduction to code VVR (SFM):
“The accessibility principle of the UN Convention on Rights for People with Disabilities states that everyone has the same rights in terms of accessibility and participation in society. This includes the right to free choice of mobility equipment.”
Unfortunately, the rest of the Code has been drawn up in stark opposition to this principle. The starting point is not inclusiveness, with the search for the opens in a new windowbest possible possible solutionfor every wheelchair passenger. But banning transport, or allowing it at most separately, individually. In addition, according to the Code, the wheelchair passenger can sort it out himself, to provide a solution himself. Even if, for users of a custom wheelchair, this is an impossible task!
It is special to see that this Code has caused little fuss. Is almost taken for granted. Where only the exceptional situation is a point of discussion.
Why accept exclusion from transport? What risk analysis is this position based on? Are there any examples of accidents that support this non-inclusive position?
Open letter
Ambiguities that prompted me in mid-October to address an opens in a new windowOpen Letter to the platform Code VVR. And also to other parties involved in the provision and financing of a wheelchair and in the financing of wheelchair transport.
A substantive response of the Platform Code VVR to the questions in the Open Letter has not been provided, even after repeated questions! An invitation was received for an interview at the Social Mobility Fund in Culemborg. Due to Covid 19 this has not happened yet.
In view of their reactions to the Open Letter, wheelchair transport assigning parties have great difficulty with the costs of individual transport.
The question then becomes: Do the social costs of this Code outweigh an improvement in safety? And what are the practical consequences for the people with disabilities from the second group?
The Working Group on Device Care of the Dutch Association of Rehabilitation Physicians is clear in their response: Assume the Medical Device Regulation, which as of 26 May 2021 also applies as legislation in the Netherlands (see the reaction under the opens in a new windowOpen Letter).
Finance
This code VVR has quite a few financial consequences:
- Accelerated depreciation of wheelchairs and replacement by those who have met the crash test take a bite out of the budget of the wheelchair providers: municipalities and care offices. The question is also whether wheelchair passengers can receive a replacement wheelchair in time, especially in the case of the more expensive wheelchairs that are often fully adapted. Why can’t we do that with the next foreseeable replacement?
- For wheelchair users, rigging transport, in which they are the only passenger, possibly still together with a companion, is particularly costly. Are the assigning parties of wheelchair transport willing to do so? Or will a group of people with disabilities, completely in violation of the UN convention, soon be finding themselves behind the geraniums?
In addition, the parties from the Code VVR platform are not the parties that bear the cost of this Code!
Monitoring of safety issues
At the moment, an up-to-date Dutch overview of accidents in wheelchair transport is lacking. These accidents are not tracked structurally. There is therefore no good overview of safety risks. Compiling a summary of serious accidents requires the vetting of many media outlets, where there is a chance that an accident has not made the news.
There is, however, a tendency to deduce from international literature which accidents are most common. Technical failure of the wheelchair during a crash is certainly not at the top of the list.
When the European Medical Devices Regulation is introduced on 26 May 2021, the maintenance of a Post Marketing Surveillance for medical devices will be mandatory. If accidents during wheelchair transport are also included, more insight into unsafe situations will automatically be created and solutions can be devised. Preferably accessible on the shop floor in consultation with the manufacturer/adjuster of the wheelchair.
A new year, new possibilities
One of the most important points is to increase inclusiveness under the principle of accessibility in the UN Convention on Rights for People with Disabilities! This means that groups are no longer excluded from transport. Because they cannot possibly have a wheelchair that has passed a crash test.
An industry association such as Firevaned is there for the entire industry and should therefore also support the technical development of customized safely transportable wheelchairs. For example, by entaming research into alternative methods, best design practices, which give attention to safety, even without a crash test. Preferably together with the wheelchair manufacturer/adjuster.
A second starting point should be that a proportional distribution of security efforts by market party should no longer be assumed. The “We have done enough now they have to do their job” and “My wheelchair product must not be used outside the working area I have indicated” leads to commandements and prohibitions which are not necessarily in the interests of safety and inclusiveness. A wheelchair is not a pacemaker with a strictly defined scope. I hope that in 2021 we will see a different development. One in which parties – looking beyond their own interests alone – together achieve safety improvements in the workplace.
Conclusion
While improving safety of wheelchair transport, the starting point should be a safety analysis. Which risks are largest and deserve extra attention. In addition, an analysis of the social consequences and costs of security measures is absolutely necessary. Then the result may be that less focus is on little to non-common risks. Engage the citizen early in the safety process. Communicate openly about this (for example, with an answer to questions from an open letter).
“ opens in a new windowConscious handling of safety. On the road to a clean, healthy and safe living environment.”the Ministry of Infrastructure and Water Management may serve as a guideline. The introduction mentions 10 policy principles:
“1. Ensure a transparent political decision-making process;
2. Make the responsibilities of government, business and citizens explicit in these decisions;
3. Weigh the dangers and risks of an activity emphatically and, as far as possible, against the social costs and benefits of that activity;
4. Involve citizens at an early stage in policy-making (where the extent and design of such involvement depends on the issue);
5. Weigh the potential accumulation of risks in decision-making;
6. Apply the precautionary principle to new, still uncertain risks;
7. Involve society (citizens, businesses, NGOs, scientists) in the entire policy-making process, from signalling to risk management, and discuss emotions, risk perception and ethical considerations;
8. Make the most of existing knowledge in society to identify new (possible) risks in a timely manner;
9. Connect security and safety: keep an eye on the one as policy attention and effort focuses on the other, and research opportunities to connect both; and
10. Ensure that innovation and security reinforce each other, that safety requirements are formulated in such a way that they do not limit the possibilities for new, smart solutions, while at the same time combining innovation with attention to safety from the outset. In this way, opportunities for improvement for safety can also more effectively serve as a driving force to innovate.”