The bloody “Seating Assessment”

All I wanted was a fix for my backache in my NHS wheelchair. Instead, two therapists spent hours on a so-called “seating assessment” that cost the NHS more, left my chair in a worse state than before, and my mum was lying on the floor at home trying to put right what the system had broken.

By Dr Emma Astra, Life Experience Specialist, 25 September 2025

Wheeling around the supermarket, tears welling up. Maybe it was the woman in the queue who let me go ahead, seeing I only had a few items. Perhaps it was the exhaustion of seeing my dad after his stroke. Or maybe it was the legs of my wheelchair scraping the floor — a direct result of the bloody “seating assessment” I’d just been through.

A fancy name for making it worse

I contacted wheelchair services because my back was aching after long periods in the chair. Two months later, I got an appointment: not one occupational therapist, but two. If an average NHS appointment costs £126, this must have been at least double that amount.

One of them yawned and said she was thinking of going back to university. When I explained that my chair doesn’t fit in every car. However, I was grateful for the Wheelchair Accessible Vehicle (WAV) I eventually managed to obtain (which is another story for another time, involving that bureaucratic system), but she had nothing to say.

Picture of a typical WAV from Istock

This wasn’t my first time. Years ago, I said the wheelchair wasn’t meeting my needs. I left with the same chair and a cushion I couldn’t use (due to incontinence). This time was déjà vu. The main OT meant well, but his “fixes” — lowering the legs, narrowing the sides, wedging in random bits of polythene for lumbar support — only made things worse. By the time I left, the side rest had ripped, the seatbelt was loosening screws, and the leg rests were still too low. One was yawning and saying she might go back to university, while the other was hands-on with the right intentions, at least.

The catch no one tells you.

Even after all the referrals, assessments and waiting, here’s the kicker: NHS wheelchair services don’t provide chairs for “outside use.” Which means if your chair breaks down in the community, the maintenance team won’t come. You’re stuck.

It wasn’t always this way. Their maintenance service used to come quickly (though still not outside). Not anymore. Now it’s another long wait, another hoop. Meanwhile, non-disabled staff are paid to gatekeep, while disabled people are left stranded with broken equipment.

“You’re lucky to have a wheelchair” — the media myth

Too often, media coverage frames people like me as “lucky” to have a wheelchair. But the reality is delays, unsuitable chairs, or none at all.

Just this week, the Express reported that disability charity Whizz-Kidz has had to halt its waiting list for properly fitted wheelchairs, calling the situation a “national crisis.” https://www.express.co.uk/news/uk/2112895/wheelchair-disability-charity-whizz-kidz

It also raises a more challenging question: Are we facing the consequences of our own progress? In the UK, advances in healthcare mean people who might not have survived years ago are now living longer, fuller lives. That should be a triumph. Yet instead of celebrating that survival with the tools for independence — like electric wheelchairs that make work, shopping, parenting, and social life possible — we ration, delay, and gatekeep. The result? People survive, but they don’t thrive.

They’re not alone.

• A Guardian investigation found people waiting up to two years for wheelchairs or parts under AJM Healthcare. https://www.theguardian.com/society/article/2024/may/21/nhss-leading-wheelchair-provider-told-to-improve-as-people-wait-up-to-two-years
• The Independent reported that 1,676 children waited more than three months for a wheelchair between January and March 2025. https://www.independent.co.uk/news/health/disabled-children-wheelchair-waits-nhs-b2832900.html
• Families are crowdfunding thousands for wheelchairs that the NHS should provide. https://www.bbc.co.uk/news/uk-66558487
• One Ombudsman case found a woman who waited 38 weeks for a replacement chair, long after her old one had become unusable. https://www.ombudsman.org.uk/about-us/our-casework/how-our-casework-makes-difference/case-summaries/534

So when someone says, “You’re lucky to have a wheelchair,” remember: luck shouldn’t come into it. It’s a basic human need.

The bitter irony

Here’s the absurdity. Thousands in Britain are stuck indoors without working chairs — yet surplus UK wheelchairs are refurbished and sent abroad. https://www.tandfonline.com/doi/full/10.1080/17483107.2024.2367717 https://physionet.org.uk

I don’t begrudge anyone else getting help. But why pay gatekeepers here while exporting equipment that disabled people desperately need?

The engineering gap

The biggest problem? Weight. NHS-issue power chairs weigh 100–150kg. You need a hoist or WAV just to leave the house.

Yes, there are lightweight power chairs — some under 30kg — but they’re usually fitted with tiny wheels. Fine for shopping centre floors, useless on pavements, potholes, and kerbs.

Carbon-fibre manual wheelchairs with tricycle-style electric attachments show promise, but they’re heavy, expensive, and out of reach unless you crowdfund.

So we’re stuck in a false choice:

• Light but flimsy — useless outside.
• Heavy and robust — traps you in expensive vehicles.

What’s missing is engineering that is co-designed with people with disabilities. Durable and light. Transportable and supportive. Not either/or.

The price tag — and the co-op solution

I found out my chair costs £2,400 to buy new. Under NHS contracts, they pay £1,200. Meanwhile, Motability Foundation research shows some NHS areas spend less than £80 per person per year on wheelchairs. They estimate that an additional £22m annually would bring the provision up to a decent minimum — a rounding error in the NHS budget. https://www.motabilityfoundation.org.uk/media/xb2jxcdo/rpt_final-report_211123.pdf

So, why not eliminate the bureaucracy? People with disabilities could form cooperatives to procure chairs directly. Scrap unnecessary gatekeeping. Pool lived experience. Collaborate with engineers to design models that truly integrate into our lives. It would save money — and save us from endless waiting.

David Graeber was right.

The late anthropologist David Graeber argued that bureaucracy isn’t just boring paperwork — it’s “organising stupidity.”

“Bureaucracies… are ways of organizing stupidity — of managing relationships that are already characterised by extremely unequal structures of imagination.” https://www.goodreads.com/quotes/7500627-bureaucracies-i-ve-suggested-are-not-themselves-forms-of-stupidity-so

Wheelchair services prove his point. Endless referrals, assessments, and waiting lists aren’t “care.” They are bureaucracy. They cost more while leaving people with less.

Image created using AI with authors prompts © Dr Emma Astra

Back to the supermarket

And so I ended up back in the supermarket. In tears. The trolley wouldn’t attach because the sides had been lowered. The legs scraped the floor with every push.

At home, Mum had already been slithering on the ground like a dolphin, trying to stop the leg rests from falling out — because maintenance would take two weeks to come. By the time we reached the supermarket, her efforts had just about held the chair together, but only just.

That’s the absurdity. The NHS pays more for an assessment. The wheelchair user ends up worse off. Families are left patching things together on their living room floor. And a simple trip for groceries ends in tears, with the sound of a chair scraping across the supermarket tiles.

As David Graeber said, we live in a dystopian bureaucracy. If we got rid of the stupid systems, life would actually improve. Wheelchair services are the perfect case study. And until that changes, the sound of metal on supermarket floors will continue to tell the same story.

• AJM Healthcare delays: up to two years waiting for wheelchairs or parts (The Guardian): https://www.theguardian.com/society/article/2024/may/21/nhss-leading-wheelchair-provider-told-to-improve-as-people-wait-up-to-two-years
• Children waiting over three months for NHS wheelchairs (The Independent): https://www.independent.co.uk/news/health/disabled-children-wheelchair-waits-nhs-b2832900.html
• Families crowdfunding for wheelchairs amid NHS delays (BBC News): https://www.bbc.co.uk/news/uk-66558487
• Ombudsman case: woman waiting 38 weeks for a replacement wheelchair: https://www.ombudsman.org.uk/about-us/our-casework/how-our-casework-makes-difference/case-summaries/534
• Express article: Whizz-Kidz halts waiting list, calls it a “national crisis”: https://www.express.co.uk/news/uk/2112895/wheelchair-disability-charity-whizz-kidz
• Surplus UK mobility equipment refurbished and redistributed overseas (Disability and Rehabilitation: Assistive Technology, 2024): https://www.tandfonline.com/doi/full/10.1080/17483107.2024.2367717
• PhysioNet charity exporting refurbished UK equipment abroad: https://physionet.org.uk
• Motability Foundation report on regional inequality in NHS wheelchair spending: https://www.motabilityfoundation.org.uk/media/xb2jxcdo/rpt_final-report_211123.pdf
• David Graeber, The Utopia of Rules (quote): https://www.goodreads.com/quotes/7500627-bureaucracies-i-ve-suggested-are-not-themselves-forms-of-stupidity-so
• David Graeber, Neoliberalism, or The Bureaucratisation of the World: https://davidgraeber.org/articles/neoliberalism-or-the-bureaucratization-of-the-world/

Thanks for taking the time to read this article. More at www.linktr.ee/emmaastra

About the author

Dr Emma Astra is an ambulatory wheelchair user living with chronic illness. Drawing on lived experience, she writes about the realities of navigating health and social care systems, exposing how bureaucracy often wastes money while leaving disabled people worse off. Her work calls for practical, user-led solutions that restore dignity, independence, and real value for both patients and the NHS.

Emma Astra is a writer, disability advocate, living with chronic illness, and various other disabilities.