Memorandum submitted by the Society of
Chiropodists and Podiatrists
RESPONSE TO THE DRAFT NATIONAL HEALTH SERVICE
1.1 The Society of Chiropodists and Podiatrists
is the professional organisation in the United Kingdom for State
Registered Chiropodists/podiatrists, with a membership of more
than 8,000, including around 350 in Wales, representing over 90
per cent of the State Registered profession. Our members practise
in the National Health Service (NHS), commercial, industrial and
private sectors; and teach in higher education institutions.
2. THE VALUE
2.1 Good foot health care is vital in ensuring
the mobility and quality of life. Those with conditions affecting
their circulation, such as diabetes, who are usually older people,
are most at risk. Without regular podiatric treatment their mobility
is likely to decline, and they risk infections which may rapidly
lead to gangrene and result in amputation. Where podiatrists are
involved in the care of patients with diabetes, the number of
amputations is reduced by 40 per cent, saving the NHS at least
£60,000 per patient. Attached at Annex 1 is a summary of
the scope of practice of the profession. Research now indicates
podiatry has a significant role in preventing older people from
becoming dependent on others and delaying their seeking assistance
from health and social care services and professions. It is therefore
2.2 At present access to podiatry varies
widely across the country and in many areas only those at highest
risk can access any treatment. The Society is concerned about
such inequalities. Given the expected increase in the ageing population
and the number of patients with diabetes, there will be a consequent
increase in demand for podiatric care. At present podiatry degree
courses, including the one at the University of Wales Institute,
Cardiff, are experiencing considerable difficulty in recruiting
to their degree courses. This issue needs urgently to be tackled.
Government needs to play its role in promoting this profession
as a career. First, the need is to raise the profile of podiatry
as a "health promotion" therapy vitally important to
the diabetic and older population. Secondly, there needs to be
active recruitment within schools and the community. There are
positive cost benefits for wider health and social care agencies.
2.3 We understand that a further 2,000 allied
health professionals are to be recruited. The Society supports
the Partnership Forum Staffside's request that funding is ring-fenced
for this purpose. We are concerned about delays in implementing
consultant therapist posts and Agenda for Change.
3. COMMENTS ON
3.1 We are disappointed that the Bill does
not mention the professional bodies who represent the various
health professions covered by this legislation. We are concerned
that there has been virtually no consultation with the Society,
and presumably with other health professional bodies, during the
preparation of this legislation, and the establishment of the
Health Professions Wales. The Society is keen to work effectively
with the Welsh Assembly in achieving developments following devolution.
4.1 The Society welcomes the aim of involving
patients more effectively in their health care, though we have
yet to be convinced that the measures outlined in the Bill will
achieve this end. There is a history of the foot care needs of
older people and those with diabetes being subsumed by NHS structures
not entirely sympathetic to the patients' wishes and we welcome
patient involvement. We recognise that some CHCs, such as Cardiff,
have been particularly effective.
5. WALES CENTRE
5.1 The Society welcomes the establishment
of the Wales Centre for Health and looks forward to working with
it. It is vital, however, that it is funded using new money, not
from existing NHS resources.
6. HEALTH PROFESSIONS
6.1 There has been a disappointing lack
of consultation with professional bodies on the establishment
of Health Professions Wales (HPW). There also seems to have been
a lack of consultation with the statutory body, the Health Professions
Council (HPC), despite the fact that the Draft Bill identifies
a relationship between the two bodies. This is sending very negative
messages to the wider profession and could result in their opting
out of systems seem to be over-bureaucratic.
6.2 We are concerned that the remit of this
new organisation appears to be extremely nurse-orientated. We
would wish for reassurance that all professions will be effectively
represented on HPW and that profession-specific issues will be
fully covered. Once again the allied health professions feel marginal
to health policy. However, their patient contacts and caseloads
are disproportionally high in relation to their numbers as a proportion
of the total health care workforce.
6.3 We would expect HPW to work closely
with the professional bodies and trade unions representing the
health professions, as well as the HPC, and other regulatory bodies,
and higher education institutions.
6.4 The Centre and Health Professions Wales
will both be concerned with training, but it is unclear how their
functions will relate to each other. This needs urgently to be
clarified. Regulation and registration issues must remain the
sole responsibility of the regulatory bodies. It is important
that there should not be overlapping responsibilities which will
lead to confusion and the possibility of inconsistency.
6.5 As with WCH, it is important that HPW
is properly funded with new money, not existing resources. It
is unclear from the Draft Bill whether there is to be an additional
registration fee for HPW. If professionals are obliged to register
with two bodies, this will put an additional financial burden
on health professionals practising in Wales, and could cause considerable
confusion. Practitioners may not realise that they need to be
registered with both bodies, and they risk practising illegally
by failing to be registered properly. The risk needs to be recognised
that podiatrists/chiropodists may not accept over-regulation.
One third of the profession are approaching retirement and may
simply choose to absent themselves from over-regulated systems
and practise under a different title. If this were to happen,
patients outside the NHS would remain unprotected, as they are
under the current system which allows unregistered chiropodists
to practise outside the NHS.
The Society would welcome assurances that it
will be fully consulted in future on all issues relating to the
practice of podiatry in Wales.
Hilary De Lyon
26 June 2002
Chiropody and Podiatry: A Summary of the Scope
1. Biomechanicsis the measurement
of the relationship between bone, muscle and soft tissue. A small
structural imbalance in the foot may cause no foot pain at all,
it may cause problems in the ankles, knees, hips, back, or neckall
parts of the body that are connected to the feet by the skeleton.
Biomechanics is often used to treat people who suffer from rheumatoid
arthritis, a disease that deforms joints, particularly those in
the legs and feet. Chiropodistsand
out biomechanical assessments of these patients to reduce their
discomfort and increase stability, keeping them as mobile as possible.
2. PodopaediatricsSome research suggests
that 90 per cent of children have foot problems, which can cause
great concern among parents. While many children's foot problems
are self-correcting, podiatrists who specialise in working with
children have an in-depth understanding of children's feet.
3. High-risk patient managementHigh-risk
patients have a condition, such as diabetes, cerebral palsy, peripheral
arterial disease and peripheral nerve damage, which puts their
legs and feet at increased risk of injury and disability. Chiropodists
assess and treat these patients to reduce the long term and sometimes
very serious problems that can result, such as amputation. Research
has proven that providing chiropody treatment reduces amputation
rates by 40 per cent. For example, many patients have very poor
circulation resulting in fragile, easily injured skin. Some patients
have no sensation in their feet; they can injure themselves without
knowing so that, for instance, waling with a stone in their shoe
for 30 minutes leads to ulceration. Ulceration, if not treated
promptly or correctly, can lead to amputation in serious cases.
4. SurgeryA State Registered Chiropdist
is qualified to administer local anaesthetics and is trained in
a number of surgical procedures such as nail surgery and soft
tissue surgery. This differentiates them from the other Allied
Health Professions, which do not underake invasive surgery at
all, but still play an important role in healthcare. Podiatrists
who have trained as podiatric surgeons surgically manage bone
and joint disorders within the foot, often working in specialised
medical teams. Research indicates that there is high patient satisfaction
when podiatric surgeons carry out their work.
5. General clinics of chiropody/podiatryeven
relatively minor foot problems such as a corn, if untreated, can
result in considerable pain, and potentially lead to life-threatening
or disabling complications. When you consider that three out of
four adults suffer foot problems, it is easy to see that chiropodists
play a vital role in the well being of the nation's health.
1 The terms "chiropodist" and "podiatrist"
are interchangeable. Back