HOME | Walk In My Shoes Campaign

A campaign for clearer pathways and better problem solving options for users of the NHS orthotics service.

WHAT NEEDS CHANGING

The NHS Constitution says

The patient will be at the heart of everything the NHS does”.

“It should support individuals to promote and manage their own health, NHS services must reflect, and should be coordinated around, and tailored to, the needs and preferences of patients”.

It is clear to many users that this does not apply to them.

There are many different pathways

Patients are not informed about the many existing pathways there are in which the NHS can purchase services and goods through non-accredited companies, such as The Cordwainer.

Sub-contracted by accredited companies (most common) to other accredited or non-accredited suppliers.
Direct purchase from......

These pathways have worked in the case of around twenty patients in the last three years.

Not all rules are clear to the user

The three main questions regularly asked by patients are:

Can non-accredited companies make footwear for the NHS?, and
Where can I go when the NHS cannot get my footwear right?
Who do I complain to when my clinic refuses to listen to my concerns?

Again, because there are no easy pathways or information to follow, patients are left in limbo.

OUR AIMS AND OBJECTIVES

So what's the problem with some NHS footwear, and why does it go wrong?

A little history.

In the 1970s, most orthopadeic footwear was bespoke (made to measure and built by craftsmen). Over 90% was perceived to be satisfactory based on accepted industry standards.

By the 1990s, around half of all NHS footwear supplier is of 'modular' type' (made on a standard last and adapted to firt the patient. Many of the experienced shoemakers within manufacturers have now retired and the satisfaction rate for bespoke footwea is dropping

Now, around 75% of all footwear is of modular type, and only 25% bespoke. The 2011 'Hutton Report@ states that around 30% of all footwear and orthotics supplied through the NHS fails to meet the criteria it was supplied for.

*Orthotic Service in the NHS: Improving Service Provision’ report 2009 stated that 70% of all NHS footwear satisfactory, costing the NHS upwards of £35m. It is generally accepted that this figure has changed little since then.

Lets start by asking the question why?

Time - Orthotists often do not get enough clinic time to see patients with complex needs.

Money - The NHS contract does not pay enough for the best quality products and services.

Skills - The most highly skilled shoe-makers are not working within NHS contractors.

Contracts - When NHS Trust change contractors, patients habe to strart again, sometimes after many years of succesful supplu.

Training - Orthotist training does not always prepare orthotist tto deal with complex foot problems.

Another why?

Why do patients not have the right to receive a satisfactory service, and

Why does the NHS have no obligation to supply a satisfactory service to paitients.

Four easy fixes, what are they?

Patient Choice - If a contractor fails to get your footwear right, you thepatient should have the choice to go back to the original contractor or a new contractor.

The Voucher Scheme - As with the NHS wheelchair services, you should be offered a voucher equivilent to the prescription, which the patient should be able to use the shoemaker of their choice.

Delay Supplier Payment - Manufacturers should only be paid when the footwear oer service is signed off by both the patient and the orthotist.

Hub and Spoke - As with prosthetics (artificial limbs) and wheelchairs, patients with complex footwear requirements should be able to visit their nearest multi-disciplinary centre where the technicians involved in manufacture are in attendance.

The Cost.

What does it cost when it goes wrong?

Case #1

1 pair modular shoes (did not work) £400

4 pairs bespoke shoes (in 5 years) £3200

22 hospital clinic appointments @£75 £1650

Patient travel etc 22 @ £30 £660

Total £5850

Cost to get it right first time £1000

What now?

My shoes are not right !

I'm tired of it all !

No-one is listening !

When do you jump out of the revolving door?

Wait until the orthotist tells you to “take the shoes home and try them”. It gives you a chance to compare the footwear to previous versions, and document the differences, what was right or wrong etc.

be blinded by “you’ll need to wear them in”. Invariably, if they are right, they will feel right

Write and keep a diary of your appointments, and what happened on each occasion.

Write to your orthotics manager. It is clear by now that the orthotist has not been able to resolve your problems. Remember, it’s not their fault, they all want to help.

In the first instance, you should write to your local Patient Advice and Liaison Service. They are independent of the NHS and the contractors, but with little muscle to make a difference.

The next step is to take your case to the Health Services Ombudsman.

Who else can help ?

If you are still getting no joy, try writing to the GP or consultant that referred you to the service

Your Member of Parliament

Be prepared to dig your heels in and say “enough is enough”

The next step is to take your case to the Health Services Ombudsman.

Remember the NHS Constitution

“The patient will be at the heart of everything the NHS does”.

“It should support individuals to promote and manage their own health, NHS services must reflect, and should be coordinated around, and tailored to, the needs and preferences of patients”.

So why does commissioning for NHS services and products not meet this basic requirement for patients?

This campaign intends to ask that question. Patients need to see that their needs are met and that contractors cannot opt out because it suits their profitability or competition from other businesses.

Which pathways are available to GP's, clinicians and patients?

Pathways are the routes which can be used to link the GP or prescribing clinic to the service they need, i.e. the footwear required.

Sub-contracted by accredited companies (most common method) to other accredited or non-accredited suppliers.
Direct purchase from NHS Trusts through their Shared Business Services.
Direct purchase from NHS Trusts through their Financial Services.
Direct purchase from NHS Integrated Care Boards (tbc).

All suppliers are required to submit a questionairre / supplier information sheet to supply the NHS directly or though sub-contractors. Suppliers within the NHS Framework Agreement will be ISO registered (quality control etc) and other stringent financial checks to become an accredited supplier within the framework.

Contractors within the framework can opt to use other accredited suppliers for specific products and services. They can also use un-accredited suppliers if they wish, the products and services are covered in their own accreditation as long as those products and services match their own accredition requirements.

Again, little information isgiven to patients, GPs and clinicians about which contractors can and cannot work within the framework. An aim of this campaign is to make this clear to all users and suppliers.