Patients in England should be able to expect greater quality and consistency in orthotic services in the future thanks to the results of a national review.
NHS England has today (Thursday 19 November) issued a call for local commissioners to improve how vital ortheses are provided, alongside a suite of guidance and resources to help them do so.
Orthotic services provide prescription insoles, braces, splints, callipers, footwear, spinal jackets and helmets which help people recover from or avoid injury, or live with lifelong conditions.
The correct supply and fitting of orthoses can help improve quality of life by reducing pain, keeping people mobile and independent and preventing more invasive and expensive interventions like surgery, amputation or the need for social care.
Previous studies have estimated that for every £1 spent on improving orthotics services, the NHS could potentially save as much as £4.
However, there remain significant variations in the quality of services and waiting times to access them across the country. Not getting things right first time for people who need orthoses is resulting in avoidable inequalities in access, worse outcomes, poor patient experience as well as poor value for money.
NHS England’s new guidance, Improving the Quality of Orthotics Services in England, aims to help local Clinical Commissioning Groups address this variation. It has been produced in cooperation with local commissioners, providers and patient groups, and draws on the findings of a recent review of services by NHS Quality Observatory triggered by concerns raised by Healthwatch England.
It sets out 10 recommended steps for commissioners to take towards better services for patients, including understanding local needs and preferences, delivering services in the community rather than out of hospitals, and encouraging joint working between health professionals to streamline the experience for patients and avoid unnecessary duplication.
Neil Churchill, Director of Patient Experience at NHS England, said: “Being able to access the right orthotics equipment, quickly, and with appropriate support, is of paramount importance to patients.
“This doesn’t always happen at the moment, but this new guidance is the beginning of what we hope will be a significant and sustained improvement in the services that patients can benefit from, wherever they live.”
Suzanne Rastrick, Chief Allied Health Professions Officer, said: “Orthotists and the services they provide are a crucial part of how we address the needs of patients who have suffered injuries or have long-term conditions which affect their movement.
“This guidance is about making sure that this important role and facet of care is properly recognised across the country, and helping local commissioners ensure that services in their area meet the needs of the local population in a timely and efficient way.”
Anna Bradley, Chair of Healthwatch England, said: “Local Healthwatch across the country have told us that people are being affected by a lack of access to the right orthotics service. We know that in turn, this can have a devastating impact on their physical and emotional health and wellbeing.
“We therefore warmly welcome this report from NHS England, following work undertaken as a result of the concerns we raised with them. We are especially pleased to see that the onus will now be with local commissioners and services to fully understand their patients’ needs and so improve orthoses and ensure their communities are getting access to the right services.
“This approach could improve orthotics care for thousands and save the health service millions. It shows what is possible when the system listens to patients and redesigns services around their needs – people get the care they deserve and the NHS makes much needed efficiency savings.”
The report launch coincides with a stakeholder workshop being held today, which aims to find a way to get better quality and performance data on orthotics services to identify variation and help drive improvement.
The full list of key recommendations to Clinical Commissioning Groups to help improve commissioning of orthotics services made in the report are:
- Understand what orthotics care is by talking to patients, carers, managers clinicians and the multi-disciplinary team.
- Examine all of the funding streams your CCG is using to fund orthotic care in your local health economy.
- Unbundle these funding streams to understand the total orthotic investment and consider using a tariff.
- Consider adopting the model service specification which includes patient satisfaction measures, Key Performance Indicators and patient outcomes.
- Clarify the service delivery model you would like to use – for example, retain NHS employed staff (‘in house’) who may use multiple product manufacturers, versus privately employed clinicians who would largely provide their employers’ own products.
- Think about the location – patients generally prefer a non-hospital setting with free parking close to the service.
- Promote access and choice – can you offer near-to-home clinics from local health centres, community venues, day services or special schools?
- Encourage multidisciplinary working by commissioning multi-disciplinary pathways for specific conditions such as diabetic foot clinics and orthopaedic clinics.
- Look at case studies to inform the most appropriate commissioning model for your area.
- Involve service users in performance reviews of the service.