New guidelines to drive improvement in orthotic services

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:

  1. Understand what orthotics care is by talking to patients, carers, managers clinicians and the multi-disciplinary team.
  2. Examine all of the funding streams your CCG is using to fund orthotic care in your local health economy.
  3. Unbundle these funding streams to understand the total orthotic investment and consider using a tariff.
  4. Consider adopting the model service specification which includes patient satisfaction measures, Key Performance Indicators and patient outcomes.
  5. 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.
  6. Think about the location – patients generally prefer a non-hospital setting with free parking close to the service.
  7. Promote access and choice – can you offer near-to-home clinics from local health centres, community venues, day services or special schools?
  8. Encourage multidisciplinary working by commissioning multi-disciplinary pathways for specific conditions such as diabetic foot clinics and orthopaedic clinics.
  9. Look at case studies to inform the most appropriate commissioning model for your area.
  10. Involve service users in performance reviews of the service.


  1. Chris. Mottram says:

    Very interesting report!
    I have an orthosis for my left arm, which needs replacing due to its age. The physiotherapist at my local community hospital was eventually able to make contact with the County service provider (N.H.S hospital) , only to be told that there are 200 (!) people in the queue waiting for various orthoses.

  2. Ann Ward says:

    I was prescribed orthoses over 1 year ago, or more, and still wait them!! So where has this process been speeded up?
    Due to the extremely poor service in this area, I have now incurred a trigger toe which can only have occurred due to the time I have waited for theses orthoses !!!!!

  3. Mrs J Palmer says:

    I am really interested to read this as my mum is now housebound because she cannot get the right cafo from the hospital to meet her needs. After two attempts the hospital cannot get it measured or made correctly for her. We are at a loss as what to do.

    • Anonymous says:

      I am sorry to hear about this experience. Have you made a complaint to the hospital? Or to the local Clinical Commissioning Group, responsible for the service? You might also like to contact the orthotics campaign, who can offer advice. Neil Churchill

  4. Rosalie Haymon says:

    I was given an ankle brace to wear, which with in a few days had given me cartridge tears in my knee. Now awaiting knee surgery to correct the podiatrists incompetence. So very very painful, frustrating, and totally unnecessary. Foot problem I originally went with still no where nearer sorted. Been on painkillers & stomach liners for 3 months just waiting for the NHS to correct their error. Why is the NHS not criminally liable for their errors and made to correct them ( if they can) straight away, instead of saying oh join another queue we have 18 weeks to treat you!

  5. Rebecca Loo says:

    Commissioners need to understand the consequences of using a block contract for Orthotics. If our local hospital had given my son the timely orthotic care he had needed, then it would have cost them money from their block contract. However, they failed to manage his condition with timely orthotic care and he inevitably ended up needing orthopaedic surgery. This Orthopaedic surgery of course is funded on a PbR tariff. Therefore to prevent my son’s deformity the hospital would have lost money – but by allowing his deformity to progress they were then able to generate income. Our children are at the mercy of a system that currently financially rewards hospitals for letting children get deformed and then performing avoidable surgery on them. THIS MUST STOP NOW. Any commissioners who want to talk to our group are most welcome to contact us at Thanks for anything you can do. I don’t want another child to have to go through what my son has gone through. Not to mention the horrific waste of tax-payers money.

  6. Breda Hurst says:

    Re Orthotic Review, The following amendments would be useful ie humane,That injuries by badly fitted fitted appliances due to unqualified assessments ie- (injuries are normal, why do you need to walk? What are your hobbies? It’s reasonable that the patient has to guess the specifications the need, ) ect ect, when will Fraud and criminality apply ie the post code lottery of unqualified assessments, the un recorded injuries and raciest remarks ie (polio is a third world decease) the cost in monetary exploitation by unregulated exploitive Orthotic indursty that NHS England must be aware of, macking them comperal in corporate criminality, NHS England is not awear of thease issues?????,Breda Hurst.

  7. Breda Hurst says:


  8. Breda Hurst says:

    Re the Orthotic review) Question? Where/how can I have my heavy badly fitted callipers (INDPENDENTLY) assessed, my condition is polio/post polio and I have endured 30 plus years nightmare of injuries, my polio has been referred to as a third world decease, does your orthotic review consider how patients are assessed by unqualified tectnitions where ( injuries are normal ) and patients are not listened to or believed?ie me,I consider I have been defrauded of my life and money, through criminal incompatance at the Royal Bolton Hospital and Salford Hope Hospital, All patients with Nhs Orthotics should be recalled to be assessed,Breda Hurst, ps Through this I have no GP, and am serverly depressed, 30 plus years of (trial and error) by these charelatons has cost me dear, when £20.000, would have bought me what I needed for life I’ve spent a lot more than that, some regulation of the orthotic industry would be a start, they advertise callipers in certain publications like they are comman consumer items but no consumer protection, please tell me where I can send my DVD of my wardrobe full of unwearable appliances, I’ve had to guess myself that I need different specifications for right and left side and have nerve damage, people with disabilitys can be injured with INPUNITY as far as the NHS is concerned ie (The Bad Health Indursty) All of this has been related to the Orthotic Campaign a very worthy cause, also to BAPO who’s response was that they represent their members only and are not concerned about patients,Says it all really, PPs my heavy badly fitted callipers and injuries are not recorded in my medical records, I hope your ORTHOTIC REVIEW MAKES SOME RECOMENDATIONS ON THIS POINT, I AM NOT HOLDING MY BREATH, AND CRIMINAL INJURIES SHOULD APPLY

    • Anonymous says:

      I understand perfectly what you’re saying Breda. My Orthotics nightmare has been ongoing since 1973 still nowhere near sorted. It becomes more complex as it goes on. Badly fitted appliances cause more damage in the long run…..
      NHS would save more money and limit service users damage if appliance provision was correct from the off.
      It appears training of Orthotists is not the simple answer.
      I too have a cupboard full of unwearable boots and appliances. I’ve offered them for use overseas but was told ” even they wouldn’t take them “.
      What a waste – as calliper wearer, the late Ian Dury would opine. Hoping with persistency we will achieve changes.

  9. Juliet Sturgess says:

    Thank you to NHS England and all those involved for this really useful report to help drive service improvement.