Orthotics: why we need national and local change

New guidelines for improving Orthotics Services published by NHS England last month have received an enthusiastic response across the healthcare system.

Not least of all from Lynne Rowley, Chair of the British Association of Prosthetists and Orthotists, who described it as “identifying the negative financial impact on the wider health economy which occurs when there is a failure to provide a high quality Orthotic service and highlighting the positive impacts on both individual patients lives and commissioning priorities that stem from a high quality service.”

Here, NHS England’s Chief Allied Health Professions Officer, Suzanne Rastrick, explains the importance of the new guidance:

It is without question that orthotics services play an essential role in enabling quality of life for people with long term conditions, disabilities and limb loss.

They 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 these 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.

Being able to access the right orthotics provision quickly, and with appropriate support, is of paramount importance but unfortunately this doesn’t always happen.

People can find themselves waiting a long time for equipment and develop secondary health complications. And long waiting times mean that children, in particular, may have grown before their specialist equipment finally arrives.

These are avoidable and unfair inequalities, while also proving costly to the taxpayer.

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.

A consistent and integrated orthotics service would provide significant health and quality of life benefits for patients, while also delivering financial benefits for the NHS and economic benefits for the wider economy

Patient feedback indicates there is much variation in orthotics services but the lack of quality measures and data have hindered effective commissioning.

Clinical Commissioning Groups and NHS Trusts have been working to improve services and to solve some of the problems we face. Some provide highly personalised care and next-day delivery for standard orthotics products.

The report, Improving the Quality of Orthotics Services in England, identifies a number of effective models which achieve excellent outcomes and levels of patient satisfaction, some provided in-house in acute trusts or in the community, others outsourced to the private sector.

The benefits include better access through reductions in waiting times for assessment and fitting of orthoses; higher activity levels at reduced costs; more focus on achieving outcomes and better overall experience of care for patients.

The report sets out a compelling case for action and explains why it is important to improve the commissioning of services in terms of patient care, clinical and cost benefits and discusses some of the key issues affecting services currently, along with the experiences that diverse patients and their families have had in using those services.

This is aligned with the Five Year Forward View by supporting a preventative approach through effective commissioning and provision of quality orthotic care and, most importantly, stresses the need to develop quality metrics to monitor orthotics services and encourages a move towards more outcome based commissioning and improving equity for patients.

Commissioners and providers can improve services in a number of ways including continuously engage and involve patients and their families. They can also implement direct access referral for general practitioners, allied health professionals, registered nurses and consider self-re-referral for appropriate patients.

It is imperative the NHS finds the correct approaches to bring about national and local change where patients can expect greater quality and consistency in orthotic services in the future. Thanks to the results of the national review and the guidance we published earlier this month, we have taken a major step towards this.

Suzanne Rastrick

Suzanne qualified as an Occupational Therapist from Oxford. Suzanne was the first Allied Health Professional (AHP) to hold a substantive Director of Nursing post in both provider and commissioning organisations. She became the Chief Executive of a Primary Care Trust, where a particular highlight was having leadership responsibility for delivering health resilience and health ‘blue light’ services during the Olympic sailing events held in Dorset in 2012. She subsequently gained authorisation for a large Clinical Commissioning Group, before moving to her current post with NHS England. She was appointed as Chief Allied Health Professions Officer for England in September 2014.

In 2017 Suzanne launched the first AHP strategy for England which has been recognised as ground-breaking in policy development from its use of crowdsourcing. Building on this, Suzanne published the second AHP strategy – ‘AHPs Deliver’ in June 2022. This iteration had a greater emphasis on patient, public voice and specifically the inclusion of those who may be digitally excluded along with communities who may find it difficult to connect with traditional consultation methods. The result is a national strategy crowdsourced from diverse populations for people and communities AHPs serve.

For over three decades, Suzanne has held non-executive portfolios outside of the NHS, including audit committee chair roles, predominantly in the housing and charitable sector. Suzanne was recognised as an Officer of the Order of the British Empire (OBE) in the Queen’s birthday honours list 2019. In 2023 Suzanne was awarded a Visiting Professor role at St George’s, University of London and at Oxford Brookes University.

Follow Suzanne on Twitter/X @SuzanneRastrick or Instagram @chief_ahp_officer_england