Postcode lottery for NHS orthotics patients

Specialist orthotics care for patients with mobility issues varies significantly depending on where they live, new research reveals.

In future, there will be an increased demand for orthotics services because of the projected population growth, the aging population and the rising prevalence of obesity, diabetes, cardiovascular and peripheral vascular diseases. Nachiappan Chockalingam, Professor of Clinical Biomechanics

Adapting splints and footwear can decrease the energy children with Cerebral Palsy use by as much as 33%. Staffordshire University

Staffordshire University 25 October 2019

The findings, published on BMJ Open, have uncovered major differences across orthotics services at various NHS trusts and health boards.

Problems within orthotic service provision in the UK have been the focus of a number of reports by the NHS and other organisations. An NHS report from 2014 highlighted that many patients experienced long waiting times which could lead to the development of secondary health complications.

Professor Chockalingam and colleagues at Staffordshire University based their research on Freedom of Information (FOI) requests sent to all NHS trusts and Health Boards in the UK. The survey scrutinises information on Finance, Service Provision, Staffing, Complaints, and Outcome measures and key performance indicators (KPIs).

The results highlight large variances in the length of appointments, appointment waiting times, product entitlements for patients, and product lead times. Certain geographical areas were found to provide shorter waiting times and wider access to assistive devices. The findings also reflect there is more information available on the quantity of service above the quality of service.

The findings showed that:

  • average and maximum waiting times for adult appointments were 7 and 34 weeks, respectively.
  • Scotland seems to fair better in all of the reported measures. Patients in Scotland have longer appointment times and the average waiting times are lower.
  • some Trusts are not fully accommodating the needs of children

Nachiappan Chockalingam, Professor of Clinical Biomechanics at Staffordshire University, explained: “Within the NHS, the Orthotics Service is poorly understood and low in priority lists. Therefore, it is essential to evaluate the current state of provision to ensure that services are capable of meeting future demands.

“In 2011, a report estimated there were two million orthotics users in England and assistive devices including wrist splints, custom footwear, foot and ankle support, back and neck braces are needed to alleviate pain, help patients recovering from injury and those with chronic conditions.

“In future, there will be an increased demand for orthotics services because of the projected population growth, the aging population and the rising prevalence of obesity, diabetes, cardiovascular and peripheral vascular diseases.”

Dr Aoife Healy who co-authored this study added: “Our results highlight that some of the Trusts appeared to not accommodate the needs of children fully. Waiting times of 20 weeks for routine and 8.2 weeks for urgent appointments are unacceptable.”

The researchers hope that these findings will prompt the NHS to instigate its own evaluation of services across the country.  Ms Lynne Rowley, Chair of British Association of Prosthetists and Orthotists (BAPO) said: “We welcome this study, which clearly showcases the inequalities across orthotic service provision in the UK. BAPO has been aware of this issue and has been working with NHS England. However, this study is timely and provides a push in the right direction.”

However, the combination of the number of Trusts and Health Boards who declined to reply to the FOI request and those who replied with limited information hindered the team’s ability to provide a national picture of Orthotic Service provision.

Professor Chockalingam added: “The UK NHS needs to establish appropriate processes to record the quality of service provision since this will enable improvements in clinical management and ensure good value for money.”

Source Staffordshire University


Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive? Chockalingam N, Eddison N, Healy A. BMJ Open 2019;9:e028186. doi: 10.1136/bmjopen-2018-028186. Full text

  Further reading

Improving the quality of Orthotics services in England, Neil Churchill, Cathy Regan. England NHS. November 2015. PDF

Orthotic Service in the NHS: Improving Service Provision, John Hutton, Manjusha Hurry, York Health Economics Consortium Ltd, University of York. July 2009. PDF

Assessment of the care process with orthotics, prosthetics and special materials, Moraes CDS, Rabin EG, Viégas K, Rev Bras Enferm. 2018 May;71(3):1099-1105. doi: 10.1590/0034-7167-2017-0031. Portuguese, English. Full text

Also see
Comparison of the healthcare systems in Canada and the United States in Wikipedia

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