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Health providers 'ignoring NICE Guidance' says College of Podiatry

Health providers ‘ignoring NICE Guidance’ says College of Podiatry

Patients are missing out on vital care from specialist podiatry services that could significantly improve long term health outcomes and enhance their lives, because commissioners and policy makers are ignoring guidance set out by healthcare advisory body NICE, a new report released today (Thursday 14 December) by the College of Podiatry reveals.

The College of Podiatry report – Podiatry: Driving value, improving outcomes – describes how patients with diabetes, peripheral arterial disease, musculoskeletal disorders and those at risk of repeated falls are being let down by a lack of services that they could reasonably expect.

The report seeks to highlight the need for podiatry services to be recognised, valued, strengthened and utilised in order to help reduce the strain on our over-stretched health service, and help both the NHS and government deliver their early intervention and prevention health agendas.

Diabetes patients are missing out on vital foot care that could save not only their limbs but also their lives because, despite a recommendation that those with diabetes at moderate or high risk of developing a foot ulcer should be referred to a podiatry foot protection service, a third of clinical commissioning groups (CCGs) do not even commission a Foot Protection Service, which offers those at risk a tailored care package in order to reduce their risk.

NICE guidelines also recommend that those with rheumatoid arthritis should have access to a podiatrist for an assessment and a periodic review of their foot health needs. The study found that only half of all rheumatology departments provide basic foot care services for their patients and less than 1 in 10 have formal care pathways or mechanisms for referral to foot health services.

A third of NHS Trusts don’t operate a dedicated Falls Prevention Team either, despite NICE guidance advising comprehensive risk assessments for older people who need medical attention because of a fall. Falls can result in serious injuries, including hip fractures and head trauma, and can be a turning point in an older person’s quality of life, impacting upon their ability to live independently and sometimes resulting in admission to residential care.  

Half of those who sustain a hip fracture never fully recover, and one person in five actually dies within three months. In addition, the likelihood of having a fall increases significantly after the first fall. 

It is estimated that the cost of falls to the NHS is £2.3 billion a year and there are also significant costs for social care services. An individual hip fracture can cost around £6,000 per patient - hospital admission costs of £5,700 and an ambulance callout of £230. 

In its report, the College stresses that both the government and the NHS need to take more notice of NICE guidance where it refers to podiatry services.

Steve Jamieson, Chief Executive at the College of Podiatry, said: “NICE guidelines exist for a reason. They are developed to provide healthcare providers with sound evidence-based advice on best and cost-effective practice. The report shows that expert services such as podiatry are being sidelined, against NICE advice, and we believe that healthcare providers and policy makers need to recognise the role of podiatry in supporting their prevention and early intervention public health agendas, and take NICE guidance more seriously.”

“Ignoring NICE guidance and side-lining expert services such as podiatry is a false economy and can result in problems escalating unnecessarily, costing patients and the health service dearly.” 

Foot and lower limb health is an important factor in the overall wellbeing of the population, and there is strong evidence to support early podiatric intervention to improve the mobility and independence of all people who experience foot health problems. 

Painful long-term conditions, like rheumatoid arthritis (RA), can result in musculoskeletal (MSK) conditions which consume around five per cent of the NHS budget, and every day in the UK over 21 per cent of the population consult a GP about this kind of pain. 

The annual financial cost of treating a single patient with RA in the UK is over £14,500, and the total bill for treating all 400,000 people in the UK with RA is around £6bn. 

Quite apart from the costs to health and social care services, these kinds of conditions can drastically impact upon a person’s quality of life. According to a European study, people with RA can have the lowest quality of life as a result of their condition, compared to people with all other chronic diseases.

Steve Jamieson continues:

“We need to see a change in the way care is provided to people with a whole range of lower limb conditions. Best practice is not about reinventing the wheel, it is about adopting good ideas. This report sets out the simple measures that could make the difference in three areas that impose a huge cost burden on the NHS across the UK and ruin countless lives. 

“By not making better use of their existing resources, healthcare leaders are missing an opportunity to save money, make our health and social care system ready for the challenges of the coming decades and improve patient outcomes.”

Case study and Notes to Editors follow

For further media information, please contact:

Claire McLoughlin, Senior Media Officer, The College of Podiatry on 020 7234 8648 or email: cm@scpod.org


Simon Colvan/Kathryn Race/Taryn Glenister at Ceres PR on 01189 475956 

or email: collegeofpodiatry@ceres-pr.co.uk 

For out-of-hours media enquiries call: 01189 475956

Notes to Editors

  1. The College of Podiatry is the academic authority for podiatry in the UK, and an independent charity dedicated to foot health research, education and public awareness. The College is the public facing and academic arm of the Society of Chiropodists and Podiatrists – the professional body for the UK’s registered podiatrists. Podiatry is the field of medicine that specialises in diagnosing and treating diseases and disorders of the foot and lower limb.
  2. The College of Podiatry has launched the Driving value, improving outcomes campaign to promote the value of podiatry and support the role of podiatrists in improving public health through preventative care and adding value to the health service through cost saving specialist services.
  3. This report makes a set of simple but effective recommendations to better and more effectively deploy podiatry services in four key areas; diabetes, vascular disease, falls prevention and musculoskeletal conditions, all areas of significant spend within the NHS and social care. 
  4. A reception, hosted by Shadow Health Secretary Sharon Hodgson MP, will take place in Dining Room A at the House of Commons, on Wednesday 13th December between 4.00pm and 6.00pm to officially launch the campaign. It will bring together parliamentarians, commissioners and practitioners to celebrate the value of podiatry. Attendees will hear from some of those services featured in the report, which are developing innovative and impactful service offerings, which can be replicated across the country. Journalists wishing to attend should contact Sara Petela at PB Consulting sara@mailpbconsulting.com
  5. The report makes a number of practical and achievable recommendations. 


Recommendations for health care providers are in three specific areas:

Diabetes, Peripheral Arterial Disease (PAD) and foot protection services:

  1. Podiatrists should be employed in community-based PAD assessment and triage services within each Trust/Board in order to facilitate early diagnosis and intervention with foot ulceration and severe or critical limb ischaemia, thereby reducing pressure on hospitals and optimising effective treatment of these life-shortening and limb-threatening conditions. 
  2. In order to reduce regional variation and ensure  higher standards of care and better patient outcomes, there should be greater compliance with NICE and SIGN recommendations that podiatrists should lead foot protection services and that people with suspected PAD be offered a NICE-recommended assessment, including ankle brachial pressure index (ABPI) and access to structured exercise programmes or vascular teams, as needed.
  3. The NHS must invest in long-term development of podiatrists with the relevant skills and competencies to deliver diabetic foot care and early diagnosis of PAD. This includes commissioning learning placements and opportunities to undergraduate and postgraduate podiatrists.


Musculoskeletal conditions:

  1. Every patient newly diagnosed with rheumatoid arthritis should be referred to podiatry services for an assessment as well as podiatric and orthotic treatment as required.
  2. Patients with rheumatoid arthritis should have an annual assessment by a podiatrist to ensure rheumatic foot health problems do not escalate. 


Falls prevention:

  1. All falls prevention teams should include a podiatrist, or have access to a podiatrist. This should be reflected in relevant NICE and SIGN guidance. 
  2. Anyone over the age of 65 who has a fall should have a foot check carried out by a podiatrist. This should be reflected in relevant NICE and SIGN guidance. 
  3. Education and signposting must be provided to patients deemed at risk of falling on how to reduce their risk of falling, including information on how they can access podiatry services within the community. 


Additional recommendations for government and the NHS are:

  1. Government should publicly recognise the unique contribution and role of podiatry in supporting the early intervention and prevention agendas. 
  2. In order to standardise access to podiatry services across the country, the NHS across the four nations should mandate data collection relating to the commissioning on the podiatry workforce and services. 
  3. Government and the NHS should take action to facilitate a wider uptake of NICE and SIGN guidance. 


CASE STUDY - Pip’s Story

Charity CEO, Pip, resolved to improve her physical fitness at the age of 49 to help her cope with the rigours of a demanding lifestyle.

Walking became her activity of choice and she embarked upon her new regime with enthusiasm, taking in some eight or so miles each day.

Pip lost weight and felt invigorated. She was even able to stop taking blood pressure medication, as her overall health and fitness improved.

After about a year though, she began to experience pains in her hip.

Pip visited her GP, who diagnosed bursitis of her hip, an inflammatory condition with many possible causes. He suggested ibuprofen and sent Pip for an x-ray which was clear. 

Pip’s new exercise regime had become important to her, and so she carried on walking eight miles a day, wearing a popular type of fitness shoe that supposedly helped to firm more muscle and burn extra calories while she walked.  

Eventually though she developed shin splints and knee pain, and the pain in her hip increased to the point where it prevented her from sleeping. 

The pain was almost unbearable. Pip was unable to walk without searing pain in her knees and shins. Sitting and lying down just shifted the pain to her hip and although she was able to continue working, there was just no escape from the agony.

It was a colleague at work who gave her the advice she needed. A former podiatrist, Pip’s colleague suggested a biomechanics assessment, so Pip asked her GP for a referral.

The podiatrist who carried out the expert assessment advised Pip to change her footwear and prescribed some bespoke orthoses to go inside her footwear.

The result was miraculous. After eight months of distress, Pip was able to walk much more comfortably within a week. Within a month she was completely pain-free and able to, meander or march through the countryside, as she walked the eight miles to work and home each day, then relax in a chair afterwards without any pain.

Pip said:

“It was remarkable; all my pain disappeared. 

“I had been so upset that, having finally committed to a form of exercise which was making such a difference to my life and health, I had been forced to stop because of my very painful aching limbs. Since seeing the podiatrist though, and having an expert assessment, I have been able to walk for as long as I like, as often as I like. 

“He explained that my feet need to be kept stable, firmly laced-in and on firm soles – not the squashy soles in my expensive, calorie-burning trainers that had allowed them to pronate, making me walk with most of the weight on the inside edge of my feet and causing a problem higher up in my hip.

“Each year my orthotic prescription is checked by my podiatrist and I get new orthoses, which are free as my treatment is from the NHS.

“Now I extol the benefits of podiatry to everyone I meet who has foot or leg pain. I tell them all how much I have benefited from taking up exercise and how my biomechanical assessment by a specialist meant that I could carry on keeping fit and enjoying being active.

“I really do wonder how many people there are who would benefit from an appointment with a podiatrist and a decent pair of shoes.

“My only regret is that I didn’t initially know what to do. I wish I had seen the podiatrist sooner.”