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NHS: Chiropody and Podiatry Services

Volume 727: debated on Tuesday 26 April 2011


Asked By

To ask Her Majesty’s Government what plans they have to ensure the continuing provision of training and practice in chiropody and podiatry services under new commissioning consortia and the National Commissioning Board.

My Lords, it is the responsibility of local National Health Service organisations to commission services to meet the needs of their community and the education and training necessary to deliver them, including the provision of chiropody and podiatry services. This will continue in the future.

I thank the Minister for that reply. Does he share my concern that GP consortia may lack the necessary strategic overview to prioritise longer-term preventive care options and ensure future podiatric care? Can he further clarify whether Health Education England, or some other body, will have full responsibility for seeing that adequate numbers of podiatrists and chiropodists are trained?

My Lords, let me first make it clear to my noble friend that GP consortia will not be responsible for commissioning training—at a local level that will be the responsibility of the skills networks, made up of healthcare providers. Health Education England will be a new organisation with new executive powers. It will provide national leadership on planning and developing the healthcare workforce and promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

Is the noble Earl aware of the recent study by the American Podiatric Medical Association which demonstrates that early recognition of foot ulcers or foot problems in diabetics can prevent hospitalisation, or indeed amputation, if action is taken early and resources are commanded to deal with potential problems?

My Lords, I am aware of that study. If we apply the lessons learnt to the UK, the noble Lord may already know that approximately 100 people have an amputation due to foot ulceration, as a complication of diabetes, every week. The International Diabetes Federation has estimated that 85 per cent of these amputations could be prevented through early intervention by a diabetic foot team that includes a specialist podiatrist. Indeed, the diabetes foot protection team in Southampton, to take one area, reduced in-patient stays from 50 to 18 bed days and saved £1.2 million in the first three years.

My Lords, is my noble friend the Minister aware that I consider that any feet over the age of six months are utterly revolting? However, I have a serious question: will wounded servicemen, who are unable to reach their own feet due to injury, be given free chiropody?

I am grateful to my noble friend. She will know that the injuries sustained by our service men and women in the theatres of conflict form a high priority for the National Health Service and the Defence Medical Services. Indeed, chiropody and foot care will play a large part, I am sure, in ensuring the mobility of those wounded personnel. The key will be to ensure that there are sufficient chiropodists and podiatrists to deliver the services required, and that requires a process of local determination and prioritisation to ensure that workforce numbers meet healthcare needs.

My Lords, I have an interest to declare as president of the Society of Chiropodists and Podiatrists. Can the Minister give the House the Government’s estimate of the number of NHS patients who have suffered preventable amputations due to lack of state-qualified podiatric care?

My Lords, it is obviously difficult for me to give the noble Lord a precise figure but his central point is absolutely correct. We know that many people suffer needless amputations who, if they had had early intervention, would be spared that appalling outcome. The role of chiropodists and podiatrists, as he will know more than anyone, is in the field of prevention not least for patients with diabetes but also in the care of the elderly to ensure mobility and proper foot care.

My Lords, in some parts of the UK it is not possible to train as a podiatric surgeon. Consequently, podiatric surgery is not widely available. Will my noble friend tell the House whether in England the Government are planning to encourage more centres for training appropriately qualified podiatrists, thus remedying the situation?

My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.

My Lords, I hope that the Minister will forgive me for being slightly personal, but I wonder how often he trims his toenails. I expect that he can actually reach his own toenails unlike many elderly people who cannot reach theirs, do not have anyone to do it for them and cannot afford a podiatrist. Would the Minister be happy to have his toenails trimmed once every three months, which seems to be the standard offer by health centres and GPs at the moment? I am sure that he will share my concern that even that service is under threat from the cuts at PCT level. Will the Minister undertake to ensure that podiatry services for the elderly become a priority for the National Commissioning Board?

My Lords, I am fortunate in being able to cut my own toenails. However, the noble Baroness makes a serious point about the elderly. It is often the lack of that simple service that prevents elderly people being as mobile as they wish and sometimes confines them to their own homes. This is a serious issue in terms of the way that we can prevent unplanned hospital admissions due to elderly people falling over. The process that I have referred to whereby we will see joint health and well-being strategies emerging from the health and well-being boards at local level should ensure a sufficient supply of the workforce over a period of time.