One question we get asked a lot, is why there is need for private provision for such things as Orthotics, when we have such a wonderful National Health Service here in the UK. This is a fantastic question, and one that can be answered in a number of ways. Firstly, there is the small matter of demand and supply. Just as with Opticians, Dentists, Physiotherapists, Surgeons, Audiologists etc etc, a market has developed for people wanting a service that offers the individual what they specifically want, be that a shorter waiting time, a more flexible appointment system, or even a greater level of choice with devices for example. This is certainly true of all of the areas mentioned here, and in many other areas of healthcare too. Another reason why private provision in so many areas is growing, is because of something known colloquially as the ‘Postcode Lottery’, which in short, means that there is not an equal level of service throughout the NHS. It has been believed for some considerable time that this lottery exists, and that the level of care you will receive would depend significantly upon where in the country you lived. This is clearly not fair, and has inevitably led to an increase in the need for alternative services in certain places. The reasons for the so-called lottery are varied, and can range from finance to geography; however the outcome is the same.

In a departure from my fairly ‘light-hearted’ approach to all things Orthotics, this month I want to highlight a study that has been conducted by a team of professionals from Staffordshire University, the authors of which are Chockalingam, N,  Eddison, N, and Healy, A (2018). This paper has been published in the British Medical Journal (BMJ) as part of their Open Access journal; however, the British Association of Prosthetists and Orthotists (BAPO), have provided a very concise, yet accurate synopsis of this study, and I have placed this here for your information. I don’t need to say much more about this topic, as this piece sums up the problem quite succinctly.

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Postcode Lottery for NHS orthotics patients

Specialist orthotics care for patients with mobility issues varies significantly depending on where they live, new research by Staffordshire University reveals.
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 2m 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.”
Read the full paper http://dx.doi.org/10.1136/bmjopen-2018-028186 here.

This is by no means an apologetic piece, but one in which I hope I have prompted thoughts about the possible causes of waiting times, the limits placed upon types or numbers of devices available, even the availability of the service at all, and so on. As I have stated several times in this blog over the last 12 months or more, the NHS in the UK is fabulous, and a model for the rest of the civilised world. What it isn’t however is perfect, and certainly not in our very imperfect society currently. Private practice exists to fill gaps for those who increasingly recognise its limitations, as they have with eye tests, dentistry etc for some years now. If you can’t access private healthcare for whatever reason however, REMEMBER, however flawed it may be at times, the NHS is still there for you, and long may this be the case. 

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