"A hope for change at Bacup Podiatry Department"

About: East Lancashire Teaching PCT / Podiatry

(as the patient),

As someone who is a champion of the NHS, and has been well served by it, what follows is not a complaint, nor is it intended as a criticism of any individual. I just hope that, by recording my experience with the Bacup Podiatry Department, some aspects of the service provided will be reviewed to the advantage of all users.

In the summer of 2008 I began to suffer from plantar fasciitis and my GP referred me to the Podiatry Department, at Bacup Primary Health Care Centre. In due course, I was told that my name was on the waiting list and that I would be given an appointment as soon as possible. Having heard nothing further for quite some time, and with the pain in my heel increasing on a daily basis, I decided to phone and enquire when I might expect to be seen. It was at this point that I noticed the August letter bore no phone number (and, for that matter, no postal code). Luckily, I have a friend working in the NHS who provided a number - 0845 054 0033 - so I called Reception at Bacup Podiatry. I was told that the Podiatry Department was very busy but that I should expect an appointment in the near future. (I took the opportunity to point out the absence of phone number and postal code on the August letter.)

A follow-up letter (this time with a phone number, but still no postal code) asked me to contact the Department if I still wanted an appointment. As a result, I attended the clinic. When I arrived, having been told how busy the department was, I had expected it to be crowded. To my amazement, I think that I was the only person in the waiting room. On every subsequent occasion that pattern has been repeated, and I can't ever recall seeing more than three patients, if that many, in the waiting room. I was issued with 3/4 length orthotic inserts, built up on the right foot, instructed how to break them in and given an exercise sheet to supplement their use.

I had assumed that I would be called in again for a review of my progress, but heard nothing. Meanwhile, the supplementary lift applied to the right insert had come unstuck. I phoned Bacup and was given an appointment for April 2009. The unstuck item was re-stuck, I was given another set of inserts for spares, and told that I should be all right for another twelve months.

On the next appointment in June 2009, exactly the same problem arose. The glue had melted in the right shoe insert and the lift had come unstuck again. I didn't have an appointment, but went back to Bacup in the hopes that somebody could help. I was told that they were, 'up to their eyes', although there was nobody in the waiting room. Another lady appeared from an office behind Reception. She, kindly, referred the problem to a member of the clinic's staff. Although they could not help immediately because they didn't have inserts in stock in my size, I was told that replacement inserts would be posted to me as soon as the correct size was available. In case of further difficulty, the lady who had tried to help gave me another phone number - 01706 253345.

Unfortunately, nothing had been received in the post by 27th July 2009 so I phoned Bacup. The call was taken by the General Reception Office of the Health Care Centre to which all calls for Podiatry were being transferred. Apparently there was nobody in Podiatry Reception and it was not known when this would change. I tried again a few days later, but with the same result, apparently due to staff holidays. Eventually, I got through to the Podiatry Department early August 2009. The lady who took my call turned out to be the same person who had helped me in June. She was extremely surprised to hear that no replacement had been received by post, but arranged for me to go in the same day at 1pm. This I did, and a member of the clinic staff I hadn't seen before did further repairs to the old insert and issued me with a new set. This lady mentioned that only one member of staff usually dealt with inserts. (I noticed that the lift just covered the heel, rather than the 3/4 length type issued previously, and was held in place by double-sided adhesive tape.) By 11th August, the same problem had occurred again, the heel lift having become dislodged. When I contacted Bacup, I was advised to wait until the podiatrist I had seen originally in October 2008, and who specialised in orthotics, returned from holiday.

At this latest, and last, meeting (when only one other patient was in the waiting room) the heel lifts were installed under my shoe insoles, again using double-sided tape. Apparently, this method had succeeded with other patients presenting with this problem in the past. (I couldn't help wondering why, if this were the case, it hadn't been tried before in my case.) That same evening I went for an hour's walk; both insole and heel lift in my right shoe came away.

The following day I phoned Bacup to explain this latest failure. The podiatrist who had dealt with me was not there but would be at Rawtenstall Health Centre the following Monday morning, and at Rossendale General Hospital in the afternoon. Reception kindly promised to email her and ask that she phone me from Rawtenstall, failing which I should call her there. (In response to my query, they also confirmed that bespoke orthotics could be supplied which, clearly, would obviate the difficulties I had encountered over several months.)

Hearing nothing on the Monday, I duly called Rawtenstall Health Centre mid-morning, but the podiatrist was with a patient. The lady at Rawtenstall Reception assured me that either she or the podiatrist would call me back shortly. By about 1.30pm, having had no call, I phoned Rawtenstall again. The receptionist had passed on my message, and could not understand why the podiatrist had not called me. Perhaps she would call later from Rossendale General? I have heard nothing further to the date of this email. Meanwhile, I went to my local cobbler and had him glue the heel lift back into place under new insoles.

This whole experience has provoked the following queries and comments:

1. Does Bacup Podiatry Department represent an efficient use of NHS resources? I waited for quite a while, in considerable pain, and suspect I only obtained an appointment when I did after finding out a phone number and enquiring. At that first appointment, and ever since, I have never seen above two or thee people in the waiting room. I cannot reconcile this with being told how busy the clinic is, and wonder how many people suffer pain and discomfort whilst this facility remains, seemingly, underused.

2. Is consideration given to a patient's address when making appointments? Perhaps it is necessary to go to Bacup for an initial assessment, but I was surprised to hear that a podiatrist attended Rawtenstall and Rossendale General Hospital. Both are nearer to me than Bacup, Rossendale General being within walking distance. Since I have a car, it's no problem for me to attend at Bacup, but others may not be so fortunate.

3. In my case, although neither system proved successful, the 3/4 length, glued, lift seemed superior to the heel-sized, taped, lift. This, latter, only survived for a matter of days, if that. Perhaps the change was driven by financial considerations, but, if so, this may prove a false economy since the newer system fails so quickly.

4. Given the number of times I have had to trouble Bacup with the identical problem, why was a bespoke solution never suggested?

5. At present, thankfully, I have no pain even when walking around the house in casual footwear without the orthotic supports. Could it be that the plantar fasciitis has gone? I am reluctant to try walking any distance outside without the inserts lest this painful condition reassert itself. The fact that I was prescribed an insert in both shoes suggests that I walk badly, particularly on the right foot, so I probably still need some support. Is the bespoke solution mentioned at, '4', above, the best option (and may I be considered for it)?

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Response from Sharon Walkden, Engagement Officer, NHS East Lancashire

Dear Sir/Madam

Thank you for taking the time to share your experience of using the podiatry service.

I am very sorry for the delay in replying to you – I have just acquired the role of overseeing the Patient Opinion website for NHS East Lancashire – and I will ensure that your comments and queries are addressed, and where possible acted upon, as soon as possible.

I am sorry to hear of the difficulties you’ve experienced in trying to contact the podiatry service and in receiving a satisfactory long term treatment method.

I have forwarded your experience to the Manager for the Podiatry service, and she is going to look into your patient journey and provide feedback on the issues raised.

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Response from Sharon Walkden, Engagement Officer, NHS East Lancashire

Dear Sir/Madam

Thank you again for taking the time to provide such a detailed account of your experience of using the podiatry service. Your experience has been looked into and the Manager for the Podiatry Service has provided the response that follows. Unfortunatley in parts the response has to be generalised as specific information could not be obtained without identifying patient information:-

"The Podiatry Service is always keen to receive feedback about what patients think about service quality, and feedback such as this is very useful in identifying where improvements can be made.

These detailed comments raise a number of important issues about the podiatry service in the Rossendale locality. The narrative is quite detailed however it has not been possible to investigate some of the points raised as it is not possible to refer to the individual case notes.

Firstly, the key issues raised in this feedback outline a less than satisfactory patient experience and the podiatry manager would like to apologise on behalf of the service. There are a number of important issues raised in this patient's experience which will feed into a programme of modernisation which is being implemented throughout 2010 and which should result in an improved quality service.

In response to the specific questions:

1 The Podiatry service across East Lancashire PCT does represent an efficient use of NHS resources. The number of patients waiting at any one time in a clinic waiting room is no indication of how well utilised a service is. On days where several clinics are scheduled there may be a large number of patients waiting. However, there has been no other podiatry clinic running in Bacup when the biomechanic specialist clinic has been scheduled. Therefore it will be normal to find only one or two patients at the most in the waiting room at any time. The clinic templates are organised so that patients arrive just before their appointment time, thereby reducing time spent unnecessarily waiting in the department. It is also important to note that the number of staff, clinic types and staff clinical programmes are carefully calculated in order to meet service demands. The types of clinics and clinical requirements include not only biomechanics but also clinics to cater for high risk wound care, diabetic, rheumatoid, and routine podiatry patients, and also domiciliary services delivered to those who are house-bound and unable to get to clinic facilities. Therefore, a snapshot of the number of people in a clinic waiting room at any one time cannot be used as an adequate indicator of the utilisation of podiatry services across the locality or wider service.

2 Consideration is always given to the patient’s address when organising appointments. However, biomechanic appointments are limited to certain clinic facilities which are appropriately equipped. Although this patient may not have required this, the equipment is essential for the diagnostics and treatment of many biomechanical conditions.

3 Without being able to access the individual’s clinical case notes the service is unable to complete a detailed investigation.

4 The condition, Plantar Fasciitis, is usually self limiting and resolves within 12 months. Podiatry treatment is geared to aid the relief of pain and to promote mobility during this period. In those cases where an orthosis is required a generic orthosis is appropriate, and in the vast majority of cases provides satisfactory support without any need to return for adaptation or re-fixing. It is not considered to be an appropriate use of resource to prescribe a bespoke orthotic solution for this condition, given that it should resolve within a year. However, it is not possible to comment on this specific case without accessing the individual’s clinical case notes.

5 As described above, it is likely that the condition has resolved. Under normal circumstances patients would be advised to continue to wear their insoles for approximately three months after their condition has resolved, gradually weaning off the orthoses completely. This information should be provided to patients when their insoles are provided as part of their treatment plan.

In addition to the answers to the specific questions set out above, work is underway to improve access to services across the whole of ELPCT Podiatry services, ensuring that all new patient referrals are managed according to the national Department of Health standards for elective referrals. As part of this work, all patient correspondence has been reviewed to ensure that the information contained in letters is up to date and includes correct telephone numbers.

A modernisation programme is underway across the whole of the Podiatry Service in order to improve the health inequalities across East Lancashire and improve the patient experience. Patient feedback is a very important factor which helps to focus where changes are required and the details within this Patient Opinion comment will help to inform key areas for further improvement."

If you would like to make any further suggestions or comments, or would like to provide your patient details so that more specific information can be obtained please contact us at the Patient Advice and Liaison Service (PALS) on 0845 6031 068 or e-mail pals@eastlancspct.nhs.uk.

Thank you again for sharing your experience. It is much appreciated.

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