Two years ago Age Concern England launched the campaign “Feet for Purpose” with the intention of improving foot care services for older people. There was a lot of evidence that many people were suffering foot problems for which they could not obtain treatment. There were patchy services across the country with varying levels of care and treatment available; some areas had good, comprehensive services and others had very limited care. “Feet for Purpose” called for free basic foot care to be made available to all older people living in Britain.
The report from Age Concern England found that many older people across England were being left housebound and disabled by a lack of foot care services. A lack of even the most basic foot care can lead to severe complications and can result in dangerous falls, severe restrictions on mobility and social isolation. Many older people struggle to care for their feet because of health problems such as sight impairment and arthritis, or they simply find it impossible to reach their feet to cut their toenails. Quality foot care services, including basic toenail cutting, are critical in enabling older people to remain active and maintain their independence. Without such services, older people can become housebound, isolated, depressed and their risk of falls is increased.
Age Concern Bristol (ACB) highlighted this campaign at its Annual General Meeting in 2007 and invited a panel of interested parties to discuss the local problems. We saw some fairly horrific pictures, which upset and appalled some of those present. ACB’s attention was drawn to the fact that local services from NHS podiatry were restricted to people with certain medical conditions, such as diabetes and circulation problems, and those with severe foot problems restricting their mobility. There was no service for simple procedures such as nail cutting and foot massage. NHS podiatry services were restricted by funding and numbers of personnel available. The alternative was to pay for private podiatry care, but even this was shown to be patchy in its provision across Bristol.
In order to gather evidence to support the campaign ACB commissioned a survey undertaken by Bristol Older People’s Forum (BOPF). This had a very high response rate and showed that 70% of older people had foot problems for which they wanted care. This figure rose to 80% for over 80 year olds. Half of the respondents stated that they were paying for foot care that they were unable to receive from the health services.
Other problems brought out in the survey were that half of the older people suffered pain from their foot problems, one in ten had suffered a fall attributable to their foot problem in the previous year, transport was a problem for one in five in accessing foot care, whilst one third of the older people said they would be prepared to pay a modest fee for foot care services.
Contacts were made with the health authority (Primary Care Trust or PCT, now re-named NHS Bristol) and with the Adult Care Team at Bristol City Council. At the same time schemes offered by Age Concerns in other parts of the country were investigated. It was clear that other areas had very good foot care services provided by trained volunteers and funded either from charitable funds or directly by local authorities or local health services.
It was hoped that the podiatry service of the PCT would train and supervise volunteers which could be recruited and managed by ACB. There was initial interest and enthusiasm. Unfortunately, this seemed to wane quite quickly and it became apparent that health and social services had concerns over whose budget would provide the necessary funding and who would manage, administer and control a foot care service. However, interest continued and ACB continued to push for action. At its meeting in December 2008, the Bristol Health Scrutiny Commission discussed foot care as a priority, after spending a morning receiving presentations and information from interested parties, including BOPF and ACB.
In recent months the City Council has received funds aimed to improve lifestyles of local people and the Transformation Team has taken a priority interest in foot care services. They have pursued their own investigations and consulted with many interested parties including ACB and have looked at foot care services in other areas and regions.
Plans from the City Council’s Transformation team are now falling into place for a foot care service to begin rolling out from January next year. They are combining with NHS Bristol, who will provide training from the podiatry department, and will involve people from social services, private care providers and volunteers to provide basic foot care across the city. Existing home care workers will be trained to give basic foot care to those they are visiting in their homes. Training will then be offered to care workers in the private sector, followed by volunteers to be recruited and managed by ACB. The service will be gradually offered and expanded as more people become trained to provide it starting in January 2010.
There will be charges for some to make the project sustainable which is outside the original aims of the “Feet for Purpose” campaign, but hopefully a more extensive and inclusive foot care service will be in place during 2010 and ACB can take some pleasure in achieving some success.