Select Committee on Welsh Affairs Appendices to the Minutes of Evidence


Memorandum submitted by the Society of Chiropodists and Podiatrists



  1.1  The Society of Chiropodists and Podiatrists is the professional organisation in the United Kingdom for State Registered Chiropodists/podiatrists, with a membership of more than 8,000, including around 350 in Wales, representing over 90 per cent of the State Registered profession. Our members practise in the National Health Service (NHS), commercial, industrial and private sectors; and teach in higher education institutions.


  2.1  Good foot health care is vital in ensuring the mobility and quality of life. Those with conditions affecting their circulation, such as diabetes, who are usually older people, are most at risk. Without regular podiatric treatment their mobility is likely to decline, and they risk infections which may rapidly lead to gangrene and result in amputation. Where podiatrists are involved in the care of patients with diabetes, the number of amputations is reduced by 40 per cent, saving the NHS at least £60,000 per patient. Attached at Annex 1 is a summary of the scope of practice of the profession. Research now indicates podiatry has a significant role in preventing older people from becoming dependent on others and delaying their seeking assistance from health and social care services and professions. It is therefore extremely cost-effective.

  2.2  At present access to podiatry varies widely across the country and in many areas only those at highest risk can access any treatment. The Society is concerned about such inequalities. Given the expected increase in the ageing population and the number of patients with diabetes, there will be a consequent increase in demand for podiatric care. At present podiatry degree courses, including the one at the University of Wales Institute, Cardiff, are experiencing considerable difficulty in recruiting to their degree courses. This issue needs urgently to be tackled. Government needs to play its role in promoting this profession as a career. First, the need is to raise the profile of podiatry as a "health promotion" therapy vitally important to the diabetic and older population. Secondly, there needs to be active recruitment within schools and the community. There are positive cost benefits for wider health and social care agencies.

  2.3  We understand that a further 2,000 allied health professionals are to be recruited. The Society supports the Partnership Forum Staffside's request that funding is ring-fenced for this purpose. We are concerned about delays in implementing consultant therapist posts and Agenda for Change.


  3.1  We are disappointed that the Bill does not mention the professional bodies who represent the various health professions covered by this legislation. We are concerned that there has been virtually no consultation with the Society, and presumably with other health professional bodies, during the preparation of this legislation, and the establishment of the Health Professions Wales. The Society is keen to work effectively with the Welsh Assembly in achieving developments following devolution.


  4.1  The Society welcomes the aim of involving patients more effectively in their health care, though we have yet to be convinced that the measures outlined in the Bill will achieve this end. There is a history of the foot care needs of older people and those with diabetes being subsumed by NHS structures not entirely sympathetic to the patients' wishes and we welcome patient involvement. We recognise that some CHCs, such as Cardiff, have been particularly effective.


  5.1  The Society welcomes the establishment of the Wales Centre for Health and looks forward to working with it. It is vital, however, that it is funded using new money, not from existing NHS resources.


  6.1  There has been a disappointing lack of consultation with professional bodies on the establishment of Health Professions Wales (HPW). There also seems to have been a lack of consultation with the statutory body, the Health Professions Council (HPC), despite the fact that the Draft Bill identifies a relationship between the two bodies. This is sending very negative messages to the wider profession and could result in their opting out of systems seem to be over-bureaucratic.

  6.2  We are concerned that the remit of this new organisation appears to be extremely nurse-orientated. We would wish for reassurance that all professions will be effectively represented on HPW and that profession-specific issues will be fully covered. Once again the allied health professions feel marginal to health policy. However, their patient contacts and caseloads are disproportionally high in relation to their numbers as a proportion of the total health care workforce.

  6.3  We would expect HPW to work closely with the professional bodies and trade unions representing the health professions, as well as the HPC, and other regulatory bodies, and higher education institutions.

  6.4  The Centre and Health Professions Wales will both be concerned with training, but it is unclear how their functions will relate to each other. This needs urgently to be clarified. Regulation and registration issues must remain the sole responsibility of the regulatory bodies. It is important that there should not be overlapping responsibilities which will lead to confusion and the possibility of inconsistency.

  6.5  As with WCH, it is important that HPW is properly funded with new money, not existing resources. It is unclear from the Draft Bill whether there is to be an additional registration fee for HPW. If professionals are obliged to register with two bodies, this will put an additional financial burden on health professionals practising in Wales, and could cause considerable confusion. Practitioners may not realise that they need to be registered with both bodies, and they risk practising illegally by failing to be registered properly. The risk needs to be recognised that podiatrists/chiropodists may not accept over-regulation. One third of the profession are approaching retirement and may simply choose to absent themselves from over-regulated systems and practise under a different title. If this were to happen, patients outside the NHS would remain unprotected, as they are under the current system which allows unregistered chiropodists to practise outside the NHS.


  The Society would welcome assurances that it will be fully consulted in future on all issues relating to the practice of podiatry in Wales.

Hilary De Lyon

Chief Executive

26 June 2002

Annex 1

Chiropody and Podiatry: A Summary of the Scope of Practice

  1.  Biomechanics—is the measurement of the relationship between bone, muscle and soft tissue. A small structural imbalance in the foot may cause no foot pain at all, it may cause problems in the ankles, knees, hips, back, or neck—all parts of the body that are connected to the feet by the skeleton. Biomechanics is often used to treat people who suffer from rheumatoid arthritis, a disease that deforms joints, particularly those in the legs and feet. Chiropodists[1]and podiatrists[2]carry out biomechanical assessments of these patients to reduce their discomfort and increase stability, keeping them as mobile as possible.

  2.  Podopaediatrics—Some research suggests that 90 per cent of children have foot problems, which can cause great concern among parents. While many children's foot problems are self-correcting, podiatrists who specialise in working with children have an in-depth understanding of children's feet.

  3.  High-risk patient management—High-risk patients have a condition, such as diabetes, cerebral palsy, peripheral arterial disease and peripheral nerve damage, which puts their legs and feet at increased risk of injury and disability. Chiropodists assess and treat these patients to reduce the long term and sometimes very serious problems that can result, such as amputation. Research has proven that providing chiropody treatment reduces amputation rates by 40 per cent. For example, many patients have very poor circulation resulting in fragile, easily injured skin. Some patients have no sensation in their feet; they can injure themselves without knowing so that, for instance, waling with a stone in their shoe for 30 minutes leads to ulceration. Ulceration, if not treated promptly or correctly, can lead to amputation in serious cases.

  4.  Surgery—A State Registered Chiropdist is qualified to administer local anaesthetics and is trained in a number of surgical procedures such as nail surgery and soft tissue surgery. This differentiates them from the other Allied Health Professions, which do not underake invasive surgery at all, but still play an important role in healthcare. Podiatrists who have trained as podiatric surgeons surgically manage bone and joint disorders within the foot, often working in specialised medical teams. Research indicates that there is high patient satisfaction when podiatric surgeons carry out their work.

  5.  General clinics of chiropody/podiatry—even relatively minor foot problems such as a corn, if untreated, can result in considerable pain, and potentially lead to life-threatening or disabling complications. When you consider that three out of four adults suffer foot problems, it is easy to see that chiropodists play a vital role in the well being of the nation's health.

1   The terms "chiropodist" and "podiatrist" are interchangeable. Back

2    Back

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