Foot health – how much consideration have you given it? If your answer is very little, we completely understand why. You’ve probably come to accept foot health is just a toenail trim for your residents; treating it as a non-essential add-on pampering treatment, because let’s be honest, that is all most care home residents currently receive from their foot health provider. But what if we were to tell you quality foot health treatments administered by regulated, qualified professionals, will improve your resident’s quality of life, prevent falls and hospitalisations, and can even reduce the chances of premature death. Would you give it more consideration then?

Care Home Podiatry are launching the Campaign for Better Foot Health to give you all the free training, guidance and resources you’ll need to give foot health the attention it rightfully deserves. Our mission is to improve care home standards to ultimately improve care home residents’ lives, because the truth is both care home providers, and most importantly care home residents have been shortchanged for too long. We firmly believe everyone should have access to #betterfootcare. We’d love for you to engage with the Campaign for Better Foot Health to make this a reality.

If you haven’t yet read Part 1: Why is foot care so important in care homes? Have a quick read before diving in to Part 2.

Part 2: What is wrong with foot care in care homes?

If you’re a care home manager you’ve probably been here before. Remember that damning report into the state of oral health in the Care Home sector by The Care Quality Commission (Smiling Matters; CQC, 2019)??? Let’s jog your memory on a few of their key findings:

  • most had no policy to promote and protect people’s oral health (52%)
  • nearly half were not training staff to support daily oral healthcare (47%)
  • 73% of care plans reviewed only partly covered or did not cover oral health
  • it could be difficult for residents to access dental care
  • 10% of homes had no way to access emergency dental treatment for residents

Now think about your care home, could you substitute “foot health” in place of “oral health” in pretty much every section of this report? Here at Care Home Podiatry we’ve worked in the care home sector for long enough to guess your answer is most probably yes.

We may be wrong, but we believe foot health is likely to be next on the CQC’s review list, more to the point we believe foot health should be next on the CQC’s review list. Why? Because there is currently so much wrong with foot care in care homes.

After Part 1 you already know why it’s so important that every older person has access to the best standard of foot care, the statistics were pretty scary! So given the health implications you’d probably assume that every older person is entitled to foot care on the NHS. Sadly, and worryingly, that’s not the case.

NHS Foot Care departments generally have strict rules around who receives treatment. These are associated with the way your local NHS services are paid for by Integrated Care Systems (ICSs). To receive NHS foot care your residents generally have to meet one or both of the following criteria:

  1. Have a medical condition which places the foot “at risk”
  2. Have a foot condition.

Only people who fall into criteria 1 would qualify for regular foot care, and even then wait times between appointments are almost always over 3 months (except for those with diabetic foot wounds). That’s certainly not enough to prevent foot health issues escalating and potentially impacting on the wider health of your residents.

Of course you probably already know this and think you’ve got it covered by accessing a private foot care provider. However the private sector brings a whole new set of problems….

1. Anyone can provide foot care … where does that leave your care home? Vulnerable

Are you aware that there are currently no rules, regulations or professional guidance governing who can provide foot health treatments to your residents? Literally anyone can do it.

If your residents need oral health treatments, you would only allow a dentist to treat them. What about foot health? Literally anyone can turn up to your home, call themselves a foot care specialist, a foot health clinician or whatever else they might like, and charge your residents to cut their toe nails, remove callus with a scalpel blade and treat other foot problems… no qualifications or training legally required. All they require is the consent of their patient. It goes without saying that this has led to a huge variation in the quality and safety of care being delivered across the care home sector.

To us this is terrifying. While you would definitely notice if your visiting dentist was going from resident to resident in a communal area using the same toothbrush, do you notice when your foot health provider does the same cutting toe nails? No changing of instruments, no changing of gloves, no hand washing, no respect for the residents dignity. This bad practice is going on in plain sight, but sadly it seems that because poor foot health provisions have gone on for so long, no one questions it. Putting aside that an individual with no qualifications will not be able to treat the conditions and pick up on the early warning signs we mentioned in Part 1, meaning your residents are definitely getting shortchanged, a visiting provider who is not HCPC registered is not held accountable by any regulatory body to any health and safety or infection control protocols.

When we consider the risks of inadequate foot care we outlined in Part 1, we wonder what the CQC will make of this when they review foot care in care homes?

2. There is little guidance for care home managers …where does that leave your care home? Vulnerable.

You would expect in an industry as well established and monitored as care homes, with a service that is so essential and as widely accessed as foot health, that there must be some clear and comprehensive guidance for care home managers on accessing foot care? Unfortunately you’d be wrong.

The “National Minimum Standards, Care Home Regulations 3rd ed 2006” sets out the Department of Healths key guidelines for care homes in the UK. This documents states that foot health should be part of the residents initial needs assessment, and that care home managers should provide access to Chiropody.

That is it. Nothing further to guide managers through the confusing process of finding and choosing an appropriate foot health provider to adequately fill the gaps left by NHS services. This is all the more worrying when you consider just how confusing the Private foot care industry is.

Similarly, The National Institute for Clinical Excellence (NICE) does not offer much support to care home management; “Diabetic foot problems – prevention and management” (NG19) being the only guidance relevant to adults living in care homes.

While this guidance sets out clear actions for preventing foot problems in individuals with Diabetes, the knowledge and implementation of NG19 appears to be patchy in the care home community, with huge variations in how this guideline is applied. For example the pathway for accessing emergency assistance when a patient has a diabetic foot ulcer often varies significantly across care homes, when appropriately following the guidance should lead to a standardised system across the sector.

3. The resident-clinician contract … where does that leave your care home? Vulnerable.

As standard private foot health is paid for directly by care home residents, meaning the care home is not directly involved in the transaction between the resident and the clinician. Too often this results in poor sharing of information between the clinician and the care home nursing team, resulting in foot health concerns escalating and ultimately the resident needing treatment that could, and should, have been avoidable. Similarly with the resident-clinician transaction the private provider is not at liberty to add to the residents care plan, potentially leading to your nurses making significant errors in care. This was one of the CQC’s key criticisms of dental care in the care home sector.

4. Who is responsible? Where does that leave your care home? Vulnerable.

Most often a visiting foot health provider will only have an informal agreement with the care home manager with no established contract or terms of business in place. This can lead to inconsistent and questionable clinical standards and health, safety and infection control practices. With no formal contract in place who is responsible for your residents feet – is it the employed nursing staff or the foot care provider who turns up every 6-10 weeks?

5. Individual practitioners … where does that leave your care home? Vulnerable.

Care homes typically source foot health providers working independently, or as part of a small local clinic. As a result the levels of governance, oversight, quality control and supervision will not be what you and your residents deserve. Residents may also miss out on some of the more complex and specialist assessments and treatments (such as advanced circulation checks, Biomechanics or falls prevention work); one person cannot be a specialist in all areas meaning you and your residents are missing out on the full spectrum of expertise a team could provide you with.

What is wrong with private foot care in the care home sector?

After reading this you might be joining us in questioning what is right with private foot care in the care home sector? Accessing foot care should not feel like trying to navigate your way through the Wild West. It simply should not be possible for non-HCPC regulated individuals to provide essential care to some of the most vulnerable people in our community.

And yet here we are. No laws to protect you and your residents. No guidance for you to really understand who you are opening your doors up to. No guidance to set out what you and your residents should be expecting from your foot health practitioner. Nothing. And yet you and your residents are paying for this, not just in money, but in risk to life and limb (as we outlined in Part 1).

At Care Home Podiatry we are passionate about changing this. We are constantly lobbying for transparency, consistency and regulation across the profession. Join us in our Campaign for Better Foot Health because you and your residents really do deserve #betterfootcare.

You’ve read the Why’s in Part 1, the What’s in Part 2, now join us for Part 3 where we will provide our ‘How To’ guide for Care Home Managers and Care Coordinators to assist you in navigating the foot care sector to ensure your residents have access to the safe and effective foot health treatments they so rightly deserve.