Footcare guidance

Appendix 2

Model 1. Supported self care for individuals

This model is based on the provision of education on personal footcare, which is provided by some NHS podiatry services. It can be delivered on an individual or small group basis to a variety of people including those with a personal footcare need and/or carers who can support self care for others.

The evaluation of the supported self care model has shown positive results. This benefits those individuals who are able to carry out their own personal footcare or have a relative or carer that can provide assistance with this. There are however some limitations to this model as it does not meet the needs of those individuals who are unable to carry out their own personal footcare and have no one to assist them.

Case example: NHS Tayside Self Management Programme - Footstep

Individuals referred to NHS Tayside Podiatry Service who are identified as having personal footcare needs, are invited to attend a self management programme called Foot. The aim of the programme is to empower people with the knowledge and skills required to undertake personal footcare safely and effectively at home. It is suitable for people who do not require podiatry treatment, but would benefit from advice and support in caring for their own or others’ feet.

Wherever possible, the sessions are delivered face to face in a non-clinical environment to de-medicalise the content. Participants are led through a series of photo storyboards, to encourage open discussion on good footcare, leading on to the offer of a practical session for those happy to participate. Attendees can also bring carers or family members along to the session if they are the person that will be supporting them to undertake their personal footcare

Additional information can be found at NHS Tayside Podiatry Services 'Footstep' Programme

Model 2. Integrated personal footcare for people receiving care

This model promotes provision of education and awareness to groups of employed care staff in all care sectors to teach them how to provide personal footcare to others.

A partnership approach with health and social care, this is a well established model currently in place across a number of areas in Scotland. Education and awareness sessions are organised locally to meet the needs of individual areas and particularly directed to care home, care at home and hospital staff. A blended approach is used with online and face to face sessions. These sessions include a practical session on toenail clipping as well as information as to when it’s appropriate to refer patients to podiatry services. Education sessions are often extended to cover other areas such as the prevention of pressure ulcers and provision of protection to those individuals with ‘at risk foot’. This can help employed care staff to confidently and safely provide personal footcare. A number of NHS Boards developed online education resources on health and care staff learning platforms such as LearnPro.

This partnership approach has clear advantages in supporting care staff in a care home, care at home and in hospital settings providing people with a viable option to meet the personal footcare needs of individuals.

National educational resources support the delivery of these sessions and the development of both confidence and skills of care staff to deliver a high standard of personal footcare.

Education supports personal footcare providers in the recognition of potential foot problems and define clear care pathways to NHS podiatry services.

Case example: NHS Borders education package to care home and community hospital staff

A foot care education package was developed by NHS Borders podiatrists building on resources shared by NHS Lothian and Forth Valley. The educational package included information on:

• What personal footcare should be delivered by care staff and how
• What instruments can be used, and how these can be purchased
• Information on footwear
• Information on when it’s appropriate to refer people to NHS podiatry services.

A slide deck for virtual or face to face delivery was developed as well as an online learning module and a poster. The target audience for the programme was anyone working in a healthcare role within community hospitals or care homes in the Borders. Initially due to Covid-19 restrictions, the programme was delivered via MS team to care home staff. This delivery was supported by the care home education team in NHS Borders. Later a blended delivery approach was offered to care home staff and staff working in community hospitals. Participants were encouraged to share, contribute and ask questions during the sessions. The training was evaluated with a feedback questionnaire. Findings suggested that for many care home and community hospital care staff, the information on footcare management was new, for example the requirement to check feet regularly, file and cut nails and the knowledge of when to refer people to podiatry services. Many staff commented that they will be changing their practice following the educational session and that they were feeling more confident , understanding their role in providing personal footcare. In addition, the online education model was uploaded on LearnPro, an online training resource available to all healthcare staff in NHS Borders, to further promote learning on footcare. The learning resources were promoted with lead nurses in the general and community hospitals.

Model 3. Social enterprise and third sector partnership for people unable to self care

This model utilises social enterprise or voluntary services that may already provide a range of support services which can include personal footcare. The service is either arranged in partnership with health or social care services or independently provided.

In terms of an option where personal footcare is delivered as a dedicated service, there is potential to reach the broader community and meet the wider demands for personal footcare within populations. This model affords an opportunity to test an innovative way of working in Scotland that could potentially provide dedicated personal footcare services to the general public. It is essential that governance arrangements are clearly defined and that service providers meet minimum standards required for safety and competency. Agencies and social enterprises may impose a charge to individuals for providing this service.

Access to national educational resources will support the development of confidence and skills to deliver a high standard of personal footcare. The education will also teach providershow to recognise potential foot problems and define clear care pathways to NHS podiatry

Case example: Roar Connections for Life

Roar Connections for Life, is a charitable organisation which enables older adults to remain independent, socially connected and physically active. Roar Connections for Life provides a nail cutting service in 10 venues across Renfrewshire. Volunteers at inception were provided with education sessions from the Greater Glasgow and Clyde NHS podiatry team which utilised NHS education resources.

Referrals are received from healthcare professionals, families or individuals for the provision of personal foot care either by calling the office or through a referral form. Foot care volunteers often identify those at risk of a fall and provide health and physical activity advice. Some volunteers are Otago trained, being able to provide strength and balance exercises.

Should social isolation be identified, the organisation has various clubs and projects the person can be referred into. The service is more than just a nail cutting service. The Roar - Connections for Life Prevention Services Coordinator can offer falls and frailty advice through helpful conversations that enable self-management of foot care and partnership in their care.

For further information, contact INFO@ROARFORLIFE.ORG