Footcare guidance

3. Links with National Policy and Guidance

The personal footcare guidance is associated with a number of policy documents including Public Bodies (Joint working) (Scotland) Act 2014 ^[12]; The carers (Scotland) Act 2016 ^[13]; National Carer Strategy ^[14]; Realistic Medicine ^[15]; Delivering value based health and care: a vision for Scotland ^[1]; Scottish Digital health and care strategy- Enabling, connection and Empowering ^[16]; Scottish Allied Health Professions (AHPs) Public Health Strategic Framework Implementation plan 2^[17]; Scotland’s National Dementia Strategy ^[18] ;Diabetes Improvement Plan^[19]; and Allied Health Professions Co-creating wellbeing with the people of Scotland- the active and independent living programme in Scotland ^[20].

National policy, principles and ongoing work that strengthen the personal footcare guidance are as follows:

Free Personal Care (including footcare)

Free personal and nursing care (FPNC) for adults aged 65 or over was introduced in Scotland on 1 July 2002 through the Community Care and Health (Scotland) Act 2002.6 On 1 April 2019, legislation - The Community Care (Personal Care and Nursing Care) (Scotland) Amendment (No. 2) Regulations 2018 - came into force which extended this to include adults of any age.

Adults, no matter their age, conditions or means, who have been assessed by their local authority as requiring personal care do not pay for this service. Learn about social care assessments and how to get support

Need assessments (which include a personal care element) are carried out by a member of staff of the local authority’s social work department. Referrals to a social work department can be made by the person themselves, a member of their family, or their carer. After the needs assessment the supported person will be given a care plan, which describes the needs the social work team feels an individual has, and how these needs will be met.

Any personal and nursing care services included in this should be free. The Community Care and Health (Scotland) Act sets out examples of personal care tasks that may not be charged for by a local authority; this includes keeping fingernails and toenails trimmed.

Carers should be encouraged to provide personal footcare as part of individual care plans. A range of free resources are available at Looking after your feet to help prevent falls | NHS inform.

The services a person receives at home will be provided either by the local authority's own staff; by the staff of an external organisation contracted by the local authority or by a personal assistant. For individuals living in residential care, a contract will be put in place between the local authority the care home, and FPNC payments will made directly to the care home.

Each local authority will have in place agreed eligibility criteria for assessments of need and are expected to ensure that their resources available are used in the most effective way to meet care needs of individuals. Local authorities should always take into consideration the preferences of the supported person, as well as those of their family and carers.

If an individual’s care support needs change, or if they feel that they are not getting the care support they believe they are entitled to (including foot care), they should contact their local social care team to request a review of their care support needs.

The Healthcare Framework for adults living in care homes was published in June 2022, healthcare-framework-adults-living-care-homes-health-care-home.pdf (www.gov.scot).This new healthcare framework provides a series of recommendations which specifically seek to strengthen the continuity and access to healthcare, both from within and out with the care home. It is about ensuring that people living in care homes have all of their needs met and are supported to live their best life possible. Care homes are where people live and call home. They should expect the same level of involvement, choice and support for their health and wellbeing as they would if they were living elsewhere in the community.

Attendance allowance:

People who are unable to undertake personal care, for example cutting their own toenails may be able to apply for an attendance allowance. This is a non-means tested allowance that can help with extra pay for personal support for someone with a disability severe enough that they need help. To qualify, one has to be physically or mentally disabled and be at state pension age or older. People can apply and use the allowance to pay for personal footcare including nail cutting service. For further information please see Attendance Allowance: Overview - GOV.UK (www.gov.uk)^[7], Citizen Advice^[8] and carer centres^[9] can support people to complete the attendance allowance request form.

Scottish Diabetes Foot Action Group (SDFAG)

The SDFAG group is a group of Healthcare Professionals representing all 14 Heath Boards across Scotland. The ethos behind the SDFAG is to provide a cohesive national diabetic foot network dedicated to service improvement and improving outcomes of individuals living with diabetes throughout Scotland.

The SDFAG has several strands of work in progress which aims to deliver these improvements to help prevent and reduce the incidence of foot disease and amputations in individuals living with diabetes.

Following a diagnosis of diabetes all individuals should undergo foot screening by a suitably trained healthcare professional/worker as soon as practically possible. ^[10]

The person carrying out this foot screening should have previously undertaken the online training which can be found at www.diabetesframe.org This screening will result in the identification of risk factors associated with the development a foot ulcer which may lead to amputation. The individual will then be assigned a risk category which their ongoing care will be based on. These risk categories are; Low, Moderate, High, In Remission or Active Foot Disease. More detail on these risk categories and the action to be taken is available in Appendix 1 (Diabetic Foot Risk Stratification and Triage).

Information during the screening process is input by the healthcare professional/worker carrying out the foot screening into the nationwide Scottish Care Information (SCI) Diabetes shared information system. This system automatically calculates the individual’s foot risks and provides recommended action according to that assigned risk. During the screening appointment verbal advice and education should be provided supported by the appropriate written information.^[11]

Good personal footcare and checking of feet everyday by the individual, their family, friends or carers is important for all people with diabetes:

• For individuals who have been screened as Low risk, it is acceptable and safe for them, their family, friends or carers to carry out personal foot care. These individuals will most likely not need to see a podiatrist and should have their foot screening carried out every 2 years by a suitably trained healthcare professional/worker.
• For individuals who have been screened as Moderate risk they should undergo an assessment by a podiatrist. If no specific podiatry needs are present then they should attend an annual foot screening by a suitably trained healthcare professional/worker. It is acceptable and safe for these individuals, their family, friends or carers to carry out all or most of their personal footcare, following advice from the podiatrist.
• For individuals who have been screened and assessed as High risk or In Remission some of their personal footcare, like nail cutting and filling can still be carried out by themselves, their family, friend or carers especially the checking their feet daily for any breaks in the skin or signs of any problems, following advice from their podiatrist. The individuals’ care in the High risk and In Remission categories will now be managed by a podiatrist and the regularity of visits to the podiatrist will be determined according to individual needs following assessment and in consultation with the individual.
• For individuals who have been discovered as suffering from Active Foot Disease which can manifest itself as a break in the skin, unexplained swelling, heat or the onset pain rapid referral to a member of the multidisciplinary foot team or a multidisciplinary foot clinic is essential to address all aspects of care. The sooner that Active foot disease is discovered and the individual receives the appropriate treatment, the better the outcomes.
• Daily foot checks should still be carried out where possible by the individual, their family, friends or carers for signs that the existing problem is deteriorating or any further problems.