NHS HDL(2000)23

Health Department

Please note that this document has been amended: click here to view.

Dear Colleague

GUIDELINES FOR THE PROVISION OF ORTHOSES/FOOTWEAR

Summary

1 . Guidelines for the provision of orthoses/footwear by the NHS in Scotland are attached at Annex A.

2. The Guidelines were compiled by the Scottish Rehabilitation Technology Providers Forum (SCOTRET) Orthotic Sub-Group to ensure consistent and equitable provision throughout Scotland, and have been endorsed by the SCOTRET Co-ordinating Group and the Rehabilitation Technology Services Advisory Group. The 5 Scottish Rehabilitation Technology Centres are represented on each Group.

Action

3. Chief Executives are requested to ensure that this letter and the attached guidance are brought to the attention of all Directors of Public Health; Area Occupational Therapists; Area Physiotherapists and any other professional staff involved in the rehabilitative care of recipients of orthoses and footwear in their area.

4. Primary Care Trust Chief Executives should also arrange for this letter to be available to all GP practices in their area.

5. Directors of Social Work should arrange for this letter and guidance to be brought to the attention of Senior/Principal Occupational Therapists and any other professional staff involved in the rehabilitative care of recipients of orthoses and footwear.

Yours sincerely

22nd November 2000

______________________________

GUIDELINES FOR THE SUPPLY OF ORTHOSES/FOOTWEAR
(ENDORSED BY SCOTRET AND ReTSAG)

1. Supply of Orthotic Devices (excluding Footwear)

In general, patients requiring orthotic management will be supplied with only one issue of their orthotic device.

A duplicate issue will only be sanctioned in special circumstances when:

1.1 their clinical need dictates duplicate issue;

1.2 their social/economic circumstances necessitate duplicate issue;

 l.3 other requests will be individually assessed.

2. Supply of Prescription Footwear

2.1 Two main criteria may be employed to justify the supply of prescription footwear:

2.1.1 those patients who are unable to be acceptably fitted with standard footwear due to abnormal foot shape;

2.1.2 those patients for whom standard footwear cannot accommodate a prescribed orthotic device;

2.1.3 other requests will be individually assessed.

2.2 Non-ambulant light user patients or children will normally receive only one pair.

2.3 Ambulant patients will normally receive a duplicate issue of the first prescription.

2.4 It is anticipated that one pair will be replaced each year, if necessary, after inspection by an orthotist.

2.5 Supply of a third pair of shoes will be individually assessed.

2.6 Stock shoes will always be considered before supplying bespoke shoes.

Split-Sized Footwear

2.7 Any patient referred because of uneven sized feet will be offered a toe filler fitted to
the shoes provided by them. Only in those cases where the patient is actually undergoing surgical treatment or where the nature or the extent of the discrepancy exceeds 2 full sizes makes the fitting of a toe filler impractical, will odd sized shoes be provided.

2.8 If it is considered that the supply of uneven sized standard footwear is appropriate, the cost of the purchase of such footwear will be partially borne by the Orthotic Service.

In these cases patients may either:

(a) purchase 2 pairs of shoes and 50% of the total will be reimbursed;

(b) purchase a split-size pair of shoes and the additional surcharge will be reimbursed on the presentation of the invoice up to an agreed maximum sum.

3. Adaptation of Patients' Own Footwear

Footwear will only be accepted for adaptation if it is of a suitable type and in sound and serviceable condition both in respect of the uppers, soles and heels.

3.2 Normally one single shoe or one pair of shoes will initially be adapted.

3.3 Once the long-term suitability of the adaptation has been confirmed up to 3 single shoes or 3 pairs of shoes will be adapted within any 12 month period.

NB: Children who outgrow or wear out shoes quickly may have additional pairs of shoes adapted.

3.4 Patients requesting any further pair of shoes adapted will be requested to have this carried out at their own expense by a suitable shoe repairer or orthotic contractor.

4. Repair of Orthoses/Footwear

4.1 Repair of Orthoses

The Orthotic Service accepts the responsibility for the repair and maintenance of all orthoses/devices provided by the Service. It is the patient's responsibility to routinely check the orthotic device for any signs of wear and to then immediately contact the Orthotic Service for maintenance procedures.

4.1.1 Any lower limb orthosis with commercially manufactured componentry should be reviewed every 6 months by the orthotist, who will then thoroughly inspect the orthosis for wear, in line with the manufacturer's specification.

4.2 Patients' Own Shoes

4.2.1 The Orthotics Service will only be responsible for the repair and maintenance of the adapted sections of patients' own shoes.

4.2.2 The Service will therefore not be responsible for the repair and maintenance of either the uppers or soles and heels of fellow (non-adapted) shoes or those sections of an adapted shoe which have not been adapted.

4.3 Stock Footwear

4.3.1 Patients are personally responsible for the repair and maintenance of the
uppers, soles and heels of stock footwear supplied by the Orthotics Service.

4.3.2 The Orthotics Service will only be responsible for the repair and maintenance of adapted sections of stock shoes issued by the Service.

4.4 Bespoke Footwear

The Orthotics Service is responsible for the execution of all repairs to bespoke footwear supplied by the Service.

5. Review of Orthoses/Footwear

5.1 All orthoses/footwear should be reviewed at appropriate intervals to check on the integrity and function of the devices.