Chiropody Service for the Elderly (Hansard, 26 March 1986)

Lord Wallace of Coslany
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, from 1978 to 1984 the number of elderly patients receiving National Health Service chiropody increased by 20 per cent. to over 1.5 million.

Lord Wallace of Coslany
My Lords, is the noble Baroness aware that three years ago I was told that there was an acute shortage of chiropodists? That is probably not the case today because it is quite easy to have treatment for £5 to £6 a go, whereas people on the National Health Service find that as economy measures are introduced the period before an elderly person gets treatment has now been extended to about three or four months. That is a vital matter. It is not a question of toe nails; it is callouses and other treatments. That means that a person is liable to fall or be unable to get about. This is a vital service and not the Cinderella that it will soon be.

§ Baroness Trumpington
My Lords, the noble Lord, Lord Wallace, is quite right. Unfortunately, for many years chiropody in the National Health Service has not been as comprehensive a service as we would wish, primarily due to the shortage of state registered chiropodists. There are now almost 20 per cent. more whole-time equivalent chiropodists in the National Health Service than in 1979 and they are treating more patients and providing more treatments. We are making progress. With regard to waiting lists, we do not centrally collect statistics on waiting time or waiting lists for chiropody and certainly have no evidence that they are increasing. Unnecessary waiting is regrettable but it is another facet of the general shortage.

Lord Inglewood
My Lords, may I ask the noble Baroness whether she is sure that there are no obstructions in the way of training, which I believe at one time held up the number of skilled chiropodists?

§ Baroness Trumpington
My Lords, the Government and the Chiropodists' Board of the Council for Professions Supplementary to Medicine are seeking to increase the intake of chiropody schools and so the 1392 number of qualified chiropodists. Since 1978, five new schools have opened, increasing student output by over 50 per cent., and another is planned. However, it will be some years before this significantly improves the position.

§ Lord Ennals
My Lords, bearing in mind that 95 per cent. of the time of the 5,750 state registered chiropodists is spent serving the needs of elderly people and that elderly people are very high among those with low incomes and very dependent upon the National Health Service, is it not disturbing to the Minister that only 50 per cent. of state registered chiropodists work in the National Health Service because of pay and conditions, and that 15 per cent. of funded posts for chiropodists in the National Health Service are not filled? What do the Minister and her colleagues propose to do about what is a very disturbing condition at a time when the number of very elderly people is growing steadily?

§ Baroness Trumpington
My Lords, I have already given details of the number of schools which have been opened and the one which is to be opened. We have advised health authorities where they cannot provide a full chiropody service, that they should give priority to elderly or handicapped people, expectant mothers and schoolchildren.
It is up to each authority to define those groups as closely or widely as their staff resources allow.

Lord Winstanley
My Lords, may I ask the noble Baroness what has happened to the home chiropody service, which so many elderly people found absolutely invaluable and which now seems to have disappeared from almost every area? As the noble Lord, Lord Ennals, said, there are now far more elderly people in society, which means that there are twice as many elderly feet. Many of those feet cause trouble and the right place for them to be attended to is in the elderly person's home. What has happened to those home services? Is there any chance of their being restored?

§ Baroness Trumpington
My Lords, the patient's home is the second most common place of treatment. While the proportion of treatment at home has declined in recent years, it still accounts for some 19 per cent. of total treatments.

§ Lord Ennals
My Lords, forgive me for coming to the Dispatch Box again, but perhaps I may again ask the noble Baroness the crux of my question, which was: is there something that can be done by the department to remedy the fact that 50 per cent. of those who have been trained as registered chiropodists are now working privately and not in the health service? Is there something that can be done about that, because it is a trend which seems to be progressing?

§ Baroness Trumpington
My Lords, I sometimes have difficulty in finding the crux of the noble Lord's questions to me, but with regard to privatisation of National Health Service chiropody services, it would be open to health authorities to make arrangements to contract out provision of National Health Service 1393 Chiropody services if they considered that that would provide the most efficient and effective service. They would need to monitor the service very carefully to ensure that it provided value for money and that standards of care and treatment were maintained. Employment in the National Health Service is open only to state registered chiropodists. Private sector chiropodists, however, are a quite flourishing profession, and we have no plans to restrict their practice outside the National Health Service.

Lord Wallace of Coslany
My Lords, I apologise for putting a further supplementary question. Is the noble Baroness aware that the home chiropody service is absolutely vital because those are the worst possible cases which need treatment? There is a delay in treatment taking place. As I have said, there is a gap of up to four months between one treatment and another. Will she ask her right honourable friend to get someone to have a look at this matter—I know that it involves a certain amount of investigation—because it is vital?

§ Baroness Trumpington
My Lords, I have sympathy with what the noble Lord said and I shall see that his remarks are drawn to the attention of my right honourable friend.