EXCLUSIVE: The impact of the COVID-19 pandemic on the NHS orthotic services

Staffordshire University’s Nicola Eddison, Aoife Healy, and Nachiappan Chockalingam explore the impact that the COVID-19 pandemic had on NHS orthotic services, and whether NHS orthotic services believe that video appointments are here to stay. 

In March 2020, the World Health Organization declared that Europe was the epi-centre of the COVID-19 pandemic (1). The UK Government declared a national lockdown, in light of rapidly escalating circumstances within UK hospitals. Social distancing restrictions were implemented as avoiding unnecessary in-person patient evaluations became essential, (2-4) causing outpatient services to reconfigure how they could continue to provide treatment interventions to their patients.

The main focus of healthcare services switched to intensive care units and other emergency services. This resulted in significant changes to routine clinical care and outpatient services. Orthotic services and the provision of assistive technology were some of the many services affected.

Previously, several studies highlighted concerns with the provision of orthotic services in the UK (5-7). These reports highlighted discrepancies in service provision including large variances in waiting times for appointments. The changes required by the pandemic will lead to widen these discrepancies.

To understand this impact, we devised a cross sectional online survey designed to be distributed amongst UK orthotists and orthotic service managers in September 2020, following the first wave of the pandemic, in an attempt to investigate the impact of COVID-19 on the NHS orthotic services.

Our overall results showed that 22 percent of respondents reported that their service had closed completely to all face-to-face and telehealth appointments, with a further 35 percent reporting a closure of the service to all patients except in-patients and urgent patients. This has resulted in increases in waiting times for adult routine appointments.

Whilst the majority of respondents reported feeling that their service had been supported, the increase in waiting times appeared to be linked with those services where participants reported that they did not feel the service had received adequate support during the pandemic. The historical issue of poor clinical facilities for orthotic services also posed a problem for services, with respondents stating having insufficient clinic space, which appears to have affected the routine appointment waiting times, with median waiting times longer in those that stated their clinical space was insufficient.

Interestingly, the vast majority of orthotists who responded said that they used video/telephone appointments (90.1 percent) whilst remaining closed to see face-to-face patients. 73 percent believed video/telephone appointments would remain in their service post-pandemic.

This novel way of providing orthotic intervention has to be researched in terms of efficacy and outcomes. The impact of the pandemic also affected staff personally with some reports of orthotists being furloughed.

To conclude, the impact of the COVID-19 pandemic resulted in significant changes to the way UK orthotic services provided treatment in the NHS. Face-to-face appointments were significantly restricted, resulting in the widespread implantation of telehealth to ensure patients could still access orthotic care.

Appointment waiting times increased and well-known historical issues of insufficient clinical space appeared to further exacerbate wait times. The impact of these delays in patient treatment are yet unknown.

References

1. World Health Organization. Rolling updates on coronavirus disease (COVID-19). 2020.
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3. Smith AC, Thomas E, Snoswell CL  et al. Telehealth for global emergencies: implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020;26:309–13.
4. Hollander JE CB. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020;382:1679–81.
5. Chockalingam N, Eddison N, Healy A. Survey of Orthotic Service Provision in the UK: Does where you live affect the service you receive? BMJ Open. 2019;1–11.
6. Business Solutions. Orthotic Pathfinder: A patient focused strategy and proven implementation plan to improve and expand access to orthotic care services and transform the quality of care delivered. 2004.
7. England NHS. Improving the quality of Orthotics services in England. [Internet]. 2015. Available from: available: https://www. england. nhs. uk/ commissioning/ wpcontent/percent0Auploads/ sites/ 12/ 2015/ 11/ orthcs- final- rep. pdf [Accessed 8percent0ANov 2018].