1. Plans for implementation of A healthier Wales: our workforce strategy for health and social care (published in October 2020), including progress made to date and whether delivery is on track for 2030.
One of the key elements of ‘A Healthier Wales’ is to foster an environment where prevention and early intervention is embedded across Health and Social Care.
Covid has been an extremely challenging experience for all health and social care services across Wales. The Royal College of Podiatry is very proud of Podiatrists working in all sectors across the length and breadth of Wales, who have risen to the challenge during Covid to refocus services where this has been required. All parts of the health and social care system have a real challenge now to rebalance care from mainly treating patients with an acute need, or those who are at high risk of illness and disease, to one which brings the early intervention and prevention principles contained within ‘A Healthier Wales’ alive.
Podiatry services exist to keep populations healthy, mobile and active. The Royal College of Podiatry is very supportive of the ambition in ‘A Healthier Wales’ to move towards a prevention and early intervention model. In order that this ambition can be realised, there is a requirement for long term and sustainable investment in services which provide preventative care and keep people healthy and active.
2. The alignment of the strategy and its implementation with other priorities and actions, including those identified in the Welsh Government’s Programme for Government for 2021-2026, and A Healthier Wales: our Plan for Health and Social Care (2018).
First Point of Contact roles are vital to ensure that people are able to see the right healthcare professional, in the right place and at the right time. Podiatrists have the skills and knowledge to work as First Contact Practitioners (FPC) which can add capacity within primary and community care and reduce the burden on secondary care.
The Royal College of Podiatry wishes to understand more about HEIW’s specific plans to enable and encourage development of FPC roles for all Allied Health Professions across Wales.
Health Education England have recently published a series of road maps to practice for a number of professions, including Podiatry, and we would like to understand what HEIW’s vision is for this in Wales. https://www.hee.nhs.uk/our-work/allied-health-professions/enable-workforce/ahp-roadmaps/roadmaps-practice
3. The extent to which HEIW/SCW’s workforce strategy and broader work on workforce planning and the commissioning/delivery of education and training, will ensure that we have a health and social care workforce which is able to meet population health and care needs, and support new models of care and ways of working, including optimising the use of digital technology and the development of Welsh language services.
The Royal College of Podiatry has specific concerns about HEIW’s streamlining process,1 which has been established for student nurses, healthcare science and allied health professional graduates.
As noted in our response to the “Health and Social Care: Priorities for the Sixth Senedd consultation”:
“The purpose of the streamlining process is to match students who have received a healthcare bursary to jobs within Health and Social Care across Wales. There are a number of concerns that stakeholders including the AHP Welsh Policy Officers Group, of which the Royal College of Podiatry is part, have regarding this process. These include Boards being prevented from employing graduates from outside Wales, including those who may be Welsh speakers or have family ties to Wales. This is a particular problem for Betsi Cadwaladr University Health Board, who currently recruit Podiatry students from University of Salford, which is their closest training provider.
It has recently been confirmed by HEIW that Podiatry will come into the streamlining process. Given the significant workforce shortages for Podiatry in Wales, the Royal College of Podiatry is concerned that the Student Streamlining Scheme will compound the problems for recruitment of Podiatrists into the NHS across Wales.
We strongly urge the Committee to look into the Student Streamlining Scheme to consider if it is an appropriate solution to the challenges of AHP recruitment in Wales, and to investigate whether this one size fits all approach is damaging to particular professions, including Podiatry.”2
4. The mechanisms, indicators and data that will be used to measure progress in implementing the workforce strategy and evaluate its effectiveness.
It is extremely important that progress in implementing the workforce strategy is mapped against data which demonstrates the healthcare needs of population groups across Wales.
We can see from Statistics for Wales that the number of Podiatrists working in NHS Wales has reduced from around 277 WTE in 2009 to 241 WTE in 2021 (a 13% decrease).3 This is at a time of increasing rates of diabetes, foot ulceration and lower limb amputation. Whilst the number of all scientific, therapeutic and technical staff has risen by 32%. In the same time period, the number of people living with long term conditions which lead to foot and lower limb complications, has risen.
Podiatry has some very specific workforce challenges meaning that one size fits all solutions such as streamlining are inappropriate, and in the view of the Royal College, will prove to be ineffective. Solutions to this problem include establishing degree apprenticeships for Podiatry within Wales. At the moment there is only one route to train as a Podiatrist in Wales, a three year undergraduate course at Cardiff Metropolitan University. This is difficult to access for mature students who may have caring and/or employment responsibilities. It is also geographically difficult to access for students living in rural and remote parts of Wales, some of whom choose to study at universities closer to them, Salford for example. Establishing degree apprenticeships would diversify pathways to podiatry training and would encourage more students to take up the programme.
Welsh Government in conjunction with HEIW should also be clearly mapping population need, for example, based on statistics about number of people living in a particular Board area with a specific long term condition, against workforces which can support people living with long term conditions to live healthier lives. For example, we know that podiatrists support the rising number of people living with diabetes to keep them healthy and reduce the risk of ulceration, amputation and early mortality.
5. Whether the financial and other resources allocated to implementation of the strategy are adequate.
As noted in response to question 1, the Royal College of Podiatry is of the belief that there will need to be additional investment in preventative services, in order to shift the balance of care towards prevention and early intervention as health and social care services emerge from Covid.
6. The extent to which the strategy and its implementation are inclusive, reflect the needs/contribution of the whole workforce—for example, on the basis of profession, stage of career or protected characteristics—and also take into account the role of unpaid carers and volunteers.
As noted above, the Royal College of Podiatry does have serious concerns about HEIW’s streamlining programme and the negative impact this could have on equality of entry for a range of groups into NHS Podiatry roles across Wales.
7. Whether there are any specific areas within the strategy that would benefit from focused follow up work by the Committee.
The Royal College of Podiatry would draw the Committee’s attention to our answer to question 3 of this consultation, where we highlight concerns about Podiatry being included in HEIW’sstreamlining process. We would urge the Committee to investigate whether they think the implementation of streamlining will negatively impact on the ability of Podiatry to deliver in line with A Healthier Wales.
Further information
Contact: Ross Barrow, Policy and Public Affairs Officer, Royal College of Podiatry: Ross.Barrow@rcpod.org.uk
Organisation and status of evidence: This response is submitted on behalf of The Royal College of Podiatry. We confirm that we are happy for this response to be made public.
References
1. https://nwssp.nhs.wales/ourservices/employment-services/student-streamlining-scheme/, Viewed on 15/09/2021
2. The Royal College of Podiatry response to Health and Social Care: Priorities for the Sixth Senedd consultation, September 2021
3. https://statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-Staff/Non-Medical-Staff/othernonmedicalstaff-by-jobtype-areaofwork-year, Viewed on 04/10/2021