Paediatric Ankle Foot Orthoses

Oral Answers to Questions — Health – in the Northern Ireland Assembly at 2:00 pm on 26th April 2021.

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Photo of Caoimhe Archibald Caoimhe Archibald Sinn Féin 2:00 pm, 26th April 2021

1. Dr Archibald asked the Minister of Health for his assessment of the quality of paediatric ankle foot orthoses provided by health and social care trusts. (AQO 1919/17-22)

Photo of Robin Swann Robin Swann UUP

I thank the Member for her question. The clinical service that provides paediatric ankle foot orthoses (AFOs) is provided mainly by orthotists through contracted services to the health and social care trusts. There are two service providers in Northern Ireland, one of which manufacturers AFOs in Northern Ireland. The production lead times for AFOs are about three weeks from assessment to delivery to the trusts, with urgent orders being able to be completed within a week for inpatients or patients who are post-operative.

Service levels for orthotic services vary across trusts. In some trusts, children with SEN are able to access the service via a consultant, GP or allied health professional (AHP) referral, while, in others, the referral sources are more limited. Some of the paediatric caseload is seen in a special school clinic by orthotists. School clinics are weekly, fortnightly or monthly, depending on the school. Most children who attend those schools should be cast and supplied with their AFO within a month. Only pupils who attend those schools are able to be seen in those clinics. All other paediatric cases are seen in general clinics across a variety of hospitals.

Typically, waiting times can vary from trust to trust and depend on how the services are delivered. At clinics, the availability of appointments determines delivery of, speed of and access to services. Paediatric patients are usually prioritised over routine patients who are seen at the clinics, but, in the main, they will be seen in a general clinic, where adults are also seen. The typical waiting time between paediatric appointments is between six and 12 weeks.

I fully recognise that there is a constant need to review service delivery models, including paediatric orthotics, as children's needs for replacement devices are often more demanding, because of children's growth and general wear and tear. As part of the AHP workforce review programme, an orthotics workforce review was taken forward. It identified a number of issues, including variations in service delivery and access to services. As a result, the Chief Allied Health Professions Officer has asked for one of her trust paediatric heads of service to take forward a review of orthotic services across Northern Ireland. The intention is to have that review completed by October 2021.

Photo of Caoimhe Archibald Caoimhe Archibald Sinn Féin

I thank the Minister for that comprehensive answer. I have been contacted by constituents who have children who require orthoses, and I have written to the Minister on a couple of occasions about one child in particular. Those constituents have found that the orthoses provided cause pain and injury to the children's little feet and have been forced to source alternatives, privately, which is expensive. As the Minister mentioned, children's feet grow. Will the Department commit to evaluating the quality of the paediatric orthoses provided to ensure that they are fit for purpose?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her question. I know that she has written to me on that point. She asked about the quality of the orthosis provided. The device can be custom-made for the child from an impression that is taken of the child's leg and foot, or, if suitable, an off-the-shelf, prefabricated AFO can be utilised. The regulations provide more stringent requirements on the manufacture of any medical device, including orthotic devices that are manufactured by orthotic services. The guidance and standards for best practice are those from the British Association of Prosthetists and Orthotists guidelines for the provision of orthotic services. The guidance sets out the quality of the fabrication of devices, and those standards will apply to all patients. As I said in my response to the Member, our Chief Allied Health Professions Officer will undertake a review. It is due to be completed by October 2021. I will ask her to include the Member's query in her review.

Photo of Paula Bradshaw Paula Bradshaw Alliance

I recently had a meeting with a consultant orthotist, who echoed the Member's comments on the issue. On a broader point, one of the consultant's concerns was that health trust managers are not allocating enough theatre time for procedures on children's feet and legs. How does having insufficient theatre capacity fit into the regional prioritisation programme, considering that the earlier the intervention to correct the issue, the better?

Photo of Robin Swann Robin Swann UUP

The Member will be aware that the trusts have published their rebuilding plans for the next three months, and we are looking at the rescheduling and utilisation of our theatre capacity at a regional level rather than solely at trust level. It is about how we rebuild core services across the entire spectrum, including some of the invaluable preventative operations that can take place. However, first of all, we are tackling red-flag cases and making immediate urgent responses while we rebuild our service back to where it should be and where it can be.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

How has the supply line of medical devices, products and medicines been impacted by the protocol? Where do we source most of our supplies? How is the protocol impacting on that? How does the Minister anticipate how that will work at the end of the grace period? What awaits us on 1 January 2022 when we come fully under restrictive EU laws?

Photo of Robin Swann Robin Swann UUP

I thank the Member for that point. It is topical, and it was raised at the Health Committee last week. We currently receive 98% of our medicines and medical devices directly through GB, so the protocol will have an implication. It is not currently having an implication because we have a derogation until the end of this year. However, the triggering of article 16 towards the end of last year, around vaccines, has unnerved suppliers. There is work in progress between my Department, the Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA) who are also involved. That incident had an unsettling effect. Consistent suppliers are now asking more questions and are concerned about the implications of the protocol. That is why we engaged with those companies to give the reassurance that our Department and the Department of Health and Social Care are doing all that we can within our remit and our power to ensure that those supply lines are as seamless as possible.

In addition, the Northern Ireland Office holds a not insignificant financial pot to facilitate and support that, and we have engaged with it on how we can utilise that best to make sure that there is no disruption to the supply of medicines or medical devices in Northern Ireland due to the protocol and its outworkings.