Professional Affairs

The National Institute for Health and Care Excellence (NICE) has recently proposed an update for the Osteoarthritis: assessment and management guidance (previously published in 2014). The new guidance recommends a significant change in practice which is likely to impact orthotic provision for adults with osteoarthritis. The new guidance recommends the following:

“On considering the evidence identified in this review, the committee agreed that, in general, the evidence for insoles, braces, tape, splints and supports showed no clinically important benefits from their usage when compared to no device use. In some cases, potential harms from the devices were identified (such as blisters with braces). Given this, the committee agreed that based on the absence of strong evidence of benefit and some evidence of harm, that these devices should not be routinely offered”

The statement can be found in “[H] Evidence reviews for the clinical and cost-effectiveness of devices for the management of osteoarthritis” on page 93 lines 33-44.

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BAPO’s position

The British Association of Prosthetists and Orthotists (BAPO) strongly opposes this recommendation. BAPO feels it reduces the service users’ conservative treatment options, particularly where surgery and pharmaceutical intervention is contraindicated.
It is ambiguous in terms of orthotic provision as an adjunct to other interventions e.g., pre-and post-surgery. Similarly, the use of the term “routinely” creates further ambiguity.

BAPO is also disappointed that an orthotist was not included as part of the committee reviewing these guidelines.

BAPO has submitted an official response to the guidance outlining our concerns. We await a response from NICE and will endeavour to keep our members up to date with any progress.

Health Inequalities in England: The Marmot Review 10 years on

On the 24th of February Professor Sir Michael Marmot and the Institute of Health Equity published ‘Health Equity in England: The Marmot Review 10 years on’[i]. This article highlights the key messages in the review report.

In the 2010 Marmot Review ‘Fair Society Healthy Lives’[ii]  Marmot shone a light on health inequalities in England highlighting that those living in the poorest neighbourhoods would on average die seven years earlier than people living in the richest areas and not only would they die sooner they would spend more of their lives with disability. The original report provided six recommendations to reduce health inequalities with a strong focus on social justice. The recommendations included giving children the best start in life and acting across all the social determinants of health including education, occupation, income, home and communities.

The 10 years on review shows that over the last decade there has been a deterioration in health and a widening of health inequalities.

Since 2010 life expectancy in England has stalled; this has not happened since at least 1900.  Life expectancy follows the social gradient in that the more deprived the area the shorter the life expectancy; this gradient has become steeper meaning that inequalities in life expectancy have increased and this is most prominent in women.

The gradient in healthy life expectancy is steeper than that of life expectancy which means that people in more deprived areas spend more of their shorter lives in ill-health than those in less deprived areas.

There are regional differences in life expectancy particularly amongst people living in the more deprived areas; so that deprived people in the North East have a poorer life expectancy than deprived people in London.

Marmot highlights that to reduce health inequalities the same actions as stated in the original report are required:

1. To give every child the best start in life
2. To enable all children, young people and adults to maximise their capabilities and have control over their lives
3. To create fair employment and good work for all
4. To ensure a healthy standard of living for all
5. To create and develop healthy and sustainable places and communities
6. To strengthen the role and impact of ill-health prevention

The main recommendation from this most recent report is to the Prime Minister, to initiate an ambitious and world-leading health inequalities strategy and lead a Cabinet-level cross-departmental committee charged with its development and implementation.

We see the outcomes of health inequalities in clinical practice and we have a role to play in reducing the impact of health inequalities by being aware of the social determinants and inequalities within the populations we serve and ensuring our services are accessible and relevant to those communities who need them most.

[i] http://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on

[ii] http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review