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I am hoping that lessons can be learned from my experience.

Posted By DHH

"I am hoping that lessons can be learned from my experience."

About: University Hospital Ayr / Prosthetics/Orthotics

(as the patient),

I wanted to share my recent and ongoing request for a new pair of shoes.

I requested a new pair of shoes in September 2016 and was told that there would be a 33 week waiting time. I was contacted in December 2016 with a cancellation appointment where I would be assessed for my suitability for a new pair of shoes. At that appointment I was told that I would be suitable for a new pair. I chose to have the same style and colour of boots that I have been having for approximately the last 10 years. I opted to have a fitting before the shoes were completed.

It is now August 2017 and I have had multiple appointments and the shoes have been highly unsuitable and unwearable on all occasions.

I am struggling to understand why it has taken a year plus to receive a pair of shoes. I am using the same company, same hospital, I have had new lasts made, I even set a pair of my shoes away so they could be compared, yet a year down the line I have still not received anything wearable

Having had my shoe wear made for me for the past 30 years and this is the worst experience I have had. During this time waiting for my new shoes, I have had surgery on my spine and the first thing I have been asked by various medical departments I have been involved with during my recovery is "are your shoes up to date? ".

What has changed in the system that has lessened my patient experience?

Perhaps it is moving the great, helpful, personalised patient service experience the admin staff provided before they were centralised. At my last appointment after waiting 4 weeks from my previous appointment I showed up to my appointment to find nothing had been done to my shoes, not amended, nothing. I'm not even sure they left the hospital to go to the factory. A wasted 4 weeks. Now I have to wait another 4 weeks to see if they will be right at the next fitting - still not completely made.

I have had issues before. I sent my shoes in to have the soles repaired last year and my shoes went on a 6 week "holiday" to NHS Dumfries and Galloway before being returned to me.

I am aware mistakes happen however I think waiting over a year, and multiple wasted appointments are unacceptable.

Can you tell my the allocation of shoes per person? It was suggested to me that it is suitable to have 2 "useable" pairs at any one time.

An interesting fact on a white board while I was waiting for a physio appointment was that after every 400-500 miles in a pair of shoes, they should be replaced. Can you tell me if this concept is used within the orthotics department or just physio?

I am hoping that lessons can be learned from my experience.

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Responses

Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
We are preparing to make a change
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 09/08/2017 at 14:51
Published on Care Opinion at 16:46

picture of Eunice Goodwin

Dear DHH,

I have spoken with our Orthotics service manager, Colin Keith and he has asked me to post this response on his behalf -

"Dear DHH,

It was with significant concern that I read your post. I am sorry that you have had these unacceptable issues but I thank you for bringing to our attention as this will provide an opportunity to address this and learn from any mistakes and errors made.

I will obviously have to look at all the factors in depth but will attempt to respond below to the main issues you have raised:

I am afraid that waiting times were at the level you state at that time due to very high demand on the service above the capacity and resources we have. However on a positive note I hope you will be reassured that various measures were introduced to address the waiting time and coupled with a reduction in referrals and more appropriate referral pathways being introduced average waiting times are now 4-5 weeks. I am glad at least that a cancellation was found for you although you would rightly not have expected to be without new footwear after such a length of time following your appointment.

I am obviously even more concerned that having received footwear for many years that problems of this magnitude have arisen and will be looking in detail into clinical and manufacturing processes that have contributed so as we can identify issues that can be addressed and learnt from to avoid future issues.

We have recently (1st July this year) had a change of contracted provider of clinical service who we are working closely with us to develop service improvements including “right first time” to provide early intervention and support in situations where fitting issues are highlighted at a very early stage. Necessary peer support for the clinicians and meaningful dialogue with the manufacturers being key factors as required. I realise that this is little consolation at this stage but hope it will help to restore your confidence for the future. I do not know at this stage whether you were seen by different clinicians at your appointments which does not provide for the best continuity and I am aware that our previous providers of clinical service had staffing issues and had to utilise locum cover which does not help in these situations. I can assure you that this is another area being addressed to reinstate continuity of clinician for patients as I strongly believe it helps greatly if the clinician has an in depth individual understanding of your clinical needs and requirements around the footwear.

I appreciate your recognition of the staff at the Ayr office and agree they are very valuable members of our team. The centralisation of the admin services is a necessary part of the larger administration reorganisation and I would hope that you will receive the same support and help from the team. One member of the Ayr staff is still at Ayr in a different role but her knowledge on site will be utilised. The other member has relocated to the Crosshouse office so knowledge of service users of the Ayr service remains. I will not pretend that such a centralisation is easy and even with the best possible forward planning I am sure you will agree that some issues are bound to arise early on until things settle down. However I am seriously concerned if as you suggest the boots were not sent to the manufacturer. Again I will look into this in detail.

We provide the service for NHS Dumfries & Galloway also and I suspect the supplier has simply wrongly boxed the repaired footwear in the Dumfries delivery rather than that to Ayr. While not acceptable I hope you can see this as an unfortunate mistake by the manufacturer. We have addressed the need for greater care and since then we have had almost no issues. I apologise that this happened and would hope it will not arise in the future.

With regard to provision of footwear the national Scottish Government endorsed guidelines state that most patients will require 2 serviceable pairs in use at any one time which is what the service provides and maintains. A mileage assessment does not work in the case of many of our service users’ circumstances. Provision is based on clinical need and assessment of footwear condition by the clinician. As you will fully understand walking pattern, weight and complexity of condition amongst other factors will all play a part in the frequency of requirement for each individual concerned. This can mean that footwear will last longer or when necessary be replaced in a shorter mileage. Obviously it would be very difficult to measure mileage and could in some cases disadvantage individuals. In addition the mileage guidance I assume is based on ordinary retail footwear which in the vast majority of cases is not nearly of the same quality as bespoke orthopaedic footwear. I have to say I have not seen any evidence behind these figures.

I apologise that my response has been somewhat long but I felt you deserved each point addressed. However, I feel that direct contact with you to discuss the issues in detail, to address the existing problems and provide a satisfactory outcome to these issues would be the best way forward. I am happy to contact you and meet with you if you wish. It will help you to be as involved with the future process and you can be as involved as you wish, helping to obtain suitable footwear as soon as possible.

Kind regards,

Colin Keith"

Orthotics service manager

I hope this is helpful DHH. If you want Colin to contact you, if you can, please email me your name, date of birth, phone number and a preferred time for a chat with Colin and I am sure he endeavour to call you at the time convenient to you.

best wishes,

Eunice

My email address is Eunice.goodwin@aapct.scot.nhs.uk

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by DHH (the patient)

Thank you both for your reply.

As a seasoned shoe orderer (30 years) I am not immune to a waiting time for shoes. I know they usually take approximately 3 months from phone call to walking away with them, I understand this and realise this is part of the process.

I must state that everyone I have met in this process for this pair of shoes have been lovely and apologetic. However, I am still without my shoes and no real reason as to why.

I may have missed the service improvement of "right first time" at the beginning of my journey however I would like to believe it would now be "right next time". I have been seen by 2 clinicians, 1 only for a brief time at the very beginning. The clinicians (both lovely and just as frustrated as me) and the factory are well aware of my clinical needs and requirements, from previous notes (at least 10 years worth), my verbal communication, a new last made and even 1 pair of my "2 serviceable pairs" sent away to copy. I had not changed my order in any way from my previous pair. I will be interested to hear the results of your investigation as to why this has happened.

I would agree that the footwear is made to a higher quality but in my own experience they do require regular repair to the soles which do not last long and are never reviewed unless I request one. I would expect due to the complex nature of surgical shoes that they would require more reviews and updated more regularly than "ordinary retail footwear" due to "walking pattern, weight and complexity of conditions" not less often.

Perhaps Government also need to look at their guidelines. Having recently had surgery and a stay in hospital I don't have slippers. If my "work shoes" are in for repair I have my second pair of "work shoes" to use, however this mean the same style shoe has to cover all shoe wear including slippers outdoor shoes, smart shoes, casual shoes, winter shoes, summer shoes. It is quite humiliating when asked where my slippers are to put on, to explain I don't have any as I am only allowed 2 pairs of foorwear at any one time and slippers would effectively be a waste of a pair. Out of interest, you may be able to tell me or point me in the right direction, how could I find out how long this guideline has been in place and if it has it ever been reviewed?

I have passed on my contact details to Eunice and look forward to hopefully meeting my completed shoes soon.

Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 10/08/2017 at 11:41
Published on Care Opinion at 15:48

picture of Eunice Goodwin

Dear DHH,

Thank you for contacting me off line. I have passed your details on to Colin and I am sure he will be in touch soon to sort things out.

best wishes,

Eunice

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful
Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
We have made a change
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 15/08/2017 at 16:36
Published on Care Opinion at 16:41

picture of Eunice Goodwin

Dear DHH,

I have been asked to post this on Colin's behalf.

"Thank you for making the time available for me to meet with you and discuss your concerns. Your comments and suggestions are valued and I will take these forward to improve our service and practice wherever possible.

I am confident that in the very near future we will have the issues that have delayed supply of your footwear resolved and I will attend your next fitting to see at firsthand how things are progressing. The manufacturers have assured me they are recording all specification changes and any errors to absolutely minimise the risk of any major problems in the future and you can once again be confident of receiving footwear that is fitting appropriately within an acceptable time.

Thank you again for your very positive attitude to our service and recognition of its value to service users despite your current issues.

Regards,

Colin

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by DHH (the patient)

It is with great sadness and disappointment that I have to update this story without a positive resolve.

I had a fitting in August. I had hoped that changes had been made as this posts status suggests. I had high hopes for obtaining “suitable footwear as soon as possible” and was confident “that in the near future we will have the issues that have delayed supply for footwear resolved.”

With this in mind, I had hoped that after waiting over a year for my shoes, they would now receive an emergency status. That they would be fast tracked as compensation for the hideous amount of time I have had to wait for a repeat pair of shoes. I had hoped I would be able to update this to say I had received a first class service since my complaint. Unfortunately the words I received are not being backed up with actions.

I have received an appointment for what is hoped to be a final fitting! 2 months since I was told things had changed and been made better. Just to be clear, this is not a waiting time for a new shoe, this is for a minor adjustment and completion of an already half completed shoe.

Having done my own research into the guidelines I have found the following:-

Patient Led Orthotic Services Document – Users Charter (2011)

“Supply Timescale Guidelines for clarification, these timescales are from the appointment at which the orthotic solution is specified until the satisfactory delivery or fitting to the patient”. “Bespoke footwear 25 working days, number of fittings 2”.

I have waited 40 working days since my last fitting.

Things do not appear to have been changed, lessons do not appear to have been learned.

I still don’t have a pair of shoes!

Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 20/09/2017 at 09:35
Published on Care Opinion at 13:49

picture of Eunice Goodwin

Dear DHH,

I too am saddened that this has not been the happy ending we both expected. I really can 't imagine how it must be to rely on someone else for your shoes. They are such a fundamental and 'ordinary' need.

I wonder if I can ask you to be a little more patient with us. I know, I can hear you say that you have been more than patient with us, and you have. However, as Colin heads this service and was involved previously, he really is the best person to help when he returns to work next week. I will ask him to look into this and contact you as soon as he possibly can.

I know this must seem less than helpful, but I know Colin will want to address and fix this for you and for others.

Thank you again for bringing this issue to our attention. I really to hope it gets sorted once and for all.

Best wishes,

Eunice

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful
Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 09/10/2017 at 11:43
Published on Care Opinion at 11:58

picture of Eunice Goodwin

Dear DHH,

Colin asked me to post this on his behalf

Thank you for contacting me. Following our meeting on Wednesday I hope you can accept my further apology and explanation around some of the unfortunate circumstances contributing to the delay. As you know the boots felt comfortable at the last fitting but there were some cosmetic issues noted. It is unfortunate that having addressed these cosmetic issues, for the reasons that we both agreed, that you do not feel the boots to be entirely satisfactory. As you known I too am very disappointed that we have not yet arrived at a final solution but I am confident our agreed plan will achieve a satisfactory outcome for us both. I will speak with you on Monday to finalise our arrangements.

Regards

Colin

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful
Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 16/10/2017 at 15:58
Published on Care Opinion at 16:25

picture of Eunice Goodwin

Hi DHH,

Colin would like to post this for you -

"Thank you for contacting me off line and highlighting that my wording may be misconstrued.

I am sorry for any distress this caused you, it was certainly not my intention. I did not mean to belittle the problems you have faced in obtaining suitable footwear.

I would like to clarify the situation for those who do not understand the process. In addition to the cosmetic issues identified at the fitting, you rightly say that the more significant design/structural and functional issues (which also impact on the appearance) became apparent when the boots were completed and had these had to be addressed. (These issues were unfortunately not identified at the trial fit stage and this may have been because the boots are not complete at this stage). As we know, this has stemmed from the supplier not being able to locate your original lasts used to make the boots that have served you well over the past years.

I have discussed the problems with the clinician and I am hopeful that your meeting with them and the footwear technician will result in the specification changes being made, resulting in all satisfaction of all your future footwear manufacture.

I would also like to say that I will continue to follow progress and support the process to achieve what is only reasonable I.e. for you to be provided with a suitable pair of footwear.

Kindest regards,

Colin

Colin Keith

Orthotics Service Manager

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by DHH (the patient)

I feel I need to bring this story to a conclusion.

I received my final completed, useable pair for shoes in early December 2017. I wore them for a month and returned to Buchanan’s direct on recently for a slight alteration that they were able to complete on the spot.

Here are some statistics, that perhaps warrant a service review.

To complete a pair of shoes it took:-

14 appointments between September 16 and January 18 – 7 of which were after I posted my feedback on here.

4 times I had to travel outside my local area to Glasgow (Buchanan’s).

14 times I had to clear time away from my work to attend the appointments – which equates to approx 15 work hours lost on appointments only.

9 posts on care opinion overall – not including this one.

Multiple phone calls and off line emails.

I am hopeful that my next order of shoes will simpler now that Buchanan’s have found my original lasts (moulds), which had been “missing” or “lost” since March 17 and were “found” on at the end of October 17.

Response from Eunice Goodwin, Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team, NHS Ayrshire and Arran 6 years ago
Eunice Goodwin
Patient Feedback Manager for NHS Ayrshire and Arran, Quality Improvement and Governance Team,
NHS Ayrshire and Arran

I respond initially to most of the posts and ensure they are passed to the appropriate team whether they are compliments, observations or grumbles. It is important to make sure all issues are addressed and I try to encourage that to happen for all the posts as required.

Submitted on 18/01/2018 at 18:13
Published on Care Opinion at 18:29

picture of Eunice Goodwin

Dear DHH,

I am sorry, you have been on such a long journey with this. As you know, we have spoken about this on a few occasions and I am grateful to you for bringing this to light. Thank you for the clear summary of your epic. I will pass this on to Colin in Orthotics for his review and reflection.

I am glad you now have wearable shoes, but the process does seem to have been very wieldy. As you say, it will hopefully be better now the original lasts are available.

I really hope that getting your next pair is a much easier process.

best wishes,

Eunice

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