Personal Footcare Guidance

3: Links with National Policy and Guidance

National policy, principles and ongoing work that strengthen the personal footcare guidance are as follows:

Free Personal Care

Free personal and nursing care was introduced in Scotland on 1 July 2002 through the Community Care and Health (Scotland) Act 2002.^[4]

Personal care is available without charge for everyone in Scotland aged 65 and over who have been assessed by the local authority as needing it. Free nursing care is available for people of any age. The legislation includes keeping fingernails and toenails trimmed as one of the personal hygiene aspects of personal care. Carers can be taught to provide personal footcare as part of a personal care plan.

Essentially, any provision of care is based on a detailed assessment of the individual's personal care needs taking into account their preferences and those of their family and carers. If the individual's circumstances change a review assessment should be conducted and the local social work department is responsible for making suitable arrangements.

Local authorities will assess whether people requiring care at home or in a care home need personal care and will make available an agreed payment directly to the individual or their care provider. However, the local authority is expected to make sure that the resources are used in the most effective way to meet individual personal care needs.

Scottish Diabetes Foot Action Group

The national group has several strands of work in progress which aim to prevent and reduce the incidence of foot disease and amputations in people with diabetes. All people with diabetes should undergo foot screening by a suitably trained person.^[5] This will result in the identification of the risk associated with the development a foot ulcer. These risk categories are; Low, Moderate, High or Active Foot Disease. More detail on the risk categories is available in Appendix 1.

Information during the screening process is input by the healthcare professional carrying out the foot screening into the nationwide Scottish Care Information (SCI) Diabetes shared information system which automatically calculates the person's foot risk status and provides recommended action according to the assigned risk. During the screening appointment verbal advice and education should be provided supported by the appropriate written information.^[6]

Good personal footcare and checking of feet everyday by the individual, their family, friends or carers is important for all people with diabetes.

• For people who have been screened and assessed as Low risk, it is acceptable and safe for them, their family, friends or carers to carry out personal foot care.
• For people who have been screened and assessed as Moderate risk, they or their family, friends or carers may still be able to carry out all or most of their personal footcare safely, following advice from the podiatrist.
• For people who have been screened and assessed as High risk some of their personal footcare may still be carried out by themselves, their family, friends or carers especially the checking their feet daily for any breaks in the skin or signs of any problems. People in the High risk group should also visit a podiatrist on a regular basis.
• For people who have been assessed as suffering from Active Foot Disease rapid referral to a member of the multidisciplinary foot team or a multidisciplinary foot clinic is essential. Daily foot checks should still be carried out where possible by themselves, their family, friends or carers for signs of any further problems.

National Policy and Guidance

The personal footcare guidance is associated with a number of policy documents including: Carers Strategy, Dementia Strategy, Falls Prevention, Healthcare Quality Strategy, Integration of Health and Social Care, National Care Standards, Reshaping Care for Older People, The National Delivery Plan for the Allied Health Professions (AHPs) in Scotland and 20:20 Vision.^{[7 - 16]}

Further information on these documents is available in Appendix 2.