1. Developing & Implementing a new role A Partnership Development Marion Rogerson (Former NHS Commissioner)

2. Other Stakeholders Dr P & GPs Mandy Cadge Ann and Jean Voluntary Sector Heather H M B College

3. A ‘Head of Steam’ NHS podiatry had discharged 4,000 people who needed routine nail cutting 3 years earlier This ‘grey lobby’ were vociferous in their lobbying –contacted health, social care, local politicians and the media Lobbying groups wanted a free service … or at least a very uniform pricing structure Social Care wanted the “political” issue “off their backs” and offered £25,000 over three years to fund nail cutting (didn’t renew the budget 3 years later ) A Director of Strategy (Commissioning) offered £125,000 to bring nail cutting back into the NHS......... BUT The Head of Podiatry had had the CEO’s support to discharge 4,000 people in order to re-profile the service and allow for growth in need and wasn’t going to take nail cutting back

4. A new role with new responsibilities Development Challenges were: – Defining what the role would (and wouldn’t) do – Having time to reflect in a busy world / thinking outside the box – other industries / models – Creating a service that was sustainable (£50k max budget in to the future with growing need) – Creating a contract of (quality)standards (Lawyers) Implementation Challenges Helping others to understand the model – eg Pharmacies and GP practices Introducing the new training and role and “trusting” we had done the right thing!

5. Securing an Education Provider Finding someone to design and deliver the education and training for the role Vested interests can cause barriers – learned that individuals can make things happen (you just have to find them!) Quid pro quo – we offered creation of the Nail Care logo as a project for students at the local college. The Head of Art and Design gave us a way into Hair and Beauty Little profit so......Find individuals who understand or who have a passion. How many of you have had to cut a relatives toenails? How many of you wanted to?

6. Recruiting to the course Avoid ‘calamity and complaint’ early on Tried to get a variety of mature people on the first course Home visits, day centres, walk in service About sustainability and not relying on training people from one background or type of employer Learned a lot from the first course: – Subsequent courses required attendees (or their employers) to pay half the fee – We changed the order subjects were taught – People wanting to attend the course had to complete a questionnaire e.g. Do you like feet? (you’d be amazed)

7. Supporting Nail Carers and their clients Seizing opportunities to develop the service - Non NHS but a health related role – investing time and effort in addressing the queries and concerns of Nail Carers Used funding to support with CPD – help line – contract of standards (for Birmingham Nail Carers) – web site (£25k then £50k) – Independent Nail Carers ( we never could set that uniform pricing structure) – Nail Carers in domiciliary care – Nail Carers in social care – Nail Carers in day centres – Nail Carers in pharmacy/GP services Insurance Marketing – 2 for the price of one – introduce a friend and get a free nail cut! NB No legislation or regulations apply! Common sense makes sense! Developing the customer base – trust, familiarity, quality service at the right price

8. What have we achieved? Helped to keep people comfortable and mobile Helped to prevent trips and falls Given some isolated clients a new lease of life ly isolated… Before – Client had been housebound for many months as they couldn’t put shoes on After – Client had immediate relief. They put their shoes on and went out socialising with friends that same evening

9. Working with Skills for Health We knew we had a model that worked and we wanted to enable our good practice to spread Saw education as key SfH supported us with their expertise to: – Develop the Transferable Role Template for Nail Care – Engage with potential Awarding Organisations – Develop the Accredited qualification with 3 AOs – Evaluate the Nail Care role and look at future impact

10. Judging Success Informally – keeping in touch, CPD, Nail Carer of the Year award, no complaints, clients keep coming (and paying) Quantitative - waiting times for routine NHS Podiatry have fallen from almost 2 years down to just a few weeks – Over 120 nail carers have been trained to date (estimate that 100 are ‘active’) – Estimated 5,000 clients – Value of the business estimated at £250,000 per annum – Lots of room for growth…. – Potentially lots of wider health benefits (although these are difficult to measure) Qualitative – lots of quality areas – – Visiting a Nail Carer is an opportunity for a meaningful social interaction, really important for people who are more socially isolated – The role is a flexible employment opportunity – allowed some people to transform their life and their careers

11. Following Birmingham’s success there is huge potential for growth and spread across the UK If we can replicate a similar level of coverage across the UK the value of the Nail Care business could easily exceed £10million per annum........ And................. Help to ensure that those who can’t cut their own toe nails keep active and healthy and avoid disability !

12. Skills for Health Evaluation Videos New nail carer role benefits South Birmingham etc... http://vimeo.com/88043092 Nail Care, a new career http://vimeo.com/88043091 NHS supports creation of new role... http://vimeo.com/88043089 Working with Skills for Health... http://vimeo.com/88043088