The Dudley Group NHS Foundation Trust

3. Mrs E has raised concerns about the care she received from the Trust. Specifically, she states that the Trust stopped her podiatry treatment in October 2024 on the basis that she no longer met the eligibility criteria. She also complains she was only made aware of this during the local resolution meeting, which she found shocking and upsetting.

4. Mrs E reports that no alternative treatment options, referrals, or support were offered. The only suggestion was to seek private care, which she explained she cannot afford as she is in receipt of Universal Credit.

5. Mrs E states that since her treatment was stopped, she has experienced constant pain, a deterioration in her mobility, and an increased risk of falls. She explained that while receiving regular care, the lump on her foot was about the size of a needle point, but it has since grown to the size of a 10p coin.

6. Mrs E describes the impact on her life as significant. She now uses a wheelchair, which she had hoped to avoid, and requires assistance from her husband for daily tasks. She also reports a serious decline in her mental health, for which she is currently prescribed a high dose of antidepressants and is receiving talking therapy through her GP. We acknowledge how distressing this must be for Mrs E and the effect it has had on her independence and quality of life.

7. By bringing this complaint to us, Mrs E would like the Trust to reconsider its decision and offer her NHS treatment for her foot. She has also indicated that she would seek a financial remedy if failings were identified, although this is not her primary concern.

8. Mrs E had foot surgery approximately eight to nine years ago. Following the procedure, she was referred to the Trust for ongoing care to manage a lump on her foot. Initially, appointments were scheduled every three months, then every six weeks, and eventually every four weeks. At each visit, the podiatry team would reduce the lump, pad and bandage her foot, and provide items to help manage the condition at home.

9. In October 2024, Mrs E says she began to feel that the podiatry team’s attitude toward her was changing. She raised a formal complaint with the Trust earlier this year and was invited to a local resolution meeting in May 2025. It was during this meeting that she was informed the service could no longer offer her treatment.

10. By August 2025, she had to begin using an electric wheelchair - something she had hoped to avoid. She now requires support from her husband for basic tasks such as using the bathroom. She described the withdrawal of treatment as having a significant and negative impact on her quality of life. We recognise the distress this caused and the loss of independence she has described.

14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

Criteria and categorisation

15. Mrs E complains that the Trust stopped her podiatry treatment in October 2024 on the basis that she no longer met the eligibility criteria.

16. The Trust told us that Mrs E’s medical history and neurovascular assessment did not qualify her for routine treatment under the updated acceptance criteria. It explained it did not categorise Mrs E as a high‑risk patient, and that several clinicians assessed her who all reached the same conclusion that she did not meet the criteria for continued care.

17. The Trust explained its acceptance and exclusion criteria for the podiatry service were updated in March 2025 in line with NICE guideline NG19. NG19 states that patients should be stratified into low, moderate, or high‑risk categories, and that NHS podiatry services should prioritise those at moderate or high risk, including patients with active ulceration or at risk of limb loss.

18. The Trust’s criteria shows it prioritises patients at moderate or high risk, such as those with active ulceration or at risk of limb loss. It states patients of all ages with a Dudley GP meet the criteria for conditions such as: • ingrowing toenails • pathological toenails (for removal) • musculoskeletal assessment • any active foot ulcer (if diabetic with no infection or mild infection only) • podiatric needs (corns, callus, lesions) with at least one of the following risk factors: • diabetes with high or moderate risk (as per NICE NG19) • history of ulceration/amputation • active end of life care • renal dialysis • rheumatoid arthritis • neurological conditions such as multiple sclerosis (MS) • peripheral vascular disease • immunocompromised status

The exclusion criteria states patients with the following conditions do not meet the criteria: • low‑risk diabetes (as per NG19) • no risk factors as stated in the acceptance criteria • nail care • annual diabetic foot checks • fungal nail infection (unless for removal) • verrucae

19. The Trust explained that the current criteria have been in place for new patients since 2021. In March 2025, with the agreement of the Integrated Care Board (ICB), the acceptance criteria were expanded to include existing patients. This change was introduced to manage demand and capacity and to ensure patients with a true podiatric need could receive treatment in a fair and timely manner.

20. We will now consider how the Trust categorised Mrs E and applied these criteria in her case.

21. Our adviser reviewed Mrs E’s podiatry records and confirmed that her pulses and sensations were good. We understand this means Mrs E is at low risk of complications or limb loss. We can see that Mrs E does not have diabetes or any of the medical conditions or risk factors listed in the Trust’s acceptance criteria. Our adviser also explained that in these circumstances, the Trust was not required to consult external clinicians regarding its decision, as this was not a consultant‑led service and had its own criteria.

22. Our adviser further explained that Mrs E has a painful corn secondary to bony deformity (a thickened area of skin that can become painful). Her records show she was comfortable with the insoles and footwear provided by the muscular-skeletal (MSK) clinic. We can also see from Mrs E’s medical records that she has never had ulceration, soft‑tissue infection, or anything that would place her in a higher‑risk category in the Trust’s criteria.

23. Taking all of this into account and considering the Trust’s criteria set out in points 17 and 18 of this statement alongside the clinical advice we received, we consider there are indications the Trust categorised Mrs E appropriately based on her presentation and level of risk. We are satisfied that the Trust’s categorisation was appropriate, consistent with commissioning requirements, and applied fairly.

24. We recognise how upsetting it must have been for Mrs E to lose access to routine care after so many years, especially given the pain she experiences and the impact this has had on her mobility and independence. We do not wish for our decision to diminish the impact this has had on her.

25. We will next consider how the Trust communicated its decision to Mrs E, and what alternatives it offered.

Communication

26. Mrs E complains that the Trust did not communicate clearly or in a timely way about its decision to discharge her, and that she only became aware of this during the local resolution meeting, which she found shocking and distressing.

27. The Trust told us it explained to Mrs E several times while she was in its care that she did not meet the criteria. She was also given an explanation in the local resolution meeting on 22 May 2025, followed by a letter from the complaints department. The Trust acknowledged that no written communication was sent prior to the local resolution meeting.

28. We reviewed Mrs E’s podiatry records to assess communication about her discharge:

• October 2024: Mrs E was identified as ineligible for care. Referral was made to the biomechanics team for insoles • January 2025: Discharge was documented as discussed with Mrs E • February 2025: Mrs E was reassessed and again found not to meet the criteria. Her case was escalated to management for a second opinion • May 2025: A third clinician confirmed she did not meet the criteria. The discharge conversation was referred to management due to her reluctance to accept the decision • 22 May 2025: Mrs E attended a local resolution meeting and was informed she would be discharged.

29. The NHS Complaints Standards emphasise that organisations should communicate openly, honestly, and in a timely way, providing clear explanations of decisions and actions.

30. While the Trust did make efforts to explain its decision through reassessments and meetings, the absence of written communication before the local resolution meeting did not fully meet these standards. We recognise how upsetting this was for Mrs E and the distress it caused her. However, we do not consider this shortcoming to amount to a failing, as the Trust did communicate its decision to her verbally.

31. Overall, we are satisfied that the Trust took reasonable steps in line with the NHS Complaint Standards to communicate its decision to Mrs E, including reassessment, escalation for second opinions (which we will cover below) and a local resolution meeting.

Alternatives

32. Mrs E complains that the Trust did not offer her appropriate alternative treatment options or support after discharge, and that the only suggestion was to seek private care, which she cannot afford.

33. The Trust offered Mrs E alternatives such as referral to podiatric surgery (which she declined), advice to seek private care, and signposting to charities such as Age Concern. Our adviser explained that this is standard practice nationally when a patient does not meet NHS criteria, and that there was nothing further the Trust could reasonably have offered at the time.

34. This approach is consistent with GMC Good Medical Practice, which states that clinicians should give patients clear information about their options and signpost them to appropriate sources of support when NHS treatment is not available. It is also in line with the Trust’s own podiatry criteria guidance, which sets out the circumstances in which alternative pathways should be offered when a patient does not meet the acceptance criteria.

35. While the Trust did offer alternatives, we recognise it would have been helpful if it had also explained that Mrs E could be re‑referred if her condition changed or if she developed a qualifying medical need. We are sorry if this was not made clear to her, as this may have provided reassurance at a difficult time.

36. Although clearer communication about re‑referral would have been beneficial, we do not consider this has fallen so far below the standard that it amounts to a service failure, because the Trust did take reasonable steps to explain its decision, offered appropriate alternative options, and signposted Mrs E to other sources of support.

37. Overall, we are satisfied that the Trust acted within national practice and took reasonable steps to support Mrs E following her discharge.

Conclusion

38. Having considered all the evidence available to us, we have not identified any indications something went wrong with the Trust’s categorisation of Mrs E’s presentation, its communication regarding the decision to discharge Mrs E, and the alternatives it offered.

39. We fully appreciate that this may not be the outcome Mrs E was hoping for. Losing access to care after so many years has understandably been distressing, and we recognise the impact Mrs E’s condition has had on her daily life and independence.

40. That said, we hope this statement provides reassurance that her concerns have been carefully reviewed and that the Trust’s actions were consistent with national guidance and commissioning requirements. We wish Mrs E the very best with her health and ongoing care.

1. We have carefully considered Mrs E’s complaint about The Dudley Group NHS Foundation Trust (the Trust). Based on the evidence available, we have seen no indication that anything went seriously wrong in terms of the care she received.

2. That being said, we fully recognise the seriousness of Mrs E’s concerns and the significant impact this situation has had on her daily life and wellbeing. It is important to acknowledge that our decision does not detract from Mrs E’s experience, nor the impact this had on her.