#121 Creating a tool to support decision making at End of Life with podiatrist Mark Povey

In this episode it is my pleasure to talk with podiatrist Mark Povey. Mark and I first met when I was lead for EoLC at an NHS Trust and Mark  presented an idea around decision making for podiatry patients towards the end of life. It’s fascinating and a privilege to hear how this idea developed into a QI project and subsequent training package.

Key messages

• Mark describes the role of a podiatrist and the long term care they can deliver to patients

• Mark explains how he came to be interested in EoLC in relation to podiatry patients

• The benefits and burden of sharp wound debridement formed the focus of Mark’s Quality Improvement project

• The decision making tool DECIDE is explained by Mark

• The underpinning importance of communication is explored

• Mark shares how his QI project has been used to deliver training to podiatrists

Resource

• Read more about Mark’s QI Project: Increasing confidence in caring for end of life patients among podiatrists 

• Read more about what End of Life Care: NHS: What end of life care involves  

• Contact Mark via: X - @markpovey77

Bio

Mark is one of the Clinical Lead Podiatrists in Kent (UK) specialising in high-risk feet. He qualified back in 1998 from the University of Brighton (Eastbourne campus) with a BSc (Hons) in Podiatry. He has spent his entire career so far working in the NHS within the east Kent region, which has involved working in both acute and community care settings, in addition to domicillary visits for housebound patients. During this time Mark has had countless opportunities for joint working with a variety of health professionals such as Community Nurses, Vascular Consultants/Nurses, Orthopaedic Consultants, GPs and Practice Nurses.

Mark has always had a keen interest in wound care and Diabetes, specialising early on in his career in this area of high-risk footcare. In 2009, he completed a diploma in “Diabetes management in primary care” which equipped him to become a facilitator in locally-run Diabetes patient education groups, working alongside Diabetes Specialist Nurses and Dietitians.

In recent years, his specialism has evolved to encompass all vulnerable high-risk feet, regardless of the medical cause. “High-risk feet” is a broad term for people whose feet are at a high risk of developing wounds that can lead to pain, infection, sepsis, amputation and disability, all of which is associated with a high mortality risk.

In 2020, Mark and his colleagues found themselves visiting more high-risk patients at home due to the Pandemic and working alongside Community Nurses who were managing palliative care patients at home. Mark and his colleagues began questioning their rationale for sharp wound debridement in patients who were deemed to be end of life and this led to him constructing a Standard Operation Procedure (SOP) and the “DECIDE” tool, which aimed to help Podiatrists in their clinical decision making.

This led to a Quality improvement project to improve confidence among Podiatrists working with eolc patients, especially regarding making appropriate decisions about wound debridement. Increasing confidence in caring for end of life patients among podiatrists. One of the outcomes of this project was the creation of a training package (in collaboration with a Consultant Nurse in eolc) which was delivered initially to his Podiatry colleagues across Kent. Mark won best Qi Project in the Kent NHS Staff awards in 2022 and presented his work briefly at the Royal College of Podiatry conference in Liverpool that year.

This led to being interviewed for an article regarding the role of Podiatry in eolc, published in “The Podiatrist” in January 2023. Following this article, Mark has had the opportunity to provide training to Podiatry teams across the east of England and Dorset. He also presented an hour-long workshop on this topic at the most recent Royal College of Podiatry conference in November 2024 in Harrogate. 

Mark is passionate about raising the profile of Podiatry in eolc and instilling confidence in clinicians, to be able to have timely and appropriate conversations with patients, carers and health professionals, so that Podiatrists can deliver the most appropriate and effective treatments in often complex situations.

Mark lives in Ashford, Kent and is married with 2 daughters, both of whom are somehow adults already and are embarking on healthcare careers that don’t involve feet! (Clinical Psychology and Paediatric Nursing to be precise). He enjoys being outdoors, whether that’s gardening, cycling or playing any type of sports!

Mark Povey BSc (Hons) Podiatry

X - @markpovey77