No More Routine Toenails?  Jings, there’s a great initiative for you! Just
what the public wants to hear! Somehow I cannot see how such a move will
engender a positive feeling towards the profession if we employ it as a
branding exercise in an ‘integrated marketing communications package’ to
take the profession forward [although I agree entirely with the main
thrust of your proposals Jaime].What the public and politicians want is
workable solutions not more intractable problems.

It is perfectly understandable that podiatry departments in the NHS have
targeted the ‘at risk’ patients in a prioritised care system. Podiatry
funding has stagnated whilst demand, stimulated by increased
specialisation and a growing elderly population, has increased
tremendously. What has to be recognised is that within the profession,
there is ample capacity to accommodate the whole of the foot health
market – of which simple toenail cutting is but one aspect. The crisis
of which the gentleman featured is but one victim – need not have arisen
if more thought had gone into accommodating the needs of the patient
rather than that of the organisation when ‘prioritisation’ was introduced.

It is a pity that the artificial barriers that exist between the public
and private sectors have prevented greater integration in structuring our
care across the professional spectrum. When it became obvious in the mid
1990’s that demand was not being met in the NHS and patients were removed
from podiatry lists, alternate provision should have been planned and
organised. Whether we like it or not, many patients felt abandoned by the
profession by the manner which their care was withdrawn.

What has happened to these patients whose care was stopped by the NHS?
Some have managed through self care or with the assistance of family
members. Some have accessed the private sector. Some have been unable to
do either, especially the most vulnerable on low incomes and those in
rural areas where private provision is sporadic. The circumstances of
these patients are the ones which the media and politicians are most
sensitive to.

In some areas a voluntary nail cutting service has been established. Age
Concern are trying to expand their programme, often with the assistance of
the local podiatry department. This is ludicrous. The ‘voluntary’ aspect
of the service relates to the workers who perform this care. Patients are
being charged for their treatment – albeit a reasonable fee of £5. Can we
not see that this will impact tremendously on the incomes of many within
the profession if it becomes fully established? Are we that complacent? I
would have thought that we seek to protect as much of the foot health
market as we could for the profession? What other business or profession
would discard such a valuable commodity to a charitable foundation?

Some of the volunteers are working through the New Deal initiative for the
unemployed. A weeks training course and off they go with their shiny new
clippers. Can you imagine the medico-legal implications?

Given all the concerns that have been aired regarding the easy passage
granted to the unregistered practitioners through the HPC grand-parenting
scheme, I find I am bemused by the nonchalance that exists regarding the
entry of a pensioners charity into a sizeable part of the professional
marketplace. I shouldn’t even be surprised if some of the ‘volunteers’
applied for registration in the months ahead. What value then for the BSc
qualification?

It may be time for the NHS to remove itself from the simple toenail
cutting market; few would argue against that. But surely we need to
utilise the existing private chiropody/podiatry sector in providing this
essential service. Possibly through an accredited national foot-care
scheme.

Certainly make as much of the public and media exposure as possible.
There’s going to be a lot more of it in the near future. But do so in a
way that benefits the profession and the public alike. Oh, for a detailed
and comprehensive ‘Strategic Plan’ that could be presented to Ministers as
a possible solution! Debate anyone?

Kindest

Mark Russell

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