Well said Mark. I think it's called privatisation by stealth. Much as I
complained about the NHS when living in the UK its ethos and principle are
without doubt the envy of many other nations. All citizens in the UK should
do all in their power to ensure that the system whereby a health service is
"free' at source is maintained for future generations. Having now lived in
2 countries where a NHS does not exist I am certainly appreciative of what
I once had in the UK. It's the age old adage that you don't miss it 'til its
gone! In Australia there is a tax rebate for private medical insurance to
encourage people to have it and then the premiums go up and folk grow old
and their cover is insufficient ...and then they realise it's been a
life-long con and they should have fought harder to make Governments provide
a decent health service. I reckon a good health system is indicative of a
civilised nation (along with the provision of an adequate education system)
Long may the British NHS continue.
Ann Marie Carr
-----Original Message-----
From: Mark Russell [mailto:[log in to unmask]]
Sent: Sunday, 29 February 2004 7:24 AM
To: [log in to unmask]
Subject: Re: Toenail maintence
Stephanie
I think that it is commendable that you provide a service on the basis you
describe, for such altruism is becoming increasingly rare within our
profession nowadays. I am sure that I am not alone in feeling dismay and
anger at the attitude displayed by many within our profession, to the many
elderly patients who depend so much on our assistance to keep them mobile
and pain free. It is not just the simple nail care patients whose care has
been withdrawn from the NHS podiatry service. Patients with a variety of
common foot disorders have been discharged as well, simply because they do
not have some underlying medical pathology like diabetes mellitus or
vascular disease which might complicate their presenting conditions. NHS
management will argue that prioritising care on the basis of
medical 'need' must be paramount when deciding who can and who cannot
receive free care, but to do so on that basis alone is deeply flawed and
grossly iniquitous.
Service 'redesign' has left us in the position whereby a fit and healthy
young diabetic in full time employment is eligible for podiatry care
even though it is only an annual screening appointment - but a ninety year
old with aging feet and an inability to self care, surviving on the basic
state pension, cannot. It is all very well introducing charges for
healthcare in the UK. Most of us are realistic to the fact that some form
of personal contributions for certain aspects of provision are inevitable.
The politicians and media may decry privatisation and fee based
healthcare, but it is already happening. By introducing a rationing policy
in podiatry there has been a de facto privatisation of the service; the
NHS may not be levying fees directly, but the patients still have to pay
for a continuation of their care. That is the net result of the policies
that have been implemented. The problem I have with the discharge policy
is that no consideration has been given to whether patients can afford
charges for podiatry services. Have we forgotten the 'ability to pay'
doctrine that underpins the whole ethos of the NHS? Even if patients can
afford to pay, has any thought been given to the availability of private
care for patients in rural areas? What is the private provision like in
Durness or Altnahara? Somewhat les than Kensington High Street I'd guess.
In my opinion many patients are entitled to feel abandoned by this
profession in recent years and reading the words from Mr Wylie and Mr
Randhawa simply reinforce my beliefs that the caring element in this
profession is rapidly seeping away.
When service restrictions were implemented in the mid 1990's - starting in
Cambridge and Dorset - alternate provision should have been established so
that care for these patients was not interrupted or compromised.. Eight
years down the line we are bearing the fruits of our negligence and lack
of forethought. When it became obvious that demand for podiatry was
increasing at a rate far in excess of what was being funded, we, as a
profession, should have made our case for a greater share of the public
purse - or secured other routes for funding the costs of our care.
Instead, both NHS management and the Society acquiesced. Podiatry stayed
firmly on the bottom rung and our patients - and the vast majority of
clinicians [podiatry managers and podiatric surgeon exempted] - have
suffered as a result. When the history comes to be written for the
establishment of the profession in the UK, the last decade will be a dark
chapter indeed.
I had hoped that an open debate on reforming our foot health services may
have gone some way in producing a realistic strategy for professional
development. It is obvious that both the Society and NHS management are
against such a forum, irrespective of the benefits that might be attained
in such an exercise. It is also obvious from the published documentation
that current strategy does not address the primary issues that face us at
the current time. Where does that leave the profession, or indeed our
patients, now?
The ostrich approach does not work. We have to face realities if we are to
develop into a dynamic and vibrant force in the provision of specialist
care. We start by providing a service for those who have consulted with us
since our inception many years ago. If we fail to do that, we are not
deserving of their support to assist us in the difficult years to come.
Sincerely
Mark Russell
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