Annmarie,
I have no doubt that you are a great supporter of the NHS, but you have
ignored the original point, that of using TNA's as a cure for nail growth.
Nowhere in the BBC piece did it talk about this chap not receiveing a
treatment, he has been offered a cure by the NHS free at the point of
delivery, he has choosen to reject the offer. It is not torture to have a
TNA and if any podiatrist thinks it is then they i am afraid should not be
doing them as they obviously lack the skill to perform the surgery
correctly.
I dont believe that even you think that routine nail care should as a matter
of course be offered to anyone who wants it, the NHS wouls be swamped with
people who just want a free nailcut, they may even have a pathology but
rather than have a PNA/TNA they will just keep coming back and moan about
their toenails not being cut requently enough. The NHS provide a bloody good
service for the at risk foot I would rather it carried this on as a
neuropathic patient with grangrene is likely to complain less abouth not
being seen on time than a perfectly able OAP with long toenails. I know
which one I would rather was treated urgently.
Akbal
----- Original Message -----
From: "Annmarie Carr" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 01, 2004 4:43 AM
Subject: Re: Toenail maintence
> 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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