Dear Mark,
I don't think your negativity is justified. Akbal's letter makes a very
salient point over the reality of NHS Podiatry Provision, if it was free to
all then even basic levels of service would be untenable.
As Ann-Marie says the NHS with all its faults is still an international
paragon for a system of State funded Healthcare. However the harsh realities
of the modern world we live in are that rationalisation of Podiatry Care in
the NHS is forced by high level budgetry constraints. To the best of my
knowledge there is no Machiavellian sub group of managers trying to decide
how to discharge patients for the sake of it. Having just spent a weekend
with a (Non-Podiatry) NHS Projects manager then these issues come up with
all the Rehab Professions, Physio, OT, etc and Rehab then competes for
funding against Cardio, Renal, Oncology etc. If we hark back to the glory
days of the post-war NHS vision then we miss out on the reality now.
My original point over an Integrated Marketing Communication (IMC) Strategy
was that "No More Routine Toenails" was a rallying cry that addresses the
reality of NHS Podiatry today, and one that could be used by all the
Podiatry Stakeholders to link with the core issues of Podiatry. I suppose
IMC is a fancy term for singing from the same hymn sheet, but lets be
positive whatever the rallying cry. IMC is easy to control in a company as I
can sack a van driver for singing off the hymn sheet, not my style but I
have a feeling within Podiatry it could be like trying to herd cats. But
surely it is worth a try.
The excellent academic debates on this mailbase are fundamental to pushing
the Professional standing of Podiatry to a higher level. I know there are
initiatives starting-up to look at the healthcare economics of Podiatry. Is
it possible to use the same level of Academic research and knowledge-sharing
to "arm" the delegates who are negotiating on the behalf of a healthy
Profession. What is the research proving that there is a VALUE to Proactive
Diabetic Footcare? What is the "value equation" that justifies the cost of a
Senior 1 Diabetes Podiatrist (forefoot amputations saved v cost of salary
etc)? There is a VALUE to the government of seeing continued Social Care
Chiropody but that has to be weighed against the NHS Budget constraints. We
then look at the infrastructure of Private Practice Podiatry and the access
to foot healthcare of NHS Dischargees.
If we can address these issues then we should be able to raise the headline
"Value" of the Podiatry Brand. Leading to higher student recruitment, easier
Foot Health Promotion, positive public perception and recognition of the
problems faced within NHS Podiatry.
Hope you are well
Kind Rgds
Jamie Sheridan
-----Original Message-----
From: Akbal Randhawa [mailto:[log in to unmask]]
Sent: Monday, March 01, 2004 08:18
To: [log in to unmask]
Subject: Re: Toenail maintence
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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