Mark,
Many thanks for your positive reply. I think the debate is happening and
from what I am hearing from around the UK there does seem to be momentum
gathering to address the issues within state funded Podiatry. Podiatry is a
diverse profession and operates on many levels. I know some research being
collated at the moment on Podiatry Recruitment is looking at what attracts
Students into Podiatry. For some it is a vocation, others a fall-in from
oversubcribed Physio courses. If the Stakeholders can take positive
initiatives about Foot Healthcare in general then the "Brand Value" of
Podiatry will go up and positive marketing of Podiatry will be easier.
I believe these are very exciting times with Podiatry staking its strong
position within the Rehabilitation Professions. I do take your point about
Chiropody care for the elderly and there is not a magic wand to wave, but
let us hope that the stronger status of Podiatry within the High Risk field
will give "leverage" to an orchestrated system of Social Care Chiropody.
There are lots of negative issues within Podiatry, between NHS and Private
Practice, grandparenting, the whole lot, that can be debated, discussed and
physically fought over but until you take a step back you will not see the
whole picture. What we need now is 1 - some hardheaded industry analysis, 2
- to gather together the research that members of this mailbase have access
to and 3 - to bring the Stakeholders needs and ideas together to be able to
feed into a central conduit for this information to be used most
effectively.
I know that similar issues on perception of Podiatry have been brought up in
Australia with the APodC and also in North America so if there are examples
of best practice please let me know.
Kind Rgds
Jamie Sheridan
-----Original Message-----
From: Mark Russell [mailto:[log in to unmask]]
Sent: Monday, March 01, 2004 04:49
To: [log in to unmask]
Subject: Re: Toenail maintence - Brand Value
Jamie
I am not making the case for free care for every aspect of foot health
provision in the NHS. I never have done. But there needs to be a debate to
decide exactly what services are to be provided and by whom. I am perfectly
aware that some people abuse the system. I've lost count of the number of
patients I have seen over the years who steadfastly refuse to take advice
regarding footwear or to comply with a particular treatment regime which
may alleviate or cure their underlying problem. But surgically removing
healthy toenails as an alternative to routine care? Come on! This is not a
serious proposal surely?
My point is this. The difficulties of capacity within the podiatry service
were not unforeseen. It wasn't that long ago that NHS Trusts opened the
door to all patient categories. A district chiropodist that I worked with
used to comment; 'We treat everyone - just don't advertise the fact'.
Planning has never been a particularly strong point of NHS management - not
just in podiatry circles.
It should have been obvious that if access was to be restricted by
manipulation of the eligibility criteria based on medical 'need', that a
backlash would occur. This might have been prevented if alternate provision
had been implemented along-side service redesign. The foot-care assistant
scheme may have gone some way to achieve this, but unfortunately, this was
not funded either. There could have been a contributory scheme where
patients paid a fiver towards the cost of their care (much in the same way
as the Age Concern scheme). That would easily have covered the costs of the
assistants' salaries. Or there could have been a partnership agreement with
accredited private practices. But quietly withdrawing the care from
thousands of elderly patients by utilising a management 'tool' such as a
matrix scoring system - which to a ninety year old is like double Dutch
is both discriminatory and grossly unfair. I don't want the return of a
post-war NHS - we're still labouring under the defective structure that was
introduced over half a century ago - and I do think that some form of
contributory scheme will have to be introduced for many aspects of our
care. But it has to be done on the basis of fairness and equity and with
the full agreement of Parliament - not by a group of managers within the
NHS.
Unfortunately the net effect of the current policy is that the most
vulnerable in society have been prejudiced on the basis of cost -v- need.
We all want to raise the 'value' of the profession in the public's
perception, but discharging patients in the way that has been occurring for
the last seven/eight years is not the way to go about it.
Sincerely
Mark Russell
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