Stephanie,
I am glad to see that you are now thinking about this issue. What makes you
think that this person is going to have problems with healing times?
If it ain't broke then why is this chap seeing a podiatrist? He has painful
involuted nails from what I understand, personally I don't see why he should
be kept in pain just to give a podiatrist a set of nails to cut.
This reminds me of a debate I had with a local GP about one of his patients
she has a compromised immune system and has an IGTN he does not want to
consider a PNA due to the risks involved re healing so he is happy for her
to have recurrent infections over the past 12 months, eventually he sent her
to me the toenail was off healing occured over ~4 weeks no problems since
that was 2 years ago.
Akbal
----- Original Message -----
From: "Stephanie Ainsley" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 01, 2004 9:33 PM
Subject: Re: Toenail maintence
> Akbal,
> I am appalled to think that anyone would suggest TNA's of all ten toes for
> an 82 year old person. It is not to do with whether one has a good
> operating technique or not - it is to do with unnecessary trauma/prolonged
> healing/health status of a person of this age group.
> .................If it's not broke - don't fix it!
> Stephanie
> ----- Original Message -----
> From: "Akbal Randhawa" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, March 01, 2004 8:18 AM
> 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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