Hear Hear, just got back from a holiday but I do the same in PPractice,
people cannot just be abandoned
Bob Golding
----- Original Message -----
From: Stephanie Ainsley <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, February 28, 2004 11:22 AM
Subject: Re: Toenail maintence
I absolutely agree with you. I am in private practice. Over the years I
have had many patients come to my practice, distressed that they were no
longer able to have NHS podiatry care. They were distressed because they
couldn't really afford to go private, distressed because they had no family
to help and most of all, totally and utterly distressed and frustrated that
they could no longer either reach or see their own feet to perform the job
for themselves. My own answer has been to introduce a nail cutting sevice,
which I do myself, at half the time of usual treatment and half the price.
Quite often, they need a little more, but the fee stays the same.
But yes, there needs to be a comprehensive strategy. We cannot abandon
older people, just at the time when their health is not what it was, because
this IS the time when they need podiatry. It will go to the volunteers! So
what about all these years of trying to indoctrinate the public to ensure
their chiropodist is state registered because then they could be sure that
they were suitably, medically qualified?
As everything in the NHS these days, from trying to find an NHS dentist to
finding your local hospital has been closed, it is obvously down to funding.
But there has to be a strategic plan. I see no reason why the NHS Podiatry
services cannot work in harmony with HPC registered podiatrists in private
practice. Whether we like it or not, the whole thing is "means tested" - by
that I mean, you can afford it or you can't. There is obviously a shortfall
in funding.....but there is obviously a shortfall in the services we are now
obtaining. We used to obtain so much more. The NHS really did fund us from
the cradle to the grave.
It seems to me that now is the time for an overall plan which we can all
slot into when we find we need the services. It may be that the plan has to
be revolutionary...........certainly proactive.
Stephanie Ainsley
Kidderminster, UK
----- Original Message -----
From: "Mark Russell" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, February 27, 2004 10:54 PM
Subject: Re: Toenail maintence
No More Routine Toenails? Jings, there's a great initiative for you! Just
what the public wants to hear! Somehow I cannot see how such a move will
engender a positive feeling towards the profession if we employ it as a
branding exercise in an 'integrated marketing communications package' to
take the profession forward [although I agree entirely with the main
thrust of your proposals Jaime].What the public and politicians want is
workable solutions not more intractable problems.
It is perfectly understandable that podiatry departments in the NHS have
targeted the 'at risk' patients in a prioritised care system. Podiatry
funding has stagnated whilst demand, stimulated by increased
specialisation and a growing elderly population, has increased
tremendously. What has to be recognised is that within the profession,
there is ample capacity to accommodate the whole of the foot health
market - of which simple toenail cutting is but one aspect. The crisis
of which the gentleman featured is but one victim - need not have arisen
if more thought had gone into accommodating the needs of the patient
rather than that of the organisation when 'prioritisation' was introduced.
It is a pity that the artificial barriers that exist between the public
and private sectors have prevented greater integration in structuring our
care across the professional spectrum. When it became obvious in the mid
1990's that demand was not being met in the NHS and patients were removed
from podiatry lists, alternate provision should have been planned and
organised. Whether we like it or not, many patients felt abandoned by the
profession by the manner which their care was withdrawn.
What has happened to these patients whose care was stopped by the NHS?
Some have managed through self care or with the assistance of family
members. Some have accessed the private sector. Some have been unable to
do either, especially the most vulnerable on low incomes and those in
rural areas where private provision is sporadic. The circumstances of
these patients are the ones which the media and politicians are most
sensitive to.
In some areas a voluntary nail cutting service has been established. Age
Concern are trying to expand their programme, often with the assistance of
the local podiatry department. This is ludicrous. The 'voluntary' aspect
of the service relates to the workers who perform this care. Patients are
being charged for their treatment - albeit a reasonable fee of £5. Can we
not see that this will impact tremendously on the incomes of many within
the profession if it becomes fully established? Are we that complacent? I
would have thought that we seek to protect as much of the foot health
market as we could for the profession? What other business or profession
would discard such a valuable commodity to a charitable foundation?
Some of the volunteers are working through the New Deal initiative for the
unemployed. A weeks training course and off they go with their shiny new
clippers. Can you imagine the medico-legal implications?
Given all the concerns that have been aired regarding the easy passage
granted to the unregistered practitioners through the HPC grand-parenting
scheme, I find I am bemused by the nonchalance that exists regarding the
entry of a pensioners charity into a sizeable part of the professional
marketplace. I shouldn't even be surprised if some of the 'volunteers'
applied for registration in the months ahead. What value then for the BSc
qualification?
It may be time for the NHS to remove itself from the simple toenail
cutting market; few would argue against that. But surely we need to
utilise the existing private chiropody/podiatry sector in providing this
essential service. Possibly through an accredited national foot-care
scheme.
Certainly make as much of the public and media exposure as possible.
There's going to be a lot more of it in the near future. But do so in a
way that benefits the profession and the public alike. Oh, for a detailed
and comprehensive 'Strategic Plan' that could be presented to Ministers as
a possible solution! Debate anyone?
Kindest
Mark Russell
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