Right, Akbal
Now I find time to respond to your condescending reply to me following my
response to Mark (who was following up Stephanie's points regarding the
position of podiatric care services). I did not intend to respond to the
newspaper article, that had been given as much publicity as it probably
deserved. I was making a contrast between what the UK has (in the NHS), and
should treasure, and do all it can to keep, with the system of health care I
have experienced in other countries. You introduce the notion of torture and
people's lack of skill. I don't believe I mentioned either. And how can
you possibly speak of what I deem to be appropriate provision of care or
otherwise ('I don't believe that even you....'). What is this all about?
You don't know me Akbal and should therefore refrain from placing me within
some sort of hierarchy of your own making that one such as I should have any
particular thought irrespective of how you feel.
And for the record: I believe a health service should be just that, a
service; provided for those in need irrespective of creed, colour, name or
socio-economic status. So that means anyone and everyone. Should the
autonomous patient want to 'moan' about that provision, all well and good,
but it does not give the practitioner the moral high ground whereby they can
deny treatment just because there is someone else who, in their opinion (and
without due moral reasoning) needs treatment and seems more worthy and
doesn't moan. I've followed the debate over the last week or so and I'm in
full agreement with Stephanie's comments on our obligation to provide care
for the foot, whether it be bone surgery, debridement of tissue or simple
nail cutting. Also with Mark who pointed out that the potential crisis in
podiatry loomed way back and was ignored.
Absolutely, a strategy needs to be put in place to cater for the needs of
individuals from a podiatric perspective. I think it is the Glasgow School
which is training foot care assistants? Can anyone remember the outcry when
this was announced or when podiatry departments began to employ them? It
might only be a simple procedure, but to an individual who cannot manage
their own nail cutting, it becomes something more than that. We, as
humankind, let alone, healthcare workers, should recognise the
sociopsychological aspects of dependency and not see our patients as
"moaners" just because they want their toenails cut. It makes them feel
better, and feeling better has all sorts of positive health outcomes. The
question of who's role it is, or should be, is one which should be discussed
outside of the debate on determining need.
Try this one Akbal: don't brush your teeth for a day. Now, it's not
exactly life threatening and over time, if you still refrained from
brushing, you might get gum disease and your teeth will fall out, but then
you won't become a burden to the subsidised NHS dental services in the
future as you won't have any teeth to worry about. Now, isn't that a good
utilitarian way of looking at reducing future costs? Let's do the same with
your toenails (did I read in one of your submissions that you would gladly
have all your nails removed should they become a problem?). Hey, why wait,
let's be pro-active about this and do them now. I'll volunteer Akbal, and
as you said, it's not torture (which would suggest you have already had at
least one nail removed already?). And then just in case you end up suffering
from PVD we should amputate when you still have an arterial supply to
guarantee healing. And how about a colostomy, large bowel disease is on the
increase and we don't want all those moaning folk clogging up the system.
You see Akbal, much as I agree there has to be a limit to the funding purse,
something as simple as a toenail cut can add so positively to the general
well being of a person in NEED. Now, if podiatrists no longer feel it is
their role to cut these nails, fine, but they are morally obliged to ensure
that their 'discharged' patients are not going to suffer unnecessarily as a
consequence. And who should be lobbying for this change in role? I'd say
podiatrists themselves, with an open, compassionate and caring stance so as
to reduce suffering, expand scope of practice and contribute to healthy
ageing.
I don't agree that charges should be introduced, even at an(initial) minimal
level. I assume you Brits still pay National Insurance contributions while
working and this, I think, should cover the expenses for necessary health
services when you are not working. And sure, there will be those who could
easily afford to make a contribution, but there are those who will not be in
such a fortunate position. Poverty is a social crime, being poor is not and
therefore does not deserve to be compounded by poor access to essential
services (and yes, regular cutting of toenails, (and brushing of teeth) are
essential for good health).
I think this debate is more than appropriate in this forum; an excellent way
of getting the professions view of where we should be heading in the future.
It is the academic institutions that will need to heed the direction of the
profession should it be changed.
By the way my comments on pro-active surgery for Akbal were made in jest
(except the toenail one!)
Looking forward to a continuing debate and seeing the outline of a strategy
to resolve some of the issues the profession is currently facing within
health care.
Ann Marie Carr
-----Original Message-----
From: Akbal Randhawa [mailto:[log in to unmask]]
Sent: Monday, 1 March 2004 4:18 PM
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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