David

My apologies if I have misread the meaning of your words. But I think your
response is a little disengenious.

Accepting all you say with regard to the particular case in the Highlands.
I have already said that I suspect the offer of surgery was made on the
basis that the patient in question had some adverse pathology. Mr
Randhawa's approach has thankfully not permeated to the NHS as yet, one
would hope. But you make the point that the NHS is only offering a cure for
the pathological nail - the routine element of his care - the social care
package is 'unavailable' to him. What you didn't say was that up until a
few months ago, that aspect of his care WAS available through the podiatry
department in the NHS. The fact that it is unavailable now is because the
podiatry managers have stopped that service by manipulating the eligibility
criteria. The patient previously had a choice of corrective surgery or
conservative management. The latter is no longer available. That option has
now been withdrawn.

Yes it is a difficult question on who gets and who doesn't in the cash
starved NHS. It may also be applicable to have a debate on who provides
such care as you suggest. But this debate should have taken place before
patients were removed from lists so that alternate provision was structured
and put in place. Surely that is part of our professional responsibilities
to our patient - irrespective of the pressures from the financial
directors - that it is incumbent on us to ensure their care is not
compromised or broken?  That is what we have failed to do.

The question on who receives care should be one for society and government
to make – not one for the profession or even podiatry managers. It is clear
that from conversations with government ministers, that they were unaware
that the NHS podiatry service were in the process of removing hundreds of
thousands of patients from their lists. That we have done so, without any
public consultation or agreement is a shameful indictment of the impunity
by which we run our public services today.

Try explaining skills escalators to a ninety year old who has just been
told that she cannot get any more treatment for her foot problems because
the component that is required to assist her has not been validated or
employed. You may suggest that the policy was inevitable; that funding has
precipitated such a move. That may be so, but the solution you prescribed
was the wrong one and has harmed many of our elders as a result.

Sincerely

Mark Russell

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