Mark,
I don't know your background, you too may be an manager of NHS foot health
services - but I doubt it. I have to say that the tone of your
correspondence suggests to me that you do not appreciate how managers feel
about removing services.
It gives rise to a huge role conflict. That of committed clinician (which
virtually all of us are at least at heart) and the manager of finite
resources. The clinician knows that simple toenail care is vital to
thousands of patients, and the manager has a moral obligation to use
resources where they will prevent significant foot complications in the most
people - namely the at-risk patient.
The decision to withdraw services has been the most difficult to live with
decision I have ever made. And it had to be done because not doing it
spread podiatrists too thin to give the level of treatment required to
maintain tissue viability in the at risk caseload.
What I am saying is this - MANAGERS ARE COMPASSIONATE - try living with your
compassion and having to compromise it. It is easy for those outside NHS
management to berate us for failing to fully meet all of our patients' needs
- given the constraints that are imposed upon us, how would you cope? But
of course, unless you are familiar the day-to-day running of an NHS service
you cannot empathise. But believe me, we are doing all that we can to
maintain the broadest provision that we can. If it doesn't look like it to
you, I suggest that you spend a week, or even a day, shadowing your local
service manager, your eyes could be opened!
Clive
Clive Chapman
Clinical Head of Foot Health
Haringey Teaching Primary Care NHS Trust
telephone 020 8442 6438
-----Original Message-----
From: Mark Russell [mailto:[log in to unmask]]
Sent: 12 March 2004 10:29
To: [log in to unmask]
Subject: Re: Toenail maintence - Brand Value
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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