Clive

Thanks for your honest response, which I found most refreshing. I have a
little experience of managing services though not as much as yourself or
many other colleagues throughout the UK. I do however appreciate your
predicament.

On the one hand you must (as we all do) prioritise the care that you
deliver. That is simply good clinical and managerial practice. On the other
you have an obligation to provide care to a section of society, who,
because of infirmity or disability, are unable to undertake basic foot-care
tasks for themselves. Traditionally these patients received care from the
NHS – some for over thirty-five years. Now that care has been withdrawn,
without first considering (i) what alternative services these patients
could access and (ii) whether they were able to meet the costs of that care
in the private sector. We have, without discussion or debate, privatised a
large part of elderly care without ensuring sufficient safeguards were in
place to protect the most vulnerable.

I am sure you will have had many sleepless nights over this. I am lucky to
count many podiatry managers as close friends and I hear at first hand the
effect that such policies have on them and their staff too – many of whom
have had stressful episodes, often requiring time off work & etc – because
of the reprofiling exercises that have been initiated. It is difficult
telling an eighty year old who has recently been widowed, maybe has no
relatives living close, that the NHS is discontinuing her care because she
doesn’t have sufficiently serious problems for us to bother with. It is not
the fact that you are focussing the care on more serious cases – I fully
support you in doing so – but it is the way that the NHS has abandoned the
remainder that I find uncomfortable. I do empathise with you, sincerely I
do, but I believe that you and your colleagues in NHS management could have
done things differently.

You could have been more vocal in promoting the issues. If senior
management had deaf ears, you could have used the media or lobbied
politicians directly. I would argue that this is the Society’s role; but in
my opinion they have been less than diligent on that issue. The discharge
policy has been running since ’96. The BBC broadcast of last December was
the first time the issue was brought into the public arena – by myself
and much to the annoyance of the podiatry managers. A greater case could
have been made for increasing our share of the public purse, but it didn’t
happen, and patients suffered as a result.

You could have introduced a chargeable service for nail care. Levying a fee
of £5.00 would have covered the salaries of a foot-care assistant. The
patients would have been willing to pay. After all they’re being charged up
to £25.00 in the private sector for the same service. Not much I hear some
say. Well maybe not to you or me, but as seven out of ten pensioner
households rely on income support to make up at least half of their weekly
income, twenty-five quid is simply pie in the sky. One in three pensioners
live on or below the poverty line. It may not be a consideration when
formulating trust policy, but it is a reality for many. That public
servants are initiating such policy without consultation is fundamentally
wrong. What would happen if GP’s decided unilaterally to charge for all non-
life threatening consultations because trusts limited the amount of funding
they received? Would there be an outcry? You bet there would!

I do empathise with you Clive, and with all our other colleagues who are in
similar predicaments. But I empathise more with the patients who have been
prejudiced by the actions that you took. This crisis should have been
brought into the public arena long before it got to this stage; it would
have been better for the profession, better for the patients and better for
the NHS. Hiding the problem under the carpet was never going to work.

If you want a debate about how you increase capacity in the service with
existing budgetary constraints, I would be happy to start one with you.
There are many ways that NHS delivery can be improved. Revising your access
and appointment protocols is one such way. Using a good evidence based
management regime is another. My eyes have been opened over the last eight
or nine years. I now intend to do something about it.

With kind regards

Mark Russell

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