David & Clive

“We need to 'LET GO WITH CONFIDENCE' and we can only do that when there are
appropriately competent people to let go to....”

Absolutely! But that’s not been happening over the last 7-8 years. The NHS
has been ‘letting go’ without making sure that there are appropriate,
competent people to provide alternate care, whether it be for ‘medical’
or ‘social’ provision. That is the point that politicians, patient
representative groups, the Society of Chiropodists and Podiatrists, the
public and the wider profession have been making for long enough. We accept
that the NHS prioritises its care to those most in need – but that does not
mean we abandon those with less serious pathology either. There has to be
greater integration within the profession to accommodate all patients
whatever their need or circumstance. We do not need to embark on a new
training programme for appropriately trained staff - we have them already.

There are approx. 3,800 podiatrists employed by the NHS out of a total pool
of some 15,000 practitioners in the UK. It is not a personnel issue. It is
a logistical one. How do we construct a state-supported foot-care scheme
(if indeed the state deems such provision is necessary and desirable in the
first place) utilising the existing capacity within the profession.

I agree with you David that the NHS podiatry service (as we both know it)
has been carrying out care that doesn’t make best use of its employees’
skills. Why train a graduate podiatrist to the level we see today if all
they do is provide a simple nail cutting service to the elderly? It is a
huge waste of resources and leaves the specialist practitioner
disillusioned and frustrated. But the point is that the NHS has, until
recently, provided a comprehensive foot-health service, including elderly
foot-care, and if we are to evolve into a specialist core NHS service, then
it is incumbent on us to first ensure an alternative programme of care is
designed and implemented for the patients the core service will no longer
treat.

However, we can only design a specialist and general practice service when
we know who is responsible for what in terms of provision and funding.
Let’s see if we can move this on.  If you are saying the core NHS service
should treat patients who have a demonstrable ‘medical’ need – define
what ‘medical’ and ‘social’ means in this context.

Best wishes

Mark Russell

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