One of the reasons that the podiatry is in such a mess in the UK is the
continuing ambivalence of the government and the DofH in specifying
precisely what podiatric care should be made available through the State
and to whom. Until the profession has clear specification on public
delivery, services will continue to be under-funded and under-resourced.
There is insufficient capacity at present to manage even the diabetic
caseload in the UK (as per the recommendations of the NSF for Diabetes)
never mind any of the other ‘at risk’ categories. Specification would allow
the profession to ‘cost’ the provision of public care more accurately –
although I accept that this may not suit the Treasury or the DofH – and
would assist the profession in structuring its care more effectively to
those not covered by the public service.

Although I can understand the reluctance of politicians to address the
issue, I am surprised that nobody from the profession seems to have much
opinion on this subject either. Is there is no point in debating such
matters because of a perception of professional impotency? Perhaps the
ambiguity suits the profession just as much as it does the politicians.

‘Redevelopment’ and ‘redesign’ of caseloads are widespread throughout the
NHS podiatry service, yet there continues to be substantial variances in
access to care. In many areas, services are still failing badly, even after
discharging up to 45% of the original caseloads. Surely we can debate and
agree a standard national access policy to end this postcode lottery?

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