Thanks to all those who managed to attend the debate in Parliament last
Wednesday; it was good to see such participation from the profession, in
what was a fairly historic occasion. I’m sure the level of support was not
lost on the MSP’s or the depute Health Minister. Who says apathy rules? To
all five of you – well done!

For what it’s worth I offer the following observation of the day.

The motion asked Parliament to specify what podiatry care should be
provided by the NHS – and to whom. It was framed in such a way as to
highlight the difficult issues that have led so many NHS departments
to ‘redesign’ the access policies in an attempt to bring their clinical
capacity more in line with demand. Of course, this has been done, not by
increasing the workforce, but by narrowing the eligibility criteria for
there has been no increase in funding for NHS podiatry expansion over the
last two decades. Although clinically essential, service redesign has
created many socio-political problems – introduction of charges for
previously free care; discriminatory and inequitable access policies.
Understandable – yes; but contentious and with serious political
implications nonetheless. What it has done however, is to offer an
opportunity for us to get these issues discussed at the highest level.

I was fortunate enough to spend a couple of hours in the Members Tearoom
prior to the debate, speaking to MSP’s from all sides of the chamber. A
couple of things struck me during the briefings. First was their
appreciation of the difficulties that the profession faced. The issue over
capacity was extremely well understood – something that was reflected in
the debate. The wholesale discharge of patients over the past several
years is simply regarded as a symptom – the first symptom - of a service
that is failing to cope. The demands on the podiatry service are dependant
on demography, incidence and prevalence of foot disease; but also on
political policies and initiatives. Free care for the Elderly in Scotland
stimulates demand (even though it’s thwarted by access policies) as does
the NSF for Diabetes. If the profession is to comply with the
recommendations of the latter in the public arena, it is unlikely that any
other patient ‘category’ will be seen, unless the workforce is increased
substantially. There are a few examples given in the debate, but
essentially, when you take into account political direction in healthcare
provision, the demand-v-capacity ratio for NHS podiatry care runs around
4:1  A positive outcome of the debate was that this discrepancy was
recorded for the first time in Parliament. It is a start.

Second was the willingness shown by MSP’s from all parties to assist the
profession in addressing this problem. Time and time again, it was
reiterated that it was up to the profession to present solutions for
Parliament to consider – rather than has ‘solutions’ imposed by
politicians or civil servants. The issues are not just seen as a NHS
problem – ergo; the DofH’s responsibility. It is seen as our problem. As
one Member put it; “there are less than four thousand podiatrists working
for the NHS but there are nearly ten thousand registered with the HPC – go
sort it out!” Another said, “we can’t back and fund something we don’t
know a great deal about – if the profession presents us with a cohesive
workable plan, we will do all we can to support it…”

There were other concerns raised too – the issue about regulation and the
inadequacy of the HPC legislation. These have to be taken into account if
we are to look at the private sector as a means of increasing capacity –
even though it’s only for simple chiropodial care. No doubt Mike Rumbles
comments will cause some consternation amongst some, but the failings of
the HPC’s ‘grand-parenting’ scheme will have to be addressed sooner or
later or the profession will be in a worse state than it was pre-2002 as
the ‘independent’ schools are still circumventing the legislation by
producing people who operate out-with the restricted titles of chiropodist
or podiatrist. This is an issue Westminster needs to sort out quickly, but
I wonder if the profession could address it in a non-partisan way first?

Finally, I would like to pay tribute to the Members who took part in the
debate for the mature and apolitical manner in which they conducted
themselves. It is something that I’m sure we in the profession would do
well to note in our own approach to dialogue.

Sincerely

Mark Russell.

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