Feet for Purpose report

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netizens

Age Concern report, summary reported.

http://www.oxfordmail.net/display.var.1628325.0.nhs_not_feet_for_purpose.php

toeslayer

 

The BBC are also reporting on this:
They said my feet weren't bad enough

Rest of story

 

Press Release:
The Society of Chiropodists and Podiatrists Welcomes Age Concern Feet for Purpose Report

 

A lot of media outlets (including radio) are running this story.

here is the Eastern Daily Press version:
Warning over chiropody services 'postcode lottery'

 

Age Concern Report attached..

 

The SCP is working with Age Concern to update our joint guidelines on the provision of Age Concern foot care services. It is particularly important that volunteers are able to identify foot problems that should be assessed by a podiatrist, and have a pathway to refer clients to a local NHS service or private practitioner.


I am sure that all HPC private practitioners both SCP members and Non members are delighted that the SCP are helping Age Concern to train 'volunteers' to deliver a substandard, 'approved' provision at a very reasonable cost!

Charity?

Concern?

Tool of the government?

Take your pick.

Bob, soon to retire, and looking for something to do.

Perhaps I'll work in a charity shop on the high street, selling clothes next to a second hand clothes shop, and books next to a 'cut price' book shop. After all at least 5% of everything they earn goes back to the needy.

 

we have an age concern volenteer service locally and in my experience it works very well

 

But you are missing the point. These elderly people are not being seen by a Chiropodist and are missing out on a much needed overview of their foot health.

Age Concern also leave much to be desired in their investigation of what private providers of foot care can supply. They appear to rely on heresay within their report rather than factual costs of what HPC regulated podiatrists and chiropodists charge for their nail cutting service.

This "problem" was 1st reported in 2002 by the BBC and most probably before that by other sources. Hasn't anyone worked out a fix yet?

GB

 

Andymiles

Please identify yourself or at least state how you practice, NHS or PP.

If NHS how high up are you?

 

At the risk of stating an "inconveniant truth" there are not enough chiropodists in the country to provide routine footcare for every elderly person.

We're a medical service. Care of non pathological feet is social care. Yes we can do it best but you don't send dentists around to peoples houses to brush their teeth.

I think age concern type folk are a good plan


Regards

Robert

 

And what does Andy's job matter?! If you are looking for a vested interest you should state your own position before asking his!

 

Robert.


Sorry this reply was before your question about andy. The reason it is relevant is because this is the classic PP vs NHS dilemma (yes I'm a PP) denied by the SCP, simple.

Time for you to come out of your NHS cocoon and stop propounding 'theory'.

Evidence would say there are far too many Podiatrists available. They may not be being employed by the NHS, because the NHS has lost it's focus and now spend far too much money on 'specialist' care MSK being a prime example as opposed to 'palliative' care the Cinderella.

However what ever the facts, people like you, prepared to 'give away' 'bits that do not interest you' are the reason 'Our' profession and 'Our Society', the SCP continues to attract such derision.

 

NHS cocoon. Great image!

I don't really understand your point here. Is it theory in general you don't like of one theory in particular?

Oh really? My mistake. Show me the evidence which says there are far too many podiatrists available and i'll admit you were right on that. Glad to see you are using evidence and not just "propounding theory".

Fair enough. (who is MSK by the way?) Which bits of specialist care should the nhs cut? Surgery? Wound management perhaps? A few diabetics might lose limbs here or there but what the hell.

I'm crushed. I've never been a "people like me before." I love that you started that paragraph with "whatever the facts" as if they are irrelevant. You're right i'm sure. We'd be much more respected as a member of the medical (that word again) team if we spent all our time cutting perfectly healthy toenails. Maybe then we could send the dentists around to brush peoples teeth and physio's to rub their backs for them. BTW i've not found myself the subject of derision.

Give bits away? We never OWNED that bit. Since when are we the only people who can cut toenails?

Are you not going to ask me how high up i am? I looked it up. This minute about 60 feet above sea level. 66 when standing. Oh and i do private work as well so i will admit to a vested interest there.

Regards
Robert

 

my name is andy miles (apart from when i am doing my cabaret act where i go under the name of rosy glitterzone )

aquarius

inside leg 29 inches

nhs - very low down, virtually subterranian

 

LOL

Ah rosy, you heartbreaker. 29 of the best inches anyone will ever see.

 

otherwise healthy people with no foot pathology who simply cannot cut their toenails do not need to be seen by a podiatrist, nhs or pp. now, should they opt to be seen privately that is their choice and i have no problem with that however it is my job to educate patients in the best way to self care wherever possible and i feel that voluntary provision falls into this catagory.

the profession as a whole, nhs and pp, surely benefits if we are seen to be treating pathology and not mearly providing social care?

 

First response was before I read your replies.

Again you NHS pods seem to have time to sit on forums and reply. Robert I give up with you, your arguments are far too persuasive.

'Normal people'.

OK they are normal, so you recommend 'volunteers'? at £6 per pop.

Very sad!


Andy

Sorry no offence meant. You clearly have spent a long time at the foot, thus seeing many changes in NHS podiatry provision.

My concern is that for the sake of expediency the 'powers that be' are prepared to follow a course that is more dictated by fiscal policy than patient need.

Have we all forgotten our role as 'primary contacts', and those silly situations, 20% of the time when we use the 80% of our knowledge.

I know that I have saved someones limb. Not because I was a brilliant practitioner but because a holiday maker came to see me with diagnosed Gout.

Why have we lost so much confidence in the 'whole' of our practice skills that we can accept cutting toenails is below us?

 

Bad news Andy. R.E.G. is onto us. On the society forum he admits he's discovered:-

And warns

Having read the other forum's threads i think i understand a little better where you are coming from now Bob (Assuming i've matched the writing styles correctly). I think you ascribe a slightly sinister slant to the whole thing and you propensity to exaggerate your case does'nt help you any, but i DO see your concern.

It seems that you see the "routine" element of our practice (including what i would call social care) as a key element of our work, indeed the foundation of our work upon which the rest is built and fear that if that is taken away from us by less skilled and therefore cheaper practitioners there will be insufficient work left for qualified pods. It seems to me that you see the NHS pods as cheerfully banging holes in the bottom of the ship we all share not realising that we are sowing the seeds of our own destruction and our lifejackets are not so boyant as we beleive. I imagine that you see the specialist fields of podiatry as the crows nest of this boat. That we are high enough to feel smugly safe but do not realise that we will follow the boat to the briny depths when we sink it, right after those manning the oars and just as inevitably.

Am i warm?

Regards
Robert

 

Long weekend actually

 

Robert.

At first I was going to argue with you, but on re reading your post No. A brilliant piece of writing if a trifle flowery.

Outing me is not a new thing Colin Bain did it 3 years ago when we debated the HPC.

My only argument would be 'who is in the crows nest'? I think it is the good PPs, because the 'specialist NHS pods' will be sailing in a different ship, under a different captain.

Just my thoughts, at least they generate some debate, who knows what is right or wrong?

Bob

 

lunchtime and dna's - i'm good but i can only do 'em if they show up

no matter, make most of my cash as rosy - the one and only drag artist in ecco shoes

 

Cool. We're on the same page now at least. Reading you're other threads makes this one make sense.

Oh and i do flowery quite a lot. Just not as much as Rosy.

I don't know what outing is in that context but i assume its bad. No worries. Venting is good for the stomach lining, hair loss and blood pressure. We should all have a rant from time to time. You do certainly generate debate and i respect that. I love it when people agree with me. I love it even more when people disagree with me. Apathy i cannot stand, so if you ever want to tick me off don't tell me that people like me are the reason the profession gets debrided. Just do a vicky pollard "whatever".

So do you think we in the nhs are holing our own ship, The good ship ppods or both? Or has the whole ship analogy gone too far?

For the benefit of this forum could you share your definition of social care vs medical care? I think it would add more to the debate than you and i tearing each other into tiny strips. I'm sure Admin is lurking with his "Oh god why can't UK threads just stay polite i swear i'll shut the whole bloody catagory" face on. Sorry Craig, blame the climate. We'll play nice from now on i promise.

Regards
Robert

PS IMage of Andy in echo's and fishnets. Thats just grim.

 

Robert,

I'm not too sure I want to continue this discussion.

You say we are now on the same page, how wrong can you be?

That you require a definition of 'Social care vs medical care' means that you will never understand where I am coming from.

But let me ask you what is so 'medical' about podiatry provision?

Perhaps if we look at 'Care' as a concept : and start from there society on the whole could improve?

Bob

 

Has anyone actually bothered to read the Age Concern Report "Feet For Purpose"?

Age Concern openly admit they are dealing with conditions outside their capibilities - involuted toenails, thickened toenails and toenails attached to patients with high risk medical conditions. Age Concern are coping with nail cutting but only to a point. The service is oversubscribed and the work they are coping with is not simple nail cutting as many of my colleagues fool themselves into thinking.

Robert, nobody is asking for the provision of routine footcare for every elderly person. For goodness sakes, there are elderly people that will pass from this earth on a daily basis never having had the need to seek the advice, attention from or nails cut by a Podiatrist or Chiropodist. What Age Concern is asking is that all footcare from basic nail cutting to chiropody must be free at the point of use for older people who need it.

Can't anyone put forward a suggestion that whilst it is impossible to provide an adequate nail care service free at the point of contact to those elderly that need it, that there are ways and means of providing a subsidised service involving private practitioners as well as the voluntary sector?

I am a Private Podiatrist. I am registered with the HPC. I came through the old diploma system. I am a member of SCP. I do not scribe under my real identity. I provide a nail cutting service which costs the elderly £1 a week. Please show me an elderly person who could not afford £1 per week? If the NHS managers, DoH, Age Concern, SCP and other professional bodies who may have an interest in palliative nail care, Private Podiatry Sector and Uncle Tom Cobbly and all cannot sit down and discuss how we can subsidise £1 a week, this profession should be towed out to mid-atlantic and sunk.

I recognise that nail care in the elderly is social but can quickly change to preventative without notice. I find the attitude of my NHS colleagues towards patient's only requiring nail care irresponsible.

Good for you Robert that you do have an interest in private practice. May be one day you will grow into the role and look at it with a business perspective on how you can remedy a situation where the NHS don't want to cut toe nails, Age Concern volunteers can cut some toenails but not all and yet the private sector has an untapped availability to provide nail care.

There is a fantastic and easy solution to all this mess staring us straight in the face but because this profession has a total inability to co-operate within the UK it gets completely by-passed.

GB

 

netizens

There is a long association between Age Concern and podiatry which goes back thirty years.

Identifying need is clearly important and trying to meet that need, equaly so, but the real concern is in thirty years nothing seems to have changed. Infact it has probably got worse. In the early eighties Winkler and Kemp's independent review of podiatric need (UK) confirmed there was a crisis, yet despite making some useful recommendations to overcome it, nothing happened. These author's findings have consistantly been reinforced by other reviews, so why has there been no change in policies?

Hopefully this new report will make a difference. (excuse me for a momement, but that is Elvis Presley and Buddy Holly on the roof again. ). I doubt it. More power to the elbow to everyone involved of course, but foot care for the elderly may not lie within the "podiatry domain" anymore?


http://new.edp24.co.uk/content/news...gory=news&itemid=NOED19 Aug 2007 17:35:38:990

toeslayer

 

Toeslayer,

I am sure what you say is factual/true, but that does mean it is right.

I think a statement like 'there has been a long association between older people and Podiatry (sorry Chiropody, older people do not want Podiatry) which goes back over 100 years, is just as valid.

I disagree with you that in the main foot care for the elderly will no longer lie within the domain of Podiatry, it will. All you need to do is redefine Podiatry as Social care Podiatry, and add yet another title to those already available, fully trained NHS qualified foot health technician?

This is all too common in the UK where you are more likely to see a practice nurse than a doctor, once you have been assessed by a 'receptionist', and to meet a 'social control operative' than a qualified Police Officer, they will be writing reports in those nasty offices.

In the main though I probably agree with you. By the way do you Ozzy's not have your own guardian angels? We Poms have Farther Christmas, Flying Pigs and Lord Lukin.

I'm out of this one.

Bob

 

Robert, nobody is asking for the provision of routine footcare for every elderly person.
GB.
Sorry. I thought that was what reg was saying here.

and here

,

That elderly people being seen by AC are missing out implys that they should be seeing us. Or have i misunderstood?

Agreed. I think this is where AC nurses have a role. Like Andy we have an AC service which works very well down here.

That said i can see a place for PPI's somewhere here. The dentists did it after all. Not the worst idea anyone has ever come up with.

I doubt it I much prefer my day job.

Firstly would you mind clarifying where you stand vis a vis the above bit? Are you advocating podiatrist provision for all over a certain age or podiatrists for some and AC nurses for others. Somewhere in all the sarcasm and hyperbole it became unclear.

Gee whiz bob, improving society as a whole is a tall order. Interesting idea though.

I think i kind of understand where you are coming from. I just don't agree is all.

Whats medical about podiatry? Well for a start my degree certificate says "podiatric medicine". We are referred to as a "proffession allied to medicine". The patients I treat are refferred by other medical practitioners with medical pathologies. The fact that the skills i learned as part of my podiatric medicine degree allow me to carry out social care does not, IMHO change the medical nature of the profession.

But if you are out of this one then answering your question was a waste of time anyway. Oh well

Regards
Robert

 

Think the glasses in Diggers will be rattling with that one!

The real problem here is not Age Concern or FHPs or anyone outside the professional community involved with footcare, but a lack of a coherent strategy by the professional body in dealing with the demand for footcare services. A clear definition of what care should be provided by the NHS and the private marketplace would be of enormous benefit to patients and the profession alike. The NHS has attempted to define what it provides as "medical" care and has tried to move away from what it calls "social" provision. I have no problem with that - providing these definitions are clearly communicated to the public, who remain, on the whole confused and uncertain what care is provided and by whom.

Should public money be used to provide care to patients who present with problems such as recurring callosities caused by inappropriate footwear for example? Should society subsidise care - even for basic footcare services such as non-pathological toenail cutting - for patients who cannot afford private fees and who cannot manage their own care due to infirmity or age? Most people, I think, would answer no and yes to both questions - the State should concentrate in providing acute and specialist care but also has an obligation to assist those in Society who are vulnerable and who are on low incomes - but that does not necessarily mean that care should be provided within the existing NHS structure.

The simplistic approach whereby patients enjoy access to free footcare when the reach pensionable age is also unfair. There are wide variations in wealth in this sector too and we need to look at more appropriate ways of delivering publicly funded care - which is not "free" - to those most in need. I agree with George Brandy wholeheartedly insomuch as there is an enormous opportunity for the profession to make the case that it would be beneficial for the public to access trained clinicians to ensure high quality care - in whatever arena - public or private- that is appropriate for them. To do so, we need better cooperation between the NHS and private practitioners through coherent policies agreed between the professional bodies and government. That way we can begin the task of meeting the foot health needs of society as a whole - not bickering between ourselves at our manifest failings.

 

Bob

I am a Scot loiving in exile in the sun and diggers to me is the 'earts pub in Edinburgh. Thanks mark. In a previous life or two ago I was a podiatry manager grappling with these issues, twenty years ago. When I was doing teacher training in the mid seventies I did the only gallent thing I ever have done in my life and gave my female colleague the idea of doing a review on the then latest Age Concern report for her assignment . She got top marks and I did'nt. So I know these reports by heart . I also worked briefly with Judith Kemp and Winkler at Cranfield Institute Social Policy Unit when they were compiling their publication.

So this is all too real.

Off to watch the Bill and have a barbie - you cann't beat it.
toeslayer

 

yes

missed the bit about AC treating high risk medical conditions, where was that?

again, can only speak from my experience locally but i am happy that all referrals to AC are appropriate and that should an AC volunteer find something outside their scope that they refer the patient back to us highly trained goverment operatives.

 

Conjures a sinister image of black suits and shades. Beats fishnets and echo's i guess.

I think Mark made several good points. There probably is a responsibility somewhere in the government to provide social care to those who cannot care for themselves but i'm not sure the NHS is the vehicle for that.

I also liked the bit about the public being confused about who provides what to whom. Since we struggle to decide this amongst ourselves it's no wonder they have trouble.

Regards
Robert

 

Robert & Andy

Much of the problem is political. There is an enormous amount of unmet need in this country and the NHS will never be able to provide a comprehensive foot health service unless it employs all registered podiatrists - and even then you will still have waiting lists. This has been apparent for decades but instead of addressing the problem sensibly and honestly, politicians still trumpet the line healthcare for all free at the point of need. Hence the redefining of health and social care.

There are many inequalities in the current provision. Defining access criteria based on contributory "at risk" medical conditions can be grossly unfair. A 30 y/o obese drug addict with type I diabetes may qualify for NHS foot care whilst an otherwise healthy 90 y/o with complex ageing foot problem might not. Of course there are variations throughout the country, but this only adds to the confusion.

As the ageing population grows - not to mention those who are diabetic - it would be sensible to define what care is provided within the NHS "free at the point of source" and what care is provided by registered podiatrists and is chargeable - and what exemptions are specified for the latter group, perhaps by some form of financial assistance in benefits/pensions. However, as this is "means testing" it is not a particularly attractive political proposition, hence the hegemony.

This is not a new problem - I looked at the BBC website this morning and it was 2002 and 2003 when I was interviewed with the various Health Ministers on this issue. At that stage, the NHS had been employing a discharge policy for some 9 years. I met with Gordon Brown - then Chancellor of the Exchequer - in 2001 and outlined the difficulty the NHS service faced and suggested the use of the registered private sector as an adjunct to public provision but the big issue is chargeable services and their political impact.

Things may be changing and it might be that someday we will have a unified profession - employed and self employed - delivering a comprehensive foot health service which is part public funded and part private funded with fairness and equality as the main drivers. But as Syd alluded, don't hold your breath.

 

i detected AC were implying ageism is a factor in the provision of diabetes footcare in the report. hmmmm

 

I will admit to being frustrated by ageism in the NHS, but in the opposite direction.

There seems to be a culture that older people are automatically entitled to stuff... because they're old people. Whilst i understand the ring fencing of high risk care it does seem somewhat unfair that a 30 year old warehouse worker on a low wage and no medical history with a massive Planter HD which makes working hard and painful is NOT eligable for NHS treatment when a 70 year old with well controlled diabetes and very mild callus IS. With all due respect to the aging and aged we should surely be looking after those who go to work and pay the taxes as well!

Minor rant over.

I miss Bob. He was fun.

Regards
Robert

 

Toeslayer.

I know I said I was out of this but I cannot in all conscience let a wrong go un-righted.

In my advancing years I confused you with the great Ozzie Craig Payne. Sorry.

Now I have come to my senses I realise I was debating with my hero, equal only to Rossi.

Enough grovelling.

Life in England is not so simple reference politically correct nationality descriptions. In Oz should you be a Scot Australian (note I did not say Scottish) or an Australian Scot, I assume Pom would be out of the question?

However I fail to come to the point. Today our Government solved all of these silly debates and thus our problems.

Their new, and this I agree fully with, approach to research is to reject it all because it is historical and things have changed since it was done.

I am now so much more happy, can relax and not return to forums.

Ciao Robert (just trying to work out how to spell Ciao and found chiropody in my thesaurus- see pedicurist, seems appropriate).


Bob


Oh B*****er, just listening to Radio 4 and the smoking debate. Lots of money to support week willed people (ex smoker who went cold turkey) to quit what they know is expensive and bad for them but then the Government would loose all...........see my silly social conscience.

 

These are difficult decisions to make - who should eligible for free care and who is not. The starting point is what can the NHS deliver - service capacity in other words, then make the decisions based on clinical need from there. Given the size of the population and the number of directly employed NHS clinicians, it is obvious that "free care" should be directed to those with acute and limb/life threatening conditions. There are 3,500 podiatrists employed by the NHS for a population of approx 61 million - stick with diabetic and vascular wound care and preventative podiatry for this group, Robert, and focus your resources in this area. As for your low paid worker with the plantar HD - there is some 7,200 registered podiatrists in independent practice who could see him - if he is low paid and qualifies for tax credits, we should be lobbying government to make a contribution to his care in the same way that he is eligible for assistance for prescriptions and dentistry charges. In that sense, our independent practitioners become part of the Health Service, and thus increase the capacity of foot health services as a whole.

The difficult question is where do you draw the line. Should it be means tested or should it be on qualifying condition. Then, of course, how do you monitor the service so that independent practitioners don't exploit the system in the same way as dentists did during the 1980s and early 1990s.

Like Syd (and a few others, I suspect) I'm getting an incredible feeling of déjà vu with this whole debate!

 

This is what gets me so frustrated. Nothing changes year upon year.

The answers to this age old problem are there but those that co-ordinate delivery of the podiatric services seem incapable of considering change and will consider the voluntary sector over and above their own private sector colleagues.

Until the politicians drop the irritating phrase "free at the point of delivery" and the public are encouraged to take responsibility for their own health and wellbeing then nothing can change.

You just missed one word out from there Cameron, "but foot care for the elderly may not lie within the NHS "podiatry domain" anymore"....unleash it fast before the NHS managers give it away to someone else ably adided and abetted by the "alleged leading professional body". What right, without consultation of the whole profession, does one sector have to gift our work away?

I just hope one day the afore mentioned alleged leading UK professional body may wake up to the need to protect all its members and their jobs, not just those within NHS then we may see changes in service delivery but until then may Age Concern lead the way in continuing the campaign for all footcare from basic nail cutting to chiropody to be free at the point of use for older people who need it.

Unless one of the other professional bodies cares to take up the cause?

GB

 

There are several points upon which we all seem to agree (and I'm sure you will correct me if I am wrong):

-we have an ageing population
-there is a proven need of foot health provision
-that provision is considered to be unsatisfactory at present
-NHS provision must include those whose care cannot be undertaken in pp

so it seems logical to accept that:

-the NHS should treat those that require greatest expertise or intensive tx.
-pts not needing the above have need of something lesser
-private practitioners are set up to offer this service.

This forum generally subscribes to the notion that the SMAE trained (and their like) are insufficiently trained to do the job properly. FHPs are given even less credence (unfairly, since their training is emotively and deliberately mis-understood). Why then, do we need AC trained workers who have even lower skill training, when the aforementioned are willingly there, trained beyond AC standards and not recognised/under-utilised? If we used ALL the resources we have to hand the provision seems to better fit the need.

AC may talk about 'free at the point of need' but, in fact is currently charging £11 for its services in the Oxford area. This is not very much less than some misguided FHPs charge for full service to feet with minor ailments.

The truth may be that there IS sufficient support already available for public wellbeing. It's just that, this being Britain, people don't like paying a reasonable cost for it. How easy is it to obtain optical services or dental treatment 'free at the point of delivery'? This notion has to go!

 

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