Does / Should the NHS Cut Toenails?

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From another thread:-

Are NHS pods at risk of RSI from nail cutting?

Discuss.

 

I can only speak for my own trust and those I know. In those areas, yes NHS pods DO do nail care in high risk patients.

Its a fairly fundamental part of a high risk care package. If a poorly controlled diabetic with a glass eye and a bad back has to take a swipe at their nails with a dirty pair of clippers (or nippers ) its a solid risk.

We Sadly don't have the resources to do nail care for everyone. Not that we don't want to, but its a finite budget and we have to spend it where it will do most good.

But the point is, I saw an activity sheet this week for somebody who'd seen 28 patients in a day, all of which included routine nail care. I can think of three pods in my team who have had carpel tunnel syndrome over the last 10 years and I think there is some research from scotland on RSI in the NHS.

The other reason NHS Pods are at risk of RSI is that we are increasingly lumbered with disposable instruments, some of which are shockingly, shockingly bad. Unfortunately we don't get to choose what we use so we are also all stuck with what the majority want / what the dept can afford. If you have unusually big hands, small hands or anything else, that's just too bad. They are also borderline unfit for purpose in some cases although they seem to be improving bit by bit.

It stinks, but it's not the fault of the poor sods at the coalface with surgery scars on their wrists.

 

For goodness sake Robert get a life.

People who work in the NHS have the massive back up of both their unions and their HR depts, so if they do 'argubly' have a work related 'injury' they have recourse.

Now talk to your PP mentor and ask him what happens in PP.

At the same time ask him about his risk assessment forms.

If one of your colleagues had 'seen' 28 patients in a six and a half hour day that was 14 mins a patient, hardly time to write the notes?

What exactly are you trying to say?

In truth in PP in a warm country I can see patients every 14 mins, cut their non pathological nails and that is about it, no time to look at their at risk foot.

Get real the NHS Podiatry service has lost it's way but unfortunately controls UNI commissioning for HPC Pods, so in the future you may be right aligning yourself with the unregulated, they could well end up being in the majority.

Have a very good day.

 

In my area they don't cut nails.

They hive everyone they can off into social enterprise nail cutting schemes. Those that these minimally-trained presons can't cope with (gryphoses etc.) get sent back to the NHS, get sick of waiting and end up in the private sector.

I'm not going to get into an argument about whether the NHS should cut nails or not, but as demand is infinite and resources are finite, then something has to give.

Now, on to RSI.

I worked for the NHS for 23 years and in that time I cut nails from dawn to dusk. I never had a problem with my fingers/hands/wrists. What I did get was shoulders like a prop forward and fibrosis of the muscle groups over my back of neck and shoulder girdle. I put this down to carrying the heavy dom bags we had in those days and lifting the leg rests of the patients chair with the patients legs on them. I now get stiffness in that area in the morning but it wear off as the day progresses.

Does that count as RSI ?

CF

 

Joe, to gain better understanding of your post would you please help me by showing where Robert stated an NHS employee works for 6 & 1/2 hours a day?

Also could you elaborate:

Many thanks,

Mandy.

 

Joe, to gain better understanding of your post would you please help me by showing where Robert stated an NHS employee works for 6 & 1/2 hours a day?

He did not

oe:
In truth in PP in a warm country I can see patients every 14 mins, cut their non pathological nails and that is about it, no time to look at their at risk foot.

No

 

Many thanks for justifying your valuable & thoughtful post.

 

I don't know that it's RSI but certainly a problem. Home visits have inherent h&s risks and I don't know if they can ever be eliminated.

 

All,
if you look at the other thread about nail clippers you will see that I have done a calculation to explain (I hope) Mr Bean's post about an NHS pods' clinical hours.

(It is my opinion that Mr Bean is a disgruntled retired NHS manager living in Clacton - but I could be wrong...)

When I worked for the NHS, in 23 years there was only one pod who suffered with RSI of their wrist. Others were taking time off with bad backs though.
We were cutting more toe nails then than they do now, IMO.

So my conclusion is that we can blame the nippers, not the operator.

I am still using nippers that I bought in 1995. Most of the nippers that are available now are c£@p.

regards

Catfoot

 

This is a recurring discussion argument.

The NHS has

NO :deadhorse:

role in providing non essential social care for a task that a normal healthy adult can do for themselves. it is called an act of daily living.

So this is what Private Practice is for.

We dont have voluntary agencies attending to teeth because dentistry is too expensive.

Dentists have agood model so why do we not use it.

When a pt is defined as being at risk due to advanced pathology of the lower limb then it is the responsibility of the NHS to pick up the tab.

But again Private Practice is well trained (3 year min training i mean here) to provide this level of care.

Having worked in Aus for last 4 years PP did most if not all care including at risk. Only referring to the local hospital Podiatry Service for specialist intervention .
The pt would on conclusion of this be referred back to PP.

It worked well and you had succesful well funded well equipped PP.

We have to break this mess of the NHS doing everything for everybody which it has never and cannot provide.

david

been fighting this nonsense since 1986 when i graduated:craig:

 

Forgot disposable instruments

Why are we as a profession using single use disposable instruments when generally we are non invasive.

Nobody else including brain surgeons do this.

So why do we.

That is what Hospital Sterile Service Depts are for and they do a very good job.

It is a complete nonsense to use disposable instruments, especially when they are only able to cut and file one nail safely due to poor sharpness and lousy durability.

RSI should used to challenge managers and employers to stop using disposable instruments.

David

 

Could not agree more. It is only one of the absurdities that we in the NHS are lumbered with. It's not a decision made by podiatrists, or even podiatry managers, it originates much higher up (down?) the food chain. Benchtop sterilizers, which I agree are entirely adequate, are simply not allowed any more. Anywhere.

CSSD (central sterilization) is a far preferable option, however it involves a larger initial outlay. The culture in the NHS at the moment is all about immediate savings. No one expects to be in the same post in a years time so very few finance directors are willing to spend now to save later.

We put in a business case for central sterilization. I won't bore you with the numbers but it would have cost more in year one, broken even about middle of year 2, and made a HUGE (tens of thousands) saving each year from then on. It was rejected, because they were not willing to make the investment in year one. We'll try again this year but I'm not optimistic. And yes, we did try the RSI argument as part of the case.

Meantime we have Blunt nippers, blacks files I would not inflict on my worst enemy and scissors which struggle to cut paper, much less felt. Unhappy Pods, Unhappy patients.

As you say, its a complete nonsense. The NHS structure has become so unweildy that steering it from the bottom is well nigh impossible. Its like trying to push an iceburg with a rowboat.

Our trust spent God knows how much money retaining a private company to send out patient satisfaction questionaires to 300 podiatry patients recently. This will happen twice a year. Why? Because the powers that be demand independant data to show that the services are meeting their satisfaction targets. And services which are not performing are penalised with budget cuts. Yes, they like to kick you when you're down. This is a year after discharging all the "low risk" biomechanics patients (best we don't ask how satisfied THEY are.):bang:

Sorry. Rant over. The NHS. Still spiraling downward.

 

Is this where Del suggests Private Practice ?

 

You are very perceptive Michael :drinks

Yep Isaacs, stick with me son and I'll show you how to rock and roll !!

Busy varied practice, happy patients in abundance ( as you have found out).

I'm not sure how to comment other than I see the fall out from the NHS with more and more GP's unable to refer to NHS podiatry.

The massive job losses coming in the public sector / NHS are there for all to see for those in the real world.

Pity the blind within WHOEVER they are cant see them coming and are making life intollerable for those like Rob on the coalface.

I had an offer to buy my house and practice last year and I would have been happy to retire ( applause and cheers from the Trolls)

The applicant couldnt raise the money coz the banks arn't lending ( Trolls crying hysterically).

Even in PP, times are not as they were in the past, SO I have to give continuity of Tx to my younger Pts until such times as retirement / Brass Handles arrives and I can hopefully hand it all over to another Pod.

I think it is really sad that the NHS is dying for the majority of non urgent pt's.

It is still a great institution if you are seriously ill / injured....

but at our level NHS Podiatry etc IMHO ..........:deadhorse:

Cheers
D

 

My previous bunch of idiots went CSSD about 7 years ago and i went cssd in my pp in about 2002.

I think cssd is great open pack use chuck in red box. fabulous. 3 days later all back and nice and shiny is nice wrapper. loverly sticky label to stick in pts notes.

No messing with washing ultrasound rinsing drying bagging and autoclave.

CSSD is what everybody else does so why pods different.??????:deadhorse:

Time is money. NHS already has cssd depts so use em.

David