Man hits out at NHS for not cutting his toenails

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The Northern Echo are reporting:
Man hits out at NHS for not cutting his toenails

 

Yes I know .... I just wonder why we get these sort of news stories only from the UK and never from any where else?

 

Yes, its enough to make one think uncharitable thoughts towards the Spending habits of the English!

Funny, but its an English pal of mine who always makes jokes about the "fiscal caution" of our beloved Scottish friends. Gives one pause for thought.

 

Hello Pods,
I feel quite saddened, not maddened by the changes to our NHS services. Indeed I agree wholeheartedly that some individuals regardless of age, disability or the existance of any underlying medical complaint will at some time require our services. This is surely why we chose this career. I believe that patients are never an interruption to my day, they are in fact the reason we come to work.

However, (this may cause a commotion). I actually agree with the majority of the policy for discharge of pts deemed to be at low risk of podiatric complications by the NHS.

I understand that this is perhaps just my opinion. But I have never been one to side with the majority, even for a quiet life.

My understanding of our NHS service is the provision of medical care & where required treatment to individuals in need of medical attention.

This may involve the provision of information, advice, treatment & yes on occasion a patient being discharged following one assessment.

If I were to develop a frozen shoulder the GP may decide to refer me to see a Physiotherapist. The Physio would assess me, advise me & perhaps follow up with an appointment after a few weeks to check on my progress. If I expressed to the Physio that indeed my shoulder improved 50% with their suggested exercise regime I feel sure they would express the need for me to continue with their regime. However, if I also expressed that massaging the area (as he showed me during my 1st appt.) reduced the discomfort even further. I feel certain regardless how much I insist it's surely his job as he's the expert to provide me with regular appointments until I no longer feel the need to attend I would after the initial assessment & review following treatment that I would surely be discharged from their care to continue with the advised exercise regime myself. If I felt that the addition of further regular treatment was required then is it not my place to pay privately for the care plan I dictate.

I know we are not Physios it was just an example. I also know the potential risks to patients who may be unable or unwilling (even if able) to safely self treat.

For many years we as individuals allowed ourselves to be disempowered. Any disorder, disease or condition we acquired was placed in the hands of the Doctors, the Consultants or another NHS provider. We were given little in the way of explanation about the condition we suffered from and it was left to us to seek out information so we so choose to do so.

Much of what the NHS provide now is governed by not just cost cutting but by prevention rather than cure.

If Mrs. Bloggs is Diabetic and has neuropathy it would be grossly negligent on the part of any medical professional to tell her that the NHS will take over her foot health. It is surely the job of us as Podiatrists, either in the private sector or the NHS to ensure Mrs. Bloggs knows how to check her feet daily, encourage the patient with appropriate footwear & emollient advice. Ensure she knows how to decrease risk factors Re: her foot health. and in doing so encourage Mrs. Bloggs to appreciate the need for HER or HER FAMILY to be involved with her health as a long term investment.

The worst case scenario may possibly be that Mrs Bloggs is seen 12 - 14 weekly by the NHS Podiatry service for regular nail clipping. Imagine if you would that the day after her last Podiatry appt (with no complications noted) she unknowingly stands on a pin. If it penetrates the plantar surface of her foot it could be days or weeks before anything untoward is noted.
If a patient was at risk of such an episode occurring then surely ''empowered patient'' with the appropriate information would be a patient who would indeed is aware of the actual potential of complications as opposed to an individual who relies upon an appointment arriving for 'her feet doing'' every 3 months.
I am not advising this neuropathic patient or her family to weild a pair of clippers at her feet. I advocate providing the patient with the appropriate information on an individual basis to ensure her best outcomes in the future.

As I mentioned in another thread that just because the NHS provided free Chiropody to the elderly & other individuals in the past does not I believe mean that this service was provided appropriately. Indeed many pensioners (wether able to self care previously without problems or not) were referred to Chiropody services as soon as they attained their bus pass. It was not seen to be the invaluable service it should be but more a treat. The NHS by doing this encouraged todays problem of seemingly withdrawing a service certain groups (because of previous provision) feel they are entitled to.
It is a harsh fact that yes there are certain services that we as individuals (if we do not meet certain criteria) will have to pay for. There are certain medical grups eg. Westfield, HSA that run an insurance scheme whereby you can claim back certain costs.
If you attend the Dentist is it free?
If you attend the Optician is it free?
Why then should the provision of our service be any different?
Please do not forget this is my view, any venemous responses will be politely ignored but I do value your comments on this contentious issue.

 

Just kidding

I think you make a very valid point. Patients are very keen to abrogate all responsibility for their health and we have to be careful not to let that happen. Regardless of medical status the person who makes most difference to a patients wellbeing is... the patient! How often do we argue to toss over why we can't cure a dorsal corn without the patient changing their unsuitable shoes? A line i have been known to use is "my job is to tell you how to solve the problem not solve it for you. That i cannot do."

Having said that let me say this. I am disturbed that the group which is usually the first to lose their right to treatment is the non high risk adults. It seems merely being in pain does not entitle one to podiatry any more!

You cite the example of physiotherapy who historically have been particularly good at packages of care. Even they, however, do not limit their access to "high risk" patients.

Why this bloke thinks he needs a home visit just because he's "a bit stiff" i don't know!

 

Well Twirly,

You certainly like to set the rules and obviously do not suffer from RSI using a key board.

The whole post reads like an application for an NHS managers job. However IMO it is not well argued or illustrated.

Examples of where your 'invaluable service' and those 'invaluable service' of your fellow NHS colleagues let down your clients (remember this 'service' is not free, only 'free at the point of delivery') are too numerous to mention and I think would be classified as venomous by you.

The NHS was one great politicians dream, it was ill conceived from day one and has been a political football ever since.

Justifying the unjustifiable is always difficult, listen to the politicians. Do not get the impression I think individual workers in the NHS are at fault, nor do I criticise them, it's the system.:bang:

 

Thank you for the snake Robert. I just love furry critters.
To respond to the point you raised Re: ''Being in pain doesn't entitle anyone to chiropody any longer''.
The Trust I currently work for still accepts referrals from any individual for an assessment. They are provided with: a) assessment, b) diagnosis of problem c) advice re: if deformity is an issue eg. Hallux Valgus deformity with pain, then a referral to the podiatry surg. team for further assess. & advice would be offered (or the patient may be encouraged to obtain bespoke footwear if surgery was not an option).
Podiatry treatment if required is provided also at this initial appointment. If it is a basic footwear issue then again the patient is advised accordingly. People are not as far as I am aware being refused access to this service. They are being encouraged to prevent further problems from occurring. The Trust still holds biomechanics assessment clinics, nail surgery clinics & also provides patients with the option of foot surgery if it were required & advised by the Podiatric Surgeon.
If the patient decided against any advice offered eg. continues to wear the 6 inch heels, then they are discharged. Rightly so I think.
My interpretation of the NHS Podiatry provisions are that it is indeed a specialised service, that is encouraging people to take ownership of their feet.
Another wonderful example for your perusal: If my scalp went scabby & my hair fell out I would hope to be referred to the Dermatologist. However if it was growing & required routine attention I wouldn't expect the NHS to pay for a regular trim or a blue rinse.

PS.
Re: R.E.Gs note that my post read like an application for a managers post in the NHS, Thank you but no thank you. Isn't odd that sometimes even the employees may occasionally agree with new policies.

To address your other note with regard to RSI R.E.G I type sitting comfortably in an ergonomically sound enrironment but thanks for your concern.
Regards,

 

Twirly,

I am very pleased your trust has, out of subscribers money, given you an ergonomic chair, and a computer, and enough time in the day to post on forums.

Your description of what your Trust supplies, and therefore can describe Podiatry as a 'specialist service' is exactly why when speaking to the head of the HPC, he referred me to the numbers game.

Have a look at the growth rate of other HPC regulated professions and Podiatry, and ask 'why'.

My conclusion is that NHS Podiatry went along the route of exclusivity, they would rather give away work to other groups than embrase the mundane and now appear to reject potential customers and basic skills in favour of 'advice'.

I predict with this attitude it will be simple for 'management' to get rid of you all within 5 years.

 

Then you are fortunate. Mine does not accept anything other than Paeds or high risk for Routine care. Even for an assessment. If the patient is healthy we send the referral back even if they have a corn the size of a golf ball. Which stinks IMO.

Of course we then have to send them to the unscrupulous private sector where they have to pay inflated prices to poorly trained and regulated... calm down, i'm just kidding Bob. Yes i know, there's nothing wrong with PPs. You're lovely. We embrace you as brothers of the blade and burr. I'm sure your posts would never be considered venomous. . Got nothing but love for you.

 

Careful bob, your chip is showing.

 

Robert

How fast was that.

Stop this bit about chips.

If you read carefully I'm in favour of the NHS and support your dilema, I'm very much against giving away the profession.

Bob

 

Pretty swift! And its 530 so out of (paid) work time. Which is just sad!

Sorry buddy. But the above sounded juuuuuust a bit sarky to me. And twirly new here and all. Be nice. Costs nothing.

Anyway. I've been here since 8 am and my butt is numb on this unergonomic chair so i'm going to shut down this ancient fossil of a pc and go home. For a Robeer:drinks

Regards
Robert.
Drink robeer. Its ace.

 

Thank you Chaps, I not only welcome but I embrace your replies, Few short tips though for yourself R.E.G,
1) on 12 week career break from NHS = my time not theirs
2) ergonomically designed chair & surrounds in my home not NHS accomodation.
3)archaic computer robbed from Noah while he was away checking the igs:

Regards as always,

 

Sorry both,

Struggling a bit with the new format.

Robert your pleas for Twirly are noted, Twirly a 12 week career break, luxury.

I'm not really the nasty person you perceive, but:butcher:.

This was the reply before I read yours Robert.

Ok Robert

'chips' is a cheap trick one that does you no credit, try this one.

Tues 5pm phone call from man requesting nail cutting for his wife in a local Cottage Hospital.

Mr money motivated PP (me) asked a few questions and a bit of history.

recognize this?

Wife over 70 t/t for breast cancer, spell in acute hospital followed by a number of transferred within the system. Ends up in my local 'cottage hospital', rescued from closure by the guy with a beard who lost out to Livingstone for mayor of London 'Dobson'? An aside.

Any way the local Podiatry service is housed in an adjacent building 'bought by local subscription, and now occasionally manned, as a result of another re organisation.

So back to the point, Mrs X finally presents with sacral ulcers and 'Black heels', so Pod dept called in. Apparently they were appalled and called for Xrays, and referall to a vascular surgeon. At this point I was informed Mrs X was diabetic.

Result the Vascular surgeons recommended amputation. Husband was not keen. No podiatric intervention.

This poor man explained he knew he was facing his wife's death, all he wanted was her toe nails cutting, nurses would not do it because of the 'risk'.

Crying yet

I promised to ring the podiatry department in the am and try to 'put on some pressure', believe it or not I get on very well with my NHS colleagues, if this failed I would go in and do what he wished cost £30. He said no problem.

At 8.50 Wed Mr X rings to say his wife died at 10.pm Tuesday. me very sympathetic despite no fee, but also dispirited.

So should he sue? Probably not for me to say, and if he did would it come out of staff salary or patient care?

Chips, no just a very old fashioned Socialist.

 

Hello once again R.E.G,
I hope it isn't considered bad form to respond to your thread addressed to Robert. It is indeed awful that the lady in Q died without receiving the treatment her husband requested.
It is only natural that during a loved ones last days that those closest try to provide them with any element of comfort possible.
I must admit though (without pointing fingers) that if the poor woman was indeed suffering from sacral wounds & black (?necrotic) heels, then her Doctor & care team within the cottage hospital would have noticed these changes.
Although I still cannot fathom why the Podiatry team were called in for (black heels?) at such a late stage. I would have thought that a patient with bed sores (sacral wound) would have been placed on an air type mattress to decrease pressure on all at risk pressure areas, but even so the Podiatrist would have been unlikely to provide a solution to her black heels. The reason behind the lack of nail care provision at short notice I can't comment on.
It is only human to feel compassionate for people at such a sad time but if her requirement for nail care was great then you did everything in your power to expediate this final request for her husband.
Am puzzled about the last bit though R.E.G, should he sue! Who for goodness sake?
As much compassion as I feel for another at such a terribly sad time, who do you believe is at fault? Also what for? I appreciate we live in a litigious society now but goodness me thats awful if you believe the poor chap would sue because she died without her nails being cut.
Regards,

 

Twirly,

It may be obvious that I do not particularly enjoy discussing subjects with you and unfortunately Robert, so this will be my last word on the role of Podiatry within the NHS.

I must be very careful how I phrase this because I can be identified so therefore so can the places I refer to.

'Black heels', you ask 'necrotic', I do not know? But here they seem to be associated with a few weeks residence in hospital. I think they may be "decubitus ulcers", or in common parlance 'bed sores'.

The Podiatry dept was consulted when the patient was transferred from the acute hospital to the Cottage hospital, because in this neck of the woods ulcers on feet are still seen as relevant to Podiatry, perhaps not so in your PCT?

(Robert, sarcasm?)

The lack of nail cutting was symptomatic of the 'care' the husband believed his wife had received, in his words 'neglected'.

Clearly he would not sue for her not having her nails cut, but lots of people successfully do for neglect.

As I said I'm relieved I did not have to get involved, I trust and believe my phone call to my NHS colleagues would have achieved a result, even if one of them nipped across in their lunch break.

IMO it is not individuals who are to blame but 'the System', however you seem to approve of that system, unlike Robert, hence I think it is fair to question your position.:drinks

 

Ah R.E.G,
It is with great sadness that I read your last post (bugler please),
I shall miss our wordy interactions but I understand that few people enjoy crossing swords especially when both sides believe opposing views. Personally I thought that formed the basis of a great discussion. I also think it your right to Q my position but not however with a final barbed remark. You mentioned that in your opinion that ''it is not individuals who are to blame but (the system)'',. If only this land of milk & honey of which you dream were a reality........ <sigh> Please feel free to forward in full your views on what you believe the NHS should provide & I in turn will attempt to appreciate how much in every pound we pay in tax will need to be forwarded to the guys at the tax office.
Don't forget though (my humble opinion again) most patients that I have provided routine nail care for on behalf of the NHS prefer to have them seen to around every 4 weeks. Just thought it may help with your calculations with milk x honey.
Regards (as always)

 

You just made me laugh tea out of my nose!

 

lol, I aim to please

 

I can understand why REG has dropped out of the debate. It gets frustrating to be able to see a bigger picture, clearly one that doesn't alarm Twirly.

In the days when REG trained, they were taught that they were a part of "the primary care system". They were told that the time they had to engage with their patients gave them a greater opportunity to glean information about a patient's health than the 8 minute interview permitted by a Dr. Where a Dr relies on a computer screen, REG and his colleagues had that real contact time to establish a proper patient/practitioner relationship.

The 'job' back then was a mixture of cure (we still are the best people to cure ingrown toenails) and palliative care - keeping the RhA sufferer's diseased ravaged foot capable of weight bearing. Excellent job satisfaction and superb recognition of skills by ones peers. All this was mixed in with a little bit of nail cutting, a bit of light relief inbetween all the responsibility. Perhaps an inconvenience to some but in truth, it never clogged the system.

Then along came the guru management in Podiatry who deliberatly convinced you that you were all overworked, underpaid, under achieving and that your skills were 'wasted' on cutting toenails. You fell for it.

Consequently to progress within the NHS you need to specialise. This is exciting and important with no compunction over the loss of service to those deemed unworthy. This management guru obviously a very clever salesman.

He got his result. ​

Not only is this having a massive impact on elderly mobility, we are now seeing patient selection before they even get a chance to speak to a Podiatrist losing the advantage over our erstwhile GP colleagues. Of more concern we are seeing a dwindling Podiatry service within the realms of the Primary Care System.

The next challenge is to survive 'commissioning' with many claiming they can do equally as good a job if not better - Age Concern?

Recognise any of this?

GB

 

Given England's Population of ~51M with ~8M over 65, If just half of these were provided with NHS podiatry services for nail care, say every 2 months, and the average Pod provides 15 services a day for 200 days per year (this allows for weekends, leave and part timers) you would need 8,000 podiatrists. Now what are the people with foot problems supposed to do?

 

George

"Sigh"

Funny how when people disagree they always claim THEY are seeing the bigger picture. Its a bleak one you paint, however i think it is inaccurate.

The job you describe from the halycon days of yore has three element. Cure (which we still do) palliative care (which we still do) and nail cutting spliced in for a breather between. (which we don't).

I would, however, take issue with you on the "guru" who convinced us we were "wasted" on toenails. Thats not how it happened. At least not in my experiance. And i'm sorry you have such a poor opinion of your NHS colleagues.

My experaince of the evolution (devoulution?) of the nhs has NOT been that we specialised because we felt that we were too good for nail care, rather that we had to select the least indispensable aspect of care to lose. To say that this was done

Is both factually inaccurate and somewhat patronising. Is this your conclusion from working within the NHS? From speaking to a representative sample?

My experiance has been somewhat different.

A combination of stealthy reductions in service via post freezes, trust boundry shifts etc combined with an increase in the number of referrals has meant that the overall pod to population ratio has been falling steadily. As this happened our waiting lists became longer. At one stage in my trust people had to wait over 2 years for an assessment.

Clearly this situation was worsening and not likely to improve. It was abundantly clear that more staff were out of the question. So we had a decision to make. Watch people with serious problems ulcerate because they had waited so long or tell people who had non pathological nails and just could'nt reach them to seek alternative care. We went with option B.

In an ideal world nothing would please me more than for the NHS to supply social as well as medical care. It would reduce acute referrals and ensure the safe and lucrative future of the profession. However with budgetary and staffing levels as they are this is simply not feasible. The recent controversy over drugs for alzheimers has illustrated all to clearly that it is not a question of "will this money do good here?" rather "will this money do MOST good here" The resources are finite.

I am not unaware that this has negativly impacted the private sector. However the power to make routine regular nail care, which the balance of the population do themselves or for their spouses, a medical proceedure is not within our gift! Sooner or later someone will ask the question "hey i don't need a podiatrist to cut MY nails, how come he does just because he's blind? The nails are no different!" At that point they will move this care out of the medical realm into the social realm. Hence AC nurses

The continued erosion of NHS provision is a worry for all of us. It is a linear progression which can only end one way. The loss of nail care was not a worry for me. The refusal of provision for those in pain because they are not "at risk" is. Those of us in the NHS are simply trying to protect the most vital aspects of care.

Whether you beleive that the care of non pathological nails belongs with a degree qualified podiatrist is a matter for personal opinion. I don't, and although i dearly wish we could sell out lords and masters that it DOES, realistically that ain't going to happen. In the mean time i will focus my attention on convinceing them that a 25 yo with acute PF or a 30yo with a big ass corn is worthy of NHS attention rather than trying to convince them that having a lay person carry out what used to be self care is a disaster.

Regards
Robert

 

Can i come work for you please?

 

I think that the situation is due to the inability/political ineptitude of the profession in the U.K. over many years, in contrast to our colleagues in the U.S.A., or, for example, the Dental profession in the U.K.

Had full closure been acheived then I suspect that may pods would be employing assistants to cut non-pathological toenails, but only after an intitial assemeement by the pod. However, we are now in a postion in which the NHS is training FCAs and others are training FHPs over whom there is no control if they choose to set up independently.

Like it or dislike it, there is only one group of people to blame - us!

Bill

:empathy:

 

Stephen,

Fascinating calculation and 10/10 for the arithmetic. As you are in academia was the 50% figure gleaned from some epidemiological data or just for illustration?

It would be interesting to see such a calulation done for all the podiatry disciplines then we could make a case for adequate funding rather than the method used so well described by Robert.

Here are some figures I find interesting taken from the HPC site

YEAR AS CH CS DT ML OD OR OT PA PH PO RA SL RG TOTAL
2006 2,309 12,799 3,999 6,260 21,322 8,538 1,234 26,855 12,343 40,005 816 22,164 10,725 - 169,369
2005 1,992 10,741 3,719 5,757 21,158 7,670 1,277 26,376 11,316 36,978 821 22,360 10,348 - 160,513
2004 2,048 10,264 3,450 6,070 19,803 - 1,234 24,191 10,224 36,812 780 20,491 9,467 - 144,834
2003 1,992 9,013 3,408 5,782 21,895 - 1,328 24,576 9,334 35,643 786 21,484 8,900 - 144,141
2002 1,903 8,810 3,323 5,469 21,541 - 1,304 23,238 8,778 34,035 763 20,655 8,035 - 137,854
2001 1,787 8,673 3,311 5,217 21,390 - 1,303 22,197 8,892 31,235 748 20,073 7,303 - 132,129
2000 1,455 8,447 - 4,999 21,174 - 1,287 21,006 - 30,602 734 19,696 - - 109,400
1999 - 8,262 - 4,690 21,000 - 1,263 19,692 - 29,313 699 19,067 - - 103,986
1998 - 7,963 - 4,454 20,804 - 1,243 18,502 - 27,975 - 18,511 - - 99,452
1997 - 7,782 - 4,267 20,910 - 1,206 17,716 - 26,569 - 18,271 - - 96,721
1996 - 7,624 - 4,003 21,008 - 1,169 16,504 - 26,264 - 18,003 - - 94,575
1995 - 7,401 - 3,853 20,963 - 1,109 15,297 - 26,072 - 17,429 - - 92,124
1994 - 7,270 - 3,640 21,069 - 1,104 14,340 - 25,259 - 17,171 - - 89,853
1993 - 7,111 - 3,472 20,830 - 1,092 13,702 - 23,757 - 16,846 - - 86,810
1992 - 6,896 - 3,307 20,832 - 1,074 12,952 - 23,260 - 16,563 - - 84,884
1991 - 6,737 - 3,150 20,724 - 1,071 12,026 - 22,445 - 16,302 - - 82,455
1990 - 6,555 - 3,012 21,052 - 1,044 11,327 - 22,020 - 16,111 - - 81,121
1989 - 6,358 - 2,827 20,567 - 1,028 10,665 - 21,168 - 15,594 - - 78,207
1988 - 6,159 - 2,668 20,446 - 1,000 9,915 - 20,376 - 15,165 - - 75,729
1987 - 5,995 - 2,526 20,011 - 963 9,238 - 19,366 - 14,690 - - 72,789
1986 - 5,789 - 2,352 19,406 - 948 8,559 - 18,900 - 14,209 - - 70,163
1985 - 5,599 - 2,188 19,138 - 935 7,890 - 17,758 - 13,816 - 678 68,002
1984 - 5,513 - 2,085 17,950 - 898 7,256 - 16,748 - 13,637 - 580 64,667
1983 - 5,345 - 2,011 17,170 - 880 6,746 - 15,885 - 13,233 - 534 61,804
1982 - 5,215 - 2,012 16,176 - 859 6,262 - 15,234 - 13,116 - 513 59,387
1981 - 5,169 - 1,876 15,586 - 839 5,970 - 14,678 - 12,720 - 502 57,340
1980 - 5,081 - 1,778 14,786 - 804 5,537 - *15,510 - *13,539 - *523 57,558
1979 - 5,116 - 1,742 14,236 - 813 5,357 - *15,228 - *13,001 - 447 55,940
1978 - 4,995 - 1,602 13,556 - 770 5,064 - 13,418 - 11,492 - 424 51,321
1977 - 4,964 - 1,475 12,774 - 757 4,800 - 12,786 - 11,245 - 403 49,204
1976 - 4,976 - 1,391 12,050 - 796 4,652 - 12,614 - 12,037 - 386 48,902
1975 - 4,879 - 1,249 11,083 - 780 4,367 - 12,410 - 10,639 - 381 45,788
1974 - 4,847 - 1,147 10,185 - 730 4,036 - 11,936 - 9,729 - 362 42,972
1973 - 4,809 - 1,060 9,526 - 689 3,824 - 11,480 - 9,376 - 346 41,110
1972 - 4,745 - 1,000 8,830 - 660 3,620 - 10,984 - 8,646 - 341 38,826
1971 - 4,657 - 930 7,918 - 620 3,359 - 10,611 - 8,171 - 322 36,588
1970 - 4,631 - 848 7,060 - 611 3,155 - 10,216 - 7,760 - 313 34,594
1969 - 4,604 - 764 6,382 - 613 2,984 - 9,808 - 7,459 - 315 32,929
1968 - 4,578 - 717 6,024 - 546 2,808 - 9,456 - 7,131 - 317 31,577
1967 - 4,530 - 670 5,596 - 261 2,627 - 9,171 - 6,617 - 315 29,787
YEAR AS CH CS DT ML OD OR OT PA PH PO RA SL RG TOTAL

Key: AS Arts Therapists
CH Chiropodists
CS Clinical Scientists
DT Dietitians
ML Medical Laboratory Scientific Officers (Biomedical Scientists)
OD Operating Department Practitioners
OR Orthoptists
OT Occupational Therapists
PA Paramedics
PH Physiotherapists
PO Prosthetics & Orthotists
RA Radiographers
SL Speech & Language Therapists
RG Remedial Gymnasts


Sorry it's a lot, but a reliable source.

Lets take Chiropody Occupational Therapy and Physiotherapy, and using the starting year of records 1996, 2003 the year 'grandparenting started' (most significant for Podiatry) and 2006.

Chiropodist 1967 5,596, 2003 9013 (+68%) 2006 12799 (+128%)
Ots 1967 2627, 2003 24,191 (+906%) 2006 26,855 (+1022%)
Physio 1967 9171, 2003 35,643 (+388%) 2006 40005 (+436%).

All dipping into that 'finite pot'.

Where did we go wrong?

 

Hi REG,
There have been cases made for increasing funding over the years - Feet First is just one which springs to mind.

The problem, as I suspect you are well aware, is nothing to do with cases for adequate funding.
It has everything to do with warring UK podiatry professional bodies who have a vested interest in keeping their own members, and poaching new ones from other professional bodies where they can.

As Bill rightly points out - the problem is one of our own making.

Perhaps things will improve in futureigs:.

Cheers,

David

 

Great,

Two big boys back on line.

David a long time sincee we have crossed pens:drinks

I take your and bills points about bodies, but on this occassion is that really the issue? I'm not sure?

This I think is about the phylosophy of Podiatry, and the fight for recognition of the value of the generalist formally the Chiropodist.

Please feel free to persue your positions, but is the politics of 'bodies' a different subject, and have you looked at the latest discussion on TFS?


Regards

Bob

(I have somehow locked my computer out of this site, so am using anotherone, some may say 'Good', any help? It happened when I tried the spell check, so please excuse any spelling,

When will DTT engage?

 

Hi Bob

Perhaps when I return fom a well earned break !!

BYE :drinks

Cheers

Derek

 

Hello Bob

I am not in any way trying to 'politisize' the situation. Just trying to make the point that my feeling is that the profession will never get anywhere until it has 'control'. There are those organisations, the Department of Health included, who are terrified of that occurring simply because they perceive that professional self determination would act in their detriment (it probably would).

Given the above comment I think that David is right and that we continue to be our own worst enemies and thus act to the detriment of that most important of persons, the patient. Since our raison de etre as professionals is to act in the best interest of the patient we automatically stand condemned - not a pleasant irony to contemplate.

All the best

Bill

:bash:

 

Bill,

If I agree with what you wrote I would have to agree with David, I’m not sure you are being fair to me. But OK just on this occasion.

Twirly asked about NHS funding. If we are looking at History what do you think of this, or is it ‘Politicising’ the debate



Funding of the NHS and the 'land of milk and honey'.

As far as I remember (I lie because I was not born then, but it is described in my 1958 copy of the Encyclopaedia Britannica) the NHS, founded by a great Socialist, was based on the misconception that there was a pool of 'illhealth' which once addressed would see an ever decreasing cost of maintenance. It was funded by a new 'levy' called the National Insurance Scheme.

That the naive concept of the NHS became the biggest political football ever was, with hindsight was predictable .

The fact that governments of every political hue have failed to explain the costs of the NHS to the people, preferring to 'tinker' with its structure to make themselves look good is to their shame.

If you took out an insurance policy with a private company you would expect that company to honour the terms and conditions of that policy? I suspect you would also accept, and expect that if circumstances changed over the life of that policy, the company would update the relevant cover and review the cost? If they failed in their duty you would have recourse to law for 'misselling'.

Correct me if I'm wrong I seem to recall words like 'cradle to grave', in the policy I am forced to buy, but silly me I forgot to read the small print.

A good point I am sure Twirly will raise is that NI is not really an insurance scheme in the true meaning of the word Insurance and just like the Road Fund Licence, the monies raised do not necessarily go to the relevant causes. We could look at a lot of these sort of words, take Value Added, is it really value or is it just increase in cost, I preferred the old 'purchase tax'. I digress.

So how do we return to the 'land of milk and honey'?

Move to France, it seems to work there.

 

Hi Bob,

Some years ago now Mark Russell pointed out the folly of having our major professional body and Trades Union run by a Council which consisted of a high % of NHS Managers, who were pretty much bound to go along with what their overlords (NHS Trusts and Dept of Health) laid down in policy.

However, the fault for our present predicament does not lie at the door of the SCP alone. The fact is that each professional body regards it as more survival for them to "go it alone",and has done so since before I qualified:bang:. As a result we pods in the UK are terribly suspicious of one another and anyone else daring to enter the foot health arena, and of course divided = weak.

Bob, good to cross pens again:drinks

Craig - the new smilies are something else!

Regards,
David

 

David,

If I keep feeding you opportunities like that people will think we are in league.:empathy:

Time for me to go quiet again.

I guess we are approaching the productive end of this thread?:bash:

See you elsewhere I think?

Bob

 

I realise the debate has moved on since I posted Saturday morning but given the time Robert put into his posting, out of respect I feel I owe him a response.

This is an assumption. I have a great deal of respect for all my colleagues and for this reason I am prepared to support the practitioner who choses not to specialise in a profession where specialism is increasing encouraged - no I will correct that to - increasingly forced. There are many generalists out there that just do not have a voice. I think you would be surprised how many of your colleagues do not agree with the situation that is being forced upon them by the shift in footcare from health to social care.

Are you prepared for the day Podiatry is downgraded within the NHS and technicians trained for a maximum of 2 years replace the majority of your NHS colleagues? The shift in nail care from health to empowerment and social is only the tip of this political iceberg.

I have listened to colleagues state that by shifting nailcare from NHS to social care they have "got rid of x number of patients". This is not a good experience. If the public hear comments, statements such as this what PR for the rest of the profession? Those employed within the NHS as Podiatrists are the minority. The PR such an exercise as empowerment has created has reflected on the whole profession. I assume you have read and absorbed the Age Concern documents - Best Foot Forward and Feet for Purpose? The long term aim being to secure funding for the care of elderly feet within the NHS. Age Concern has power.

Maybe just one day a igs: happens to land in the appropriate Government Office and succeeds in securing funding for a vast increase in care for elderly feet, then with the "success" of the shift in General Care out to the social sector we won't need Podiatrists but technicians. A very stealthy way of ousting the Hons Degree trained Pods? Or will they accept a drop in salary to continue in the world of employment? It could happen.

I appreciate that when a manager is given a budget to "manage" and that budget falls short of the demand and supply ratio, then something has to give. I assume therefore a consultation programme took place to consider the management of patients as the shift from healthcare to social care took place.

I assume that thorough research took place on the effectiveness of the empowerment scheme, the provision of service that Age Concern could provide and contact was made with a representative sample of the private sector to establish what service they coud provide and at what cost. I am certainly mortified at how Age Concern represents the Private Sector within its publications although one of their recommendations to resolve the current situation is to " Commission services to the level required from a diverse range of providers - in the NHS, social care, private and voluntary sectors -best placed to meet the needs of older people."

I am going to assume that you are not aware rather than not unaware. The PR of the effects in loss of service to low risk patients has negatively affected the whole profession and not any one sector. For fear of becoming repetative, it is the private sector who has to explain NHS policy to the disgruntled service user who has lost their NHS footcare. This impact is negative. How many private practitioners will use this opportunity to portray a positive image of service provision by the NHS to the elderly? I am in the minority.

I assume that Registered General Nurses reading this will take offence at your term AC nurses. Sorry just being picky.

So my concern and it always has been, is the loss of a foot health check to the low risk category of patient with nail care needs. Here we are back to palliative care and preventative medicine and does the NHS have plans to provide this service to all those needy Podiatry patients it has discharged?

So to come full circle, the care of non-pathological nails belonging with the degree qualified podiatrist is debateable but the provision of an annual foot check is not.

So this is the bigger picture I see and it is not a case of disagreement with you or your NHS colleagues. There is need for provision of care to low risk feet. It is now a matter of who provides this care and how the demand is met.

Sadly this will not be by degree trained podiatrists within the NHS should the reliance on and "success" of the social sector continue. So it begs the question, how many degree trained podiatrists do we need? Not that many unless some service provision is re-instated to all low risk Podiatry users over the age of 65.

GB

 

Is it just me:morning: or is this thread starting to be taken over byigs::bash::empathy:.

 

George

Thankyou for you rather excellant response. Now we're getting to the nitty gritty and the debate has become useful again.

This is a very relevant point. Whilst we may disagree on who should provide social care i don't know ANYONE who would advocate the withdrawal of care from low risk pathological feet as is increasingly happening. The cutting of services is a steep slope covered in grease. Once it has been done successfully once the powers that be will inevitably want to do it again!

The tricky bit is where do we draw the line. Or rather where we should have drawn the line. Pandora's box has been opened now!

Its a long time since you worked in the nhs is'nt it. What you outline above is certainly the intelligent and organised way to do it. Probably would happen that way in business. I suspect it was more a process of

Manager 1 "who can we stop seeing then?"
Manager 2"ginger people?"
Manager 1"i like ginger people."
Manager 2"diabetics?"
Manager 1"bits fall off them and they start sueing us"
Manager 2"sigh. which groups make most fuss?"
Manager 1"diabetics, children, old folk and the ones who bleed out easy"
Manager 2"oh we'll get rid of the rest then. And lets do another re-org, some of my mistakes are starting to catch up on me.
Manager 1"yep, ive got some bodies to bury as well. And we're nearly a quarter of the way through the headed stationary. 'bout time we changed the trust name again."
Manager 2 "have you seen my new beemer?"

Nope i meant not unaware. As in i am aware. Whether it does damage to the reputation of the profession as a whole to not do social care i'm not so sure. But i do know that it is financially more of a downer for those who are not on fixed salaries to allow other groups to do what was once "ours".

You think you have a hard time explaining things to the disgruntled service user? Think how it feels for us telling somebody who has had our care for ten years that they cannot have it anymore. We get tears tantrums and nasty letters and telling them not to shoot the messenger don't help.

Non path feet Diabetic annual foot checks are now provided by practice nurses in our PCT. So they don't see a pod at all.

Pause for cries of alarm and dismay.

And thats non path Diabetics. Non path non diabetics? Norfolk 'n Chance.igs:

See earlier answer. The NHS at its best. They don't debate, they just do it.:bang:

Sing with me,
This is the end,, dum dum dum, beautiful friend, the end.

Regards
Robert

 

just out of interest in your neck of the woods what would happen to that 25yo PF pt when they went to the GP? would they be told to live with it or would they be referred to another department, say physio?

 

Presently we're still seeing those although the argument is raging. New manager, new ideas. We can't possibly need all that biomechanics time, nobody else does this much biomechanics, going to have to cut back on something, yaady yaady yada. I'll let you know in 6 months.

BTW did anyone see the thing on the news about maidstone hospital and C DIFF

THATS MY HOSPITAL!!! MY WIFE GAVE BIRTH THEIR, I SOMETIMES WORK THERE!!

Fame at last. :dizzy:

Regards
Robert