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Should the NHS do routine nail cutting?

Discussion in 'United Kingdom' started by Paul_UK, Nov 4, 2009.

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Should the NHS provide routine nail cutting?

  1. Yes - it's a vital part of the service

    22 vote(s)
    34.9%
  2. No - we need to focus on other treatment options

    34 vote(s)
    54.0%
  3. Not sure- im sitting on the fence for this one

    7 vote(s)
    11.1%
  1. Lawrence Bevan

    Lawrence Bevan Active Member

    There's a couple (or more) of problems at the heart of this

    1 There is no nationally agreed level of minimum Podiatry provision within the NHS
    2 The UK spends far less than many similar countries on healthcare. This equals less care.

    As Charlie70 points out, if his department wanted to keep doing the same and also lower the waiting list they needed a massive funding increase. This could be argued as what should happen (see point 1 above). However because of point 2 above, they had to make decisions on how to reduce the wait in other ways.

    In many countries there is a system of part state/part private provision. I see the re-categorisation of footcare and change of provision in NHS Podiatry as being an evolution to a part state/part private system. Where some patients pay for some care this will probably lead to an overall increase in healthcare spending making the UK equal to other comparable countries.

    It is being done through the back-door like this because it can't be done any other way due to the politics of the NHS and the dogma of "free" healthcare. There is no such thing as free.

    But it has to happen because there is no more money. In fact we ran out of real money a long time ago. The UK government borrowed 11 billion just to balance the books for October, the highest amount borrowed since 1946. If you worry about the toenails of this generation of pensioners, think about those healthcare of those in the next 2-3 generations who are paying for themselves and the folly of the last decade!
     
  2. DTT

    DTT Well-Known Member

    Hi Michael

    So are you suggesting that you are just left to fend for yourself and never get your nails cut ? Because I fear with the elderly and the discharge policy of some trusts that is exactly what is happening.

    The end result is increased falls ulcerations etc and hospital time taken up

    There is the rub , the differential between the two.

    My contention is the nails are part of the foot I treat feet so... ,I'm an IPP and as such run a business and therefore have to charge these people for my service. I don't believe THEY should pay my fee because they are entitled to free care from the cradle to the grave from the NHS but because of the division of social care and podiatric care that has been established the PATIENT is not getting it in many instances that have been quoted in this thread.

    Now we can and have sat back and given those patients to the likes of age concern for their routine care who are now giving services to diabetics, vascular insufficiency ,neuro pathetic patients routinely ,why ? because they dont have the diagnostic skills to recognise the symptoms or the training in the dangers of treating this group or just believe they can.

    That in my book is wrong and these elderly patients have been let down badly. Old age is probably the one thing that routinely make your arms shorter or your legs longer so you cant reach your feet. Do something for me Michael don't cut YOUR toenails for 6 months and report back, see if you've changed your mind ;)

    Cheers
    Derek;)
     
  3. Lawrence Bevan

    Lawrence Bevan Active Member

    Derek

    Times change, the elderly population is growing and the tax-paying base is shrinking. Politicians simply lied to the current elderly generation when they said the NHS was "free" healthcare and it should provide everything to everybody from the "cradle to the grave". The NHS is not free, its paid for by taxes. If it is not covering everything then more must be paid. This can be done through more taxes or paying directly to the healthcare provider.
     
  4. mgates01

    mgates01 Active Member

    Hi Derek,
    lets extend my problems, not only can I not cut my nails but my foot hygiene is poor and the skin around my heels is drying needing me to apply emollient at the very least daily to this area.

    My heels (and skin) are part of my foot - is this the podiatrists domain?

    Perhaps this is what Charlie 70 was hinting at when he said where do we draw the line?

    BTW how do you do those quote boxes?

    cheers
    michael
     
  5. charlie70

    charlie70 Active Member

    We discussed charging patients for treatments as a way of getting enough staff to treat all those who need treatment.
    It was decided against because
    a) the logisitics are horrific and in the good old NHS the admin to deal with the financial side would have wiped out the benefit.
    b) We would have charged a non-profit/minimal amount which would probably have undercut a lot of private practitioners. This was felt to be detrimental to our private colleagues.
    The idea was shelved.

    I throw that into the mix just as an illustration that we do not see private practitioners as being our competition or as the "enemy". I sometimes get the impression that private pods think we are fighting against each other. We do try to work together...maybe we should be trying harder. I dunno....I wonder why I think about these wider things either before lunch or on Friday afternoons, rather than during the week??

    P.S. I'm a woman, sorrry about the confusing "Charlie" nickname.
     
  6. DTT

    DTT Well-Known Member

    Hi Lawrence


    The majority of the elderly HAVE paid their taxes throughout their working lives and been promised yes by successive lying politicians free care from cradle to grave, and yes it has been stopped and yes it in this profession someway in part to the attitude of the pods themselves because they dont want to cut nails.

    Now at the risk of upsetting the politically correct among us again, I have to make the point that the reason in part that we have this situation is the increased numbers using the system that have made no contribution to it at all but are oversubscribing to the existing services. We have to put a stop to that or increase the taxes to the shrinking tax paying base.

    ( interesting debate on question Time last night on education where white kids are bottom of the league and are falling behind their immigrant counterparts. Same cry of racism went up and was swiftly smacked down by those that wanted a discussion on immigration NOT racism which all agreed is so difficult to do nowadays, but the problem of oversubscribing and resources was the same as the NHS)

    But in the meantime all the abandoned elderly are left where ??

    In Michael s example I think creek and paddles spring to mind ??

    We need an honest re- appraisal of the NHS and the level of care the public can expect from it and perhaps then after the dust has settled we can get on with caring for our elderly who will then know how much they have been let down and the prospect of future care.

    Now as i'm not to far away from and old person myself who has worked for 46 years never asked for a penny from anyone and never had a day out of work but did expect a good retirement that I have paid for and still am paying for with free health provision.....don't get me started.....:mad:
    Cheers
    Derek;)
     
  7. dgroberts

    dgroberts Active Member


    Don't apologise for being a woman Charlie, it's not your fault ;)

    I think the profession as a whole would benefit if there was a direct link between the NHS -> IPP.

    For instance.

    It would be so very useful to have a scheme of somekind that could allow IPP's to register interest in becoming an NHS affiliated practice. This could simply be having to be an accredited SOCAP practice, you fill in a form and your registered with the trust. The NHS then has a discharge route that would ensure the patient ends up in the care of a competent and properly registered clinician.

    It's full of contention though and brings up lots of issues.

    But, it would give the NHS a safe discharge route, safe in terms of protecting the trust form litigation and safe for the patient as they will end up with a registered and properly qualified Podiatrist.
     
  8. DTT

    DTT Well-Known Member

    Hi Charlie

    I have been an IPP for over twenty years and for the majority of that time worked alone. I have over the last couple of years networked with a few pods that work in the NHS and also have a PP.We meet together periodicly and just chat as friends as well as colleagues.

    The one thing that is very clear is that IPP's and NHS pods are miles apart in their thinking even between their own trusts but with the IPP.
    IMHO that is in part because IPP' are usually single practitioners that work alone and don't routinely come into contact with other pods on the above basis. We have all found it to be a great help to discuss and exchange ideas and theories which has honed our thinking and has helped us understand each others problems. I don't think it is and enemy situation (though with some of the threads on here and other places you could be forgiven if you came to that conclusion !!:D ) I just feel its lack of contact and communication ?? I dunno either but that's my take

    Just thought of ans example, I was at the diabetic foot conference a few weeks ago and many of us came away with the opinion that some of the main NHS speakers did not know what an IPP was or of their existence. Even when and IPP made the point that IPP carry out 33 million patient treatments a year in the UK (not sure where he got the figure) but the speakers thought he was referring to NHS clinics outside of the hospital !! so again Charlie I dunno :confused:

    I never stop trying and at times that makes me very trying to some :D

    Cheers
    Derek;)
     
  9. dgroberts

    dgroberts Active Member

    Oh, and why don't we prop up the system by charging, as per dentistry?
     
  10. DTT

    DTT Well-Known Member


    I dont think once the skin is intact the pod would need to get involved but if at the same time the neglected foot had nails that were so long the penetrated the skin on the plantar surface of the foot would you expect the home help to do that as well as put the cream on ??

    It happens ,we all see it day in day out and I do know there will never be agreement so in the words of Charlie I dunno ...;)


    Wot these, highlight your text look at the icon 4th from the right at the top of the message (little white square = quote) click and its done;) or just use the quote button from the message you want to quote from

    Cheers
    Derek;)
     
    Last edited: Nov 20, 2009
  11. mgates01

    mgates01 Active Member

    Hi Derek
    I suppose I'm trying to establish from you where you think the line between socail care and medical (i.e. podiatric) care should be drawn.
    You said the nails are attached to the feet and you treat feet. So are you prepared to say that podiatry should be resonsible for daily application of emollient to heels, or daily foot washing!
    Michael
     
  12. DTT

    DTT Well-Known Member

    I'm saying anyone who is incapable of their own nailcare for whatever reason should be able to get it free of charge on the NHS. I still believe prevention is better than cure.

    I dont think creams and foot washing come into it ,the thread is about nailcare but to answer your question no I dont think that is part of the remit of a podiatrist as a routine to wash and cream feet that is more a nursing /homecare function BUT I have done both if the need arose so.....
    Cheers
    Derek;)
     
  13. You cannot choose one professional group, i.e. the SCP, over another. Who says the SCP accredited clinics provide any different quality of service to unaccredited practices?
     
  14. DTT

    DTT Well-Known Member

    I'll second that !! thank you Simon .

    Membership of a particular professional body does not make you a better practitioner or run a better practice.

    Cheers
    Derek;)
     
  15. DTT

    DTT Well-Known Member

    Sorry missed this one :

    Dentists are part paid by the NHS ,thats my point that could happen with podiatry and the patient pays a nominal fee.
    Cheers
    Derek;)
     
  16. mgates01

    mgates01 Active Member

    Hi DTT
    just so I can be absolutely clear about this, quote

    "I'm saying anyone who is incapable of their own nailcare for whatever reason should be able to get it free of charge on the NHS."

    You would not class any nail care as social under the circumstances you describe above. You feel it should all fall under the NHS (i.e. Podiatry) remit.

    Michael
     
  17. DTT

    DTT Well-Known Member

    Yes, people need their nails cutting , if they are not cut it leads to eventual problems that will require more permanent medical care = further costs to the NHS
    Cheers
    Derek;)
     
  18. twirly

    twirly Well-Known Member

    Hi Del & Co. :D

    Surely that could be identified as self neglect. Albeit through incapacity though would that not be classed as a social issue?

    If an individual is prescribed medication but is incapable of self administering the drug social carers are then provided (at cost to the individual in need).
    If the individual refused to pay for carers would the GP services be accountable for non compliance by the patient?

    Basic human requirements do indeed include regular nail care. I do find it very difficult to understand why non pathological nails should fall into the remit of NHS care.

    Interesting discussion ;)
     
  19. DTT

    DTT Well-Known Member

    Hiya Twirls ( why you no speak to me ??:empathy:)

    there ya go answered my point yourself :D

    Yes and look at the hardship it is causing the elderly, I cant av an old person that cant reach their OX / OG nails coz they are old being kicked onto the scrap heap and left to suffer. THEY WERE PROMISED MORE AND PAID FOR IT IN TAXES and IMHO they should still get it :bash:

    cheers
    Dx ;)
     
  20. twirly

    twirly Well-Known Member

    I been sending psychic messages of lurve. Didn't you get them? :eek:
    I would describe O/G or O/X nails as pathological. As such should fall within the boundaries of NHS treatment. :D

    See, we almost agreed there. ;)

    xM
     
  21. DTT

    DTT Well-Known Member

    Oh it was you that was doing that to me in the morning was it !! Fanks:eek: :D

    How many elderly Dont have ox /og nails Twirls ?? cumon you know no one is taking that as a criteria for care and they SHOULD BE !! carers deal with ordinary nails we should deal with this category BUT WE DON'T that IMHO is out of order.

    Agreed :drinks

    Cheers
    D;)
     
  22. Demerara UK

    Demerara UK Welcome New Poster

    To add my bit..no I don't think the NHS (chiropodist) should do routine nail-cutting for all the reasons that others have given. Now that the HPC has regulated the chiropody profession, there is need for regulating the growing number of Foot Health Practitioners. These individuals can do the basic foot care, along with routine diabetic assessment. Any complications would be referred on to the podiatrist/chiropodist. This would insure that many of the elderly who do not at present qualify for NHS treatment, would have their feet taken cared for on a regular basis by a registered professional.
     
  23. cornmerchant

    cornmerchant Well-Known Member

    Demerara UK

    I do not understand why you think that FHPs would be the practitioners to pick up routine nail cutting. There are 8000 private pods out there who are happy to do nail cutting as part of their remit, unlike NHS practitioners. What planet are you on?

    Cornmerchant
     
  24. DTT

    DTT Well-Known Member

    Hi Demerara

    Welcome to the Arena


    is that the posts that agree or disagree with your opinion ?? please expand on that comment.

    We as a profession can also carry out these tasks so why do you want to give the patients to others ? I believe nurses are now doing much of the diabetic assesments and routine footcare and having recently returned from the diabetic foot conference I can confirm that would appear to be the case.

    Why do they not qualify?? what is your model for qualification of these old folk ??

    Cheers

    Derek;)
     
    Last edited: Nov 20, 2009
  25. Demerara UK

    Demerara UK Welcome New Poster

    Nice meeting you too, Cornmerchant

    Derek, maybe I didn't get my point across quite clearly. What I was trying to say was that with the lack of NHS pods, more of their time could be freeded up for more expertise work,by using FHP's within the NHS structure to do basic jobs. The system varies depending on where you are. Here in Suffolk, referrals to the Podiatry clinic are very difficult, and even healthy diabetics can wait up to six months before they can get their nails cut. As you said, more checks are being done at GP surgeries by nurses. However, nurses are not allowed to cut nails, remove hard skin etc . I feel that the present NHS structure cannot support basic foot care, but with a re-structure all professionals can play a part in foot health care for everyone that needs it.
     
  26. cornmerchant

    cornmerchant Well-Known Member

    Demerara

    You suggested FHPs- are you aware that these practitioners are unregulated? Private practice pods DO cut nails - in fact we do what we have to do because that is how it is when you are self employed. Therefore if the NHS want to refer on to the outside, it should be to pods.

    However, that said, your model of using 'FHPs' to do the routine work is already happening , with the training and employment of podiatry assistants- watch out for your job, if cuts have to be made it is the higher bands that will go!It is only a matter of time before these assistants will be working unsupervised.


    Cornmerchant
     
  27. mgates01

    mgates01 Active Member

    Hi Derek,
    you've changed your argument here slightly.

    Originally you stated that,


    "I'm saying anyone who is incapable of their own nailcare for whatever reason should be able to get it free of charge on the NHS."

    I asked

    "You would not class any nail care as social under the circumstances you describe above. You feel it should all fall under the NHS (i.e. Podiatry) remit."

    you replied

    "Yes, people need their nails cutting , if they are not cut it leads to eventual problems that will require more permanent medical care = further costs to the NHS"

    Now you obviously thought about this statement in later replies because this would mean that podiatrists would be cutting the nails of

    • every child up to age ... (I'm not sure when I stopped cutting my kids feet but lets say 12yrs)
      the entire blind and partially sited population
      all those with hand injuries or deformities
      all persons over a certain girth size
      etc etc ...
      you can see where I'm going with this and I haven't even got to the elderly yet.


      Now you've rescued yourself by saying,

      Actually quite a few elderly in my area used to turn up with "non-pathological" nails for routine nail cutting (a lot more than you would imagine - "because it's the NHS, and it's free, and I'm now 60yrs!!").
      I can't speak for other areas but we do still see OX/OG nails. We've also invested a lot of time in trying to ensure that carers are confident to deal with the routine nails and know how to contact us, (very similar idea to the FOOTSTEP project infact, and I think we could learn from that and build on it).

      Our profession couldn't possibly deal with all the ordinary nails and, I may be wrong but, I feel that is what most people who are replying no to the question are trying to argue.

      So carers can deal with ordinary nails, now we seem to have agreement!!

      Now what do we mean by ordinary nails, or this is open to clinician interpretation!!

      Michael
     
  28. DTT

    DTT Well-Known Member

    Hi Demerera


    :rolleyes: sorry she's a bit harsh on your first post I'm sure she didn't mean to be. Again welcome ;)

    Correct me if I'm wrong but don't Pod assistants do that already ??

    But why not by podiatrists ?? why do you apparently advocate the disposal of basic podiatry care to those that wish(IMHO) to conquor and rule the medical profession ?

    The resorse is there already in the guise of IPP's registered podiatrists of which many would happily take the burden of routine care away from the NHS to release the "specialist pods" to treat more high risk by reducing the workload of routine work.

    BUT

    The devil is in the funding that is what this thread is partly about.

    I think again with repect you really should re read this thread and i think many of your comments have already been answered ( BTW if Simon has a go at you ..He's a pussycat really ...:eek: ):D

    Cheers
    Derek;)
     
  29. DTT

    DTT Well-Known Member



    • Again Mike common sense and a caring attitude is all that is required for assessment and because the elderly are not all cuddly and nice but old and wrinkled dosent make that a criteria for making them second class citizens and withdrawing a basic human need for those that cannot self care is wrong !! . Sorry I cant av it any other way


      Cheers
      Derek;)


      And to all, I have been on the pc all the evening fending off attack from many quarters. As enjoyable as it is , Im off to bed now as i have a busy day tomorrow so any further replies will be made at some point over the weekend.
      Nite;)
     
    Last edited: Nov 20, 2009
  30. mgates01

    mgates01 Active Member

    Hi Derek,

    "so are you telling me you are now training carers to do basic podiatry ?? I can accept ordinary non pathological nails (cuttable) but anything more than that NO it should be done by a properly trained registered podiatrist IMHO"

    I know it was probably late but I can assure you, if you care to reread my reply, I said no such thing!
    I don't regard non-pathological nails as "basic podiatry". I think we are all in agreement it's social care!!
    Our "training" (encouragement is probably a better description - training sounds like you need to pass an exam to cut nails!!;)), is trying to give carers more confidence to deal with these social nails.

    Night all

    Michael
     
  31. dgroberts

    dgroberts Active Member


    I was just thinking out loud, stimulating debate.

    You're not wrong of course. Having current HPC registration would cover this point anyway.
     
  32. DTT

    DTT Well-Known Member

    Sorry for the delay in getting back to you Mike this one slipped my mind:eek:

    I wasnt saying you had said that I was asking you if thats what you thought . sorry it was late and I forgot the question mark. (its me age you know:D)
    Cheers
    Derek;)
     
  33. mgates01

    mgates01 Active Member

    Hi Derek,
    It's not your age and it was late but you actually did put in question marks - apologies that's me jumping to the defense when it's not called for.:eek:
    My advancing years must be making me cranky (at least that's what everyone says!!);)
    regards
    Michael
     
  34. DTT

    DTT Well-Known Member

    Hi Mike

    Thats something we have in common then :D

    Be Lucky
    Cheers
    Derek;)
     
  35. betty boop

    betty boop Welcome New Poster

    Hello,
    I am new to the Areana;
    I recently qualified this year and am in private practice, I have been shocked by the leval of foot problems I have seen as a direct result of poor toe nail cutting services available to those who need it. I know this puts a starin on NHS funds and our training is far more involved than simple nail cutting, but these people are often over looked and left with painful nails that have a direct effect on their mobility and quality of life.

    Don't we as podiatrists have a duty of care regardless what the foot complaint is?

    NHS funding is a problem at the moment and understandably toenail cutting services would be very costly to provide; maybe it would be helpful to have a referal pathway via NHS Podiatry into private podiatry for those who would benefit from general nail care ensuring that these patients are treated by HPC registered Podiatrists.

    Does one egsist?

    Sorry if I've gone on a bit

    regards

    Nessy
     
  36. DAVOhorn

    DAVOhorn Well-Known Member

    Dear Betty Boop,

    The NHS provides health care to people with an identified medical pathology allied to an implied risk.

    So nail care is provided when there is a medical reason to do so.

    A social reason is therefore not a reason to cut nails.

    How this should be funded in Private Practice is open to debate.

    As a cynic i would say the day that a woman considers her nail care worthy of a greater investment than her hair will be the day i consider this a decent argument.

    Many people who suffer self neglect have made a personal choice.

    I worked in Aus for 4 years where there was a mechanism for providing Podiatry in PP funded by the tax payer. Sadly it was quite seriously abused by the public and GP's.

    So after 25 years of practice i have not seen any mechanism which is able to provide social nail care funded by the taxpayer that works well.

    Most are abused, defrauded and not valued by the user.:deadhorse:

    Ho Hum

    David:drinks
     
  37. cornmerchant

    cornmerchant Well-Known Member

    Nessy

    I believe that pods have pushed for referral pathways to regulated practitoners in pp for a long time to no avail- at one stage patients were even referred to Age concern. Now Hampshire have taken it upon themselves to provide fee paying podiatry at reduced prices for those who are not eligable for NHS treatments! Mmmmmmm.. money goes into the trust I gather however specific pods are employed for this role, so the profit is probably minimal. It stinks a bit eh?

    CM
     
  38. Wendy

    Wendy Active Member

    Interesting to see that the nail cutting debate has not gone away. When I had my PP I found that the nail cutting service was very popular as I was able to keep an eye on any pts that had underlying health problems, the pt did not feel they had to have a full appt every 6 weeks (as I know can be a popular time frame bx appts).
    Good luck to all PPs out there offering this service, it can be invaluable to the older pt.
     
  39. Kyrret

    Kyrret Active Member

     
  40. Wendy

    Wendy Active Member

    I would agree with all you say however there are circumstances (ie the market place) where you sometimes have to do what is needed to earn a living. I did not do dom work though I admire those who do but doing the basics within a clinic environment with the knowledge and skills you aquire at uni can prevent pts who believe they only need basic care going on to have serious problems in the future...
    Also I will respectfully point out that a trichologist might be the professional not offering hair cuts ; )
     
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