Political Developments

[Mark Russell]

Dear Colleagues

For those of you interested in politics, podiatry will be on the agenda
tomorrow (Tuesday 2 November) at Westminster during Health Questions (Q8 if I recall).

A briefing will also be given in the Scottish Parliament on Wednesday 3
November at 5pm in Committee Rm 4. You are most welcome to attend.

Best wishes

Mark Russell

[davidh]

Hi Mark,
I for one would be interested in comments from our leading professional bodies
(SCP and SMAE) regarding these developments (the above + the Scottish Petition).
I have to admit to being a little baffled as to why the SCP spokesperson prefers to use the academic forum (jiscmail) to voice his opinions, rather than this forum :confused:
Cheers,
David

[Mark Russell]

The first cross-party briefing session with politicians was held in the contemporary splendour of Scotland’s new parliament building in Edinburgh on Wednesday 3 November. This event followed the debate on podiatry provision in May, where, for the first time in any British parliament, politicians examined the issues surrounding the delivery of services and care that we provide.

The session was reasonably well attended with around twenty members of the profession and half a dozen members of parliament – including the deputy convenor.

Mr Ralph Graham started the proceedings with an eloquent speech, which highlighted the perennial problem of capacity and demand within the National health Service. He then went on to explain the benefits of podiatric surgery and touched on the agreement between the Society and the Royal College of Surgeons (Edin) that resulted in the joint initiative MSc (Surgery), which started earlier this year.

Mr Stephen Moore from the Society then spoke at length regarding workforce planning – a subject he covered in October during his evidence to the Health Committee in Holyrood. He explained some of the initiatives that were running in Scotland’s health service, including new posts for podiatry educators and researchers. Stephen also reinforced the maxim that “NHS Scotland Podiatry Services exist to ensure that the people of Scotland can achieve their optimum mobility and independence of movement, with the minimum of pain and disability, enabling them to undertake active, healthy and productive lives.” The debate was then opened to the floor.

Mary Scanlon MSP welcomed the profession’s willingness to highlight the difficulties it faces in the delivery of its care and stressed the importance of communication between members and politicians. This was a central theme of her keynote speech a week earlier at the Society’s annual conference in Glasgow. Mary enquired what solutions the profession was considering in addressing the problems surrounding capacity.

Mr David Wylie (Podiatry Manager Glasgow) explained the current approach to skill mixing and offered a portrayal of the podiatry triage system that is being used in Glasgow at present. David also spoke at length about the Scottish Managers Forum and the work it has been doing in relation to service redesign.

Mr Stephen Moore supported this with an illustration of the use of the voluntary sector in supporting clinical practice for ‘low risk’ patients. He also stressed the importance of training new grades of professionals – assistant grade practitioners - to support specialist podiatrists in their daily work.

Dr Jean Turner MSP asked what measures could be taken to increase the workforce to cope with rising demand from all sectors.

Mr Stuart Baird (Head of School in Glasgow) explained the limitations of producing more graduates within the current educational boundaries, suggesting that with the right amount of support and resources, his school could increase its output by up to 15 graduates each year. A discussion followed on how this could be achieved.

Mr Mike Rumbles MSP also offered his support to the profession in its quest to secure a greater share of the health budget explaining he had a vested interest in podiatry’s future – his wife is a practising member in Grampian. Mike also touched on the problems with capacity and urged the profession to consider imaginative delivery options for future provision.

Mr Ralph Graham reinforced the tiered approach to care – from empowering carers and family members and harnessing the voluntary and social services to assist the NHS in patient care – through to the use of podiatric surgeons to assist in reducing orthopaedic waiting times.

Mr Stephen Moore then introduced one of his podiatry team in the western isles whose role it is to educate and train members of the public and voluntary sector in the provision of low-risk foot care.

Mr Graham Pirie made a valuable submission towards the close of proceedings regarding sterilisation of instruments. It was explained how much of an impact this would have on services at current funding levels.

Mr Brian Christie (Podiatry Manager Tayside) remarked that the cost of providing sterile instruments would be greater than his entire budget at present. Mr David Wylie supported this position adding that if disposable instruments were used instead, the resulting stockpile would fill one of Scotland’s lochs in a very short time! Mr Ralph Graham explained the thinking behind the initiative and suggested that there was no need for this approach in general podiatric practice as evidence showed that cross-contamination with prions did not occur with non-surgical chiropodial procedures.

Trish Gorman MSP (Deputy Convenor) interjected some controversy when she remarked that recently she had taken to having a pedicure and found it a wonderful experience. Some members of the profession were clearly in a state of apoplexy over the choice of her words but Mary Scanlon redressed the balance and restored order by explaining to the Deputy Convenor the folly of her ways.

The session concluded at 7pm with an undertaking from the members of parliament to hold further meetings with the profession during the coming year. An pledge was also given to secure access to the Health Minister to highlight the problems surrounding NHS practice.

The Society had produced a briefing paper for the event entitled “Developing a Podiatry Framework for NHS Scotland” and this was distributed to those present during refreshments at the close of proceedings.

My thanks to the Society for accepting the invitation to attend, especially their Scottish Liaison Officer, Karen Utting, for co-ordinating with Mary Scanlon’s office. My thanks also to the five podiatry managers, Mr Christie (Tayside), Mr Wylie (Glasgow), Mr McCrossan (Lanarkshire), Mr Moore (Western Isles) and Ms Donald (Lothian) and nine of their NHS staff who made the effort to travel to Parliament. Thanks also to Mr Stuart Baird and Mr Ralph Graham who, along with Mr Stephen Moore are members of the Society’s Council.

Mark Russell

6 November 2004

[Admin]

Mark - thanks for the valuable posts .... much appeciated.:)

[davidh]

Mark,
The NHS clearly have a problem with volume foot-health delivery.
Isn't it obvious that the simplest solution would be to devolve footcare into regulated private practice :confused: ?
After all, the private practitioners already exist....
The bricks and mortar already exist...
The chairs, units, instruments already exist....

The profession (made up largely, as far as I could see from your report, of SCP members with a vested interest in keeping NHS podiatry a separate entity) represented at this meeting would then not have to seek unusual/untried solutions, such as use of the voluntary sector for low risk patients :eek: .

Would you be willing to share your own thoughts/observations on this?
Cheers,
David

[davidh]

From looking at the SCP forum today it would seem that the SCP are taking the credit for organising this meeting, and further, that they actively talked about private practice as being an option to deal with too many pod patients/not enough NHS pods.
Mark, can you confirm or deny that these statements?
Regards,
David

[Mark Russell]

Hi Dave

If I may I'll come back on all these issues in the coming few days. The purpose of staging a brief was two-fold - it gave the professional hierarchy access to a non-partisan political audience and it revealed the Society's strategy for developing practice in the UK. The latter is something many of us have been enquiring about for some time, but to no avail. Now we know. My observations and recommendations will follow shortly.

Kind regards

Mark Russell

[davidh]

Thanks Mark,
I and many others are aware that you, whilst holding no brief for any third party, are au-fait with the current political scene in the UK as regards podiatry. Your viewpoint is of great value to the profession, since you have no vested interests, other than those of the profession and it's patients.

To my mind, the ramifications of devolving some NHS work into a structured private practice scenerio could be hugely beneficial to three parties; the profession as a whole, the private practitioner (his/her income anyway), and last, but by no means least, the patient :) .

Look forward to your clarification, comments and impressions in due course.
Regards,
David

[Admin]

House of Commons debates Tuesday, 2 November 2004 (http://www.theyworkforyou.com/debates/?id=2004-11-02.159.3&m=715) Oral Answers to Questions — Health - Chiropody (http://www.theyworkforyou.com/debates/?id=2004-11-02.159.3&m=715)

[Mark Russell]

The following were lodged in the Scotish Parliament:
S2W-12055 Mary Scanlon: To ask the Scottish Executive whether all patients with an assessed clinical need for podiatry will be provided with care and treatment free at the point of delivery.
S2W-12056 Mary Scanlon: To ask the Scottish Executive how it will ensure that all patients receiving podiatric care are treated by appropriately-trained and clinically-competent staff.
S2W-12057 Mary Scanlon: To ask the Scottish Executive whether national waiting time targets will be set and monitored for podiatric care based upon assessed clinical need.
S2W-12058 Mary Scanlon: To ask the Scottish Executive whether there are any plans for patients requiring podiatric care to be able to self-refer to open access clinics.
S2W-12059 Mary Scanlon: To ask the Scottish Executive whether it has any plans to introduce emergency clinics for patients with acute foot problems.S2W-12060 Mary Scanlon: To ask the Scottish Executive whether it has any plans to develop podiatry assistant or assistant practitioner-led clinics for (a) patients with specific foot health needs and (b) foot health education.
S2W-12061 Mary Scanlon: To ask the Scottish Executive how patients gain access to podiatry care for the management of (a) gait and mobility problems and (b) musculo-skeletal disease.
S2W-12062 Mary Scanlon: To ask the Scottish Executive how it will ensure that patients suffering from osteoarthritis and rheumatoid arthritis are given access to early podiatric intervention to address the risks of developing severe deformities of the feet, ulceration and infection, on a similar basis to people with diabetes.
S2W-12063 Mary Scanlon: To ask the Scottish Executive whether it has any plans to develop extended roles, skills enhancement and access to a wider range of assessment tools to allow podiatrists to make a significant impact on prevention of lower limb amputations.
S2W-12064 Mary Scanlon: To ask the Scottish Executive how it will ensure that elderly people receive good foot health and footwear advice in order to prevent foot and gait-related problems and in order to meet the NHS’s target of increasing the number of older people taking physical exercise.

[Mark Russell]

The following answers were received today regarding podiatry provision in Scotland.

Yours sincerely

Mark Russell

**********************************************

SCOTTISH PARLIAMENT
WRITTEN ANSWER
10 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive how many podiatry patients have been treated in (a) the community and (b) hospital in each of the last five years.
(S2W-11831)
Mr Andy Kerr:

The available information showing the number of new podiatry patients treated in Scotland is presented in the table:

NHSScotland New Podiatry Patients
Patients treated Hospital1 Patients treated Community2
1999 69,715 424,418
2000 61,151 424,808
2001 60,102 437,478
2002 58,928 431,232
2003 54,651 445,068p
2004 57,088p n/a

1 year ending March
2 year ending December
p provisional

Source: ISD Scotland Forms (ISD(S)1, ISD(S)8

*************************************************

SCOTTISH PARLIAMENT
WRITTEN ANSWER
10 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive what provision is made to ensure that children are screened to detect foot problems and help prevent conditions that develop as a result of defective and abnormal gait.
(S2W-11833)
Mr Andy Kerr:

There is currently no national screening programme for the detection of foot problems or abnormal gait in children. The most recent Royal College of Paediatrics and Child Health review of childhood screening and surveillance activity found little evidence to support a formal screening programme for defective or abnormal gait. However, a check of the hips is part of the general physical examination of all children within the first 24 hours of birth and at 6-8 weeks. Health professionals will also explore any cause for concern in the course of their regular contact with children and their families. Information about local practice is not held centrally.

************************************


SCOTTISH PARLIAMENT
WRITTEN ANSWER
10 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive how many podiatric surgeons are currently being trained in Scotland.
(S2W-11832)
Mr Andy Kerr:

Twenty students have registered for the first year of the recently introduced MSc in the theory of podiatric surgery being run jointly by Glasgow Caledonian University and Queen Margaret University College.


SCOTTISH EXECUTIVE

[Cameron]

Mark's posting reminds me of a little gem from Colin Dagnell's British Journal of Chiropody many years ago and it referred to Hassard on the 21st October, the year escapes me. In parliament (London) John Smith (sadly lamented parliamentarian who would in my humble opinion made an excellent Prime Minister) took to his feet during a debate on 'Closure of the Podiatry professio' and reminded the house that this was the anniversary of the Battle of Trafalgar (21st of October 1805), and why on Earth would the seat of government concern itself with such trivia.

What Smith perhaps was unaware of, was the Duke of Wellington despised all corn operators and said so, quite publically. He was of the belief all people with sore feet deserved them and would not have a general in his army who complained of sore feet. He sued at least one corn operator for having the audacity to involve his name as a form of quasi endorsement of the toe nail clippers services. Napoleon on the other hand (or was it foot) had as his best friend and confident his corn cutter. The foot man accommpanied the Boggieman throughout all his campaigns and was held captive with him on board ship in the port of in Elba. The Brits could not get Nappy's inner circle to spill the beans on the Napoleon's plans and offered immunity to anyone who was able to put a foot on British soil. The only one to jump ship when the guards turned a blind eye was the corn cutter. He was given his freedom in return and allowed to set up in business in London.

With the above in mind perhaps the conflict between Britain and France had more to do with the rights to foot care, than Smith and other detractors might have realised. It is interesting to note that everytime closure of the profession has been on statute it has corresponded to a time of major national disaster, like WWI and II and the Falklands. What is it about feet that brings the worst out in bipeds?

Comments please. :-)


Have a good one

[Mark Russell]

SCOTTISH PARLIAMENT
WRITTEN ANSWER
12 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive what procedures are in place to assure patients that all podiatrists are trained, qualified and fit to practice.
(S2W-11501)
Mr Andy Kerr:

Since July 2003, podiatry is a protected title. This means that all podiatrists must have undergone the minimum of a 3 year undergraduate degree programme or an honours degree. Successful completion of the education programmes leads to registration by the Health Professions Council (HPC). The HPC is an independent, UK wide regulatory body responsible for setting and maintaining standards of professional training, performance and conduct of the professions it regulates. Registration is also a condition of employment. It is an offence to practice as a podiatrist while unregistered and anyone who does is subject to prosecution. The education programmes are quality assured by the Quality Assurance Agency to make sure that graduates are fit to practice.

Non registered professionals who have used the now protected title prior to July 2003 must undergo a “grandparenting” process. This means that they must have been engaged in the lawful, safe and effective practice in the profession they wish to be registered in for a period of three out of the last five years. If they fall short of this they must demonstrate that they have undergone additional training and experience that satisfies the HPC that they have the requisite standard of proficiency for admission to the register.


SCOTTISH EXECUTIVE


Comments?

[Mark Russell]

Written answers to the questions lodged earlier this month. Any comments?

Mark Russell

************************************************
SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether all patients with an assessed clinical need for podiatry will be provided with care and treatment free at the point of delivery.
(S2W-12055)
Mr Andy Kerr:

The planning and provision of NHS podiatry services is a matter for NHS boards. As part of NHS service provision there is no charge to patients for NHS podiatry services.



SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive how it will ensure that all patients receiving podiatric care are treated by appropriately-trained and clinically-competent staff.
(S2W-12056)
Mr Andy Kerr:

NHS Boards and Operating Divisions are responsibility for both clinical and staff governance. They must therefore ensure that all Allied Health Professionals, including Podiatrists, are registered to practice with the Health Professions Council and that they are appropriately trained.




SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether national waiting time targets will be set and monitored for podiatric care based upon assessed clinical need.
(S2W-12057)
Mr Andy Kerr

There are no plans to include podiatric care in the national waiting time targets.



SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether there are any plans for patients requiring podiatric care to be able to self-refer to open access clinics.
(S2W-12058)
Mr Andy Kerr:

The planning and provision of NHS podiatry services is a matter for NHS boards. The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.



SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether it has any plans to introduce emergency clinics for patients with acute foot problems.
(S2W-12059)
Mr Andy Kerr:

There are no plans to introduce emergency clinics for patients with acute foot problems. The planning and provision of NHS podiatry services is a matter for NHS boards. The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.




SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether it has any plans to develop podiatry assistant or assistant practitioner-led clinics for (a) patients with specific foot health needs and (b) foot health education.
(S2W-12060)
Mr Andy Kerr:

The planning and provision of NHS podiatry services is a matter for NHS boards. The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.

The Allied Health Professions Officer in the Scottish Executive has commissioned a national consultation on Allied Health Professions role development, which includes podiatrists, and this is currently underway.




SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive how patients gain access to podiatry care for the management of (a) gait and mobility problems and (b) musculo-skeletal disease.
(S2W-12061)
Mr Andy Kerr:

The planning and provision of NHS podiatry services is a matter for NHS boards. The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.




SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive how it will ensure that patients suffering from osteoarthritis and rheumatoid arthritis are given access to early podiatric intervention to address the risks of developing severe deformities of the feet, ulceration and infection, on a similar basis to people with diabetes.
(S2W-12062)
Mr Andy Kerr:

The planning and provision of NHS podiatry services is a matter for NHS boards. The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.




SCOTTISH PARLIAMENT
WRITTEN ANSWER
19 November 2004
Index Heading: Health Department
Mary Scanlon (Highlands and Islands) (Con): To ask the Scottish Executive whether it has any plans to develop extended roles, skills enhancement and access to a wider range of assessment tools to allow podiatrists to make a significant impact on prevention of lower-limb amputations.
(S2W-12063)
Mr Andy Kerr:

The planning and provision of NHS podiatry services are matters for NHS Boards. The Allied Health Professions Officer in the Scottish Executive has commissioned a national consultation on Allied Health Professions role development, which includes podiatrists, and this is currently underway. The consultation will inform the development of a generic Framework for role development.


************************************************** **

[Robin Crawley]

Well they certainly like this sentence: "The planning and provision of NHS podiatry services is a matter for NHS boards."

It seems that they don't really want to address these issues...

I'm wondering then who exactly are the NHS boards, and how could they be influenced by us?

Cheers,

Robin.

[davidh]

I'm wondering then who exactly are the NHS boards, and how could they be influenced by us?



Good question Robin.
Mark has the answer on who the NHS Boards are/ are answerable to.

How can they be influenced? (Why are more UK pods not asking this :eek: ).

Follow this thread :) !
Regards,
David

[DTT]

Hi Robin

Quote

"It seems that they don't really want to address these issues..."

I think the Scottish Executive have ( see post 13 in this thread)

Nice to see common sense prevailing in Scotland as well .

To unify rather than divide .

Hopefully the HPC will prevail in Scotland under that name or any other but bound by the same rules and regulation.

Best wishes

Derek

[Mark Russell]

Aye right Derek. Keep taking the medication. It's the best policy!

[Stephen Moore]

There are fifteen Health Boards in Scotland, in simple terms Health Boards are charged with commissioning health care for a designated population. Their structure, the non-executive directors of the Board and their funding (based around a complex formula – the Arbuthnott Formula) is controlled centrally by the Scottish Executive Health Department (a civil service arm of the Government).

The Health Boards are as follows (lets hope I do not get it wrong as I will never live it down!) :o

Dumfries and Galloway Health Board
Borders Health Board
Lanarkshire Health Board
Ayrshire and Arran Health Board
Argyll and Clyde Health Board
Greater Glasgow Health Board
Lothian Health Board
Forth Valley Health Board
Fife Health Board
Tayside Health Board
Grampian Health Board
Highland Health Board
Western Isles Health Board (where I am Head of Podiatry)
Orkney Health Board
Shetland Health Board

Go to Scottish Health on the Web website for more information, link below

Scottish Health on the Web (http://www.show.scot.nhs.uk/organisations/orgindex.htm)


The response from the Minister is typical of any politician (its not me its them!)

]“The planning and provision of NHS podiatry services is a matter for NHS boards.”[/[/I]B]

Sure planning of local services to meet the needs of the population is a responsibility of Health Boards, but how do you ensure that there is a NATIONAL Health Services. Podiatry by postcode is a very real problem in England and there are unfortunately signs of this migrating north of the border.

Government must (with advice!!) set out what it wishes to see delivered nationally, it is then up to individual Health Boards to determine how this will be achieved, what resources will be made available etc..

[B]“The issue of access to NHS podiatry services is a matter for clinical decision in the light of the health needs of individual patients.” – not to do with the availability of funding, staff etc. how re-assuring. :rolleyes:

It is important to understand however, that Scotland has a devolved government and more importantly Health care is devolved to the Scottish Parliament. Therefore Scotland is not forced, required or otherwise to follow the approach taken in England. I am pleased that in many respects it does not and is perhaps starting to stand on its own two feet! (Lets not get into the independence debate please!) – Hopefully it will therefore understand the importance of access to podiatry care :D

Influencing Health Boards - best approach initially is through SEHD and local/national politicians.

Getting good evidence of the impact podiatry can have on a population, demonstrating how podiatry can deliver within the very challenging modern health care agenda.

I would recommend colleagues obtain a copy of a document produced by the Chartered Society of Physiotherapists (UK) which sets out the benefits of NHS Physiotherapy and a very effective way. Title has gone completely out of my head will post details later. podiatry needs a very similar documents.

Regards

Stephen

[Stephen Moore]

Derek

Mark Russell has posed a very interesting question to the Scottish Parliament within his e-petition (see his earlier posts)


Forget the registered/previously not registered debate, but it potentially presents a challenge to statute etc. (I do not pretend to understand for one minute the leglisative framework in which our parliament(s) operate, but as I understand it Scotland agreed to a UK wide regulator (for obvious commonsense reasons), however, the Scottish Parliament is responsible for the delivery of safe and effective healthcare. What if for what ever reason it was unhappy with the operation of the HPC, could it pull out of the agreement, force changes to UK legislation or set up its own (one presumes better) regulator?

Regards

Stephen

[Stephen Moore]

I would recommend colleagues obtain a copy of a document produced by the Chartered Society of Physiotherapists (UK) which sets out the benefits of NHS Physiotherapy and a very effective way. Title has gone completely out of my head will post details later. podiatry needs a very similar documents.

Regards

Stephen

Its now come to me, the document is called "Making Physiotherapy Count - a range of quality assured services"

Link to document on CSP website (http://www.csp.org.uk/effectivepractice/sepp/publication.cfm)

Regards

stephen

[davidh]

What if for what ever reason it was unhappy with the operation of the HPC, could it pull out of the agreement, force changes to UK legislation or set up its own (one presumes better) regulator?



Stephen,
Succinctly put.
This would then lead the way for a self-regulating profession. Unification of the whole profession is certainly one of my long-term ambitions, and this would seem to be the best way to go about it.

Few would argue against the premise that a unified profession is a strong profession, but some should bear in mind that unification does not only mean unification of grandparented + degree-trained. Unification means uniting all the factions, which include private practitioners, NHS-staff, graduates, SMAE-trained, surgeons - to name but a few :eek: .

I'm a little disappointed that the SCP have not been seen to be doing more in this corner - but appreciate your personal postings which, as always, are balanced and informative.
Regards,
David

[DTT]

Hi Stephen

You say


"it Scotland agreed to a UK wide regulator (for obvious commonsense reasons),"

That is the HPC .

Like it or not you have it .

Best wishes

Derek

[davidh]

Hi Derek,
The HPC are the only regulatory body we have, but that does not mean they represent the best for us, or our profession :eek: .

I started off believing that the HPC would benefit all. I have serious doubts about that now. I think the current political scene in Scotland is interesting, and could pave the way forward for a self-regulatory podiatry body.
Not one which is going to castigate the grandparented in favour of the previously SRCh'd, but one which will work for the good of the whole profession.

Stephen's view is very valid and welcome, given that he is an SCP Council member AND an NHS Head of Podiatry Sevices.

In case you don't see the relevance, this is the first moderated forum on which SCP members, SCP Council members, former SRCh, SMAE graduates etc etc can enter into meaningful dialogue on this type of matter.
Cheers,
David

[DTT]

David H

My point to Stephen is , the HPC comes into force in a few months time as part of a NATIONAL scheme .

Now like it or not , that is going to happen certainly in England and Wales and at the moment I believe Scotland as well.

As I have said before I also agree with a podiatry council its the methods being used by some to get it I object to .

But I'm not going down that road again :p :)

Let's hope that the differing views expressed on this site will go some way towards solving problems and those of Stephens eminence will carry them forward to make a united profession .

Best wishes
Derek

[Mark Russell]

Mark Russell has posed a very interesting question to the Scottish Parliament within his e-petition (see his earlier posts)




I was always regarded as a bit of a troublemaker Stephen. It was partly due to the deviant company I kept during student days in Edinburgh. You remember the curious incident with the shark's head Syd? I still have trouble sleeping today when I think back on it! Good job Fanny never found out, huh?

[davidh]

You remember the curious incident with the shark's head Syd? I still have trouble sleeping today when I think back on it! Good job Fanny never found out, huh?

I heard about that..........................................

[Mark Russell]

For another time Dave. Perhaps with some festive spirit??

[Mark Russell]

Just a short update on the petition that was submitted to the Public Petitions Committee of the Scottish Parliament last month.

I have received notification that the petition was formally lodged with Parliament on 14 December and will be considered by the Committee at its meeting on Wednesday 19 January 2005 where a statement will be made in support of the position adopted by the petition, followed by a Q & A session.

Can I just express my thanks to all those who signed the petition and sent messages of encouragement. It was much appreciated. I shall, of course, keep you informed of further progress.


Mark Russell

[Mark Russell]

Colleagues

Yesterday, the Public Petitions Committee of the Scottish Parliament took evidence in relation to the petition submitted on 27 October 2004 regarding regulation of health professionals in Scotland. This has direct implications for podiatrists throughout the UK as it directly refers to the grand-parenting process implemented by the Health Professions Council (HPC) in 2002. At the end of the session, the committee took the decision to refer the matter to the Health Minister and to write formally to the HPC in relation to the issues raised.

Colleagues who wish to view the session can view the broadcast by clicking the link below.

The submission is third on the agenda.

Can I also thank all those who supported this petition by adding their name to the Parliament website during November, and also a big thanks to Jacqui Baggeley who gave supporting evidence on the day. Jacqui - you’re a star and the very best wishes for your big day this weekend!

Mark Russell


Petition: http://epetitions.scottish.parliament.uk/backgroundinfo.asp?TopicID=36

Broadcast: http://www.holyrood.tv/library.asp?iPid=3&section=43&title=Public+Petitions

[Mark Russell]

Transcript of debate at Westminster on 18/1/5 regarding podiatry provision in NHS.
**************************************************

Dame Marion Roe (Broxbourne) (Con): What assessment he has made of the availability of chiropody services for senior citizens. [208902]

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): There are 3,807 chiropodists employed in the NHS, which is a 15.9 per cent. increase since 1997. It is for local primary care trusts to determine local priorities for access to chiropody.

Dame Marion Roe: I am grateful to the Minister for that reply, but will he tell the House his estimate of the number of patients with foot problems who have been deemed to be low risk and thus discharged from NHS care and forced to look in the voluntary and private sectors to find the specialist chiropody services that they need? What plans does he have to draw up guidelines on the management and treatment of foot problems to lay down a patient's minimum entitlement to NHS care and remove the current postcode lottery of entitlement to foot care?

Dr. Ladyman: Once upon a time there was such guidance on who should have access to chiropody services, but it was scrapped in 1994 under the previous Government. We have simply moved to a situation in which local primary care trusts are responsible for ensuring that everyone in their areas has access to the foot care that they need. Most PCTs are concentrating specialist problems on specialist chiropodists and thus leaving other organisations, such as those in the voluntary sector, to deal with less specialist needs, but each PCT has the responsibility to ensure that everyone in its area has access to the appropriate foot care that they need.

Miss Anne Begg (Aberdeen, South) (Lab): A number of senior citizens go to private chiropodists for their care. Has my hon. Friend made an assessment of how many of those chiropodists will fail to register with the new Health Professions Council? One chiropodist in my constituency said that the process is very bureaucratic and expensive. My constituent would like to see automatic registration for anyone who has three years' experience. He thinks that the level of presently practising chiropodists will fall because they will no longer be able to practise under that title. That may cause a crisis and, obviously, difficulties for those who are receiving treatment under the NHS as well.

Dr. Ladyman: I do understand the issue that my hon. Friend is raising. These are matters, first, for the Health Professions Council. More importantly, they are negotiated closely with the professional bodies representing chiropodists and podiatrists. We try to meet their needs in terms of registration. Although individual chiropodists may have views about the democratic nature of the requirements for registration, I can assure my hon. Friend that the professional bodies that represent those individual podiatrists are having their views closely adhered to by those who have to implement these arrangements.

Miss Julie Kirkbride (Bromsgrove) (Con): Can the Minister explain why over the years since Labour came to power fewer people have had access to NHS chiropody services?

Dr. Ladyman: I can certainly do that. The figures are roughly similar to the number of new starts in each year since we came to power. The total number of procedures carried out each year is roughly the same. There is a slight decrease, and that entirely reflects the fact that more and more of the specialist podiatrists are concentrating on specialist processes that take longer than the old, simple foot care procedures that are now being undertaken by people who are not specialists. That is good value for money. The assertions of Opposition Members that there is a massive removal of people from NHS podiatry services is simply not true. Like the Opposition's announcements yesterday from the shadow Chancellor of the Exchequer, their figures just do not add up.

Rob Marris (Wolverhampton, South-West) (Lab): Can my hon. Friend assure me that we have enough training places for chiropodists and podiatrists?

Dr. Ladyman: I can give my hon. Friend that assurance. Since 1997, there has been a 33 per cent. increase in the number of people training for this speciality.

[Mark Russell]

Health Professionals (Regulation) (PE802)

The Convener: Petition PE802, from Mark Russell, calls on the Scottish Parliament to express its deep concern that, despite the fact that health is a devolved matter, regulation of health professionals is reserved to the Westminster Parliament. Mark Russell is here to make a brief statement in support of his petition and is joined by Jacqui Baggaley.

Mark Russell: Good morning. I start by saying something that most of you already know: life is all about choices. One of the first important choices that we make is what our job will be when we leave school. Some 25 years ago, my choice of career was podiatry—or chiropody as it was called then. I trained about a mile and a half away from this building, at the other end of Holyrood Park, at the Edinburgh Foot Clinic and School of chiropody in Newington. After three years of full-time study I graduated with a diploma in podiatric medicine, which allowed me entry on to the state register. That meant that I was allowed to wreak havoc in the National Health Service, in a manner of speaking.

State registration was the benchmark for employment in the NHS, with good reason. Back in 1979, I could have chosen to take a correspondence course in chiropody and I could have graduated as a qualified chiropodist after just three weeks. I could have chosen not to have taken any course at all. There was nothing to prevent me from sending away for a set of instruments from one of the many medical suppliers, hanging a sign at my bedroom window, starting to wreak absolute havoc on the public at large and charging them into the bargain. Until 2002, there was no effective regulation to prevent bogus practitioners from calling themselves chiropodists or podiatrists and setting themselves up in private practice. The NHS demanded a benchmark for employment, but there was none in the private sector.

In 2002, the Westminster Parliament created the Health Professions Council, a new registrar that regulates 13 health professions from speech and language therapists to physiotherapists and podiatrists. One of the tasks that the Government set the body was to offer the public greater protection by regulating the professions that fell outwith the remit of the old regulator. Legislation was passed to protect the titles "chiropodist" and "podiatrist", so that only those who held recognised qualifications from approved institutions could be registered under those names. However, an important consideration had to be taken into account. What about those people who were currently lawfully engaged in employment as podiatrists who had not undertaken the recognised course of training? It was proposed that those people would undergo a process called "grandparenting", whereby they would undertake some form of examination or test of proficiency to ensure that they met basic, safe and effective clinical standards.

However, the Health Professions Council has interpreted the legislation very loosely. There is no test of competency and there is certainly no examination to ensure that those practitioners meet basic, safe clinical standards. When applicants with no training apply to join the HPC register, they must be accepted. All that they have to do is to supply a character reference, a health reference, a statement that they have derived some of their income through the practice of podiatry in three of the past five years and a certificate of indemnity insurance, which any member of the public could buy through most insurance brokers. Those applicants do not need to meet the standards of proficiency that apply to graduate practitioners. All that is required is for them to avoid any statement that might indicate that their practice is unlawful, unsafe or ineffective.

To date, more than 1,000 applicants have been approved for registration under the grandparenting scheme. That means that those people can practise in the NHS on equal standing with a university honours graduate who studied for four years. We are comparing no training and no test of competence with four years of training and four sets of end-of-year examinations. If members were a high-risk diabetic with a complex foot problem, which practitioner would they feel comfortable sitting in front of in a surgery chair? Before 2002, people could have been assured that the practitioner would have come from the latter category, in the NHS at least. Now, they cannot tell.

During the debate on podiatry in the Scottish Parliament last year, Mike Rumbles made an important point. He said:

"For many years, the professional image of chiropodists and podiatrists has been dogged by the fact that there has been a problem in respect of closure of the profession—anyone has been able to set themselves up as a chiropodist with the minimum of training. They cannot practise within our national health service, but the general public do not know that. Graduate entry has been required for state registration for some time, but that has not helped to clarify in the public's mind exactly who is a qualified chiropodist and who is not."

He went on:

"If one looks in the 'Yellow Pages'—the first port of call for many people—to find a qualified chiropodist or podiatrist, one sees that some adverts helpfully have a display advert that states:

'The British Chiropody and Podiatry Association.
The Practitioners listed below are all fully qualified and can be consulted without referral by a doctor. Always ensure your chiropodist is qualified.'

A helpful warning to unsuspecting members of the public—that they should 'Always ensure your chiropodist is qualified'— does not tell them that those chiropodists are not state registered and are not qualified to work in the NHS. That is deliberately misleading and almost dishonest."—[Official Report, 28 April, 2004; c 7856.]

Sadly, I would advise Mike Rumbles today that the problem has been compounded. Unfortunately, we cannot now differentiate which of those practitioners has undertaken a graduate route to practise. The laxity of the grandparenting process has undermined the whole ethos of safe and effective practice. We do not know which practitioners admitted to the register since 2002 are competent in their work other than through the fact that they have not yet been sued. Is that the basis on which we allow people to practise health care today?

No one likes regulations and it might seem strange to members that two podiatrists should be sitting in front of them arguing for tighter regulations for the profession, but we do so because there is a clear and present danger to the health and welfare of many people if the defective legislation is allowed to persist.
It was envisaged that, when the grandparenting period ended in July 2005, the podiatry profession would be finally closed and protected, but it will not be.

Already the correspondence courses are advertising again—this time, for qualifications not to become chiropodists and podiatrists, but to become foot health practitioners—and they have already submitted proposals to the regulator for a second round of grandparenting in a few years' time. What is happening amounts to a reduction in the skills base in the registered workforce and a promise of more to come. That cannot be right for the profession or for the public whom it serves.

The Holyrood Parliament has a unique opportunity to redress the situation for the people of Scotland. As members are aware, health is a devolved matter to Scotland, yet the regulation of the people who deliver that health care in Scotland's NHS has been reserved to Westminster. It seems a glaring anomaly that the responsibility for delivering good, safe and effective health care lies with this legislature when the Scottish Parliament has no authority to determine the qualifications or the competence of the people who undertake to provide that care on our behalf.

However, I am encouraged by the words of the First Minister, Jack McConnell. On the "Today" programme on 6 January this year, he said:

"It would be unhealthy if we created a devolved Parliament in Scotland and then that devolved Parliament did exactly the same things as the Parliament in Westminster. I represent the people of Scotland and I act on their behalf."

Finally, I return to the issue of choice. The Scotland Act 1998 was passed because the Scottish people made a choice to have a greater say in the affairs of their country. That is the purpose of this building and of the people who are elected to work here on behalf of, and in the best interests of, Scotland's population.

Ensuring safe and effective standards in the delivery of health—by maintaining robust regulations in a fair and equitable manner—is a matter over which I suggest this Parliament has competency. However, the Parliament will have to make a choice—whether or not to challenge Westminster over reserved matters.

Again, I am reassured by the words of the First Minister—

The Convener: Mr Russell, you have run well over your three minutes. I have given you a bit of leeway, so will you please conclude?

Mark Russell: I am almost finished; this is my concluding paragraph.

Earlier this month, the First Minister said:

"There would be little point in having devolution if we simply copied what was happening elsewhere in the country."

Indeed—and that would be especially true if simply copying allowed the dilution of the qualification standards that are required by health professionals in Scotland. No one can gainsay that the issue is crucial to the protection of the health and welfare of the people of Scotland. I contend that the First Minister and the Scottish Parliament have a duty to the people of Scotland to uphold and safeguard those standards by addressing without delay the legislative and constitutional inequities that this petition outlines.

John Scott: Good morning, Mr Russell. Have you any evidence that standards in Scotland are falling?

Mark Russell: Clinical standards?

John Scott: Yes.

Mark Russell: You can assume that clinical standards will fall because no mechanisms exist to inspect the premises or competency of people who have been allowed on to the register. To get on to the register, there is self-declaration; in other words, there are no hurdles to overcome and no examinations to be taken.

John Scott: Are your concerns shared by regulatory bodies such as the General Medical Council?

Mark Russell: I would not think so. Podiatry is quite a small profession, so the issue is very much within the profession.

John Scott: There are seven United Kingdom statutory regulatory bodies and it would be surprising if there was a huge problem and only you had concerns about it.

Mark Russell: I have spoken to many colleagues in the medical arena and they are very concerned about lax regulation.

Campbell Martin (West of Scotland) (Ind): I am probably heavily outnumbered on the committee this morning in my belief that this Parliament should be a normal national Parliament with all the powers of a normal national Parliament.

The petition has two parts to it. One has to do with the lack of powers of this Parliament and the other has to do with the effective regulation of some health professionals. Again, I am probably outnumbered in thinking that there is a simple solution to the first part—this Parliament becoming an independent Parliament in an independent nation, with all the powers that it needs.

As for effective regulation, do you have any idea why there is no examination of competence before people are allowed on to the register?

Mark Russell: I think that it is to do with administrative efficiency more than anything else. During the consultation period when the HPC was being set up, it was envisaged that there would be some test of proficiency. This is the second time that this has happened to our profession. Back in the 1960s, there was a grandparenting period as well and people with minimal training were allowed on to the register. That was when we had the old Council for Professions Supplementary to Medicine. Back then, the council set a test of competency, but this time there is no test.

Campbell Martin: Has any representation been made to the HPC about its responsibility to ensure that the people on the register are competent and have qualifications?

Mark Russell: Many representations have been made to the HPC, but we do not seem to be getting very far.

Campbell Martin: What has been the response?

Mark Russell: The response has been that the council interprets the legislation in that particular way.

Jackie Baillie: I do not want to stray too far into constitutional issues. I get the sense—and you can correct me if I am wrong—that the nub of your petition is to do with ensuring that we have the best standards and competency. Does it really matter who regulates that? What do you feel will deliver the improvements that you seek? Irrespective of whether a person lives in Scotland, England, Wales or anywhere else, I would want that person to be treated to the same standard.

Mark Russell: I would like a test of competency for all grandparented practitioners. There are a couple of issues where the legislation is defective and an issue of competency. There is also the issue of closure of the profession. The legislation has not been effective at closing the profession—we are to have another round of grandparenting in a few years' time and correspondence courses are still running. We can see from the papers that I bought today that one or two colleges undertake to graduate foot health practitioners within three to four months, on the payment of £1,000.

Jacqui Baggaley: Some of them charge £300.

Mark Russell: Yes. Therefore, the legislation will not close the profession or protect the public in the longer term. In three or four years, we will have the same problem and another dilution of standards. We must have effective standards. People have gone to college or university for three to four years to do an honours degree, or in my case a diploma. Anyone who practises in the health care arena should undergo a test of competency. If Jackie Baillie or her relatives sought our assistance, she would want to know that we were properly qualified and competent.

In the various public inquiries in recent years, such as the Shipman, Bristol royal infirmary and Alder Hey inquiries, the emphasis has always been on greater protection of the public interest and public safety, but that is not the case with the legislation that we are discussing, which is a glaring anomaly.

Jacqui Baggaley: We want members to be aware that there are two ways in which to graduate as a podiatrist. One is to take a four-year honours degree at a recognised university, of which there are two in Scotland that offer those courses; the other is to take a correspondence course. One thousand hours of practical experience is required for a graduate podiatrist in a university, whereas to become what used to be an unregistrable podiatrist, the total requirement, including the correspondence side of learning, is merely 100 hours. However, there is now no difference between the two: the HPC takes in anyone.

Helen Eadie (Dunfermline East) (Lab): I share Jackie Baillie's view that we all want to be 100 per cent certain that any practitioner to whom we go will give us good-quality treatment, no matter who we are. I have two questions. First, when petitioners come to the Parliament, they generally mention representations that they have made elsewhere. If you have made other representations, will you tell us about them? If you have not made them, that does not matter. Secondly, in your time as practitioners, what sort of regulatory inspections have you had?

Mark Russell: I have a correspondence file that is about 5in thick with representations to the highest offices in the land: the Prime Minister, the Secretary of State for Health, Nigel Crisp, who is the chief executive of the NHS, and the HPC. We have also made representations through our professional body, the Society of Chiropodists and Podiatrists. However, we seem to be running up against a brick wall when it comes to the regulator.
At present, there are no effective inspections for our profession, although the regulator now requires a minimum number of hours of continuing professional development, such as attending courses or lectures. Until 2002, there was no effective regulation. A person had to be reported, perhaps for professional misconduct, before the regulator intervened. There is no proactive regulation in health care at present; it tends to be reactive.

The Convener: The committee is joined by Mike Rumbles, who, as Mr Russell said, has an interest in the issue. Do you have anything to add, Mike?

Mike Rumbles (West Aberdeenshire and Kincardine) (LD): Yes, but before I say anything, I will declare an interest, because I believe in openness and transparency—people need to know where we are coming from. My wife is a graduate member of the Society of Chiropodists and Podiatrists. She is an honours graduate and has a practice in Banchory. I have had the information that members have received today for many years.
I ask members, when they go home or back to their office, to pick up a copy of the "Yellow Pages" and flick through the section on chiropodists. I defy them to tell me which is the registered chiropodist—the proper chiropodist.

Advertisements in the "Yellow Pages" state that the people are qualified chiropodists and, as has been referred to, there might even be a warning at the bottom saying, "Make sure you get the right one." The situation would be funny if it were not so sad and so serious.

The issue is not really about constitutional matters—committees work best when we do not get involved in that sort of thing. This is a public safety issue. When a member of the general public contacts a podiatrist or a chiropodist, they expect a certain standard of service and a standard of professionalism. If someone contacts a doctor, a member of any medical profession or a member of a profession allied to medicine, they expect the same level of service, but that cannot exist under the current system. The HPC thought that the approach that it has taken would be a solution but, as the committee has heard, the system is not working. It will certainly not ensure the closure of the profession.

Reference has been made to the matter being a constitutional issue, but as we have effective control of all aspects of the NHS bar the regulation of the professionals, a major constitutional change is not required. Consider what is happening in the railway industry. The biggest devolution of powers since the establishment of the Parliament is taking place in relation to the railway industry in Scotland. I believe that the situation that the petition raises is similar. We could move in the same direction on the health service as we have on railways.

The Society of Chiropodists and Podiatrists has done a great deal in trying to get changes made at Westminster, but its efforts have not been well received. We have a duty in Scotland, given the Scottish Parliament's responsibility for the health service, to push for a change in the sector. The matter is in the committee's remit. I would like the committee to refer the petition to the Health Committee so that we can get some backing for change. If we in the Scottish Parliament feel that that is important, we can pass that on to the UK Parliament and try to secure co-operation in order to achieve change.

Jackie Baillie: I am not opposed to taking that route ultimately, but the practice of the committee has been to correspond directly with the Executive and to pursue its own investigations first. I would be keen to do that. I am also clear—although I seek the convener's guidance on this point—that the petition is specifically about constitutional matters. However, what I have heard today convinces me to support an investigation to ensure that there are appropriate standards. That has nothing to do with constitutional issues.

My recommendation is that we write to the Executive to inquire whether there are concerns about a difference in standards and what it, as the provider of the NHS in Scotland, feels should be done about that. That is as far as I would go at this stage.

I do not want to correct another member, but I point out that not all responsibility for the railways is devolved. Some issues of safety and competency remain with Westminster, so there is not a direct parallel, although I do not close my mind to the proposal. I certainly subscribe to the initial concern, which is about standards rather than about constitutional issues.

Mike Rumbles: I agree that we do not want any confusion on the matter. I do not disagree with what Jackie Baillie has said. All that I was trying to say is that the current settlement is not set in stone; the UK Government and the Scottish Executive work together to change and tweak the arrangements. That approach could work on this issue.

The Convener: We must bear in mind the fact that the petition calls for the regulation of health services; I do not think that it specifies podiatry. The issue is about responsibility for regulation being transferred from Westminster to the Scottish Parliament.

Mike Watson: I agree that we should write to the Executive. I would also like us to write to the HPC to ask why it does not see the issue that Mr Russell and Ms Baggaley have outlined as being a problem. It seems to me that, if we stopped the average man or woman in the street, they would say, "That can't be right." I would like to know what justification there is for the fact that those individuals who are not formally qualified do not have to submit themselves to some kind of test of competency or examination.

Helen Eadie: I agree with what my colleagues have said. However, I would like to clarify one matter. I know that the committee does not impose a restriction on where petitions come from, but I note that your address is in Lytham St Annes, Mr Russell. Are you still based there?

Mark Russell: Yes. I am from Kirkcaldy and also have a Kirkcaldy address. The petition was originally lodged when I was in Kirkcaldy. I am working down south for a few months.

Campbell Martin: To go back to what Mike Rumbles said, I do not expect to argue for independence on the basis of this petition, quite honestly. We should ask the Executive whether it would be prepared, if it considers that there has been a lack of UK regulation, to seek the devolution of powers for the regulation of health professionals to safeguard the public interest in Scotland. Would that be possible?

The Convener: There is no harm in asking that question; it will be interesting to know the Executive's answer. Is the Executive pursuing the devolution of regulation? As Mike Rumbles said, the Executive has pursued the transfer of powers before and there is no harm in asking whether that is something that it intends to do or is considering in this case. That is a legitimate question to ask.

Campbell Martin: Thank you.

John Scott: The Scottish Executive recently consulted on the proposal. Presumably it would not have done that unless it was considering updating the legislation.

The Convener: We can ask for that to be clarified.

Mark Russell: There is a difficulty with that. If the HPC does not satisfy the concerns that have been raised here, what will you do? Is the Parliament impotent in dealing with such issues?

Jackie Baillie: I suggest that the matter comes back before the committee. My recollection of the record of the Public Petitions Committee is that it is not impotent, given some of the disposals that have happened because of petitions. I think that we should wait and see.

Mark Russell: The proof of the pudding is in the eating.

The Convener: Thank you for presenting your petition to us this morning. We will let you know about the responses that we receive.

*************************************************

[Graeme Franklin]

Mark Russell:
"Back in 1979, I could have chosen to take a correspondence course in chiropody and I could have graduated as a qualified chiropodist after just three weeks."



Erm, could you supply evidence of anyone who has actually done this?
In my experience most people take at least 18 months to finish the theory.


Graeme.

[Mark Russell]

CHIROPODY & PODIATRY course no 63
Distance education diploma course of 12 lessons with 10 days of practical training. As well as general Chiropody work, you will learn techniques such as wax baths to help with painful muscular and skeletal problems, and farradic stimulation to help with flat foot and associated problems. These treatments are all included in the training you will receive and you will not be expected to pay hundreds of pounds extra for what should be general chiropody knowledge.
Award. Diploma in Chiropody/Podiatry and the letters SAC. S.Ch./POD., and after the practical training the letters WMSCh.
Professional Membership. On qualification you are immediately eligible to apply for Full Membership of the Association of Chiropodists & Podiatrists (ACP).

Twelve lessons and ten days practical training, Graeme. But you still don't need to do that. Just set yourself up as a FHP with no training whatsoever and you too could be included in the next round of grand-parenting. The above is from the WMSC info pack. You want some more?

[Graeme Franklin]

But the question still stands; who has qualified as a chiropodist in 3 weeks?


Graeme

[Mark Russell]

But the question still stands; who has qualified as a chiropodist in 3 weeks?


Graeme


I use the term advisedly and with tongue in cheek, but the fact remains there are people who would have you believe they are 'qualified' podiatrists even though they have undertaken a few days training and in some cases no training whatsoever. That is the problem with the regulatory implementation.

When grand-parenting was proposed it was envisaged that there would be some measure of competency in place to vet applicants' suitablility for practice, but unfortunately this went by the board, more out of corporate expediency than anything else. Applicants essentially self-certify and it's easy to falsify application forms. Without the rigour of independent examination there can be no basis for confidence in the process. That doesn't help the public, the registered profession or the applicants.

What is more, without protecting the practise of podiatry - as opposed to protecting titles - we will see a further dilution of the skill base in the coming years as the Foot Health Professionals apply for registration. And remember, you don't have to undertake any course to call yourself a FHP in the first place. What next? Toe and Heel Consultants?

I'm all for grand-parenting providing it is done as it was in the 1960's and providing the legislation addressed the real problems of closure. The interpretation and implementation of the Order by the HPC does neither.

Mark Russell

[Graeme Franklin]

but the fact remains there are people who would have you believe they are 'qualified' podiatrists even though they have undertaken a few days training and in some cases no training whatsoever.

Mark Russell


I have met hundreds of pods and have yet to meet anyone who completed their training in a few days so your "fact" has yet to be proven. As I have mentioned previously 18 months is about average so I don't know where "a few days" has come from.

Graeme

[Robin Crawley]

Hi Mark!

This is all very interesting, but I humbly ask what is the point?

1)Grandparenting has happened. Maybe not in the way that you would have liked, but it has happened. Surely what you are proposing may take away the right to use a protected title from someone to whom whether you like it or not it has been given. The point of Grandparenting was because of European rights legislation wasn't it? IE not taking away people's livelihoods. Scotland is in Europe isn't it?

2)Like I've said before, and I'll say it again, you won't get the ACT of Podiatry/Chiropody/Footcare whatever protected, only titles. I met the HPC lawyer and asked him directly. There are very few acts that are protected, just titles. The ACT of Dentistry for example is not protected, there is nothing to stop me calling myself the tooth man tomorrow and doing toothcare, I just am not allowed to call myself a Dentist and so wouldn't get any NHS work... Have you asked the HPC's legal department about this?

3)Foot Health Professionals etc: The HPC can protect whatever titles it likes, and it IS the law that ANY new protected title will have a 2 year Grandparenting period. That is how the legislation is set up. If Foot Health Professional is protected the HPC will be looking at what makes a Chiropodist/Podiatrist different from a Chiropodist. ~I asked that one as well.

I understand your point of view, although I do feel (and please don't slap me) that it is to some extent driven my ones who feel cheated that the Grandparented Pods have the same legal status as those who are University trained. It HAS happened.

What I do feel the HPC has achieved is that CPD is now mandatory, so at least everyone must keep their 'skills' uptodate and that they must be able to prove that they still practice their profession to stay on the register. No once qualified always qualified.

The HPC is quite transparent and accessible and all can read their decisions etc on their website (a new one will be appearing sometime soon), and we all are eligable (whether grandparented or not) to take part in the HPC process if we are registrants, by becoming Partners (when there are vacancies) or dare I say it standing in the HPC Council Elections, and thus being able to influence the Chiropody/Podiatry regulatory process.

On that note I feel that current HPC Council members have done a good job.

Personally I think your efforts are too late. Why not direct your considerable energies into improving on what there is rather than what may or may not be?

Cheers,

Robin.

PS I am a fan of a lot of your stuff, but not this, oh and I won't re-start the thread about fees again (Well not tonight) :D

[C Bain]

Hi Robin,
Thank you for bringing back an act of reality into this thread. At the risk of getting my hand slapped I also find a drift away from that which IS rather than that which might have been!

Never mind the Scottish Parliament, what about the Privy Council! I knew this sort of thing would happen living in a Disunited Kingdom. I'm becoming more English by the day and less British as the time after 1998 passes???

Turning the clock back may work in Scotland but as a Northern Englishman I feel we are locked into the statuesque. The worry is that somebody in Whitehall may start making it up as they go along rather than by Act and Statute!!!

No, Grandparenting is here to stay I think and one day someone will define 'Chiropodist' and 'Podiatrist' which would have been done in an Act of Parliament before any of this could have started, but no it had to be a Statutory Instrument, (or should that be an 'Order in Council'?), didn't it!

Regards,

Colin Bain.

[Polly]

Hi Robin
With reference to your post, not wishing to cause an argument but actually the act of dentistry is protected as well as the title. It is (to my knowledge) the only profession to enjoy such protection under the law. We should be so lucky eh!
Best regards, Poll.

[Robin Crawley]

Hi Polly!

That's interesting...
If you are right the I have been misinformed.
I really was told this. Honest!

I just found the Dentists Act on the Net and YES! :o Dentistry is protected, BUT could someone do Mouth Care and be a Mouth Care Professional?

I've just emailed the General Dental Council and I'll tell you what they say if/when they reply.

Mark certainly gets us thinking... :confused:

Cheers,

Robin.

[Robin Crawley]

Hi All!

Today I got a reply from the General Dental Council regarding the question of if one could practice as a 'Mouth Health Pofessional'.

Here is the answer:

Dear Mr Crawley,

Thank you for your e-mail dated 29 January 2005.

The business of dentistry
You cannot call yourself a mouth care professional and carry out the business of dentistry. I would like to draw your attention to section 38(1) of the Dentists Act 1984 ("the Act") which makes it illegal for a person who is not a registered dentist, registered medical practitioner or visiting EEA practitioner to "practise or hold himself out, whether directly or by implication, as practising or as being prepared to practise dentistry." The Act defines the practice of dentistry as: "...the performance of any such operation and the giving of any such treatment, advice or attendance as is usually performed or given by dentists; and any person who performs any operation or gives any treatment, advice or attendance on or to any person as preparatory to or for the purpose of or in connection with the fitting, insertion or fixing of dentures, artifical teeth or other dental appliances shall be deemed to have practised dentistry within the meaning of this Act." I would also highlight the following extract from Maintaining Standards, which is guidance to dentists, dental hygienists and dental therapists on professional and personal conduct.

Carrying on the Business of Dentistry - Restrictions
6.10 A person is said to be involved in the business of dentistry when, either as an individual or as a member of a partnership, that person receives payment for services amounting to the practice of dentistry provided by that person, by a partner, or by an employee of either of them.

Under the Dentists Act there are a number of circumstances in which a body corporate or a person who is not a registered dental or medical practitioner may be involved in the business of dentistry. These include persons and bodies corporate who were involved in the business of dentistry before 21 July 1955; spouses or children of deceased dentists; trustees in bankruptcy; and companies providing dental treatment for their employees where the company does not profit from this.

A dentist who becomes a partner or an employee of someone who is carrying on the business of dentistry illegally may be liable to a charge of serious professional misconduct. A dentist who becomes a director or an employee of a body corporate which is carrying on the business of dentistry illegally would be similarly liable.

The Use of 'dental' and 'dentistry'
I also wish to draw your attention to another section in Maintaining Standards about the the use of the words 'dental' and 'dentistry' in company titles

6.13 Under the provisions of the Companies Act 1985 the words 'dental' and 'dentistry' are protected. A company, or applicant for a Consumer Credit Licence, which proposes to use either or both of these words in its registered title is therefore required by Companies House to obtain a letter of non-objection from the Council.

I hope the information is of assistance to you.

Regards

Jonathan Martin
Lead Case Officer
Professional Standards Directorate

So!

Dentistry and anything construed as dentisry IS protected!!!

Mark I apologise :D

Dentists do have the whole mouthcare thing tied up.
Very very interesting I'd say...

This is the opposite of what I was told previously!
Hmmm....

Get you thinking doesn't it!

Cheers,

Robin.

[C Bain]

Hi Robin,
That was one of the points I was trying to make before, also. To do the job properly in law you need an Act and Section. This makes the offence and defines it! But the Powers-that-be have not seen fit to do this in our case?
We are left with a title protected, with nothing else. To enclose chiropody, the act not the title, we need a prosecution under the present Order in Council which will have to go right up to the High Court, possibly? That is if someone has the will and the money to follow it through of cause? (I have never read the old Act, was it 1960, but if the action was hedged in law I'm sure we would not be having this conversation now).
This Government just does not seem to have the will to do it as per dentistry which was well and truly worked out in Act, Statute and Statutory Instrument!!! But they (The Dentists), draw more blood than us don't they? (Only joking Dentists!).
Regards,
Colin.

[Mark Russell]

Hi All!

Dentistry and anything construed as dentisry IS protected!!!

Mark I apologise :D

Dentists do have the whole mouthcare thing tied up.


Don't worry about it. Makes a change from me putting my foot in it. It appears though that every time the issue of regulation comes around, folks get very defensive about their respective positions. The purpose of raising regulation with government was not to take a swipe at grand-parented registrants or to open up further division within the profession; it was to try and get government to examine the failings of current legislation in the hope they might redress the position by considering a Podiatry Act to protect the practice of podiatry - just like dentistry.

No sector within this profession holds a monopoly of practice rights, but the profession itself is a monopoly provider. As long as there is division along the lines of professional bodies and training - with all the historical issues at play - disunity will continue and with it the inability to deal with government and the institutions from a position of strength. If anything, the current regualtory environment will promote division for the forseeable future. The profession is not closed and the market remains unprotected and vulnerable. And whether you are a graduate podiatrist or a grand-parented registrant your ability to be part of a dynamic and established profession will remain extremely limited.

Some time ago, on this forum, I promised to set-out proposals for the development of a professional policy for establishement of podiatry in the UK - looking at what I would consider to be our aims, objectives and strategy. Over the last four months, these proposals were submitted to the forum of the Society of Chiropodists and Podiatrists who, as the largest professional body, were best placed (in my opinion) to take them forward. They have declined to do so. Given that the issues the profession faces are not unique to the UK, I reproduce the outline proposals for development of the profession in the hope that someone, somewhere may derive a little benefit from the content.

Mark Russell

OBJECTIVES

The principal objective of this profession must be the establishment of a network of practice that, through its operation, benefits its members, and by association, its patients, to the maximum possible level. In material terms, that means creating a system that rewards and increases the wealth of those who participate in the delivery of service, commensurate with their ability and status they engender through the application of their practice. In practical terms, that means securing a platform of operation that provides a measure of security, independence and autonomy that protects the individual’s employment, irrespective of prevailing market conditions.

At present we have a foot health market that exists in two distinct arenas – the public and private sectors. Both demonstrate considerable strengths and weaknesses. Within the public sphere, the NHS podiatry service has reached a point of crisis, where demand has spiraled without a corresponding rise in the available supply. Today, many thousands of patients are being denied essential care through no fault of their own and because of circumstance; the profession is unable to offer them an equitable alternative.

Legislative and practical barriers prohibit greater integration between the public and private providers and as a result patients have been placed in professional limbo. Solutions to this problem have been the utilisation of the voluntary sector and the unplanned migration to an unregulated private market of many of our patients without the necessary safeguards in terms of utility and ability to pay.

Within the workforce these changes have had an adverse effect. Salaried employment within the public sector has proved a negative experience for podiatrists. There is no incentive for rewarding good practice and no inhibition for retarding poor care either. Patient choice is non-existent and the standard of clinical practice has fallen as the workforce languishes in a depressed and counter-productive working environment. Income within NHS practice is extremely poor and has fallen in real terms with that of the average private practitioner, thus creating a dangerous imbalance in the marketplace. Whilst there is a desirable need for some level of public care, we are in danger of an imminent collapse of NHS podiatry, thus threatening the livelihood of many members and the health and well-being of those they serve.

But the private market is fragmented too. Changes to the regulation through the Health Professions Order have resulted in a lowering of standards without any foreseeable benefit. That such organisations as SMAE and the Alliance are seeking HPC accreditation for their Foot Health Practitioner courses demonstrate obvious weaknesses in current legislation and undermine the whole reasoning behind the Society’s tacit acceptance of the HPC’s implementation of the Act. The net effect is a constant dilution of the market in real terms to our members – something not helped by the SCP’s decision to admit the grand-parented registrant into general membership without first setting some benchmark through an examination to ensure competency and fitness to practice.

The principal objective, therefore, would be to protect and develop the market by reversing adverse trends, and in doing so, secure the following goals for the profession within a specified timeframe that I would suggest be considered at five years:

• Establishment of a secure, independent and autonomous practice network, protected, as far as possible from all adverse market conditions.
• Increase the wealth and prosperity of all members commensurate with the status they crave and deserve.
• Develop the clinical practice of podiatry for the benefit of society as a whole.
• Promote professional policies that sustain and develop the market for future generations to come.

To do so will require changes to the following:

• The structure of the profession within this country to a core NHS service and a devolved general practice.
• The way podiatric practice is funded and the system of remuneration for clinicians.
• How podiatry is regulated.
• How podiatry is represented.
• How and where podiatry education is structured and delivered.
• The transitional educational programme for foot and ankle surgery and how our graduates are supported financially through that process.
• The transitional educational programme for podiatric medical specialists and how our graduates are supported financially through that process.
• The collation of research and development for gait related disorders.




STRATEGY

There are two strategies the profession can employ. The first is what I would call the confrontational approach. You mobilise opinion within the body of the profession and withdraw wholesale from the public arena. Given the prevailing conditions within the NHS podiatry service, such a move might not prove all that terribly difficult. The repressive environment of public sector practice combined with the insecurities and inhibitions engendered by ‘Agenda for Change’ have created an atmosphere of discontent like never before. Whereas in previous years it would have been near impossible to consider the possibilities of industrial action, now we are faced with the reality of mass defection to the private marketplace by many experienced (and not so experienced) NHS employees. Retaining the NHS workforce has become an enormous problem; dismantling it might not prove all that difficult.

But such a strategy, although it may very well secure the ultimate goal, would be detrimental to our patients, at the same time as producing unstable and uncertain conditions for practitioners in both marketplaces. Podiatry does not benefit in the same way as dentistry from an established, developed and protected private market. The supporting institutions such as dedicated insurance carriers and mutuals, simply do not exist. A smooth transition to establishing a vibrant practice base in the private market would not be easy and the effect on many of our colleagues may well prove detrimental in the short to medium term. When dentistry pulled out of NHS care they had a viable fall-back option which subsequently enhanced their bargaining position with government immensely. If the dental profession re-engages with public care in the future it will be on their terms. Unfortunately, if we adopted a similar strategy, it would take many years before podiatry was able to do the same.

The alternative strategy would be a considered and planned approach.

• We need to undertake scientific population based needs assessment to establish the levels of foot/mobility problems within the community (not simply the existing caseload)
• This needs to be mapped to the projected changes in demographics and disease prevalence etc.
• We need to do work on identifying the input required to meet these health needs
• We need to examine in detail the aspirations and skills/competencies of the ‘whole’ profession
• We need to have a long-term policy/strategy, invest in it and deliver.

And to have a long-term policy and strategy we need to create one in the first instance. That is the first step.


POLITICAL POLICY

It is a fact that the delivery of Podiatry and Related activities have become a political issue. To some degree they always have been but often drowned out by that on the National Health Service as a whole. However, in recent years, through a range of pressures and government’s attempts to increase the regulatory control on health professionals, the dialogue has become increasingly strident.

The social pressures regarding health and how it impacts on the profession are various and wide ranging. As a society we are living longer, increasing the amount of age related infirmities. Obesity is an increasing problem bringing with it a wide range of potentially dangerous clinical conditions; the recent statistics relating to the alarming acceleration in the numbers of those suffering from diabetes are but one example. The rise of “Sports Medicine” shows that the public’s awareness of activity related warning signs of potential injuries and chronic malfunctions is increasing. The fortunes spent on research into special equipment for sports of all types, show that there is real economic activity aimed at the areas of gait and biomechanical movement. This is bound to raise a need for medical services in these areas.

In developing a plan to address many of these issues the Society could, as has been done often by others in different professions, seek to persuade the creation of yet another committee of inquiry or quango to enlarge upon and report on the issues. The Society would no doubt be asked to prepare a submission as part of that process – which would almost certainly take years.

This Government, which will probably form the basis of the next, has determined that a large part of its focus for justification for re-election is its emphasis on public services and at the heart of that is the National Health Service. For good or ill, podiatry has had its profile and place within that service, raised considerably in recent times. The Society has a choice. It can either await government’s re-election (and in some ways it does not matter which political party or parties form the government) or it can begin to prepare its view of the way forward, so that when a new administration comes into being there are proposals to hand to be developed with the blessing of central government.

However, it is not just the proposals that are important, it is the implementation phase that will be an equal focus of attention and given the will the Society is well placed to be a mainstay in that implementation.

In round terms there are some 16,000 practicing chiropodists/ podiatrists in the UK. The profession is divided almost equally between those who are state registered, of whom there are some 9,000 working in both the NHS and private practice and those who are not. New legislation coming into effect this year 2005 seeks to protect the title of “chiropodist” or “podiatrist” in that registration with the Health Professions Council is necessary to use these titles legally.

The Society has a membership of some 10,000 and, irrespective of the composition of that membership, is thus well placed to take a leadership position in advancing the role and status of the profession. It is in existence, it has a representative membership, can tap into a wealth of knowledge regarding clinical practice and its place and importance in communities. Above all, it can position itself as being a medium for change in the delivery of services to the public at large. Clearly the Society is not the only professional grouping in the podiatry marketplace and its preponderance of state registered members could lead to its being viewed entirely as form of trade union for that grouping. However outside the profession the Society is not seen as that simply because in the first instance its perceived profile has been subsumed into that of the NHS as a whole; the fact that there are other groupings has protected it from such an overt charge. It can thus develop a position whereby it presents itself as a body, which, having identified the developing pressures in its field, is reacting and indeed anticipating the impact throughout its health sector and society.

However this is not a short or one off process. The timing is set by government and within that the way in which our parliamentary process works. Each year government has to go to parliament for supply – the annual budget - round and no government can commit any succeeding one. Thus if real progress is to be made it is essential that initiatives are raised as early as possible in a government’s programme to get a level of interest and commitment and thereby insertion into their programme. The common assumption is that there will be an election in May of this year. This means that the intervening months have to be used to prepare a submission to government making clear the Society’s views on the future of both it and the profession as a whole.

It is always easy to state that one must aim high. Dealing with government is not an easy ride. Part of the difficulty lies in the fact that both government and the Society have a wide range of constituencies to address if success is to be achieved; the professions, Parliament and individual members, the government of the day, the civil service and the public at large will all have an interest and special positions to argue.

Modest aims are often not recognised as such but carry the danger of not being seen to be ambitious enough. Governments cannot appreciate that management by initiative is not a substitute for steady progress. However in the general melee at the beginning of a government where there is a real chance of being heard it is important to have well thought through proposed initiatives which can be put into the Civil Service for analysis and endorsement and then converted into policies. It is not simply that the loudest voice will be listened to. It is that the loudest voice which is judged to be the one that knows what it is talking about; has proposals that make sense and appreciate that dealing with the wheels of government takes patience, a capacity for taking pains (repetitively!) and above all has a well researched and thought through attitude approach to the problem in hand.

It is believed that as a necessarily broad starting point the aims and objectives for the Society's political policy should comprise the following

The Preparation of a Report from the Society to Government for presentation after the next General Election
An outline of this Report is attached to this proposal. Clearly at this stage with the short time available for preparation the outline cannot be all embracing and there must be omissions that the Society would seek to include.

Formulate a Basis for Consultation throughout the Chiropody/Podiatry Professional Organisations
It is believed that in the first instance the consultation should focus on the profession. There will have to be wider consultation with the medical profession as a whole but it is believed that this should follow the clarification of the Society’s and fellow professional views so that if it is possible to speak with one voice the profession should do so

Agree as far as Possible with those Organisations the Future Structure of the Profession
This is likely to be the most difficult and contentious part of the whole exercise. Some forty years have passed since the Society’s element of health care was brought into the NHS and it would not be an exaggeration to say that to some degree the sector has suffered in terms of government’s attention because of that. However as pointed out above the pressures for focusing that attention are now substantial and given the Society’s positioning and the demands made by government then a consensus should be possible – but not without time, effort and patience.

Act as the Spearhead in Dialogue with Government and the Medical Profession as a whole as to the Implementation of that Structure
To occupy this crucial position it is necessary to have negotiated a successful closure on that above. It is believed that for the reasons already stated that this is possible.

AN OUTLINE OF THE REPORT

There follows below an outline of a possible outline plan for presentation by the Society to government. At this stage it has to be an outline since much work will need to be done in both formulating the document and consultation within the Society


INTRODUCTION
What this report is about and why it is needed

A POLITICAL SERVICE
The place of podiatry within the health service and why the delivery
within that service has become a political issue
The Role of Politicians
The Five Constituencies
1. The Government
2. The Civil Service
3. Parliament
4. The Public
5. The Profession
Managing the Interfaces

THE SERVICE AND HOW IT WORKS
The Demand for Chiropody and Podiatry Services
How and Where it is delivered
The Basic Cost and Price Mechanisms
The Public and Private Delivery Mechanisms

THE SYSTEM AND HOW IT WORKS
The History of Regulation
The Scope of Present Regulation
The Pressure for Change
The Impact and Management of Change

THE PRESENT COST AND BENEFIT STRUCTURE TO THE CONSUMER
How does the Consumer access the Service
What are the Barriers to Access
How does the Cost/Price Structure impact the Consumer
How does the Consumer measure the Effectiveness of Delivery
The Issue of Compensation for the Consumer

THE PRESENT COST AND BENEFIT STRUCTURE TO THE HEALTH SERVICE
How is the Profession viewed by The Health Service
How is its effectiveness assessed
What does The Government see as the coming pressures on the service
What are the Barriers to a dialogue with Government re Change
Why should Government Care

THE PRESSURES ON THE PROFESSION
Demographic
Social
The Changing Nature of Health Care
The Need to Finance such Changes
The Need to Manage the Profession
The Medical Institutions
The Society’s Relationship with Its Peer Groups

THE GOVERNANCE OF THE PROFESSION
The various Representative Bodies
The Relationship with The Health Service
The Society as a Leader
The Relationship with The Medical Institutions
The Relationship with The Health Professions Council

THE WAY FORWARD
Should Anything be Done
Who should do it
A Response to Known Pressures
An Approach to Change

RECOMMENDATIONS
Structural Revision
Finance and The Financing of Practice
Private Health Schemes
Education and Standards

APPENDICES

[DTT]

Mark
"the purpose of raising regulation with government was not to take a swipe at grand-parented registrants or to open up further division within the profession;"

Oh really ??

"And whether you are a graduate podiatrist or a grand-parented registrant "

Yet another division ??

Et tu brutae

Yours mistrustingly

Derek

[davidh]

Hi Derek,
I don't know if you are being deliberately obtuse or not.
In the past Mark has called for all podiatrists to undergo a test of competence every 5 years (thats all, and would include the Chairman of the SCP, Mike Batt, you, me and Mark).
He has explained that this would at least give us a standard across the boards.
He has acknowledged that there are good and bad practitioners from the privately-trained sector and the 3-year trained sector.

His proposals would have a far-reaching beneficial effect on the profession as a whole if they were carried through. They would certainly get rid of the factions which still exist (if unsure tap into thatfootsite).

I'm certain Mark is right - I wouldn't have a problem with being tested every five years - would you?
Regards,
Davidh

[Cameron]

Netizens

Please forgive the intrusion to a most worthwhile discussion, my contribution is simply for information only and not intended to be any more

Many years ago when Australia were thinking about introducing a competency test for overseas podiatrists they put together a set of questions and tasks to be observed. This was the equivolent of a second year clinical examination at university. The education of podiatrists within the Commonwealth are very similar and have reciprosity via their Bachelor degree status.

To test the validity of the competence based examination a group of practitoners were selected at random from the Australian community and put to the test under the exact same conditions as would be in operation when the attestation of overseas candidates were being tested.


The result -- more than half of the group failed to reach 50%.

I am reminded of Charles Kaleb Cotton when he so wisely said, "Examinations are formidible enough , for the greatest fool can ask more than the wisest man can answer."


MOT style competence testing would not be a mode, I would choose and prefer other models such as recent evidence of CPD.

Cameron
Hey what do I know?

[C Bain]

Hi Derek,
Well there we have it in David H.' reply above!

I'm still listening to doubt, suggestion and DPM's at £20 a time (Is this right or have I misunderstood?).

How much will the new five year test cost? Yet another £200 plus???

Reference what is going on in the 'Thatfootsite' at the moment, I think some need a psychiatrist not a podiatrist - Sorry should that be a chiropodist, that is where the work is for the majority of us ISN'T IT!?!

Regards,

Colin.

[Mark Russell]

Netizens

MOT style competence testing would not be a mode, I would choose and prefer other models such as recent evidence of CPD.



Likewise, but it's coming anyhow. Recertification is already in place for dentists and doctors and I suspect is penciled in for podiatry too. Sometimes it's best to pre-empt the move from government - if we had with regulation we might just have had a dedicated registrar and actual closure by now.

Whatever method one uses it's bound to be flawed. Recent evidence of attendance at CME/CPD accredited courses doesn't prove anything except you were at the venue. Maybe they should check the bar receipts as well? I know one NHS manager who spent the entire weekend in bed with his secretary at a post-graduate course and claimed maximum points for his effort. But even recertification has problems - what is the point - to ensure the practitioner is safe to be let loose on the public? If so, where do you set the barrier?

In some areas this is not a problem - dosage of analgesia, sterilisation of instrumentation & etc. But what about prescribing functional orthoses? Read any of the streams on orthotic intervention and you have multiple views for most condition. More harm can be done to the developing foot with the wrong prescription, yet take a child with a gait defect and have them examined by ten podiatrists and you'll have ten different diagnoses and ten different prescriptions - and that's before you take into account the manufacturing process, which will also give differing devices even though the diagnoses and prescription are the same!

In 20+ years of practice I think I know only a dozen or so clinicians in the UK whom I would consider as competent in prescribing functional orthoses (and I’m not one of them), so where does that leave the rest of us? What’s more dangerous – the wrong dosage of LA or a damaging prescription in an eight-year-old child? Knowing and adhering to one’s limitations is obviously the best policy but how does society legislate to protect from errant and malicious practitioners like Shipman? Simply it cannot, but it can and should ensure that there is some standards of proficiency in every profession both at the end of training and throughout the career. As far as the latter is concerned, some accredited CME/CPD is preferable but surely it must also be supported by some form of examination and/or inspection too, otherwise what’s the point?

[Cameron]

I knew you would pull me into this discussion, Mark, you silver tongued individual you.

>As far as the latter is concerned, some accredited CME/CPD is preferable but surely it must also be supported by some form of examination and/or inspection too, otherwise what’s the point?

I suppose that is what I am saying about examinations, there is no point. Irrespective what other disciplines have in position the likelihood of introducing a new barrier to podiatry is probably fraught with more problems than not. Despite whether it seems a good idea or not. For example one can only imagine if a practitioner was deemed unfit to practice, by whatever means, what litigation would follow if their ability to continue to earn a living were severely sanctioned. That would be, I would suggest, unfair and therefore unlikely to be implemented. Members of the same society (note the small 's') judging their peers would be morally wrong let alone the costs of seeding new guardian bodies, incredibly expensive.

CME/CPD may have major flaws but at least it does deal in the now and can be made compulsory for continued membership of a professional association. If this were extended to all members of HPC this would represent a level of quality assurance and reassurance to the public.

You know I wont be pulled into the orthoses debate because it is no secret I am not convinced of its authenticity and believe all podiatric biomechanics is gobbledegook and jargonised tripe, anyway :-) .

However I would agree with you there are some outstanding examples of practitioners with flair and exemplary results. Not in the symptom reduction hooha that has little to condone the occult practice other than anecdotal bla, but the very interesting works reported by Slattery and Tinley on the number of bleeds in haemophiliacs. Not everyone may be aware of their pilot research but the number of bleeds reduced significantly with off the peg accommodative foot orthoses. Maintaining middle range motion and preserving end of range movement with lifts, tilts and wedges does appear to have a predictable physiological effect. Now that is interesting.

Something I have long been an advocate of is the recognition of specialities by registration authories such as the HPC or Registration Boards. Before a practitioner can trade as a biomechanic specialist, for example, I believe they should have credible qualification to do so. The same can be applied to a plethora of podiatric specialities including, a general practitioner. Progress to this level would involve examination and may I believe offer a more positive career structure to the clinical field.

To me that would present a simple and economical way to regulate a growing profession which if it does not watch out for itself will, I fear become smaller and smaller as individual specialities thrive at the expense of an apathetic majority.

The enemy is not without, Mark, the enemy is within.

What say you....?

Cameron
Hey what do I know

[DTT]

Hi David h

Because I disagree with one of your friends or you are incapable of understanding common sense does not make me obtuse thick or any other patronising insult you can think of!!

In fact I think you will find the vast majority of IPP's are now considering the real costs that this coming hpc legislation will make in real terms by forcing them to raise their fee's or take a cut in their profit margins.

To continue with a frankly unworkable "ideal" on top of an imperfect but soon to be working hpc I do not believe helps anyone especially those of us in private practice.

The NHS disease of meetings and committee's , endless form filling etc fill me with dread as it will soon be spilling into my world reducing efficiency and more to the point making me work longer hours for nothing . I talk to many Gp's , hosptal cosultants who are sick and tired of the administration because it is taking away their time to heal patients which is what they trained for.

I think Cameron and Colin have understood more that you and reply sensibly from two different aspects of the argument .

Mark has made what I deem a serious allegation of deception against an
" NHS manager" , I look forward to him supplying details of this to the HPC for disciplinary action to be taken against this/ these people as there may have been fraudulent use of expenses ,paid time etc . I await the outcome with interest.

Derek

[Mark Russell]

Something I have long been an advocate of is the recognition of specialities by registration authories such as the HPC or Registration Boards. Before a practitioner can trade as a biomechanic specialist, for example, I believe they should have credible qualification to do so. The same can be applied to a plethora of podiatric specialities including, a general practitioner. Progress to this level would involve examination and may I believe offer a more positive career structure to the clinical field.


I agree. You can do this by creating a licensing system within the registration system in much the same way as the GMC has done. Have a peek at the following suggestion and note the date:

http://www.jiscmail.ac.uk/cgi-bin/webadmin?A2=ind03&L=podiatry&T=0&O=A&P=154919



The enemy is not without, Mark, the enemy is within.


You think I haven't figured that out by now? Besides, you told me as much twenty-two years ago. Somethings I never forget, even with the dementia.

[Mark Russell]

Mark has made what I deem a serious allegation of deception against an
" NHS manager" , I look forward to him supplying details of this to the HPC for disciplinary action to be taken against this/ these people as there may have been fraudulent use of expenses ,paid time etc . I await the outcome with interest.
Derek

Get a grip, son. You never heard of blackmail?

[DTT]

Ahh Mark

Never thought of that one :)

One hazard of working alone

Derek

[DTT]

Davidh

Sorry I didnt give a positive response to your question of testing every 5 years ( pressure of work)

I would willingly take a test every five years if that was in any way relevent to the practicality and improvement to the present system (or that which will come into force in a couple of months.)

For yours ( and others) benefit in case you have any further trouble understanding me :-

Every time I treat a patient , that patient has the opportunity to :-

1. State they are satisfied / dissatisfied with the service I have provided.

2 . If they are satisfied they will come back / recommend to others.

3 . If they are dissatified they can :-

1a . Not come back and not recommend me .

1b .Complain to other health care professionals and / or ( and here is the punch line)

2a . Complain to the HPC who will investgate the allegation and If proven due process will follow.

Advocating tests examinations is not only a waste of time it is not cost effective proves nothing . To quote Cameron :-

"I am reminded of Charles Kaleb Cotton when he so wisely said, "Examinations are formidible enough , for the greatest fool can ask more than the wisest man can answer."

Some of the wisest words I have seen on any podiatry sites I have seen on podiatry arena the above being a quote to remember.

The other I have taken from Craig in another thread :-


"Double fees --> loose half your patients --> make just as much money --> don't have to work so hard --> have a life."

That to me is called common sense !!!

The life I want ( and I believe I speak for a majority here ) is to make a good living as I have done for many years. Charge a fair fee for a good ,safe, effective service. Most of all HAVE A LIFE !!!

I do not want to be bogged down in unnecessary paperwork , beurocracy or have the stress involved in continual restriction or having my livelyhood put under threat by perpetual futile examinations much of which would certainly pertain to irelavancies that have no bearing on the "patient type" I treat or my "scope of practice" and again would take me away from my fee earning function and raise fee's .

The HPC is here to stay like it or not.

They have started EVERY registrant on a level playing field. Changes will obviously follow to structure the profession. That is common sense as academic / training levels and individual aspirations vary as we all know.

If the working format of the HPC is looked at without hysteria and bigotry you will see most of the concerns expressed by others are already covered within the framework , not perfectly , but a start to our future as a unified profession.

My opinion (obtuse or not)

Derek

[DTT]

Davidh (and others)

Oh and furthermore , in case You had not noticed:-

In the real world the politcal dictate in this country has been :-

To reduce civil servants (by 100.000 I think )

To reduce the "nanny state" ( as the public CAN decide for themselves)

As Marks proposal would INCREASE administration ( by creating yet another comittee etc).THAT is why it (at this time) it as an "IDEAL" ,and it aint gonna happen under this government!!!

So why persue a devisive course ??

Take away patient choice??

Who would treat the excess of patients left over if by Marks proposals to get rid of "practitioners HE deems are unsafe"?? Would they be better off with no care at all ?? I don't know the answer , do you ????

Backed up by Camerons facts on testing , if we got rid of the 50 % of practitioners who would fail revalidation testing , how would that help the present situation ??

Inevitably the NHS would not cope ,they cannot treat effectivly the patients they have now!!

"Harold" has been brought into the equasion in the name of patient protection

You cannot and never will eradicate the "Shipmans" of this world and certainly not by legislation . Corruption is self perpetuating and one(or more) will always slip through, that unfortunatly is the way of things.

"THE PODIATRY PROFESSION" is a very small cog in a great big wheel , not acute ( life threatening) , not glamorous ( as in your tv soaps) but downright ESSENTIAL to thousands of patients and because of that EVOLUTION must happen and that takes time.

No one can force things through at this stage ( however clever you are) to try breeds is division and mistrust .

We can only work together to achieve out aims ( Mark once told me " we both sing from the same hymn sheet)

Even after all that has been said I still believe that !! but we sing from opposing sides and until we can UNITE HONESTLY that will never change.

So once more "obtuse"?? ok if it makes you happy :p

But ,

If , after 38 years in "hands on health care" NOT ONE" of my patients has EVER complained about my treatments and care" my record speaks for itself !

Can you say the same ????

One last thing (sorry if I'm boring you)

This is an excellent site but it must be remembered by ALL , it is NOT a personal messaging service!!

It is viewed by the rest of the world along with insults ,spurious allegations and comments.

Can we please get back to a uniting dialogue and dare I say" lighten up "???

Yours in health



Derek

[dmdon]

Hi all

I can't for the life o