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High-quality foot care is vital for older people

Discussion in 'United Kingdom' started by NewsBot, Jan 5, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    The Scotsman are reporting:
    High-quality foot care is vital for older people
    Nick Waugh
    Link to story
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. William Fowler

    William Fowler Active Member

    Been there. Done that :sinking: :boohoo: :craig:
     
  4. greatwhite

    greatwhite Active Member

    It does annoy me this. Podiatry is not about a toe nail cutting service in my opinion. Do old people go to Dentists to get their teeth brushed? No! They 'manage' somehow. I know that many old people who say they 'can't get to their feet' are quite capable of bending down and pointing out their problems.

    Seriously, if they can't be bothered to buy a file and file there nails once every day for 5 minutes why should they be using taxpayers money and wasting professionals time? Furthermore if they can afford private Podiatry treatment and they haven't got a medical problem what is the big deal? They are choosing to spend money on a luxury which they could easily do themselves. Being old shouldn't be a right to special treatment; being ill should, regardless of age.
     
  5. Cheesy

    Cheesy Member

    Yes i quite agree greatwhite.:bang:
     
  6. George Brandy

    George Brandy Active Member

    Dear Greatwhite

    Define ill.

    I gather you are neither elderly, suffering an ability to reach, see, hear, breath, bend. One day you will.

    But do not fear, the governement, the NHS, the Universities and now the HPC plan to replace you graduates in NHS employment with assistant practitioners so if you haven't specialised, do so quick.

    Perhaps attitudes to nail care will change when 80% of the UK Podiatrists are competing with everyone from GP's to beauticians for their share of the footcare market.

    Survival of the fittest? Nah, survival of those without the NHS indoctrinated attitude.

    GB
     
  7. Dido

    Dido Active Member

    Hi George,
    This is a very old topic but I do think Great White has a point. I do not think we should be providing free treatment for non-pathogenic nail cutting, in the same way as we do not provide free haircuts or shaves, except in extenuating circumstances.
    The problem as I see it, and no doubt some will take issue with me here, is that so many of the elderly have been brainwashed into thinking they simply cannot manage without a 6 weekly nail-cut. I would not like to speculate how this fallacy originated. Consiquently many of them want 6-weekly trims but aren't prepared to pay a chiropodist's fee for the priviledge.
    I think we should be re-educating folks away from the magical 6-week return date :bang:, empowering them to take more responsibility for their own footcare, and those of us in pp need a more flexible pricing structure to accomodate this growing market.
    Easier said than done.
    regards
    Dido
     
  8. greatwhite

    greatwhite Active Member

    You are quite right George I am 'neither elderly, suffering an ability to reach, see, hear, breath, bend'. However, if I was I would hope that would entitle me to a toenail cutting service although not necessarily by a Podiatrist or within the NHS. The deciding factor as to why I should receive said treatment would not just be based on age but as you yourself stated the ability to 'reach, see, hear, breath, bend' or medical need.

    As for toenail cutting for those who aren't what I would term 'at risk'? It doesn't really need a great deal of education or experience to do so, so why shouldn't beauticians and GP's (although I'm sure it would never come to a GP doing such a treatment; heaven forbid ;) ) do so? It's not like you need a high level of training and experience to do it. Now when it comes to those with other medical conditions that may affect the feet, or even foot problems that may affect the rest of the body that is a different matter entirely.

    Of course none of this would prevent a private practitioner from doing such a treatment.
     
    Last edited: Jan 11, 2008
  9. George Brandy

    George Brandy Active Member

    A very old topic indeed Dido and one that just won't go away.

    Perhaps the DoH is being battered enough to do something about it with the identification of a "skills gap" in the NHS and realise that
    any of
    . Look at the real issues: the development of Assistant Practitioners with core skills pushed in at band 4, along with footcare assistants at band 3 - pretty much capable of carrying out the work of band 5 and perhaps band 6 between them leaving the specialised work to a few graduate Podiatrists. So funds available to cut nails once more? We shall see.

    Greatwhite, the GPs already deal with much of the footcare market. This is the first point of contact for heel pain, fungal infections, ingrown toenails, verrucae, interdigital corns....I could go on. Most GP practices now have waiting lists for Partial Nail Avulsions beyond the 18 week limit. They cherry pick.

    We Podiatrists are our own worst enemies giving away large chunks of our work without fiercely protecting our skills and joining ranks to protect re closure. The profession wishes to be compared to the dental profession? Now tell me what have they given away? Which dentists were made redundant through funding issues? How many were replaced by assistants?

    Look very carefully and very closely how you are playing straight into the hands of the Stategic Health Authority and regional NHS managers.

    GB
     
  10. Dido

    Dido Active Member

    Hi George & Great White,
    I agree with the original title of this thread ie:- "High quality footcare is vital for older people." Footcare not nailcutting.
    Having worked in the NHS for 25 years I can tell you cynically that they don't give a stuff about old folks. What the NHS general managers want is more work out of its staff for less money. In the time I worked in the NHS I saw our department cut from 24 chiropodists to 12, and the criteria for treatment being altered to exclude ever more people each year. A whole industry has now grown up within the NHS purely to provide statistical information for Central Government. That costs money that could be spent on healthcare.
    I could go on but it's making me depressed. :boohoo:
    What the whole answer is, I really don't know. :confused:
    Making me redundant was the best thing the NHS ever did for me. :D
    regards
    Dido
     
  11. DTT

    DTT Well-Known Member

    Hi All

    Well here we go then ,

    Just finished a surgery and the last patient asked me "how long have hairdressers been doing feet ??:confused:

    She had been to have a hairdoo at a local hairdressers and was say next to an "old girl" with her feet in a "foot steeper" which was a "new service" the hairdresser was offering.

    She said the water looked dirty and there were bits of hair falling into it from the old lady who was having her hair done at the same time .

    Just out of interest this patient deemed that as "chiropody" and made much of the fact "how standards with many people in my profession had fallen and how pleased she was that she came to me to have her feet "done properly".

    I just wonder what image this sort of thing projects for our "profession" in the eyes of the general public.:eek:

    And before anyone asks I don't know what the "hairdresser" is advertising herself or her foot service as.

    Just something to ponder as a possible future of much routine work:rolleyes:

    Cheers

    Derek;)
     
  12. Dido

    Dido Active Member

    Sorry George,
    But I don't think that's anything new.
    Years ago we use to have an old boy of about 80 in my area who used to go around on this pushbike doing some kind of treatments (I won't call it Chiropody) to other old folks. He used to visit in between the NHS treatments and all his patients denied he existed. ( They knew they'd get crossed of the NHS list if they did admit to going elsewhere for treatment - that was the policy at the time.) We always knew when he had been visiting, as the patients' feet bore evidence of several recent haems.
    Apparently he carried his "knives", as folks called them, in a little cotton holder with pockets in that could be rolled up, and then place in the basket on the front of his bike.
    Apparently he decided to give up after he had a TIA and fell in a dyke. I'm not sure if he lost his instruments and/or his bike and that was the final impetus to cease trading.
    regards
    Dido
     
  13. DTT

    DTT Well-Known Member

    Hi Dido

    Nope I'm Derek (I know it's an age thing, I do it all the time myself:boohoo:)

    There has always been the "witch doctor chiropodist about I agree but this is blatant up front footcare.

    No secrets there and having the desired effect from her point of view :rolleyes:

    I agree with George on the point we have given away what is in essence the basic need chiropody to anyone that will take it.

    Non pathological nail cutting is we all agree not a priority but nevertheless a basic human need ( on whatever time scale is right for the patient) if as George says you cannot see ,reach,cut your nails than someone has to do it for you.

    That does nor detract from the fact that patient should still be able to get that service safely and include screening from a professional with proper record kept and in a clean environment with clinical cleanliness.

    There is now a 75 year old screening programme that all GP's have to carry out on all patients of that age.

    I wonder if when ( if) they get to their feet, they send them to that hairdresser to get them sorted ??

    Would it not be better to see ALL patients in the first instance at an NHS facility ( to get over the free at point of delivery thing) and then give the Pt a list of ALL local HPC registered Pods for follow up treatment ??

    There is another thread on this subject and the upshot of that was, if a pod wants to go down that road in his PP then so be it and the Pt will get safe effective treatment.

    If ( like me) that is not where you want your practice to be, then don't get involved.

    For those who do a fee structure could be set to match the time involved etc

    Cheers
    DEREK ;)
     
  14. Dido

    Dido Active Member

    Hi Derek (and George),
    Apologies for the mix-up :eek: another 10,000 brain cells must have committed suicide. :boohoo:
    I agree totally that every elderly person should, at some time in their pensionable life, have free foot screening. But who will pay for it?
    At the moment in the NHS mammograms are only available to ladies over 50 despite the fact that breast cancer is a big killer of much younger women. Not cost-effective apparently
    As a side issue I had a funny 'phone call today. A young lady rang me up to see if I wanted to advertise in the magazine she was putting together for Age Concern. This would go to 10,000 GP surgeries in the area etc. She told me that Age Concern are going to pay for every pensioner to have one free chiropody treatment. Unfortunately she couldn't tell me the source of this information. I wonder if this is a marketing ploy or if my hearing is failing along with my other faculties,:confused:
    regards
    Dido
     
  15. DTT

    DTT Well-Known Member

    Hi Dido
    No worries :)

    Thats the point the pods in the NHS have bemoaned the job and now the managers have seen the "given saving" and acted upon it.

    That does not alter the fact there are many PATIENTS out there that cannot manage their own nailcare for the obvious reasons of infirmity and have to go to "witch doctors or hairdressers " to get any sort of care.

    They are quite capable to pay for it themselves but will not because of the fee charged by IPP's.

    That could change if it was managed properly and a link was forged between the NHS & IPP's thereby giving the elderly safe effective screened care from qualified professionals and NOT hairdressers and witch doctors:bash:

    Yes probably wanting you to fund their "volunteer nail care people" who are cutting all nails pathalogical and non pathalogical which in an adjacent area costs £18 to register ,£10 for their own nippers to the patient and £10 a time to have the nais cut = £38 for the first visit and £10 a time after that.
    Your prospective advertising is a profit margin on top.

    As an IPP I'm sure you can appreciate the loss of revenue that means to many Pods that have also lost positions in the ever decreasing pod services in the NHS and find themselves out in the big wide world with no income and an ever self inflicted loss of available opportunities.

    Just my thoughts

    cheers
    Derek;)
     
  16. Dido

    Dido Active Member

    Hi Derek,
    You are singing off my hymn-sheet. :boohoo:
    However, I don't know what we can do about this. :confused: We are a small fragmented lobby. That is a big part of the problem. :deadhorse:
    regards
    Dido
     
  17. DTT

    DTT Well-Known Member

    Hi Dido


    The problem is communication between the NHS (SCP ) and the IPP professional bodies (SMAE etc) .

    It really cant be that hard to sort out can it??

    Just a will from all sides to give the elderly PROPER CARE from HPC registered Pods and continue the HPC's policy of "safe effective practice" but of course this could be yet another attempt to fool the public into believing they matter and the pro bodies from all sides that they are actually representing their members interests ??

    Cheers
    Derek;)
     
  18. R.E.G

    R.E.G Active Member

    Oh dear Derek,

    You were doing fairly well up till now.

    Fact:

    The SCP does not = NHS.

    Smae etc does not = IPP professional bodies.

    The SCP represents approx 9000 HPC reg Pods, over 50% of them work in PP.

    Smae etc represents between them less than 4000 registered Pods. They also represent the FHP market, which as we all know allows the existence of 'hairdressers' 'doing' feet.

    The Society already has 'the ear' of the NHS (history) and PPs within the Society are already working on exactly the sort of issues you describe. However the NHS = government, so it is an uphill struggle.

    A struggle which may have been helped if people like yourself had taken the offer of Society membership, instead of being so untrusting, and Government/HPC could be faced with a single voice.

    Easy really:pigs:

    Bob

    Just broken my NY resolution to quit Forums.

    While I'm at it does all the 'news' really enhance this forum?
     
  19. DTT

    DTT Well-Known Member

    Hi Bob

    Sorry to have made you break your NYR :rolleyes:

    I'm not knocking the SCP Bob and I am aware that many within are IPP's who I am sure have the same views as myself on the disposal of routine work and thank you for the information that they are working toward a solution on the lines I describe.

    Errm, was it not you who stated in another thread "you were going to vote to have the Grandparented removed form the SCP at this years conference" or was I mistaken ??

    Incidentally that wasn't the reason I didnt follow up on it but good call on my part then possibly?

    :deadhorse::sinking:

    Do we:confused: Rather a bold statement if I may say ?

    This hairdresser may have no training whatsoever and be nothing to do with any organisation for all I know so how does that involve FHP's or SMAE ? so how would they be empowered to stop her doing feet ?


    Ain't gonna happen fella is it :bash:

    Cheers

    Derek;)
     
  20. Dido

    Dido Active Member

    Hello again,
    I can remember once upon a time, a very long time ago, in a country not far from here, when the provision of chiropody services was controlled by the Local Authorities. Patients went along to a practitioner of their choice for treatment, signed a form and the practitioner submitted these every month for payment.
    It worked very nicely, so nicely in fact that someone somewhere decided it was too good to be true and found it necessary to louse it all up and incorporate chiropody within the NHS.
    Need I say more.
    :sinking:
    regards
    Dido
     
  21. DTT

    DTT Well-Known Member

    Hi Dido

    I still do that now with "War Veterans" Bless em:drinks

    They sign the form I send it off and get paid direct into my bank account.

    No reason that could not happen with all the elderly if the will was there from everyone and the "care instead of lip service" was applied from the powers that be :rolleyes:


    I have a 17th century limited edition print called " THE BARBER SURGEON" depicting a poor soul having an obviously painful procedure performed on his foot , his anguish was much to the obvious delight of the onlooker :eek:

    Funny how things have a way of turning full circle innit ?:boohoo:

    Cheers
    Derek;)
     
  22. Cheesy

    Cheesy Member

    How about training carers, other healthcare support workers (HCA's, staff nurses etc) to carry out basic (social) nail care? this is the road that the trust I work for has gone down and seems to be very successful
    Cheesy
     
  23. milo2145

    milo2145 Member

    the thing is ....to most private pods the nail cutting is a big source of thier income, its also easy, stressless and earns pretty good money.
    when i first started in the nhs we would see everyone over 60 every 4 months and the majority were for nail cutting, then we moved to seeing high risk patients only, and discharged 60% of our caseload.
    i turned private part time and made good money seeing those patients discharged from the nhs for routine nail cutting, they were very concerned with their nail getting long and digging in etc.
    i will be perfectly honest and some may disagree but you dont really need a whole lot of training if any to cut nails - mothers have been cutting their own childrens (pets, parents, cats budgies) since time began, and there is no training course for that. and nobody ever sterilised their equipment either. obviously when you are using your clippers on many some sort of sterilising will be needed, maybe not even an autoclave but an antifungal sterilising solution would be adequate. (i can hear the horrified gasps)
    anyway coming to the point of the op, elderly people need to have their nails cut by someone, whether it be pods, hairdressers, family or whoever, but someone has to do it, i am 7 months pregnant and someone has to do mine.
    most elderly people are willing to pay, so it may as well be podiatrists who do it

    i used to charge 16 pounds and it would take me 20 minutes to cut the nails and get the hell out of dodge, (yes i used to autoclave!) so even though you wont be outstandingly rich you will be performing a great service and that gives you a good feeling.
    incidentally we also used to have the 80 year old guy in my area who used to go around cutting nails, he qualified as an electrician and used to used wire cutters to cut the nails for a fiver, all the old folks loved him and were extremely happy with his treatment, even though to me the nails were mangled, he finally died, but my hubbie swears by his wire cutters to do his own nails, he never lets me do them - says i dont cut them short enough, he likes to have them "almost bleeding" (his words) but thats another story
     
  24. Cheesy

    Cheesy Member

    Oh I understand completely that private practitioners need these people to continue to see them for their footcare etc and wouldnt dream of changing that, but these discussions are often about those patients, (and there a quite a lot out there) who would come to the NHS for podiatry because they cant manage themselves and genuinely cant afford (or cant remember) to get private treatment.....it also placates those who argue that there should be social nail care available on the NHS, we run a course at the local college to educate those who are interested in performing basic nail care, nursing home staff, carers etc, but not to carry out any other type of podiatry work.
    Cheesy
     
  25. zaffie

    zaffie Active Member

    Hi all

    I've tried to keep out of this debate and failed:eek:

    I still see some MOP (ministry of war pension patients) they do not pay any thing near my normal fee. They don;t get any "less" from me so I loose money on them:craig:

    Years and years ago I used to do "contract" work for local NHS. It paid badly and involved heaps of paperwork. They were tardy in their payments and quite frankly I did not think it was worth the effort.:bash:

    I do feel sorry for some of my old dears who were let us remember promised NHS care from cradle to grave:empathy:

    Coming to the end of my career I feel great sadness for younger pods and the way the profession is being eroded. It does not seem any better than when I first started out bright eyed and bushy tailed :bash:
     
  26. DTT

    DTT Well-Known Member

    Hi again

    That's really constructive in the future of this profession ??

    I don't think anyone is advocating social nailcare should be done on the NHS but they are advocating the elderly should have proper PREVENTATIVE care and screening by A PROFESSIONAL who can recognise early signs of diabetes /pvd etc ?

    So why are the NHS / age concern providing nippers to the elderly without any sterilisation procedure / information :rolleyes:

    Congratulations:D

    Who does yours then ?? do you go private ?? or perhaps the hairdresser ?? or perhaps through the back door of the NHS to a "mate" ??

    The fact is many patients ( pregnant included) cannot get nailcare on the NHS in many area's.

    We can ( and are) giving the income away to others rather than keeping it "in house" as part of continuing preventative care.

    History will dictate the outcome ,but with the apparent contempt for the service by some I feel it will be the profession as a whole that will be the losers.

    cheers
    Derek;)
     
  27. twirly

    twirly Well-Known Member

    Hi Zaffie & all others in this thread,

    I too tried my refrain from participating in this thread.

    Oh how I tried...................

    But. Well you know how it is.

    My private practice is a small concern when compared to many others but it is mine.

    I am fortunate in the fact that I have a number of patients who regularly attend my clinic for 'routine' treatment.

    I provide them with professional podiatric care in a clean, professional clinic abiding with H&S (health & safety) regulations, CPD requirements, local authority compliance & professional indemnity legislation prerequisite. (Does this list ever end?)

    I do appreciate cheesys' standpoint & many others who have taken the time to be included in this thread but (BIG BUT) why do chiropody/podiatry patients believe that they can haggle a cheaper deal?

    I am all for free enterprise but 'joe public' have no clue what a podiatrist is. They are inclined to follow their nose & ring the one who says what they do on the packet..............

    I do not wish to give away my services to another provider be they FHP, hairdresser or anyone else.

    I want to provide foot health to individuals seeking a professional service.

    In truth I feel the biggest let down for both patients & professionals is the lack of advertising for our services. What we do, who we are etc. Our professional bodies let us down by taking our money & underselling our profession.

    However, given this I still will NOT negotiate my 'basic' routine care costs.

    We all know WE meet our overheads therefore our overheads + time + treatment = cost to patient.

    I will never understand selling ourselves short to appease an individual who wouldn't look twice at the cost of any other professional treatment.

    Regards,
     
  28. zaffie

    zaffie Active Member

    Hi all

    How many times have you been asked if you give a senior citizen discount because the hairdresser does?:confused:

    Problem is jo publics perception of our profession.:eek:

    I think a lot of the time we are not classed as "professionals":bash:

    And I for one am a bit fed up of trying to educate jo public as to our status:bang:

    Like i said earlier feel sorry for the younger pods and what their inheritance might be
     
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