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The BBC are also reporting on this: They said my feet weren't bad enough
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Foot care is vital for older people to stay mobile
Age Concern has warned older people are struggling to access vital foot-care services on the NHS.
Ethel Rourke, 87, from Basildon in Essex, knows only too well the frustration of not being able to care for her feet.
She has arthritis in her knees and spine and so cannot bend over to reach her toe-nails.
For years she attended her local NHS chiropodist to get her nails cut and to remove hard skin on the bottom of her feet but then she was told she was not a severe enough case.
'Too busy'
"The chiropodist always did a really good job," she said.
"But then I was told I couldn't get it anymore.
"They just said there were so many people and they were so busy they just didn't have time to cater for people that are not too bad," says Mrs Rourke, who is registered as disabled and has to use a wheelchair on longer journeys.
"My husband cuts them as best he can but it isn't as good," she said.
"He manages to keep me comfortable."
Mrs Rourke's husband Ernie, who is 85 and also disabled, still gets an appointment as he has much worse problems with his feet including ingrowing toe-nails and corns.
"If you're suffering enough fortunately they'll still see you," Mrs Rourke said.
Press Release: The Society of Chiropodists and Podiatrists Welcomes Age Concern Feet for Purpose Report
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LONDON, August 20 /PRNewswire/ — The Society of Chiropodists and Podiatrists welcomes Age Concern’s campaign to improve the foot care of older people and the publication of the Feet for Purpose report,etquot ; said Janet McInnes, chairman of the SCP.
The SCP, along with other organisations including Age Concern, has highlighted again and again the impact of a lack of investment in foot health treatment for older people. The importance of good foot health in maintaining older people’s independence, mobility and social contact cannot be overstated.
The SCP supports the recommendation in the report that PCTs, in co-operation with local authorities, should undertake comprehensive assessments of local foot health needs and commission services from a diverse range of providers.
Like Age Concern, the SCP is unable to estimate with any accuracy the cost of fully funding podiatry and foot care services, because the Department of Health no longer collects the data. But physically active older people place fewer burdens on other parts of health and social services than those who are housebound and isolated, so the health and economic benefits of funding these services are clear.
The SCP shares the concerns about the position of people with diabetes who are not receiving an appropriate service. Diabetes UK has highlighted the increasing number of cuts to NHS diabetes services and has called for integrated care for all people with diabetes.
The SCP is working with Age Concern to update our joint guidelines on the provision of Age Concern foot care services. It is particularly important that volunteers are able to identify foot problems that should be assessed by a podiatrist, and have a pathway to refer clients to a local NHS service or private practitioner.
The SCP joins Age Concern in calling on the Department of Heath to give a lead in ensuring that the important issues in the report are addressed.
Notes to Editors
The Society of Chiropodists and Podiatrists represents 83 per cent of registered chiropodists and podiatrists in the UK. It is the professional, educational and trade union body for chiropodists and podiatrists.
A lot of media outlets (including radio) are running this story.
here is the Eastern Daily Press version: Warning over chiropody services 'postcode lottery'
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More than 2m older people are being left housebound and disabled because of a lack of footcare, a leading charity warns today.
Age Concern say chiropody services on the NHS are often a postcode lottery, leaving many people to either put up with painful foot and toenail problems - or pay privately for treatment.
The alternative - which affects many of the poorest and most vulnerable older people - is to lose independence and suffer deterioration of their physical and mental health.
Age Concern Norfolk last night called for "timely and accessible" footcare to be available through the NHS to all who need it.
Linda Gill, information and advice manager for Age Concern Norfolk, said: "There is no widescale footcare in Norfolk provided by the NHS/GP surgeries There may be some chiropody provided for people with specific medical complaints, but even this is patchy and may entail travelling miles to a designated clinic.
"The impact of the lack of footcare cannot be underestimated, not only can it cause great discomfort and distress, it can impede mobility and cause deteriorating physical and mental health.
"Age Concern Norfolk would like to see footcare back where it belongs, a service from the NHS which is timely and accessible."
The charity is launching a major national campaign called Feet for Purpose, aiming to ensure older people who need footcare can receive it without the need to pay.
Gordon Lishman, director general of Age Concern, said: "Foot care services are failing older people, and a postcode lottery is leaving those in some areas without any services at all. Footcare services should be free and universally available to those who need them - yet increasingly in many parts of England they are being restricted or withdrawn."
The charity, which says NHS chiropody services have been rationed over the last decade, called on the Department of Health to take a lead in resolving the problem and include chiropody in the NHS maximum waiting time target of 18 weeks.
In Norfolk, podiatry services have been hit by staff shortages particularly in the west of the county, but the service is also being reviewed as part of the turnaround plan drawn up by the PCT as it endeavours to cut a £46m deficit.
Norfolk PCT say that podiatry services for older people are currently provided within hospital settings, clinics and community services. A spokesman said: "In west Norfolk patients are referred to the service by a healthcare professional. The rest of Norfolk patients have the option to self refer for some services and are triaged according to their condition. The PCT recognises the need for a consistent and equitable service for all patients."
Great Yarmouth and Waveney PCT say demand for podiatry services are high but stress that people with significant risk factors that may lead to complications are given a higher priority. People can apply direct to the service for treatment, by completing an application form from local clinic receptions and GPs.
A PCT spokesman said: "On receipt, application forms are screened by a podiatrist. If, after screening, a patient is considered eligible for treatment they are sent an appointment for assessment."
The SCP is working with Age Concern to update our joint guidelines on the provision of Age Concern foot care services. It is particularly important that volunteers are able to identify foot problems that should be assessed by a podiatrist, and have a pathway to refer clients to a local NHS service or private practitioner.
I am sure that all HPC private practitioners both SCP members and Non members are delighted that the SCP are helping Age Concern to train 'volunteers' to deliver a substandard, 'approved' provision at a very reasonable cost!
Charity?
Concern?
Tool of the government?
Take your pick.
Bob, soon to retire, and looking for something to do.
Perhaps I'll work in a charity shop on the high street, selling clothes next to a second hand clothes shop, and books next to a 'cut price' book shop. After all at least 5% of everything they earn goes back to the needy.
we have an age concern volenteer service locally and in my experience it works very well
But you are missing the point. These elderly people are not being seen by a Chiropodist and are missing out on a much needed overview of their foot health.
Age Concern also leave much to be desired in their investigation of what private providers of foot care can supply. They appear to rely on heresay within their report rather than factual costs of what HPC regulated podiatrists and chiropodists charge for their nail cutting service.
This "problem" was 1st reported in 2002 by the BBC and most probably before that by other sources. Hasn't anyone worked out a fix yet?
At the risk of stating an "inconveniant truth" there are not enough chiropodists in the country to provide routine footcare for every elderly person.
We're a medical service. Care of non pathological feet is social care. Yes we can do it best but you don't send dentists around to peoples houses to brush their teeth.
Sorry this reply was before your question about andy. The reason it is relevant is because this is the classic PP vs NHS dilemma (yes I'm a PP) denied by the SCP, simple.
Time for you to come out of your NHS cocoon and stop propounding 'theory'.
Evidence would say there are far too many Podiatrists available. They may not be being employed by the NHS, because the NHS has lost it's focus and now spend far too much money on 'specialist' care MSK being a prime example as opposed to 'palliative' care the Cinderella.
However what ever the facts, people like you, prepared to 'give away' 'bits that do not interest you' are the reason 'Our' profession and 'Our Society', the SCP continues to attract such derision.
Time for you to come out of your NHS cocoon and stop propounding 'theory'.
NHS cocoon. Great image!
I don't really understand your point here. Is it theory in general you don't like of one theory in particular?
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Evidence would say there are far too many Podiatrists available. .
Oh really? My mistake. Show me the evidence which says there are far too many podiatrists available and i'll admit you were right on that. Glad to see you are using evidence and not just "propounding theory".
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They may not be being employed by the NHS, because the NHS has lost it's focus and now spend far too much money on 'specialist' care MSK being a prime example as opposed to 'palliative' care the Cinderella
Fair enough. (who is MSK by the way?) Which bits of specialist care should the nhs cut? Surgery? Wound management perhaps? A few diabetics might lose limbs here or there but what the hell.
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However what ever the facts, people like you, prepared to 'give away' 'bits that do not interest you' are the reason 'Our' profession and 'Our Society', the SCP continues to attract such derision.
I'm crushed. I've never been a "people like me before." I love that you started that paragraph with "whatever the facts" as if they are irrelevant. You're right i'm sure. We'd be much more respected as a member of the medical (that word again) team if we spent all our time cutting perfectly healthy toenails. Maybe then we could send the dentists around to brush peoples teeth and physio's to rub their backs for them. BTW i've not found myself the subject of derision.
Give bits away? We never OWNED that bit. Since when are we the only people who can cut toenails?
Are you not going to ask me how high up i am? I looked it up. This minute about 60 feet above sea level. 66 when standing. Oh and i do private work as well so i will admit to a vested interest there.
Sorry this reply was before your question about andy. The reason it is relevant is because this is the classic PP vs NHS dilemma (yes I'm a PP) denied by the SCP, simple.
Time for you to come out of your NHS cocoon and stop propounding 'theory'.
However what ever the facts, people like you, prepared to 'give away' 'bits that do not interest you' are the reason 'Our' profession and 'Our Society', the SCP continues to attract such derision.
otherwise healthy people with no foot pathology who simply cannot cut their toenails do not need to be seen by a podiatrist, nhs or pp. now, should they opt to be seen privately that is their choice and i have no problem with that however it is my job to educate patients in the best way to self care wherever possible and i feel that voluntary provision falls into this catagory.
the profession as a whole, nhs and pp, surely benefits if we are seen to be treating pathology and not mearly providing social care?
Again you NHS pods seem to have time to sit on forums and reply. Robert I give up with you, your arguments are far too persuasive.
'Normal people'.
OK they are normal, so you recommend 'volunteers'? at £6 per pop.
Very sad!
Andy
Sorry no offence meant. You clearly have spent a long time at the foot, thus seeing many changes in NHS podiatry provision.
My concern is that for the sake of expediency the 'powers that be' are prepared to follow a course that is more dictated by fiscal policy than patient need.
Have we all forgotten our role as 'primary contacts', and those silly situations, 20% of the time when we use the 80% of our knowledge.
I know that I have saved someones limb. Not because I was a brilliant practitioner but because a holiday maker came to see me with diagnosed Gout.
Why have we lost so much confidence in the 'whole' of our practice skills that we can accept cutting toenails is below us?
Bad news Andy. R.E.G. is onto us. On the society forum he admits he's discovered:-
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the collusion of the NHS pods to destroy the profession!
And warns
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NHS pods should be very careful, at the rate NHS posts are disappearing, and the headlong rush into ‘specialist’ posts, they could soon find themselves out on the streets with us PPs, then the true competition can start.
Having read the other forum's threads i think i understand a little better where you are coming from now Bob (Assuming i've matched the writing styles correctly). I think you ascribe a slightly sinister slant to the whole thing and you propensity to exaggerate your case does'nt help you any, but i DO see your concern.
It seems that you see the "routine" element of our practice (including what i would call social care) as a key element of our work, indeed the foundation of our work upon which the rest is built and fear that if that is taken away from us by less skilled and therefore cheaper practitioners there will be insufficient work left for qualified pods. It seems to me that you see the NHS pods as cheerfully banging holes in the bottom of the ship we all share not realising that we are sowing the seeds of our own destruction and our lifejackets are not so boyant as we beleive. I imagine that you see the specialist fields of podiatry as the crows nest of this boat. That we are high enough to feel smugly safe but do not realise that we will follow the boat to the briny depths when we sink it, right after those manning the oars and just as inevitably.
At first I was going to argue with you, but on re reading your post No. A brilliant piece of writing if a trifle flowery.
Outing me is not a new thing Colin Bain did it 3 years ago when we debated the HPC.
My only argument would be 'who is in the crows nest'? I think it is the good PPs, because the 'specialist NHS pods' will be sailing in a different ship, under a different captain.
Just my thoughts, at least they generate some debate, who knows what is right or wrong?
At first I was going to argue with you, but on re reading your post No. A brilliant piece of writing if a trifle flowery.
Outing me is not a new thing Colin Bain did it 3 years ago when we debated the HPC.
My only argument would be 'who is in the crows nest'? I think it is the good PPs, because the 'specialist NHS pods' will be sailing in a different ship, under a different captain.
Just my thoughts, at least they generate some debate, who knows what is right or wrong?
Bob
Cool. We're on the same page now at least. Reading you're other threads makes this one make sense.
Oh and i do flowery quite a lot. Just not as much as Rosy.
I don't know what outing is in that context but i assume its bad. No worries. Venting is good for the stomach lining, hair loss and blood pressure. We should all have a rant from time to time. You do certainly generate debate and i respect that. I love it when people agree with me. I love it even more when people disagree with me. Apathy i cannot stand, so if you ever want to tick me off don't tell me that people like me are the reason the profession gets debrided. Just do a vicky pollard "whatever".
Quote:
My only argument would be 'who is in the crows nest'? I think it is the good PPs, because the 'specialist NHS pods' will be sailing in a different ship, under a different captain.
So do you think we in the nhs are holing our own ship, The good ship ppods or both? Or has the whole ship analogy gone too far?
For the benefit of this forum could you share your definition of social care vs medical care? I think it would add more to the debate than you and i tearing each other into tiny strips. I'm sure Admin is lurking with his "Oh god why can't UK threads just stay polite i swear i'll shut the whole bloody catagory" face on. Sorry Craig, blame the climate. We'll play nice from now on i promise.
Regards
Robert
PS IMage of Andy in echo's and fishnets. Thats just grim. :(
At the risk of stating an "inconveniant truth" there are not enough chiropodists in the country to provide routine footcare for every elderly person.
We're a medical service. Care of non pathological feet is social care. Yes we can do it best but you don't send dentists around to peoples houses to brush their teeth.
I think age concern type folk are a good plan
Regards
Robert
Has anyone actually bothered to read the Age Concern Report "Feet For Purpose"?
Age Concern openly admit they are dealing with conditions outside their capibilities - involuted toenails, thickened toenails and toenails attached to patients with high risk medical conditions. Age Concern are coping with nail cutting but only to a point. The service is oversubscribed and the work they are coping with is not simple nail cutting as many of my colleagues fool themselves into thinking.
Robert, nobody is asking for the provision of routine footcare for every elderly person. For goodness sakes, there are elderly people that will pass from this earth on a daily basis never having had the need to seek the advice, attention from or nails cut by a Podiatrist or Chiropodist. What Age Concern is asking is that all footcare from basic nail cutting to chiropody must be free at the point of use for older people who need it.
Can't anyone put forward a suggestion that whilst it is impossible to provide an adequate nail care service free at the point of contact to those elderly that need it, that there are ways and means of providing a subsidised service involving private practitioners as well as the voluntary sector?
I am a Private Podiatrist. I am registered with the HPC. I came through the old diploma system. I am a member of SCP. I do not scribe under my real identity. I provide a nail cutting service which costs the elderly £1 a week. Please show me an elderly person who could not afford £1 per week? If the NHS managers, DoH, Age Concern, SCP and other professional bodies who may have an interest in palliative nail care, Private Podiatry Sector and Uncle Tom Cobbly and all cannot sit down and discuss how we can subsidise £1 a week, this profession should be towed out to mid-atlantic and sunk.
I recognise that nail care in the elderly is social but can quickly change to preventative without notice. I find the attitude of my NHS colleagues towards patient's only requiring nail care irresponsible.
Good for you Robert that you do have an interest in private practice. May be one day you will grow into the role and look at it with a business perspective on how you can remedy a situation where the NHS don't want to cut toe nails, Age Concern volunteers can cut some toenails but not all and yet the private sector has an untapped availability to provide nail care.
There is a fantastic and easy solution to all this mess staring us straight in the face but because this profession has a total inability to co-operate within the UK it gets completely by-passed.
GB
Last edited by George Brandy : 20th August 2007 at 10:16 PM.
There is a long association between Age Concern and podiatry which goes back thirty years.
Identifying need is clearly important and trying to meet that need, equaly so, but the real concern is in thirty years nothing seems to have changed. Infact it has probably got worse. In the early eighties Winkler and Kemp's independent review of podiatric need (UK) confirmed there was a crisis, yet despite making some useful recommendations to overcome it, nothing happened. These author's findings have consistantly been reinforced by other reviews, so why has there been no change in policies?
Hopefully this new report will make a difference. (excuse me for a momement, but that is Elvis Presley and Buddy Holly on the roof again. ). I doubt it. More power to the elbow to everyone involved of course, but foot care for the elderly may not lie within the "podiatry domain" anymore?
I am sure what you say is factual/true, but that does mean it is right.
I think a statement like 'there has been a long association between older people and Podiatry (sorry Chiropody, older people do not want Podiatry) which goes back over 100 years, is just as valid.
I disagree with you that in the main foot care for the elderly will no longer lie within the domain of Podiatry, it will. All you need to do is redefine Podiatry as Social care Podiatry, and add yet another title to those already available, fully trained NHS qualified foot health technician?
This is all too common in the UK where you are more likely to see a practice nurse than a doctor, once you have been assessed by a 'receptionist', and to meet a 'social control operative' than a qualified Police Officer, they will be writing reports in those nasty offices.
In the main though I probably agree with you. By the way do you Ozzy's not have your own guardian angels? We Poms have Farther Christmas, Flying Pigs and Lord Lukin.
Robert, nobody is asking for the provision of routine footcare for every elderly person.
GB.
Sorry. I thought that was what reg was saying here.
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Andy - we have an age concern volenteer service locally and in my experience it works very well
REG - But you are missing the point. These elderly people are not being seen by a Chiropodist and are missing out on a much needed overview of their foot health.
and here
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I disagree with you that in the main foot care for the elderly will no longer lie within the domain of Podiatry, it will. All you need to do is redefine Podiatry as Social care Podiatry
,
That elderly people being seen by AC are missing out implys that they should be seeing us. Or have i misunderstood?
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For goodness sakes, there are elderly people that will pass from this earth on a daily basis never having had the need to seek the advice, attention from or nails cut by a Podiatrist or Chiropodist.
Agreed. I think this is where AC nurses have a role. Like Andy we have an AC service which works very well down here.
That said i can see a place for PPI's somewhere here. The dentists did it after all. Not the worst idea anyone has ever come up with.
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Good for you Robert that you do have an interest in private practice. May be one day you will grow into the role
I doubt it I much prefer my day job.
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I'm not too sure I want to continue this discussion.
You say we are now on the same page, how wrong can you be?
That you require a definition of 'Social care vs medical care' means that you will never understand where I am coming from.
But let me ask you what is so 'medical' about podiatry provision?
Perhaps if we look at 'Care' as a concept : and start from there society on the whole could improve?
Firstly would you mind clarifying where you stand vis a vis the above bit? Are you advocating podiatrist provision for all over a certain age or podiatrists for some and AC nurses for others. Somewhere in all the sarcasm and hyperbole it became unclear.
Gee whiz bob, improving society as a whole is a tall order. Interesting idea though.
I think i kind of understand where you are coming from. I just don't agree is all.
Whats medical about podiatry? Well for a start my degree certificate says "podiatric medicine". We are referred to as a "proffession allied to medicine". The patients I treat are refferred by other medical practitioners with medical pathologies. The fact that the skills i learned as part of my podiatric medicine degree allow me to carry out social care does not, IMHO change the medical nature of the profession.
But if you are out of this one then answering your question was a waste of time anyway. Oh well
Originally Posted by R.E.G in response to TOESLAYER
Do you Ozzy's not have your own guardian angels?
Think the glasses in Diggers will be rattling with that one!
The real problem here is not Age Concern or FHPs or anyone outside the professional community involved with footcare, but a lack of a coherent strategy by the professional body in dealing with the demand for footcare services. A clear definition of what care should be provided by the NHS and the private marketplace would be of enormous benefit to patients and the profession alike. The NHS has attempted to define what it provides as "medical" care and has tried to move away from what it calls "social" provision. I have no problem with that - providing these definitions are clearly communicated to the public, who remain, on the whole confused and uncertain what care is provided and by whom.
Should public money be used to provide care to patients who present with problems such as recurring callosities caused by inappropriate footwear for example? Should society subsidise care - even for basic footcare services such as non-pathological toenail cutting - for patients who cannot afford private fees and who cannot manage their own care due to infirmity or age? Most people, I think, would answer no and yes to both questions - the State should concentrate in providing acute and specialist care but also has an obligation to assist those in Society who are vulnerable and who are on low incomes - but that does not necessarily mean that care should be provided within the existing NHS structure.
The simplistic approach whereby patients enjoy access to free footcare when the reach pensionable age is also unfair. There are wide variations in wealth in this sector too and we need to look at more appropriate ways of delivering publicly funded care - which is not "free" - to those most in need. I agree with George Brandy wholeheartedly insomuch as there is an enormous opportunity for the profession to make the case that it would be beneficial for the public to access trained clinicians to ensure high quality care - in whatever arena - public or private- that is appropriate for them. To do so, we need better cooperation between the NHS and private practitioners through coherent policies agreed between the professional bodies and government. That way we can begin the task of meeting the foot health needs of society as a whole - not bickering between ourselves at our manifest failings.
__________________
"citing an indisposition due to special circumstances"
I am a Scot loiving in exile in the sun and diggers to me is the 'earts pub in Edinburgh. Thanks mark. In a previous life or two ago I was a podiatry manager grappling with these issues, twenty years ago. When I was doing teacher training in the mid seventies I did the only gallent thing I ever have done in my life and gave my female colleague the idea of doing a review on the then latest Age Concern report for her assignment . She got top marks and I did'nt. So I know these reports by heart . I also worked briefly with Judith Kemp and Winkler at Cranfield Institute Social Policy Unit when they were compiling their publication.
So this is all too real.
Off to watch the Bill and have a barbie - you cann't beat it.
toeslayer
Has anyone actually bothered to read the Age Concern Report "Feet For Purpose"?
yes
Quote:
Originally Posted by George Brandy
Age Concern openly admit they are dealing with conditions outside their capibilities - involuted toenails, thickened toenails and toenails attached to patients with high risk medical conditions. Age Concern are coping with nail cutting but only to a point. The service is oversubscribed and the work they are coping with is not simple nail cutting as many of my colleagues fool themselves into thinking.
missed the bit about AC treating high risk medical conditions, where was that?
again, can only speak from my experience locally but i am happy that all referrals to AC are appropriate and that should an AC volunteer find something outside their scope that they refer the patient back to us highly trained goverment operatives.
__________________ malpractice makes perfect
Last edited by andymiles : 21st August 2007 at 05:57 AM.
Reason: clarification
Feet for Purpose report
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Re: Feet for Purpose report
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