Memorandum by The Chartered Society of
Physiotherapy (WP 66)
INTRODUCTION
The Chartered Society of Physiotherapy (CSP)
is the professional, educational and trade union body for the
45,000 chartered physiotherapists, physiotherapy assistants and
students in the UK.
The CSP welcomes the opportunity to respond
to the Health Select Committee's inquiry into the Government's
public health white paper. While physiotherapists are involved
in a wide range of public health work, our submission will focus
on occupational health and vocational rehabilitation, active self
management through self referral and NHS staff development. Our
submission to Choosing Health is available at www.csp.org.uk/libraryandinformation/publications/view.cfm?id=344
and refers in addition to the CSP's position on chronic disease
management; improving the health of children; maintaining active
and independent lives for older people; access to sports and leisure
facilities for vulnerable groups; extension of exercise referral
programmes; and leadership roles for physiotherapists and other
allied health professions.
The CSP congratulates the Government on the
publication of Choosing Health. The white paper restores some
of the balance towards primary care after sustained focus on hospitals
and acute conditions. We support the aims and objectives of the
paper and hope that public health will remain at the top of the
Government's agenda.
Physiotherapists are involved in the improvement
of public health at every stage from prevention, to diagnosis
and treatment and on to the development of sustainable programmes
for patients after treatment to maintain and improve general good
health. Physiotherapists also play a vital role in the promotion
of improved quality of life through occupational health, exercise
advice, fall prevention and smoking cessation. A greater focus
on preventative measures to improve public health, rather than
merely treating symptoms, will inevitably highlight the contribution
that is being made by professions such as physiotherapy.
OCCUPATIONAL HEALTH
AND VOCATIONAL
REHABILITATION
The Government is right to focus on improving
workplace health in the white paper. Health and Safety Executive
figures show that sickness absence costs British society up to
£30 billion a year and 40.2 million days are lost each year.
A third of these are due to musculoskeletal conditions and both
the Association of British Insurers and Trades Union Congress
have stressed the importance of early access to physiotherapy
services that can provide proper assessment and rehabilitation
for workers.
Vocational physiotherapy and rehabilitation
not only allow for a quick return to work and therefore economic
benefits of increased productivity, they can also provide fast
access to treatment, increase confidence about work abilities
and improve the general wellbeing of people who have had work-related
illness or injury.
However, the CSP is concerned that the emphasis
on returning to work as the ultimate goal could be counterproductive
in some circumstances and might overlook the needs of the long
term sick. The aim of rehabilitation should be restoration of
independence and resumption of normal daily life alongside prevention
of illness or injury in the workplace.
The CSP supports the introduction of a new dimension
to the Investors in People scheme to address employees' health
and wellbeing at work. This kind of voluntary scheme would enable
employers of all sizes to seek accreditation based on the provision
of early access to rehabilitative treatment for work-related illness,
a range of preventative measures and referral pathways to services
such as physiotherapy. It is vital that the scheme be based on
clear evidence and goes beyond superficial or cosmetic measures.
SELF REFERRAL
PROGRAMMES
While there is much that the Government, NHS
and healthcare professionals can do to improve the nation's public
health, it will only be when the public are able to take more
responsibility that health inequalities be reduced and significant
inroads be made. The white paper does not focus enough on developing
the skills needed by the public when using the health service.
Empowering patients to access healthcare when, how and when they
want it must be a major thrust of the public health agenda. The
Expert Patient Programme has begun to alter the way patients interact
with the NHS and how they manage their condition on a day to day
basis. Furthermore, there is growing evidence that patients are
more likely to undertake active self-management of their conditions
if they refer themselves for treatments such as physiotherapy
rather than being referred through many parts of the healthcare
system. Furthermore, it is also possible to introduce self referral
schemes for many other treatments, such as midwifery, podiatry
and occupational therapy.
The CSP argues that the extension of forms of
direct access, such as self referral to NHS physiotherapy, would
encourage people to seek clinical advice more quickly than otherwise,
and can promote healthy lifestyle and behaviour choices as part
of their clinical and medical diagnosis.
The Scottish Executive has supported a substantial
multi-site pilot to assess the detailed impact of self referral
in a range of settings. This project is due to report imminently
but initial research (Holdsworth L K. Webster V S. Direct access
to physiotherapy in primary care: now?—and into the future?
Physiotherapy 2004; 2: 64-72) demonstrates the difference
self referral can make to patient experience, GP consulting time
and outcomes. Patients were significantly more likely to attend
their appointment and to comply with treatment (this was particularly
marked amongst young men who are the least likely group to adhere
to their treatment plans). As patients were seen earlier in the
patient journey, their condition tended to be less chronic and
require fewer interventions. Furthermore, as such a large proportion
of GP appointments are for long term and musculoskeletal conditions,
the amount of time saved was a month's consulting time a year
for an average five GP practice.
Self referral for patients to physiotherapy
services is an eminently deliverable way to make patient choice
a reality, especially for those with long term conditions. We
are happy to make further costings and results available to the
Health Select Committee as well as statements of support from
the Royal College of General Practitioners, the Long Term Medical
Conditions Alliance and NHS Confederation.
STRATEGIC, SYSTEMS
AND WORKFORCE
DEVELOPMENT
For public health to improve across the spectrum,
multidisciplinary working must be more common, both at strategic
and implementation level. It is imperative that service delivery
is based on the experience and expertise of a wider range of healthcare
professionals, not just doctors and nurses, so that it reflects
the needs of all patients during their whole engagement with the
NHS and other government agencies.
The CSP very much welcomes the Government's
commitment to introduce training modules for all NHS staff. We
believe that continuing professional development is necessary
to underpin the white paper's objectives. It is important that
protected time for learning is available for all staff to ensure
take up is high. We recognise that staff training is not limited
to the NHS. As the professional body representing 98% of physiotherapists
in the UK, the CSP is currently undertaking a project to assist
our members in incorporating public health into their working
lives and if necessary redesign services so that they will more
actively promote public health.
The Public Health Institute of Scotland fosters
networks which bring together the full range of healthcare professionals
to develop its evidence base. The CSP believes that this attitude
to NHS staff will filter through to better standards of healthcare
and better outcomes than if only a limited range of people were
involved in the development of public health strategy and its
implementation. The white paper is not explicit about which healthcare
professionals will deliver on their proposals. We would like assurances
that the Government is not restricting roles, so that for example
physiotherapists, as well as nurses, would be considered for the
role of community matron. It will be crucial for the Government
to address this for workforce planning to be effective.
CONCLUSION
The CSP endorses the approach taken by the Government
in its white paper, but would like to see more substantial proposals
and improved consultation with all the professional bodies. Improved
public health very much depends on partnership working, Government,
trusts, NHS staff and patients alike, and the Department of Health
must formulate policy with all stakeholders. There is widespread
commitment to delivering the Government's goals and it is vital
that public health remains high on everyone's agenda.
January 2005
| 
