Evidence submitted by the Chartered Society
of Physiotherapy (ISTC 7)
INTRODUCTION
1. The Chartered Society of Physiotherapy
(CSP) is the professional, education and trade union body representing
the UK's 47,000 physiotherapists, physiotherapy students and assistants.
More than 98% of all physiotherapists in the UK are members of
the CSP and physiotherapy is the third largest health care profession.
Approximately 60% of chartered physiotherapists work in the NHS.
The remainder are in education (including students), independent
practice, the voluntary sector and with other employers, such
as sports clubs or large businesses.
2. The CSP welcomes the opportunity to submit
to the inquiry into independent sector treatment centres as a
significant proportion of our members either work for one or work
in an area which is served by one.
3. In response to this inquiry, we have
asked our members to assess what impact ISTCs have had on their
workload, their patients' experiences and pathways and any other
issues which they wished us to raise with the Committee.
4. The majority of them reported that they
could not yet give a clear indication of the impact that they
have made as they are relatively recent innovations and that there
has been so much other change taking place concurrently. The submission,
therefore, relies primarily on a small number of cases where some
impact has been detected as well as our policy as a national body.
What role have ISTCs played in increasing capacity
and choice, and stimulating innovation?
5. The first wave of ISTCs were subject
to the rule of additionality (ie staff were recruited from either
overseas or from staff who were not currently in the NHS or who
had not worked for the NHS in the previous six months) and so
were able to increase capacity to some extent. The CSP is concerned
that, with this rule not applying to the second wave, that the
NHS will lose staff to the independent sector which will hinder
the NHS's ability to innovate. We have no evidence that demonstrates
that the ISTCs are innovating more and offering better choices
to patients than the NHS treatment centres. There is also some
anecdotal evidence to suggest that NHS treatment centres are working
more closely with the rest of the local health economy which would
have a positive impact on patient pathways and innovative working.
What contribution have ISTCs made to the reduction
of waiting times and waiting lists?
6. The CSP acknowledges that there were
particular problems in terms of waiting times for some elective
surgical procedures and that ISTCs and NHS treatment centres have
had a role in bringing them down. However, we have reports from
members stating that waiting times for physiotherapy in primary
care has increased due to patients requesting that rehabilitation
takes place more locally to them than ISTCs or the acute trusts
can offer.
Are ISTCs providing value for money?
7. The CSP believes that it is not possible
to judge this question as, unlike the NHS, the ISTCs are not operating
on the national tariff and have guaranteed income streams regardless
of the number of operations undertaken. We are very concerned
that this has had an adverse affect on the ability of the NHS
to deliver, especially when the rule of additionality is removed
for the second wave. Furthermore, as outlined above, ISTCs are
sometimes being paid for rehabilitation services which are actually
being delivered by the local NHS. This funding does not appear
to follow the patient. This can result in an increase in local
physiotherapy waiting lists because this additional rehabilitation
activity is not been formally funded by PCTs.
Does the operation of ISTCs have an adverse effect
on NHS services in their areas?
8. We are concerned that there has been
some adverse effect on local NHS physiotherapy, but that it could
be rectified through effective planning. If the whole pathway
was defined in advance of the operation, including where rehabilitation
would be located, then it could reduce the impact on other services.
PCTs might then also see this increased activity reflected financially
as they are currently paying the wrong provider for rehabilitation
while NHS waiting lists lengthen and become more expensive to
manage.
What arrangements are made for patient follow-up
and the management of complications?
9. Evidence from the British Medical Association
suggests that the local NHS has borne the brunt of the management
of complications, especially for orthopaedic patients. This may
have been due to the lack of clarity in the delivery of rehabilitation.
What role have ISTCs played and should they play
in training medical staff?
10. It is imperative that ISTCs liaise with
local NHS services to undertake training and workforce planning.
Much of the routine work will be undertaken by the ISTCs and junior
physiotherapists will need to have some exposure to these procedures
as part of their training. The CSP believes that particular action
must be taken to ensure that there is no "cherry picking"
by ISTCs and that there is an appropriate workload mix for junior
staff.
Are ISTCs providing care of the same or higher
standard as that provided by the NHS?
11. We have no evidence to comment on this
question, but we would wish to see that this is monitored in some
way.
What implications does commercial confidentiality
have for access to information and public accountability with
regard to ISTCs?
12. We have no comment to make on this question.
What changes should the Government make to its
policy towards ISTCs in the light of experience to date?
13. The CSP believes that there should be
a level playing field and that the payment by results system should
apply wholesale to all providers. We would also wish to see physiotherapy
managers in the locality consulted in advance about effective
patient pathways following discharge. Rehabilitation must also
form a more explicit part of future contracts.
What criteria should be used in evaluating the
bids for the Second Wave of ISTCs?
— Whether they offer genuine value
for money (in terms of a level playing field).
— Whether they offer genuine additionality
of provision.
— Whether they have the support of
the local community as a whole and can demonstrate this through
a consultation process.
— Whether detailed systems are in place
to manage complications following discharge which does not unnecessarily
disadvantage the local NHS.
What factors have been and should be taken into
account when deciding the location of ISTCs?
14. ISTCs must offer additional support
to the NHS and therefore should be placed where there is most
need, most probably demonstrated through length of waiting lists.
They must, though, be accessible, especially to those who are
already subject to health inequalities.
How many ISTCs should there be?
15. It is not clear whether ISTCs will remain
in the market once the national tariff is applied, particularly
given that the backlog of operations will have been cleared to
a large extent. We believe that this should not be determined
in advance and that consideration should be given about whether
the independent sector is the appropriate place to expand this
service given the, admittedly still limited evidence, that the
NHS treatment centres have fitted more neatly into the local health
economy.
Rachel Haynes
The Chartered Society of Physiotherapy
9 February 2006
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