Select Committee on Work and Pensions Written Evidence

Memorandum submitted by the Chartered Society of Physiotherapy

  1.  The Chartered Society of Physiotherapy (CSP) is the trade union, professional, and educational body for the 47,000 chartered physiotherapists, physiotherapy assistants and students in the UK.

  2.  The CSP is pleased to have the opportunity to submit to the House of Commons Work and Pensions Committee inquiry into reform of incapacity benefits and Pathways to Work. This submission will focus on the involvement of healthcare professionals and the implications for a successful nationwide roll out of Pathways to Work.

  3.  The CSP welcomes the current focus on occupational health and vocational rehabilitation within the public health debate. We believe that it has not been a high enough priority for Government and employers and the current levels of sickness, injuries, fatal accidents and disease originating in the workplace are unacceptable. The relationship between unemployment, poverty and poor health is well documented and health inequalities will continue to grow unless the issue of workplace health, and effective rehabilitative treatment, is addressed.

  4.  Physiotherapists, with their expertise in ergonomics and work-related ill-health, have a key role to play in supporting people on Incapacity Benefit through the provision of:

    —    rehabilitation;

    —    health education;

    —    return to work assessments, as appropriate; and

    —    secondary injury prevention strategies.


  6.  The primary aim of Incapacity Benefit reform must not be saving money. We would be concerned if 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.

  7.  The CSP supports the division of Incapacity Benefit into two as it should clearly and swiftly signpost people to the help that they need. We believe that this should reduce the number of medical assessments, thus relieving pressure on healthcare staff to concentrate on the delivery of healthcare. It must be based on up to date medical advice and also be open to the opinions of those claiming benefit about their capacity.


  9.  The CSP believes that Pathways to Work has been a very successful pilot which has enabled many people to return to work with the support that they need, when they need it. It has demonstrated that a multitude of professionals, working as a team, are required so that individuals are treated holistically and have all their needs addressed in a systematic and timely fashion. We fully support its roll out nationwide.

  10.  However, we are concerned that the intensive level of resources required to implement Pathways to Work will limit its scope due to the shortages of appropriately qualified staff. For example, there is not currently a surplus of physiotherapists specialising in rehabilitation who will be available to implement to Pathways to Work on a UK-wide basis, even if it was rolled out in a gradual manner.

  11.  In order to meet the needs of the population, issues around recruitment and retention of physiotherapists must be addressed. There are high levels of physiotherapy graduate unemployment (53% as of November 2005) and we are in danger of losing a cohort of physiotherapists if more is not done to ensure that they find an NHS post as soon as possible.

  12.  Furthermore, allowing people to self refer to physiotherapy, either through the NHS or through an employer-sponsored scheme would improve the opportunity for prompt and equitable treatment. Research into self referral schemes has demonstrated that patients received swifter and fewer physiotherapy interventions than if they were referred through their GP. This can only relieve the pressures on an already stretched service.

  13.  Prevention must form a much larger part of the strategy for incapacity benefit reform if we are to succeed with the limited resources available. The current rehabilitation situation is not targeted at the workplace, with the majority of care taking place in the acute setting and to a lesser degree in primary care. With closer ties between employers and Pathways to Work staff, and speedier access to occupational health services, much more could be done to prevent injuries becoming chronic.

  14.  We fully support 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.

  15.  The Association of British Insurers and Trades Union Congress have both stressed the importance of early access to physiotherapy services that can provide proper assessment and rehabilitation for workers. Many organisations are already promoting healthier working lives and have seen their sickness levels fall significantly. They have found that appropriate early physiotherapy intervention can reduce the recurrence rate of low back pain and reduces the likelihood of an acute episode of back pain becoming chronic.

  16.  A study of 14,000 US postal workers using an early treatment protocol implemented if the worker was off work for more than seven days, reduced costs by 55% and days lost by 60%. Other studies show that early physiotherapy intervention, including education and activity for acute episodes of back pain (ie seen within three days instead of 10) meant that 57% of patients returned to work within 10 days compared to the control group of 36%. The risk of developing chronic pain was eight times lower for patients in the early intervention group, with only 2% remaining out of work at seven month follow up compared with 15% in the control group.

  17.  The CSP strongly urges the Government to develop morbidity targets within the public health strategy. Quality of life must not be discounted when planning priorities and setting important targets. The Government must also develop a fair definition of rehabilitation so that it can be included in the payment by results system. Unless this happens, it is likely to continue to be a Cinderella service.


  19.  The Government must invest in Pathways to Work and the relevant staff in order for Incapacity Benefit reform to be a success. This must not be merely a money saving exercise. There are ways of using our staff more efficiently, such as self referral to a variety of healthcare services, but the Government must also do more to expand the number of professionals working in this area. Reform must also be accompanied by improved access to occupational health services and other preventative measures.

Rachel Haynes

4 January 2006

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