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
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
return to work assessments,
as appropriate; and
secondary injury prevention
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.
8. PATHWAYS TO
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
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
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
4 January 2006