Supplementary evidence submitted by the
Chartered Society of Physiotherapy (WP36A)
INTRODUCTION
1. The Chartered Society of Physiotherapy
(CSP) is the professional, educational and trade union body for
the 47,000 chartered physiotherapists, physiotherapy assistants
and students in the UK
SUMMARY
2. NHS workforce planning has put few resources
into future demand forecasting for the smaller professions such
as the Allied Health Professions (AHPs) or healthcare scientists.
The considerable effort at forecasting made during the development
of the NHS Plan in 2000 has not been sustained. Any work
has concentrated on nurses and multiple medical specialties. AHPs
have been subject recently to poor guess work not workforce planning.
3. This is against a background of an increase
in demand for physiotherapy as a consequence of the many Department
of Health (DH) policy initiatives since the publication of the
NHS Plan. These include: delivery of the 18 week wait;
primary care developments; faster access to treatment via patient
self referral; increased rehabilitation and independence provision;
meeting the needs of older people; the Musculoskeletal Services
Framework; and recognition of the value of prompt intervention
in order to reduce the number of people requiring incapacity benefit.
4. Graduate employment problems are serious
in physiotherapy, speech and language therapy, dietetics; occupational
therapy; nursing and midwifery. The problems in physiotherapy:
— are not caused by too many physiotherapists.
The present output is in approximately in accordance with the
NHS Plan.
5. The problems are caused by:
— the NHS deficit reduction programme;
resulting in many frozen posts (and some eliminated) which would
have been suitable for new graduates;
— the creation of senior posts by Primary
Care Trusts (PCTs) instead of planning new junior posts;
— the senior post vacancies have been
filled by a flow of overseas (including Europe) physiotherapists
of around 1,200 pa. in 2004 and 2005; and
— serious failure by Strategic Health
Authorities (SHAs) and trusts to take responsibility for the new
graduates they have commissioned.
SOLUTIONS
6. The CSP is seeking the following solutions:
— increased resources into future demand
forecasting for AHPs and scientists in particular around national
co-ordination and at SHA level;
— "unfreezing" physiotherapy
posts;
— removal of physiotherapy from the
Home Office shortage occupation list; and
— a 1 year guarantee of jobs for new
graduates with a view to ensuring that new graduates are not lost
from the NHS.
RECRUITMENT, RETENTION
AND WORKFORCE
PLANNING
7. There has been a serious lack of resources
put into future demand forecasting for physiotherapy, other AHPs
or healthcare scientists. The exception to this was the work undertaken
in forecasting for the NHS Plan in 2000. However, in recent
times this focus on the future of the smaller professions has
not been maintained. Since 2000 the number of physiotherapy posts
expanded substantially; and traditionally there were many vacant
posts. The impact of measures to address NHS deficits has resulted
in many frozen posts and some post reductions in physiotherapy
and most other professions.
8. A workforce survey of physiotherapy managers
was undertaken by the CSP in July 2006. Responses covered
nearly half the physiotherapy workforce in England. Managers were
asked about the numbers of vacant and frozen posts within their
physiotherapy service and this revealed that in total 4.7% of
funded establishment posts were vacant on 30 June 2006. Taking
account of numbers of part time roles, and allowing for non-respondents,
it is calculated that across the UK 1,215 physiotherapists would
be needed to fill all vacant posts.
9. This is far in excess of the 1.1% vacancy
rate reported by the DH in its latest vacancy survey (31st March
2006) and, being closer to the "coal face" represents
a much more accurate picture of the true extent of vacant posts
in physiotherapy. The DH survey only records posts which have
been vacant for three months or more and which employers are actively
trying to fill. This therefore completely disregards any frozen
posts or posts which employers have stopped advertising due to
lack of applicants. The numbers of job freezes imposed as a result
of the financial problems affecting the NHS has reduced turnover
and impacted on the numbers of Band 5 posts available for new
graduates.
10. In Spring 2006, using the Freedom of
Information Act, the CSP obtained copies of the information submitted
by SHAs at the request of the WRT on future demand for physiotherapy.
The CSP was concerned to learn that the SHAs were only asked to
supply predicted figures and were not asked to justify or explain
how they had reached those totals. Furthermore, when questioned
by the CSP, few senior physiotherapy managers had known that this
information had been requested or had been asked to input their
views to the process. Eleven out of 28 SHAs had not submitted
information on future demand, including all (of the then) five
London SHAs. Few SHAs had separate data for physiotherapists.
This exercise resulted in predicted expansion in 2006-10 of just
1,648 wte. physiotherapists in England—the fact that the
same figure has been given for both headcount and wte. also has
caused the CSP concern about the accuracy of these predictions
and how much background work had gone into their calculation.
Yet it was this less than robust information that led the WRT
to conclude that there may be an oversupply of physiotherapists
if current commissioning levels are not reduced.
11. The CSP was extremely concerned by the
reports of the draft DH workforce planning document that was leaked
to the Health Service Journal (4 January 2007). Although reported
comments by Andy Burnham MP, Minister of State, that this was
an early draft might have been intended to reassure, the reported
predicted levels of oversupply of 16,200 AHPs and scientific technical
and therapeutic staff (ST&Ts) by 2010/11 have not been dismissed.
Of equal concern is that there has been no explanation of how
such a conclusion was arrived at, especially as it represents
an "about turn" in DH policy as set out in the NHS
Plan. To produce a "headline" figure for such an
amalgamation of professions indicates how little resource has
been invested in workforce planning for these professions since
the extensive work done in producing Investment and Reform
for NHS Staff—Taking forward the NHS Plan.
12. The CSP has been unable to obtain any
details of the proportion of the predicted oversupply that physiotherapists
would constitute. According to the DH Workforce Census figures
for September 2005 physiotherapists form around 14.5% of this
group. On this basis the DH prediction would imply that around
2,350 wte. physiotherapists (equating to a headcount of 2,800)
would be affected.
13. Demand for physiotherapy has been increasing
for many years. The DH workforce census shows that between 2003
and 2005 alone the workforce in England expanded by 11% or nearly
2,000 physiotherapists. The CSP has supplied detailed evidence
to the DH and WRT on the many ways in which expansion of physiotherapy
services can contribute to a range of government targets for the
NHS across a number of clinical specialties; reduce the workload
of GPs and consultants; contribute to achieving the 18 week wait
and the 4 hour waiting target for A&E; promote healthy living;
reduce the length of hospital stays, etc.
14. Out-patient waiting data is not routinely
collected by the DH (although Welsh and Scottish Executive bodies
do). A "snapshot" telephone survey of over 30 CSP stewards
in England (May 2006) confirmed anecdotal concerns raised by members
that significant increases in waiting times for physiotherapy
treatment are being experienced, with musculoskeletal outpatients
the worst affected, but also access to paediatric services, learning
disabilities, older patients and those with long-term conditions.
Examples include:
— in North Staffordshire, waiting times
for musculoskeletal outpatients were reported to have increased
from 36 weeks to 47 weeks, and waiting times in respiratory from
zero to four months;
— one trust in the West Midlands reported
community physiotherapy waiting times to have increased from one
week to six weeks;
— in Kent and Yorkshire, waiting times
increased to six-seven weeks from two weeks previously, with musculoskeletal,
rheumatology and neurology patients most affected;
— a doubling of waiting times from
four to eight weeks in Thames Valley, Kent and the North West;
— in the North East, outpatient waiting
times increased up to three months;
— in the East Midlands, routine waiting
lists reported to have increased to 43 weeks and rising.
15. In terms of services being cut or withdrawn,
outreach community work in GP surgeries and patients' homes were
mentioned the most frequently, but also hydrotherapy services,
women's health, mental health, respiratory rehabilitation, amputees,
falls and exercise clinics were also being affected
16. The issues outlined above highlight
the inadequacies of current workforce planning mechanisms and
the CSP is keen to work in partnership with the DH and NHS Employers
to provide constructive solutions to establish effective and meaningful
workforce planning. A strong co-ordinating role in workforce planning
should be established at national level. This must be supported
by the establishment of a senior post responsible for AHP workforce
issues within each SHA to help coordinate and support local activity
as well as providing strategic leadership and engaging with education
providers
GRADUATE EMPLOYMENT
17. The CSP has undertaken regular surveys
of employment of physiotherapy graduate since 2004. The DH did
not collect such data until quite recently.
18. The survey of the employment status
of physiotherapists graduating in 2005 (undertaken in January
2006) showed that approximately one third had been unable to find
work within the NHS. Whilst it has not been possible to track
them all, anecdotal information suggests that many of these have
now sought alternative careers and are lost to the profession
and to the health service.
19. A survey of those graduating in 2006
revealed that in July around 93% had not secured a physiotherapy
position. In December a sample survey of the employment status
of 706 of the 1,954 physiotherapists who graduated in England
in 2006 revealed:
— 13% had found permanent employment
as physiotherapists.
— 17% had only been able to obtain
short-term contracts as physiotherapists.
— 68% were still seeking their first
physiotherapy post.
— The remainder were no longer seeking
employment as physiotherapists.
20. In general, physiotherapy graduates
are very flexible in terms of how far they are prepared to move
geographically across the UK to take up a post—this has
inevitably caused a problem in other parts of the UK. There is
also recognition that service provision is moving from the acute
to the community sector. Although in the past physiotherapy graduates
have traditionally taken up their first post in the acute sector
they are both competent and willing to begin their career in the
community. The CSP is therefore concerned that both the DH and
NHS Employers continue to state that physiotherapy graduates need
to be more flexible in where they are prepared to work. The problem
is a serious lack of any suitable physiotherapy posts to apply
for as evidenced by managers reporting receiving up to 100 or
more applications for each "newly qualified" post.
21. The CSP remains extremely concerned
that:
— At a cost of around £30,000
to train a physiotherapist, £40 million pounds of taxpayers'
money will have been wasted if 68% of English graduates are unable
to find physiotherapy posts.
— Due to the current financial situation
within the NHS in England, many of those who have obtained short
term contracts may find that their contracts are not renewed in
order to help meet the vigorous financial savings targets that
are being imposed in many trusts. Junior physiotherapy posts traditionally
have a high turnover, with junior physiotherapists seeking to
expand their experience in a variety of settings. As these posts
fall vacant they become vulnerable to being frozen and cut.
— It is now six months since the majority
of these physiotherapists graduated and they will soon face increased
competition for posts from the 2,250 (over 2,600 across the UK)
physiotherapists due to graduate in England in 2007.
— A very clear commitment to expand
the physiotherapy workforce by 59% between 2000 and 2010 was made
by the Government as part of the The NHS Plan—a plan
for investment, a plan for reform. This was deliberately planned
in recognition of the increasing role physiotherapists have in
meeting rising patient demand and helping to realise a variety
of key Government manifesto commitments since 1997, such as the
18-week wait. The Plan required a total headcount of 24,800 qualified
physiotherapists by 2010. The latest available DH workforce census
for England (September 2005) shows that there were 19,997 physiotherapists
in post. This means that in order to achieve the target of 24,800
an increase of 24% or 4,803 physiotherapists will be needed. In
answer to a written question (Hansard, 29 July 2002, col
WA155) Lord Hunt of Kings Heath replied that as at 30 September
2001, there were 16,210 physiotherapists employed in the NHS in
England and that projections were that there would be around 8,000
more in 2009. The latest WRT projections exceed this.
22. The CSP remains committed to working
in partnership with the Department of Health and NHS Employers
to resolve this problem. Although dissemination of good practice
and encouragement to SHAs and trusts to take action will provide
some help, this will only tamper at the edges and will not have
a major impact on reducing unemployment. The CSP, along with other
health service trade unions and professional bodies is continuing
to press for a guarantee of one year's employment for graduates.
Only by such direct action can this problem be prevented from
escalating. All SHAs and employers must take their share of responsibility
for providing employment opportunities, as must third and independent
sector providers. If left to good will alone this will not happen.
INTERNATIONAL RECRUITMENT
23. During the past few years the high vacancy
rates among physiotherapists has resulted in a significant increase
in the recruitment of overseas-qualified physiotherapists. Non-EEA
citizens requiring work permits to work in the UK are only able
to apply for posts which appear on the Home Office shortage occupation
list. Since the summer of 2005 junior physiotherapists have been
removed from this list in recognition of the large numbers of
newly qualified UK physiotherapists who were unable to find jobs.
24. The CSP has analysed the figures collected
by the Health Professions Council (HPC) of the numbers of non-EEA
physiotherapists successfully applying for registration in the
UK.
25. In 1999 the CSP commissioned a report
into the recruitment of international physiotherapists.[48]
It has been useful to compare the information on international
registrants collected at that time with the current data as highlighted
below:
— There has been a huge rise in the
number of non-UK nationals who have successfully applied for HPC
registration since 1999. In that year there were 579 non-UK nationals
registered with the then Council for Professions Supplementary
to Medicine—the forerunner of the HPC. In 2005 there were
a total of 1,219 registrants—a rise of 210%.
— The country with the biggest increase
in registrants is India. In 1999 registrants from India featured
only in a category labelled "Other" which totalled 22. In
2004 there were 432 registrants from India rising to 472 in 2005.
— There are also a significant number
of registrants from the Africa with 376 applicants in 2004 and
a further 245 in 2005.
— There has been a fall in the numbers
being registered from Australia, from 256 in 1999 to 151 in 2004
and 178 in 2005. Numbers from New Zealand have dropped slightly
from 90 in 1999 to 70 in 2005. Many of these physiotherapists
use working holiday visas rather than work permits to obtain physiotherapy
posts in the UK and so will not be affected by the restrictions
of the shortage occupation list.
26. It is understood that a proposal to
remove all physiotherapy posts from the work permit shortage list
is now with Ministers—this was first mooted by the DH in
June last year. The CSP has supported this move on the basis that
this will help to create more vacancies at Band 6 and above and
will allow more movement of physiotherapists from Band 5 posts,
thus freeing up more posts for new graduates. More physiotherapists
will be needed to fill the vacancies that will be created in future
once non-EEA physiotherapists are no longer able to apply for
jobs in the UK.
CONCLUSIONS
27. Whilst workforce planning across the
health service will never be easy, it is disappointing that so
little effort appears to be made in the case of physiotherapy
or indeed other AHPs, as the FoI request revealed. Given that
the Government has done much to rightly to take advantage of the
skills that physiotherapists employ in an increasing range of
treatments and settings to complement the ongoing reform programme,
not to try to adequately quantify this growing demand is difficult
to understand.
28. The supply of physiotherapists, had
until this month, been a much more straightforward matter. The
Government had shown real courage with the NHS Plan in
2000 in seeking to implement a strategy that looked beyond the
next General Election, indeed beyond the next two. This enabled
the profession, the NHS and the academic institutions to produce
the necessary number of physiotherapy graduates to support the
investment in and reforms to the health service. With a three-year
training period, longer for other health professionals such as
doctors, the certainty of working to such a plan was a significant
improvement for all concerned—not least patients. The draft
workforce strategy report leaked earlier this month challenges
the NHS Plan and does so without appearing to have any
basis for suggesting hugely differing workforce demand. Against
a background of the impact that trying to return the NHS to financial
equilibrium over too short a period has had, it is questionable
whether there is any workforce strategy other than a return to
a "boom and bust" approach.
Phil Gray
Chief Executive, Chartered Society of Physiotherapy
January 2007
48 International Recruitment of Physiotherapists,
Buchan & O'May, 2000. Back
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