Health CommitteeWritten evidence from the Chartered Society of Physiotherapy (ETWP 80)

1. Summary of Main Points

Effective workforce planning and provision of high quality qualifying and post-qualifying education is vital to ensure NHS-funded healthcare is able to meet changing patient/population needs in clinically- and cost-effective ways.

The CSP believes that all providers of NHS funded healthcare must contribute to the future of the workforce. This includes student placements and learning opportunities.

Physiotherapy is made up of a national workforce, with staff moving around the UK throughout their careers. As a result, effective co-ordination and future planning cannot be co-ordinated solely at a local level. Nor can the NHS only commission for an NHS Workforce when competition will result in increasingly diverse health provision.

Investment in the existing workforce is essential to sustain and improve standards and quality of care. It is important to ensure due recognition/support of Continuing Professional Development (CPD) for sustaining service delivery, delivering a quality service and supporting staff development.

The CSP believes that if decisions about the numbers of healthcare professionals being trained are made locally it will become increasingly difficult to achieve a national overview and avoid piecemeal cuts being made by an increased number of commissioners. There is a clear danger that a more fragmented approach to workforce planning will lead to a boom and bust in staffing provision which has been so damaging to the health service in the past.

2. The Chartered Society of Physiotherapy (CSP)

2.1 The CSP is the professional, educational and trade union body for the UK’s 51,500 chartered physiotherapists, physiotherapy students and support workers.

2.2 Physiotherapy staff offer clinically effective and cost-efficient services for patients, across healthcare sectors and along the whole patient pathway. Physiotherapy enables people to move and function as well as they can, maximising quality of life, physical and mental health and well-being.

2.3 Physiotherapists facilitate early intervention, support self management and promote independence, and help prevent episodes of ill health and disability developing into chronic conditions. Reduction in sick leave and maintenance of independence is a major focus of physiotherapy care.

2.4 Physiotherapy is ideally placed to provide solutions to current healthcare challenges. It can play a strong role in addressing healthcare priorities in a rapidly changing health and well-being economy, maximising productivity and efficiency while providing high quality care. Physiotherapists are already developing and focusing their practice, demonstrating both clinical and cost effectiveness. They are assuming greater responsibility for complex, non-routine caseloads, taking on activity previously undertaken by medical colleagues and overseeing the delivery of care by others. There are areas where physiotherapy can extend its reach and deliver quality patient care and outcomes in a clinically and cost efficient manner.

2.5 Many physiotherapy services across England have successfully innovated and introduced initiatives to increase productivity. NHS Evidence has recently included self-referral to physiotherapy for musculoskeletal conditions in QIPP,1 based on evidence of its ability to improve quality and productivity. However efforts to continue to develop such initiatives are being hampered by both the demand for short-term efficiency savings and the speed with which the Government reforms of the NHS are being implemented. In our 2010 survey of NHS physiotherapy service managers 41% of respondents agreed or strongly agreed with the statement “Inadequate physiotherapy staffing levels are obstructing me from redesigning and modernising our service”.

3. Future Workforce Planning

3.1 All providers of NHS funded healthcare must contribute to the future of the workforce. However, the CSP is concerned that the scale of the new clinical commissioning groups will be too small to provide the big picture context needed to effectively plan the future demand and workforce need. It is also unclear how, at this level, the breadth of physiotherapy skills and practice could be preserved.

3.2 Physiotherapy is made up of a national workforce, with staff moving around the UK throughout their careers. As a result, effective coordination and future planning cannot be managed solely at a local level. National leadership with coordinated, accountable, regional decision-making is needed.

3.3 Service development should be aligned with financial and workforce planning and the involvement of clinical service managers, who can provide accurate data about the existing workforce and expert assessment of future staffing requirements at a local level, is imperative to achieving stronger, more effective workforce planning. This local level assessment must be co-ordinated in both regional and national level assessments of workforce needed.

3.4 It is our view that the Centre for Workforce Intelligence (CfWI) has an important role to play in providing leadership and expert advice on workforce planning at a national level across the whole healthcare economy. In our opinion, it is imperative for there to be an overview of workforce supply and demand and we have been concerned that CfWI recommendations are not consistently taken into account in workforce planning decisions at local and regional levels.

3.5 It is critical that the quality of data and analysis produced by the CfWI is of the highest standard and it is then consistently taken into account by commissioners when making decisions about the future demand/workforce planning. However, recently we have been concerned about the quality of reports from the CfWI, because for a reduction in the CfWI staff resources available to produce them. We have been unable to support their conclusions based on inadequate time and professional resources. It is essential that the CWfI is properly resourced by the Department of Health.

3.6 CSP believes that all healthcare providers should have a mandatory duty to provide data on their current workforce and their future workforce needs. This duty should apply to all providers and not only those providing care to NHS patients. This is the only way to ensure effective workforce planning and training support in an increasingly fragmented provider environment. There is an increasing danger that the NHS locally will only commission for its own NHS local needs and ignore the needs of the growing independent sector. These mistakes were made in the early 1990s and should not be repeated today. However, we acknowledge that there is potential for data about workforce to be misused and would argue that access and purpose will need to be explicit and regulated to ensure accountability.

3.7 Moves towards increasing the opportunities for flexible local implementation and innovation should be done within the context of ensuring that there is consistency in service provision and workforce development at local level. This will help to prevent a postcode lottery in the range and quality of services available to any local population. We support the need for professional engagement at local and national levels, but have concerns that this could be dominated by the larger professions of nursing and medicine. It is very important that there is an opportunity for smaller professions to have a voice at both levels.

4. Role of Commissioners and Providers in Education and Training

4.1 The CSP would like to see alternative providers of healthcare services taking their fair share of responsibility for student placements, for the funding of both qualifying and post-qualifying education and CPD, and for providing rotation posts for newly qualified staff. This is essential in order to ensure that the policy of “any qualified provider” is truly based on a level playing field. It is not enough to impose a “training levy” on independent providers which leaves the NHS with the role of providing placements. The responsibility of placements should be shared by providers.

4.2 We would argue that the provision of education and training for the future workforce needs to be a standard to be delivered by any qualified provider wishing to provide NHS services and therefore set and monitored within contractual requirements. We would also wish to see those health providers that do not currently provide NHS services contribute, as they benefit from public sector funding of all the costs involved in training and supporting healthcare professionals and support workers throughout their careers.

4.3 It is important that funding budgets include the costs of allowing all staff time to attend CPD training and development particularly at a time when efficiency savings and cuts to staffing are making it increasingly difficult for staff to be allowed this time.

4.4 It is unlikely all healthcare providers will volunteer to contribute in this way in an increasingly competitive provider market, so robust and transparent mechanisms must be introduced to ensure that each provider takes their fair share of the costs and responsibility. Smaller providers may not have the capacity to contribute directly in terms of providing placements, so we support the concept of a levy as an alternative means of contributing towards these costs, however, safeguards must be put in place to avoid a situation where all providers opt to pay the levy and there are no organisations prepared to offer the training.

5. Standards of Education and Training

5.1 CSP believes it is important to introduce a mandatory requirement that all healthcare providers should contribute to practice-based learning for students, while ensuring rigorous quality standards are upheld. Within the NHS Knowledge and Skills Framework, expectations on employers were explicit. These standards should form a mandatory minimum for staff CPD and training.

5.2 The CSP has well-established expectations of both practice-based learning and practice educators. Processes for implementing both sets of expectations are an integral part of our quality assurance and enhancement activity. Recognising the need for practice-based learning opportunities to develop students’ learning experience and outcomes in ways that reflect changing patterns of service delivery, CSP expectations of practice-based learning also complement the threshold standards for education and training as set out by the Health Professions Council as the statutory regulator.

5.3 The CSP is concerned that the Government’s proposals make no recognition of the role of professional bodies in education and standard setting etc CSP accreditation of education programmes is a clear quality standard, particularly in the context of a potential for greater diversity in education providers and given parallel policy directions in higher education reform. CSP is concerned that without the involvement of professional bodies the quality of education programmes will fall.

6. Developing the Existing Workforce

6.1 Investment in the existing workforce is essential to sustain and improve standards and quality of care. Staff who are empowered, engaged and well supported provide better care and we welcome the Government’s aspiration to support everyone in the healthcare workforce to realise their potential. We believe that the Government should place a requirement on all providers of NHS-funded healthcare to fund CPD for all healthcare staff.

6.2 It is important to ensure due recognition/support of CPD for sustaining service delivery, delivering a quality service and supporting staff development (including lateral career shifts to meet changing need). This has to take place at all levels of the workforce, recognising the diversity of practice and development that needs to be supported.

6.3 Although newly qualified physiotherapists are autonomous practitioners, appropriate clinical supervision is needed to support new graduates to consolidate and develop their learning. Broad based rotations are needed to ensure that the newly qualified are able to develop their skills in a variety of clinical settings, including to support their subsequent progression to advanced and specialist roles. This ensures that the physiotherapy workforce will have the necessary transferable skills and flexibility needed to be able to adapt to changes in health care provision rather than specialising too early in their careers. For this reason, it is also vital that senior physiotherapy roles of band 7 and above continue to be funded in order that this clinical supervision and leadership can be provided.

6.4 CSP is concerned that the positive investment made by Strategic Health Authorities in CPD for healthcare staff is at risk of being lost in the reforms.

6.5 We believe that all staff providing NHS-funded services should have access to appropriate forms of learning and development which supports service development and delivery, meets changing patient/population needs and provide appropriate opportunities for professional and career development.

6.6 We would argue that Higher Education Institutions need to have an expanded role in CPD to ensure the supply of high-quality evidence based learning that provides structured opportunities for professional and career development and the sustainable fulfilment of clinical service needs.

7. Proposed Reforms of the Healthcare Education and Training System

7.1 The CSP is concerned by the proposed dismantling of existing workforce planning structures, particularly the loss of expertise at national and regional level as a result of this. We do not believe that the capacity and skills needed to take this forward currently exist at the local level and, if this proposal is adopted, we would like to see plans put in place to ensure these skills are developed within local networks. We are also very concerned that proposed Local Education and Training Boards (LETBs) will lead to extensive and unnecessary duplication in the commissioning process for student places (for those in commissioning roles, those informing the process and education providers). This will work against high-quality workforce planning and create added expense.

7.2 The CSP is very worried by the potential collapse in vital workforce data collection for AHPs and other smaller professions under the new local plans and national structures. It would appear that the detailed national workforce data collection for medical specialities will continue but not for AHPs or other professions. The growing diversity of healthcare providers should mean an increased need for effective workforce data collection and analysis not less. This issue must be addressed and resolved in the new structures being created for workforce planning.

7.3 The CSP is concerned that the proposals really only consider entry to the profession. It is vital that the education and training system looks at the workforce across the board and considers the education needs of all staff, including the education needs of support workers and CPD for all staff.

7.4 Support from employers is vital to ensure effective education, training and CPD, but it is not enough in itself. In order for the system to be sustainable support is needed at a regional and national level from NHS managers, commissioners and the Government.

7.5 The CSP welcomes the creation of Health Education England (HEE) to provide sector-wide leadership and oversight of workforce planning, education and training. We believe it is positive that the proposed structure should enable an integrated approach at national level to identify the education and workforce needs across the health professions and to achieve this across medicine/other professions for the first time However, we believe this raises questions about how the new structure will be set up and implemented in line with the principle of a “level playing field”, so that the contributions and needs across all professional groups are looked at in an equitable and measured way. The benefits achieved under the AHP Professional Advisory Board should not be lost.

7.6 The CSP is calling for Health Education England to have an independent Chair and a broad interdisciplinary membership, as well as service user involvement. The CSP believes it is essential for the Allied Health Profession (AHP)/physiotherapy voice to be strongly heard at national (HEE) and local level and would like to see a clear role for AHPs on HEE.

7.7 The CSP believes that if decisions about the numbers of healthcare professionals being trained are made locally it will become increasingly difficult to achieve a national overview and avoid piecemeal cuts being made by an increased number of commissioners. There is a clear danger that a more fragmented approach to workforce planning will lead to a boom and bust in staffing provision which has been so damaging to the health service in the past. (See all the research into the huge mistakes of nurse workforce planning in the 1990s.)

7.8 We believe it is essential that the proposed LETBs remain as part of the NHS and work with strong accountability to Health Education England, with access to quality data about national and local workforce needs, and ensuring adherence to rigorous quality standards.

7.9 In terms of structure, national requirements are essential to mandate how LETBs are established, hosted and held strongly accountable for both the commissioning decisions that they make and their evaluation of the effectiveness of their commissioning decisions. As part of this, achieving standardisation and consistency in how the LETBs perform their role (including avoiding partial, perverse and destabilising decision-making) is imperative.

December 2011

1 NHS Evidence (2011) Musculoskeletal physiotherapy: patient self-referral

Prepared 22nd May 2012