ARC motions 2005/1

Primary Agenda

• CSP Policy
• Professional Practice
• Social Issues

CSP Policy

1. With the Government agenda focused on modernisation and new ways of working, there is an increasing need for AHPs to undertake joint activities and pool resources. Conference calls upon the CSP to actively pursue stronger links with other AHP organisations, including discussions on the possible creation of a College of Allied Health Professions. Trent Board .

   The CSP is already taking action on several aspects of this resolution which concerns joint activities with other AHP organisations and the pooling of resources. The Allied Health Professions Federation (AHPF) includes all the AHP professional organisations whose members are registered with the Health Professions Council. The Chairs and the Chief Executives of the AHP Professional organisations meet together six times per year. The AHPF is chaired currently by Grahame Pope (the previous CSP Chair of Council 2003-2005). Sarah Bazin currently CSP Chair of Council is the CSP elected representative.
   
   The AHPF already co-operates extensively on a wide range of Health Policy issues which affect the organisations collectively. It has been undertaking a number of joint activities. For example, in England the major new policy on Long Term Conditions resulted in an AHPF joint publication produced by the CSP which appeared within days of the publication of the policy. It outlines the positive role which AHPs can contribute to the delivery of improved services for those with long-term conditions. The CSP is leading work on Payment by Results and a guidance document has been produced which has been shared with the other professions. Work led by the Royal College of Speech and Language Therapists on the development of Children's Services is also an opportunity for partnership working with the CSP and other organisations. Joint working on graduate employment and on NHS commissioning is also planned.
   
   The AHPF also enables joint working through the AHPF Board in Scotland and Northern Ireland. The professions in Wales co-operate closely through the statutory system. AHPs in Northern Ireland meet regularly.
   
   The AHPF continues to look for opportunities to undertake joint working on relevant issues. It is also looking closely at the possibility of sharing services (on a contract basis) such as finance, IT, publications, etc. The organisations are also discussing the opportunities in the future for sharing a building with common facilities and services. However, this is a longer-term possibility that will require considerable discussion. There are no current discussions about the possible creation of a Royal College of Allied Health Professions and none of the AHP organisations have proposed this. The AHP organisations wish to co-operate and work more closely together while maintaining autonomy of the professional organisations

Composite Motion

2. Conference notes the continued anomaly in the Society whereby assistants and student members are unable to vote on a range of important matters affecting them such as the rate of subscriptions. Conference urges Council to re-consider this issue and resolve this unfair anomaly as soon as possible.  National Group Of Regional Stewards/Norfolk Branch

   Council has taken action to resolve this problem by the Bye-Law changes which were approved at the 2005 AGM. These changes will ensure that assistants/associates have the opportunity to vote on subscription proposals which were more than 5% above the rate of inflation in the same way as any other CSP member, together with the right to participate in other AGM discussions. (Apart from the right to vote on amendments to CSP Bye-Laws). The CSP now has final approval from the Privy Council to these new Bye Laws and they can therefore be implemented for 2006.

3. Conference calls upon the CSP Council, within its next cycle of business, to publish (through all communication channels and networks) a full assessment of the potential for future associate membership growth of the CSP in order to allow a fully informed discussion among the members and to formulate any necessary policy in the future.  Welsh Board

   This issue has been discussed (among a wide range of other issues) by the Council Working Group on CSP membership.
   
   Council decided in 2005 to enable a limited number of physiotherapists who are registered by the Health Professions Council under the "grandparenting" arrangements (which closed on 8th July 2005) to be considered for possible CSP membership under a detailed case-by-case review by the CSP Regulatory Board. Around 200 new members (registered with the HPC) have been admitted under these procedures. It is a time-limited opportunity to do with the legal protection of title by the HPC. The Society has no other plans for new membership groups outside of existing membership categories. The Working Party of Council will keep the matter under review if necessary.

4. Conference calls on Council to change its rules to allow the alternate to the Chair of Council to attend Council meetings with full voting rights during the Chair’s term of office. This will enable the voice of the representative group to be expressed without compromising the position of the Chair.  Trent Board

   This ARC resolution was not voted upon at ARC. Instead it was "referred to Council" for consideration. Council considered this matter and has rejected the proposal.

5. In developing structures for minority groups within the membership, the CSP has emphasised the differences between members. As a result, some members feel that positive discrimination exists within the Society resulting in perceived divisions between members. Conference therefore asks Council to review its networks and structures to determine whether the current system is still appropriate in 2005.   Eastern Board - Motion Failed

Professional practice

6. Conference is shocked at the scandalous lack of early rehabilitation for the many working people who each year are injured at work. All the evidence shows that the longer it takes to get physiotherapy or other rehabilitation, the greater the chance that they will never return to work.
   
   Conference calls on the CSP to lobby Government and employers to expand substantially musculoskeletal physiotherapy and vocational rehabilitation services which guarantee a rapid access to assessment and treatment both for those recently injured and for those who are on long term benefits.
   
   This has been a much neglected area by successive governments. The announcements by the Prime Minister and Alan Johnson, Minister in the Department of Works and Pensions on the need for proper rehabilitation following injury at work provides an important focus for the discussion of the need to expand vocational rehabilitation.   Council

   Vocational rehabilitation and musculoskeletal physiotherapy services have been a key area of work for the CSP during 2005/6 and this is highlighted in both the CSP corporate plan and the MN&R function plan. Incapacity Benefit (IB) Reform and the aim of reducing the numbers on IB is a UK government matter affecting all the 4 countries.
   
   The Society has influenced the development of the Government's Green Paper on Welfare to Work which states that as part of the Department of Work and Pensions work plan they will be "working with the Chartered Society of Physiotherapists to improve the work-focused messages given by their staff". The Society also made a Submission to the House of Commons Work and Pensions Select Committee inquiry into reform of incapacity benefits and "Pathways to Work". It was a major theme of the CSP lobbying of ministers at the autumn 2005 Labour Party Conference in Brighton. On January 23rd the Society ran a day promoting the Job Centre plus initiatives such as the condition management programme to members and the role of physiotherapists.
   
   In June 2006 the Department of Work and Pensions (under its Secretary of State, John Hutton, the previous England Minister of Health) published the legislation for IB reform (Welfare Reform Bill) which includes plans to promote early and rapid treatment interventions, to aim to reduce the number of IT claimants by 1 million over 10 years. 30% of new claimants have a musculoskeletal problem. CSP is arguing that this will require a major investment in early access to physiotherapy treatment, as well as in more specialist physiotherapists to help those who have been out of employment for long periods. The Department of Work and Pensions is sympathetic but the Department of Health in England is unwilling to commit itself to further expenditure whilst it tackles NHS deficits. The CSP has produced a briefing document for MPs discussing the Reform Bill.
   
   The Society also lobbied hard to influence the development of the "Musculoskeletal (MSK) Framework" for England and Wales which was published in July 2006. Following on from the success of the White Paper, 'Our Health, Our Care, Our Say', (England Jan 2006), in which self referral to physiotherapy was specifically mentioned. The MSK framework mentions access to physiotherapy services and self referral for patients. Physiotherapists will be recognised as first contact practitioners within various NHS service models.
   
   The CSP has been successful in promoting the benefits of patient self referral systems. The 32 successful pilot sites in Scotland resulted in 4 research articles being published in early 2006 on self referral. The work is being extended in Scotland. In England, 6 self-referral pilots are being undertaken as part of the primary care developments. Work is also underway in Wales. The overall CSP aim to promote easy self referral and rapid access to treatment which will substantially assist those who have recent injuries.

7. Conference requests that, due to the current issues of employment difficulties of new graduates, that the CSP should actively support and encourage new ways of whole systems working between different service providers. Advice and guidance on joint posts, rotations between differing employing bodies and into non-health settings, as well as finance and logistic issues of such an approach, should be produced.
   
   In light of the increasing numbers of new graduates, and issues of them being able to find their first posts, it is necessary to consider rotational and joint posts in new ways. Some managers are rising to the challenge by thinking of new opportunities, but some systems are daunted by what is seen as the enormity of delivering rotations across different Trusts organising payments, supervision, etc. In such cases, it is easier to say it cannot be done, but active support from the CSP would overcome these obstacles and assist in ensuring all new graduates can be supported in appropriate employment.    Association Of Chartered Physiotherapists In Management

   Through a series of regular meetings, the Society is actively working with employers, managers, HEIs, government and the national workforce team to highlight the issues and seek active solutions. A cross-organisational group of officers is actively monitoring the situation and identifying a range of actions to be undertaken. The CSP has undertaken a huge amount of work during 2005/6 on the issues of new graduate employment. These have included:

   • A complete revision of the CSP guidance paper PA52 on "Developing New Graduate Post and Rotations within a range of Health Care settings", (in conjunction with the Association of Chartered Physiotherapists in Management). This paper shows that new graduates are already autonomous practitioners who can be employed with appropriate guidance in a wider range of health settings.
   • The CSP has agreed an "Action Plan" with the Department of Health in England and local employers on finding jobs for graduates. A similar plan has been drawn up for Scotland and Wales.
   • The plans for 2005 Graduates meant that although the June 2005 survey of the 220 graduates showed that 75% did not have a job, the subsequent surveys in October 2005 and February 2006 showed that all but around 180 had found either permanent or shorter term physiotherapy posts thanks to the effort of physiotherapy managers and the CSP across the UK.
   • CSP has worked closely with CSP students' Association, including the introduction by Council of a reduced CSP subscription rate (with PLI) for unemployed new graduates.
   • The position for 2500 graduates in 2006 looks much more serious because of the freezing of junior vacant posts caused by the NHS financial deficits particularly in England. CSP Council continues to discuss action at every meeting.
   • Despite these problems, physiotherapy has continued to rapidly expand with over 2000 new posts created between September 2003 and September 2005.
   • The UK government has also taken action to restrict work permits for non-EU physiotherapists by removing junior physiotherapists from the "shortage" lists for immigration. This continues to be kept under review for other physiotherapy grades of employment
   • Both NHS and non-NHS employers are being encouraged to consider employing senior physiotherapists, even if they haven't previously done so

8. Conference urges Council to work with appropriate Clinical Interest Groups and other networks in campaigning at a national level to highlight gaps in the provision of continence services and to promote the development and implementation of integrated continence services specified as mandatory in the National Service Framework for Older People.
   
   Incontinence has a major impact on both physical and psychological well-being and often results in social exclusion. The NSF for Older People stated a mandatory requirement for all Trusts to provide integrated continence services by April 2004. However, one year on there are gaps in service provision across the country. CSP members have been highlighting this issue at a local level. However, a national campaign would have a greater impact in improving services for this client group.   Association Of Chartered Physiotherapists In Women's Health

   Council wholly supports this motion and will be happy to work with the relevant clinical interest groups and other campaigning networks. In particular the NSF for older people will be used to highlight gaps and identify solutions to comply with mandatory requirements.
   
   However, it is important for members to understand that pressure is best put on local policy makers and budget holders by members working locally, and to this end, officers within the Member Networks and Relations function will continue to work with the relevant CSP clinical and occupational interest groups to ensure members are informed of opportunities and are actively seeking to lobby commissioners locally to ensure the provision of integrated services.

Social issues

9. We call on the CSP to lobby the Department of Health and government agencies to ensure that resources both financial and physical are made available to enhance the well being and health of all groups in society. This is in line with Government Drivers such as Choosing Health, Essence of Care – Mental Health Awareness, Making it Happen, Putting Mental Health promotion centre stage, NSF for Mental Health, Valuing People, all of which acknowledge the lack of take up of health initiatives by mental health service users.
   
   Specific action is required such as reduced fees for leisure centres, training of sports and leisure centre staff and development of the GP referral – schemes to proactively encourage disaffected groups to take ownership of their physical and mental health. In actively encouraging the resource provision and protection for those people with mental health disorder or learning disability the CSP will also be supporting members whose work includes health promotion for these groups.   Chartered Physiotherapists In Mental Health

   Council is aware that people with mental health problems have a higher mortality rate due to heart and respiratory disease, much of which could be alleviated by regular meaningful exercise. People with mental health problems often have a lower level of disposable income and are therefore unable to afford regular access to leisure facilities such as gyms and swimming pools. Carers also have difficulty in accessing these services.
   
   To date three information papers have been developed looking at the role of physiotherapy in public health, covering England, Scotland and Wales, a further paper identifying the specific issues in Northern Ireland will be published during late spring 2006. These papers contain information on the role of clinicians, assistants and managers and identify relevant actions that if used locally would support the development of and access to health, leisure and well-being services for all population groups.
   
   The CSP has established a mental health strategy group and has physiotherapy representation on each of the DH working groups.

10. This Conference notes with concern the recent evidence that global warming is progressing at an accelerated pace due to on-going man-made pollutants. Conference also notes that world leaders have to consider the economic implications of a change in practice. This Conference believes that profits should not be put before people in today’s society and calls on the CSP to:
    (a) actively lobby the Government to ensure that the people of this country take priority over profit in the issues of global warming and the economy
    (b) become a lead within the TUC to bring this matter to the forefront of its campaigns.
    
    This is the most important issue that should concern us as a population at the moment. As a physiotherapy profession, the CSP should also be involved in promoting wealth interests of its members, staff and their families. It is a highly political issue, and the CSP should respond at that level, and be prominent in its campaigns against global warming.  Welsh Stewards

    The TUC, to which the CSP is affiliated, actively campaigns on these and other environment issues, in part because of the implications for jobs in sectors such as mining, power generation, transport, distribution and supply, and manufacturing. The Society has therefore taken the following steps to implement the spirit of the motion:

    • We have publicised the work of the TUC in this area to CSP members, and the opportunities which exist for individual members to lobby on energy and environment issues.
      
      To this effect: a front cover article entitled 'Global Warning' appeared in the 16 November 2005 issue of Frontline; and other related news items have been posted on the CSP website, including:
      • 'Why is climate change a union issue?'  (25 September 2006)
      • 'Greening should start at work'  (11 September 2006)
      • 'New CSP study shows extent of nitrogen dioxide pollution in London  (1 June 2006)
      • 'Dangerous levels of toxic gas detailed at most major airports  (13 March 2006)
      • 'A guide to Greening the Workplace'  (9 March 2006)
      • 'Greening the Workplace'  (14 December 2005)
      • 'Unions urged to join fight for cleaner air'  (22 September 2005)
      • 'Physios issue warning over pollution emissions'  (28 February 2005)
      • 'Respiratory physios urge action of air pollution'  (2 February 2005)
      • 'Respiratory physios urge action against UK air pollution hot spots'  (19 January 2005)
    • Encourage CSP stewards and safety representatives to negotiate, in liaison with other health unions, local workplace agreements based on the advice contained in the TUSDAC 'Greening the Workplace' report. Articles on this will be prepared for Stewards News and Safety News. In addition, the Society launched a campaign this year specifically on air pollution, including submitting a motion to the 2005 TUC Congress. However, it should be noted, that as a relatively small organisation, the CSP does not have the resources in terms of officer time and research back up to carry out the full role called for in the motion. Nevertheless, the CSP is committed to disseminating information to members on this and related environmental issues.