ARC motions 2005/2

• Regulation
• Health and safety
• National Health Service (NHS)
• Employment relations

Primary Agenda

Regulation

11. We urge the CSP to lobby the HPC to ensure that members receive their registration efficiently, to safeguard against temporary loss of registration and the ensuring loss of earnings.   Members who have been unable to demonstrate their initial registration, or registration renewal with the HPC, because of bureaucratic delays have had to be suspended from duties and found alternative work that does not require registration. These members have had to be paid at the rate for the job they have been redeployed into and many have suffered loss of earnings which cannot be remunerated. The HPC must be made aware that it is unacceptable for CSP members who have made timely, correct registration applications, to suffer the loss of their professional status and be financially disadvantaged as a result.  South West Stewards

     

    The Society has notified the HPC of members' concerns and the fact that a number of Physiotherapists had experienced difficulties. A number of letters have been exchanged. As a result of this, the HPC agreed to investigate thoroughly any complaints raised in connection with the renewal process. In addition to this, the HPC informed the Society that they are conducting a review of their processes to make registration more efficient. They will be considering the following:

    • sending reply paid envelopes with renewal forms
    • improving relations with professional bodies
    • additional advertising
    • arranging a facility to change contact details via the HPC website
    • implementing a process to renew registration online.

     

Health and Safety

12. Conference calls upon the CSP to convene a group consisting of manual handling specialists/experts, SIG/OG members, and representatives from ERUS in order to draw up CSP guidelines on Therapeutic Handling. The guidance should be specific to particular specialities wherever possible, the aim being to prevent the musculoskeletal strains and injuries that were found in the recent study undertaken by the CSP.
    
    The recent study undertaken by the CSP found that 67.5% of physiotherapists reported to have sustained work related musculoskeletal strains and injuries. This was despite their specialist knowledge and adequate basic training on manual handling. However as physiotherapy treatment sometimes challenges the basic manual skills making them irrelevant and inapplicable to some patients and treatment techniques. Speciality specific handling guidance would be a much more practical and beneficial tool for physiotherapists to use.  National Group Of Regional Safety Representatives

    The Society is about to revise its document on manual handling for physiotherapists which is due out in 2007. Members from the Health and Safety network and CIOGs worked with CSP officers to develop this updated guidance.
    
    The aim of the document being to advise on appropriate manual handling principles to facilitate maximum mobility and function for the patient and the least risk of injury for the physiotherapist, it will also include similar guidance on therapeutic handling.

13. This Conference urges Council to request that all students on physiotherapy pre-registration courses are taught management techniques for dealing with inappropriate sexual behaviour from patients.
    With the increase in Inappropriate Patient Sexual Behaviour (IPSB) within the health services both NHS and Private (Weekaroon, 1998). Nursing staff and medical students are taught self-defence and conflict avoidance techniques as a mandatory component of the course programme. Physiotherapists both qualified and students are vulnerable to IPSB due to isolated spaces the are sometimes required to work in. As such, the incidence of IPSB has been reported to be on the increase across all professions allied to medicine (PAM). Pre-registration courses should be taught how to handle the incidence of such behaviours and apply avoidance techniques when required. Student Executive Committee

    It is important for students to be prepared in how to manage inappropriate sexual behaviour from patients. Evidence is being gained through clinical education co-ordinators, subject heads and course leaders as to which universities already cover this as part of placement preparation with a view to recommending good practice in this area. The curriculum framework will be reviewed in 2007 and this will be incorporated in the review process.

14. Conference notes the increasing number of physiotherapists undertaking standby duty as part of an emergency service. Conference therefore calls on the CSP to:

    1. review the relevant Trusts to assess how far the European Working Time regulations are being met with regards to physiotherapists working standby
    2. work with managers and stewards locally to ensure appropriate policies are in place to protect the health and safety of physiotherapists and ensure there is full compliance with the regulations.
    Working Time Regulations require an employee gets 11 hours continuous rest in every 24 hours. However, many physiotherapists doing overnight standby work are still required to do a full day’s work immediately before and afterwards, thus not having the required rest. Many Trusts are now putting in safeguards/policies to ensure doctors meet the regulations, but have not reviewed their practice with regards to physiotherapists having to do emergency and out of hours working. The CSP should work with local managers to ensure policies are put in place so their departments comply with the regulations and physiotherapists are not disadvantaged.   London South Stewards

     

    The CSP has gathered and will continue to monitor information from various Trusts on compensatory rest for physiotherapists undertaking stand-by duty. Information on assessing such policies can be found on CSP website best practice policy page. Guidance on compensatory rest is also included in CSP briefing paper on the Working Time Regulations, which is available to assist stewards/members in negotiating arrangements to safeguard physiotherapists' health and safety. Introduction of iCSP in 2006 has provided a useful forum for manager members and stewards for discussion and information sharing on this subject.

National Health Service

15. Conference requests that in light of continuing Government Policy directives, the CSP needs to lobby the Department of Health to set a waiting list target for physiotherapy services of six weeks. This would raise the profile of physiotherapy. While the impact of physiotherapy on reducing waiting times is recognised, the wider impact of physiotherapy on healthy life styles is often overlooked. The opportunity to influence this along with other emerging policy is often not recognised by commissioning bodies or the population at large.  Association Of Physiotherapists In Management

    Council supports the intention of this motion to set and deliver on physiotherapy waiting times. However, it is clear that a six week wait in the current environment is not achievable in terms of a national government target across the UK. Wales is the only country with measurement of physiotherapy outpatient waiting lists and times thanks to active lobbying of the Welsh Assembly by CSP and Welsh managers.
    
    Welsh waiting times are being published monthly in 2006. In Scotland, the Scottish Executive have carried out a census of AHP services the results of which are due to be published. The Society has lobbied and responded to the Department of Health (England) consultation on the 18 week wait programme, and around the collection of physiotherapy waiting list data. The Department has published waiting list times for AHP diagnostics but unfortunately not for physiotherapy or other AHP services. The result of the NHS financial deficits may be to cut staff and cause waiting times to increase. The CSP will continue to lobby on the need to reduce physiotherapy waiting times.

16. Conference condemns the serious failure of the NHS Workforce Planning to give adequate attention to delivering the UK Government’s plans for the expansion of physiotherapy and other AHP professions.
    
    Conference calls upon the CSP to continue to lobby the NHS at national and local levels to plan urgently for the substantial expansion of junior physiotherapy posts to ensure that the large number of vacant senior posts can be filled in the future. In 2004, the profession is faced with a significant problem of physiotherapy graduates not being able to find their first junior jobs because of a lack of adequate planning by the NHS. This is despite high vacancy rates in physiotherapy at Senior I and Senior II levels (pre Agenda for Change). This motion is intended to give ARC’s backing to CSP Council in seeking permanent solutions to deliver the expanded physiotherapy workforce which the Governments in the four countries seek.   Council

     

    The CSP has been continuing to monitor the employment position of all those graduating in 2006 and as at October 2006 only 14% of graduates had found permanent physiotherapy posts. The situation has become even more desperate in 2006 because of the high number of posts being permanently lost or frozen due to the financial deficits in the NHS, with posts for newly qualified physiotherapists particularly vulnerable. The CSP will continue to monitor the situation on a regular basis.

    • The issue has been raised at the highest levels with Patricia Hewitt, Secretary of State for Health. Approaches continue to be made to Health Departments and senior civil servants and ministers in Wales, Scotland and Northern Ireland.
    • The CSP put out press releases in July and November 2005 and during 2006, calling upon the Government to take action to address this. The press releases received a significant amount of publicity in both the written media and on TV and radio stations. The CSP has also organised and advised students and new graduates on campaigning direct to their MPs.
    • In July 2006 the CSP organised a mass lobbying of MPs in the Westminster Parliament to raise concerns about graduate employment. This was very influential with widespread support from MPs and widespread reports in the media.
    • The CSP has fulfilled the actions which it was allocated to under the Action Plan for England drawn up by key stakeholders including DH and NHS Employers and continues to pressure the other action leads to fulfil their commitments.
    • CSP Council has set up a Graduate Action Group with representation from members of all four countries, unemployed graduates and students. The group is producing a new action plan for the CSP to focus on what needs to be done next to support graduates including support for workshops to help unemployed graduates maintain their clinical skills. The Alliance for Health Professionals has also set up a sub group for member organisations affected by this issue who will work together to lobby the Health Departments, NHS Employers and other relevant stakeholders to resolve the problem.
    • In October there was a well attended lobby of the Scottish Parliament which received a high level of media attention. The CSP Scottish Board has produced an action plan for Scotland and held a conference of Scottish managers in January 2006 to discuss implementation. CSP officers have met with senior civil servants, MSPs and are in contact with the Health Minister.
    • In Wales a conference was held at the beginning of the year for managers and commissioners organised by the Welsh Assembly at CSP's request and addressed by the Minister for Health and Social Services. The Assembly also commissioned a scoping exercise into novice graduates which has produced a series of recommendations. Three regional workshops for managers and commissioners will be held on how local health boards can create the conditions for new posts. Welsh graduates have been sending letters to the Minister outlining the issues and requesting the Welsh Assembly provides the necessary finance to solve the problem.
    • Physiotherapy students from the University of Ulster emailed their concerns regarding the current employment situation to their political representatives. The CSP has established a Graduate Action Group for Northern Ireland which met in September to decide a plan of action. The CSP raised the matter directly at a meeting with the Minister for Health who has instructed the Department to establish a 'Taskforce' to consider how to maximise opportunities for getting recently graduated Physiotherapists into employment.
    • The 18 October issue of Frontline contained an article on graduate unemployment and included a postcard for members to send to their local parliamentary or assembly member urging them to raise the issue with ministers.
    • Well over 100 parliamentary questions have been tabled in Westminster, the Welsh Assembly and Scottish Parliament to continue to put pressure on ministers to take action. Meetings with Ministers have taken place in the Welsh Assembly and the Scottish Parliament.
    • The CSP submitted evidence to the House of Commons Health Select Committee into the problems of NHS Workforce planning highlighting the problems of graduate employment. Phil Gray and a delegation of unemployed graduates met with the Chair of the Committee in October to discuss their concerns.
    • The CSP has joined the TUC led NHS Together campaigning alliance of all NHS unions and staff organisations. At a rally and lobby of Parliament on 1 November organised as part of this campaign, Claire Sullivan, Assistant Director of ERUS, made a speech which included references to the problems of graduate unemployment.
    • The CSP attended the main political party conferences in October 2006. The effective role of physiotherapy and the problems of graduate employment were highlighted when lobbying politicians. A motion passed at the TUC Congress in September was amended by CSP calling for better workforce planning in the NHS.
    • A dedicated page appears on the CSP website on graduate employment setting out case studies showing how managers have created new posts; guidance on how to write a CV and prepare for interviews, and information on action CSP is taking. The website is being regularly updated with considerable information and guidance for new graduates.
    • New guidance (Briefing Paper PA52) on expanding junior rotations from traditional settings into the community has been published. A briefing paper with guidance and examples of how managers have created new posts will be available shortly.
    • The CSP established a Clearing House for new graduates and is sending out adverts for vacant junior posts to graduates looking for jobs at no cost to advertisers. The CSP has agreed that for a period of 12 months it will accept free advertisements for junior physiotherapy posts onto the CSP jobs website. (However, very few junior posts are advertised currently with most posts being filled from local waiting lists).
    • The Health Professions Council revealed that there has been a very large increase in the number of non-EU, overseas qualified physiotherapists gaining registration to work in the UK rising to nearly 1,000 in 2005. The UK Home Office has amended the shortage occupations list so that with effect from July 2005 work permits are no longer granted for junior physiotherapy posts from applicants outside the EEA. The Home Office is currently considering removing all physiotherapist posts from the list of UK 'shortage professions' for which automatic work permits are granted.
    • The Workforce Review Team for England recommended that student intakes be reduced by 10% in 2006 and is proposing a further cut of 10% in 2007. Reductions have also been implemented in Wales, Scotland and Northern Ireland.
    • The CSP has linked up with a number of patient groups (such as the MS Society, Parkinson's Society, etc) to help lobby the government on the need for more physiotherapists and the opportunities which the position on graduate numbers enables an expansion of services to take place.
    • The position for 2006 graduates remains very difficult. CSP continues to lobby hard and use press, radio and TV to raise the profile of the problems in 2006. CSP Council debates progress at every meeting and has given its firm commitment to campaigning to achieve a satisfactory resolution of the employment problems for new graduate physiotherapists.

     

17. Conference calls on the CSP to continue to influence both the Government and the Strategic Health Authorities to ensure that Agenda for Change (including KSF) is fully funded and that current funding and new monies are ring fenced. Money for AfC needs to be ensured it is used for AfC. There is the risk that AfC monies may be used by PCTs and Trusts to manage their financial deficits. If this happens then AfC will not deliver the promised benefits either to staff or patients.   London North Stewards

    Members will be aware the CSP received assurances from Ministers and the Department of Health during negotiations that Agenda for Change including the Knowledge and Skills Framework was fully funded. Given the serious concerns over the current financial situation of many NHS employers the CSP included, as part of its evidence to the Pay Review Body for the 2006 pay award, a request that all aspects of Agenda for Change would be properly funded.
    
    Our evidence for 2007 also identifies the need to ensure sufficient resources are made available to enable the development needs of staff, identified through the KSF are met. As a member of the NHS Staff Council the CSP continues to raise this issue where evidence arises which suggests funding problems in implementation of either the new pay system or the Knowledge and Skills Framework.

Employment Relations

18. A possible outcome of the NHS Pension Review is that the national pension age may increase to 65. In the event of this happening, Conference calls on the CSP to lobby strongly to ensure that any changes to the pension scheme provide for significant career end flexibility. This should allow members to reduce their hours, grade, or to retrain, during the latter part of their career, in order to continue to meet the physical demands of the job, but with minimal detriment to their final pension.
    
    If physiotherapists are required to work to the age of 65, many may not be able to continue in their current roles due to the physical demands required of the job. To be able to continue working till age 65 they may have to reduce their hours, grade or retrain in another speciality to be able to take on a less physically demanding role. This will likely have a detrimental effect on both their salary and final pension income.   London South Stewards

    Consultation is currently taking place on the proposals agreed by the health unions and NHS Employers in July. The consultation period for England and Wales is from 1 September until 30 November, for Scotland from 1 October to 5 January 2007 and details are still to be confirmed in Northern Ireland. The CSP consultation closes on 17 November. The NHS Pension Scheme Steering Group will review the consultation in England and Wales and report to the Staff Council Executive, which will then make recommendations to Ministers
    
    ERUS published a briefing paper and powerpoint presentation for meetings of stewards, and for stewards to use in workplace meetings. Information is updated on the website and email established for dealing with members' queries.

Common debate: Motions 19 and 20

19. Conference urges the CSP to develop and implement a national scheme to monitor the impact of the implementation of Agenda for Change on the pay progression, clinical and professional development of stewards and safety representatives following rollout.
    
    Following national rollout of AfC it has become increasingly apparent that our stewards and safety representatives have sacrificed a significant amount of clinical time to facilitate the project. Considering the process will continue until September 2005 many representatives involved are becoming increasingly concerned that their assistance in the project is at the expense of their clinical and professional development and that currently there is no acknowledgement of this. It is possible that their progression through KSF gateways will be affected as they will have less time to satisfy the dimensions required for their clinical role, ie. their KSF post outline.  Trent Regional Stewards

    The CSP has been and will continue to monitor the matching and assimilation results for all its members via a pro-forma issued to stewards and information received through the NHS Staff Council. The impact of progression through the pay gateways and implementation of the Knowledge and Skills Framework will form part of the work of ERUS during 2007, be monitored at the regional training days organised for stewards and reported to the Industrial Relations Committee.

20. This Conference notes the on-going negotiations on the KSF and career pathways. As stewards and safety representatives within the CSP it is plain to see how taking on the voluntary roles can mean an increase in personal and inter-professional skills which would translate into all six of the core dimensions of the KSF, and into at least five of the specific dimensions.
    
    This Conference believes that the CSP should set up a working group of the main CSP stakeholders to discuss this issue further, and to ensure that stewards and safety representatives and the skills they acquire are represented on the KSF. It is important that this discussion takes place within the CSP. It has consequences for stewards and safety representatives, and this large group must feel that they have been represented on the KSF.  Welsh Stewards

    The CSP is supporting members with the broad aspects of implementation of the KSF through training and briefings to stewards and managers (ACPM) training. Additionally members are supported and advised about compiling CPD evidence for the development review process and to demonstrate examples of application for KSF outlines.
    
    While the knowledge and skills developed in trade union roles is helpful to members, KSF outlines and examples of application must be directly applicable to a post holder's job. Trade union roles remain separate from the employee's post and any training and skill development provided by the CSP is separate to the development opportunities that employers are required to provide to employees to undertake their job. Any direct integration of the skills attained as a trade union representative and job role may lead to a substitution of trade union training for job related development and CPD opportunities. Advice on KSF has been published on the CSP web site (in the members' section) and training has been provided for representatives.

21. Conference urges the CSP to work with employers as a matter of urgency, to develop comprehensive and realistic career pathways for Senior I community physiotherapists and support workers, in view of potential inequities of opportunity between acute and community services under Agenda for Change.
    
    It is of concern to members in the community that many work in relatively small teams with limited opportunities to progress beyond their current grades within the speciality and locality. Experience suggests that many of these posts will be banded 6 and 3 respectively. Consequently there is a significant risk of a drift out of the community back into the acute sector, raising recruitment and retention issues with negative effects on morale, workload and service delivery.   Trent Regional Stewards

    It is recognised that there may be some inequities between community and acute physiotherapy posts during the banding process. However, it feels that development opportunities offered with the Knowledge and Skills Framework and the Skills for Health competence-based career framework for Allied Health Professions (AHPs) are likely to identify and facilitate pathways in the community, recognising the skills and knowledge required.

22. Conference welcomes and supports the national roll-out of Agenda for Change within the NHS and looks forward to the improved fairness to pay and terms and conditions. However, Conference strongly urges the CSP to campaign in the negotiations for the revised ‘Unsocial Hours Payments’ for clinical staff in Bands 8a to 8d to be able to receive pay enhancements during the same time periods as those staff in bands 1 to 7.
    
    With the emphasis in the NHS now moving towards the benefits and realisations of AfC, there is an increased possibility of the introduction of seven day working to replace weekend oncall working. If this happens and unsocial enhancements are based on the original proposed agreement, then Band 8 clinical staff would not receive unsocial hours recognition for working between 9am and 1pm on Saturdays and Sundays. This could have a detrimental effect on service provision if the most experienced staff are not willing to work at these times.   London South

    The CSP submitted a request on this issue to the unsocial hours sub-group of the NHS Staff Council and raised the matter formally in the Staff Council Executive Committee. Negotiations on revised unsocial hours payments have yet to be concluded but the latest proposals include enhancements for staff in Pay Band 8. When negotiations have concluded the final proposals will be considered by the Industrial Relations Committee.