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Painful process

Drastic cuts in funding mean physios are paying for their own professional development courses and some may risk being struck off. Jennifer Trueland explains

It doesn't seem too much to ask. Physiotherapists want properly funded training - and a bit of time to do it in - at a point when they are facing unprecedented demands to show they are keeping up to date.

Instead the opposite is happening. NHS employers from across the country have been raiding training budgets to help them balance the books. Physios have also been reporting problems in getting time off to do courses they have paid for themselves.

Some are becoming so demoralised - and broke - that they are considering leaving the profession.

And all the while, a major deadline is looming. Under new regulations, if physios can't show they are undertaking proper continuous professional development, then they risk being struck off.

'This is a real bugbear of mine,' says Chantalle Farrow, a band 7 community physio with North Lancashire primary care trust.  'What's available for training depends on where you work. We're lucky in that we get £65 a year but that doesn't even cover a half-day course. Some trusts give double that and some give nothing at all. I think we should be going on two to three courses a year but we simply can't afford it.'

Until 2005, physios were expected to undergo continuous professional training to make sure their knowledge and skills were up to date. With the setting up of the Health Professions Council, however, this has become a more formal process.

Now the HPC sets standards for CPD, which physios must meet if they want to remain registered.

But while the HPC has a big stick (it can remove physios from the register), it has very little in the way of teeth to ensure that employers make it easier for staff to fulfil their CPD obligations.

 BUDGETS SCRAPPED

In its guidance, the HPC says that during its 2004 consultation on CPD, many people asked whether the body could make sure employers gave their staff a certain amount of time for CPD. 'Unfortunately the Health Professions Order 2001 doesn't allow us to do this,' the organisation says. It continues with some optimism: 'We believe that responsible employers will want to encourage the development of their staff. We believe that employers will benefit a great deal from supporting CPD.'

That doesn't seem to be happening on the ground. In May, the CSP published a survey that involved speaking to senior physiotherapy staff in more than a third of NHS organisations in England (around 110). Over half (55 per cent) said there was no allocated training budget for physiotherapy staff. More than 70 per cent said the training budget was inadequate for Knowledge and Skills Framework needs, while 80 per cent said the training budget was inadequate for CPD needs.

'It's a major problem,' says Gary Robjent, CSP head of public affairs and policy development. 'The government is rightly promoting quality and safety as a priority for all health professionals. But this is coming at a time when training and CPD are being sacrificed for short-term political expediency.

'That's not good for patients and it's not good for physiotherapists either. Their livelihood is at risk if they don't meet the required standards.'

There is no secret that the NHS, particularly in England, is facing financial problems, with many trusts in debt. And when money is tight, training budgets can be among the first casualties. When Sir Ian Carruthers, the then acting chief executive of the NHS in England, appeared before the health select committee last year, he admitted that there was a correlation between deficits and reduced spending on training. It also emerged that there was great variation in the amounts cut from the training budgets of different strategic health authorities. Those in areas with bigger deficits lost more from their training budgets.

THREAT TO MORALE

In its report, published in December, the committee said that 'cuts in the budget for the education of hospital workers is having an adverse effect on staff morale and could have a significant effect on the quality of the workforce', and warned against making savings disproportionately in areas like training.

Speaking in the House of Lords in April of this year, the then health minister Lord Hunt said that 2006-07 had been an 'exceptional' year which had led to 'hard decisions' on education and training. He said training budgets would not be ring-fenced but that there would be a service level agreement with strategic health authorities on workforce planning. This was published on 27 April and puts a number of duties on strategic health authorities in return for allocation of the multiprofessional education and training levy, the money passed to strategic health authorities  by the Department of Health for investment in training and development.

A DH spokesperson  said: 'Education and training is important. The NHS training budget is part of strategic health authorities' overall allocations, which they must manage to meet local needs and priorities.

'The DH allocated £4.3 billion for the training and development of the NHS workforce over the next financial year, which was an increase of 3.6 per cent over last year. This allocation covers commissions for physiotherapists.'

The spokesperson went on: 'SHAs must find a sensible balance between achieving financial stability and  investing in the development of the local workforce.'

Whether that will be enough remains to be seen. And there is some urgency over the matter. Health professionals needed to begin recording their CPD from July of last year and in July 2008, the HPC will carry out its first random audit (of chiropodists and podiatrists). A sample of physiotherapists (probably 2.5 per cent) will be audited for the first time from April 2010 and thereafter every two years. Arguably,  physios have never needed more support to ensure they meet requirements. FUNDING

NOT RING-FENCED

Jill Higgins, CSP director of practice and development, says the funding situation varies across different strategic health authorities.  'We know that money has been siphoned off training budgets to meet other financial needs. We're worried that although some of the money is back in the budget, it isn't ring-fenced.

'Physiotherapists are highly motivated and keen to provide a high quality of care. They also want to advance their careers under Agenda for Change and the KSF. I think the NHS should be supporting that.'

Lorraine Favoretto, superintendant physiotherapist with Southampton City primary care trust, has seen trust budgets for training fall, from an initially good set-up with funding and time off in lieu for training done in staff's own time, to a situation where there is no trust training budget at all. But she adds: 'I think we're quite lucky because our budget manager has agreed that we can get some money for courses and time off in lieu.

The funding - £100 per staff member a year - has encouraged physios to find ways of getting the most they can for their money. 'We're trying to organise training here and we can usually get one or two free places,' Ms Favoretto adds.

'I believe that CPD should be a joint responsibility between employer and employee. But support for CPD is going down as requirements are being pushed up,' she says. FL

The CPD experience

Senior 2 in outpatients 'During my last job I paid for two courses for a total of £550 but this is before adding travel, accommodation and food. We do not earn enough to pay for all this ourselves. I always thought you worked to provide money for your life, but now I have to put any spare money aside for courses instead of holidays and social life. I love being a physio but I am not sure how long I can continue in the profession.'Senior 1 in outpatients

'In the PCT where I work it has been said there is money for training. However there are three tiers of management involved. The difficulty of getting funding seems intended to discourage applications.'

Senior physio 'We've been told we can only be released for training if it fulfils the trust objectives; that is, reduces spending. It is interesting that excellence in clinical care is not among these objectives. The impact on staff morale is palpable.'

Community paediatric physio 'At our last team meeting we were told there was no budget available for training courses - full stop. At 55 I'm moving towards the end of my career but I feel for young people.'

Senior 2 'I am yet  to attend a single course due to funding problems. This is hampering my development  and I risk falling behind my peers.'

Senior physio 'We are told that cuts to training budgets are temporary, but experience has taught us that once services or funding are lost they are very rarely reinstated. The outlook for training for NHS staff is very bleak.'

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