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Welfare Reform

In the fourth article in our latest Policy in Focus series we look at welfare reform. Reports and research by Matthew Limb

The focus on reducing long-term sickness and helping people to return to and remain in employment offers big opportunities for physiotherapy, as well as some concerns about how policies will be implemented.

What’s happening and why?

As Britain’s population ages, there are likely to be fewer people paying taxes to support the growing numbers claiming state pensions and needing NHS and social care and benefits. Policy makers say these costs cannot be sustained and more must be done to maximise the eligible workforce, not just for the good of the economy but for the benefit of the individuals themselves. There are currently around 2.6 million people of working age who are inactive and claiming incapacity benefit, while sickness absence costs the country £13 billion a year. National director for health and work Dame Carol Black (left) says if half the people currently on long-term sickness absence were helped to return to work just one week earlier, this could save the economy £88 million a year. In March 2008, Dame Carol published Working for a Healthier Tomorrow, which highlighted the positive benefits of work for people’s health and well-being, as well as the harmful effects of long-term unemployment and prolonged sickness absence. She recommended a range of initiatives to tackle this. Then in July 2008, the government published the green paper, No-one Written Off. Its ethos is that people should take on more personal responsibility for their health in return for more effective support in joining and remaining in the workforce, and for a better choice of services. Specific proposals include giving private and voluntary providers the right to bid for any back-to-work service. In January 2009, the Welfare Reform Bill followed up with proposals for improved support and incentives to move from benefits into work.

What will it mean for physiotherapy?

Musculoskeletal disorders, particularly back pain, are the most commonly reported cause of work-related ill health in the UK. The benefits of prompt access to physiotherapy to prevent such disorders becoming chronic are well known and research has shown how physiotherapy-led pain management can reduce people’s use of other health services and cut NHS costs overall. Dame Carol Black identified physiotherapists as among the key professionals to lead on delivering the new Fit for Work early intervention services. Self referral to physiotherapy, which has been shown to be successful in pilot schemes, could enhance the Fit for Work approach. But Gary Robjent, CSP head of policy development and public affairs, says the welfare reform agenda has implications for members that go even further: ‘It is about recognising that the potential contribution of physiotherapy may not be in the traditional clinical sense or in clinical settings or even in being part of a clinical team. It is about having services in place that people can access sooner rather than later, that fit around their other commitments and may be located in different, non-clinical settings, such as an industrial estate or in a community or leisure centre. This is an opportunity for physiotherapists to think imaginatively.’

What are the opportunities?

With services increasingly slanted towards the individual’s responsibility for their own health and well-being, AHPs’ focus on empowerment of patients and the biopsychosocial model make them ideally suited to deliver in this context. The plans to widen access to psychological therapies could also open up more opportunities, and training available for physiotherapists in cognitive behavioural therapies is increasing. Occupational health services could expand to plug perceived gaps in provision, particularly for the small and medium enterprises, which employ most of the workforce, some experts say. Return-to-work treatment specialist and chair of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics Nicola Hunter believes there is scope for strengthening the understanding of work issues in physiotherapy training. ‘Everybody appreciates that work is good for you and people are far worse off if they aren’t  in work. Every physio needs to understand that. We’ve got to get it somewhere into the fundamentals of what we do,’ she says.

What are the concerns?

Trade unions, the TUC and patient organisations have warned that vulnerable people should not be forced into work that is inappropriate for them. Critics say applying ‘punitive’ welfare changes to people with health problems is contrary to the aspiration that they should be in control of their own lives. The TUC in particular has expressed concerns about what it regards as a ‘work for benefit’ scheme and has vowed to oppose plans to privatise Jobcentre Plus services. The government dropped a plan to make disabled people look for jobs or risk losing their benefits, but is proposing withdrawing Access to Work funding from public sector organisations. This provides support such as specialist equipment to help disabled people return or remain in work. The CSP says disabled NHS physiotherapists may have to rely on funding from physio budgets for this support in future, thus eating into funds for patient services.

What physiotherapists need to know

Fit for Work services

Instead of signing people off sick, GPs will ultimately be able to use electronic ‘fit notes’ to indicate what level of work an individual may be able to do. The reformed medical certification system is meant to tie in with new ‘Fit for Work’ services providing coordinated support for people to return to work after ill health. These multidisciplinary early intervention services would offer holistic assessments based on a biopsychosocial model. Some could be sited in polyclinics, although options would not be restricted to medical treatment. They could include exercise, physiotherapy, cognitive behavioural therapy and counselling, occupational health interventions, workplace assessments, as well as advice on finances and housing. People with more serious underlying conditions would be referred on. Between now and 2011 a number of pilot schemes will test different service models, involving a mix of providers from public, private and voluntary sectors.

Boorman Review

In April, the government launched a major review into the health and well-being of the NHS workforce. Occupational health expert Steve Boorman was tasked with looking at what practices and policies work best and identifying where funds should be targeted. Evidence is being sought from trusts, leaders and experts across the NHS, and staff are being asked their views on health and well-being in their organisations. The CSP is contributing to the review, both directly and through the English social partnership forum staff side.

NHS Plus

NHS Plus, launched in November 2001, aims to improve the quality and delivery of occupational health services to NHS staff. It also delivers services to other public sector bodies and smaller businesses, encourages the development of best practice in occupational health and funds the occupational health clinical effectiveness unit at the Royal College of Physicians that publishes evidence-based guidelines and strategies.

Personal budgets

The government is currently consulting on plans to shake up the way disabled people can use the funding they receive from the state. Under the ‘right to control’ policy, disabled people would be able to choose what support they need and who should provide it to enable them to live their lives with greater independence and freedom. This could mean employing someone directly to help with work, home and leisure activities rather than using public services, or choosing a mixture of provision. Pilot projects in a small number of local authorities in England will run from 2010 for an initial period of two to three years before a decision is made on implementing the policy nationally. Health unions, including the CSP, recently raised concerns about the possible impact on workforce planning, job security, pay, pensions and continuing professional development support. They said the introduction of direct payments in social care had led a drive towards a minimum wage culture. Health minister Ann Keen responded that she was committed to ensuring that union representatives were properly involved in setting up the pilots at local level and evaluating the results.


  • The UK Rehabilitation Council has published standards for services to help people return to or remain in work. They aim to ensure services are delivered safely, competently and cost effectively in all sectors, whether private, public or not-for-profit, and protect the rights and dignity of service users.
  • Members working at the personal budget pilot sites in England should look out for a forthcoming leaflet on the implications for staff produced by the Department of Health in conjunction with NHS Employers and health unions.


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Article Information


Matthew Limb

Issue date

15 July 2009

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