CSP held its annual congress in Liverpool from 15-16 October

Frontline reporters bring you the first of two reports from the event for more reports see www.csp.org.uk

We are there for you, says CSP No matter what the outcome of the government’s proposed changes for the NHS, the CSP will be there for all its members. That was the message from the Society’s chief executive Phil Gray. The session focused on the impact of the White Paper and on plans for GP consortia to take over the role of PCTs. Members attending asked if they should consider working in social enterprise units that the coalition government appeared to favour. Claire Sullivan, the Society’s assistant director for employment relations and union services, warned against working in structures that might well be failing organisations in the longer term. ‘But if you are in agreement that a social enterprise unit is the right thing we will be doing everything to support members,’ she said. However, they would be losing out on access to the NHS pay scales and to NHS pensions, she warned. ‘There is a lot of misinformation about what a social enterprise is going to look like.’ Phil Gray emphasised that the Society would help members wherever they ended up. ‘Although the NHS is far from perfect, it is not broken,’ he insisted. ‘In the party manifestos there was no mention of these changes. The government can’t say they’ve got a mandate.’

Seize opportunities – don’t just see threats

In crises there are opportunities but the danger of not spotting them will be the real challenge, warned health economist and journalist Noel Plumridge. Physios could demonstrate their worth through, for example, payment by results initiatives. The Department of Health’s intention to include hip and knee replacement in the best practice tariff, outlined in September, will enable them to show the effectiveness of physiotherapy in reducing bed stay. The real level of savings required within the NHS was closer to five per cent than the 3.5 per cent efficiency savings the government was suggesting, pushed up by the rate of inflation in the general economy. And Noel Plumridge questioned the £80 billion of tax payers’ money that would be divided up among the new GP consortia – who could number anything between 80 and 800 in total. ‘Frankly we don’t know how many there will be. The government say they will grow organically from the relationship between GPs.’ Expenditure per head of population was likely to be £9 a year, compared to an average of £20 a year under PCTs. And questions remained about how the funding would be distributed, who would handle that money and what the management model would be for any new social enterprise units. ‘We have people advocating models like the John Lewis Partnership but do we really think we are going into a world of dividends and discounts?’ he asked.

Speak up for what you do

  Allied health professionals should speak up for the invaluable services they provide to ensure commissioned services come their way, delegates were told. Lisa Hughes, a dietician and now AHP officer at the Department of Health, said money was going to be tight throughout the NHS but AHPs had to show they could deliver services better than other healthcare staff and provide more value for money. Leading a session on workforce planning, she said: ‘We need to think out of the box and be upfront about what we do. And we need to take ownership of areas of healthcare where we excel and say it’s our job, not community nurses’ for example.’ Looking ahead to the new system of commissioning through GP consortia, she went on: ‘AHPs needed to go to GPs and ask them what they want and how they can provide it.’

Frankness ‘key’ says Campbell

Mental health problems should not be a barrier to work and being open about mental illness should be a positive way of dealing with it, Alastair Campbell told Congress. The author and political commentator said mental health remained a taboo in society, but he stressed he had always been open about his background. Delivering the prestigious Founders’ lecture, Alastair Campbell outlined his history of mental health problems. He also praised the CSP’s recent ‘Fit to work’ campaign and commended the Society’s campaign against cuts. A former Fleet Street journalist and later communications director at Number 10 Downing Street, Alastair Campbell said he knew he had problems coping with stress, but he hadn’t realised its seriousness. ‘I knew I had a drink problem, and I knew I had depression, but it wasn’t until I was sectioned that I realised I had to change the way I lived.  Talking about the anticipated cuts to frontline NHS services, Alastair Campbell welcomed the Society’s move to ‘understand there will be cuts and ask how physiotherapy can prove its worth’. ‘Highlighting the way physiotherapy can be a cost-saving intervention is a really positive way to campaign, but it will be hard work,’ he said.

Physios have huge contribution to make to Olympic campaign

Physiotherapists can make a huge contribution to the NHS’s 2012 by 2012 campaign, the chief executive of NHS North West strategic health authority, and an NHS National Champion for Physical activity, Mike Farrar, told Congress. The campaign aims to increase physical activity among 2,012 members of staff in each PCT area by 2012 through ‘offers’ of physical activity for staff as part of their working day. Mike Farrar said the NHS was chosen to help create an Olympic legacy because it was the country’s largest employer, and because health service staff were ideally placed to act as role models and advisers to the rest of the population. Within the health service, physios can and should perform that advisory role, he said. The 2012 campaign would offer NHS staff the chance to learn to swim or dance, take coaching badges in different sports and take part in led runs, he said. ‘We are challenging individuals and organisations to create an environment where members of staff can take part,’ he added. The campaign will announce gold, silver and bronze awards for organisations involved next summer, one year before the London Olympics begin.

Warnings of underlying problems in back pain are ‘not recorded’

Attempts in Scotland to improve physiotherapy practice in back pain revealed poor accounting of possible red flag signals that could indicate serious underlying disease. The signals included a history of cancer or being over 60.  All 14 health boards asked more than 360 physios working at 186 sites to take part in the quality improvement work, Fraser Ferguson, a physiotherapist with the Greater Glasgow back pain service, told delegates. But only one in two of patients with a known red flag condition was having that condition documented. The recording of HIV or drug abuse was particularly low. ‘There has been a change in practice but there’s much more room for improvement,’ he said, acknowledging that nationally led but locally driven indicators were the way forward. Some smaller trusts didn’t record red flags because they ‘said they knew everything going on’. In others physios were ‘too embarrassed to ask’.  For further information go to: www.nhshealthquality.org/nhsqis/5888.html

Communication style affects clinical outcomes

Health professionals’ choice of words has a dramatic effect on patients and can make all the difference to their treatment, said Dr Ruth Parry, senior research fellow, University of Nottingham. Even small variations in speech could produce large differences, such as asking ‘Is there something else you want to address?’ rather than just saying: ‘Anything else?’.

Don’t jog after knee surgery

Patients who have a knee replacement should be advised to avoid jogging and running. Walking down a mountainside with a heavy rucksack was not a good idea either. That was the message from surgeon Martyn Porter, consultant orthopaedic surgeon at the Wrightington hospital, Wigan, who outlined the pros and cons of different knee replacement operations, including the unicondylar knee arthroplasty (where only part of the knee is replaced) and the total knee arthroplasty. He warned that not all surgeons could achieve the high success rates cited in some reports. ‘It is better for a surgeon to be doing 40-50 knee replacements a year rather than just doing 15,’ he said. ‘It’s a real problem to know what we do with patients who don’t do well after the operation.’ But he questioned the impact physios had on patients who had knee operations, saying he had searched the literature and the only strong evidence he could find of any positive outcome from their involvement was a two per cent increase in movement. ‘That’s not clinically significant,’ he said. The best patient for a knee operation was someone under 70, who was fit and well., he told delegates.

Exercise programmes need team approach, cardiac expert advises

Delivering effective exercise programmes requires input from physiotherapists, exercise professionals and exercise scientists, Dr John Buckley, president of the British Association for Cardiac Rehabilitation and programme leader of the MSc in cardiovascular rehabilitation at the University of Chester, told Congress. He said the Association of Chartered Physiotherapists in Cardiac Rehabilitation, the British Association of Sport and Exercise Sciences, and the BACR exercise professionals group, had been working to formalise this through a memorandum of collaboration published in 2008, a position statement on the essential core competencies, and a definition of minimum qualifications needed to lead the exercise component of an early cardiac rehabilitation programme, published earlier this year. The position outlined what was needed to lead a team developing a rehabilitation programme, rather than leading exercise classes, he said. The three groups were now developing competencies across all phases of rehabilitation, which they hoped to publish by the end of next year. ‘It’s important that patients receive the best that all three professions can provide,’ he added.

Sitting is bad for your health

‘The more time you spend sitting the higher your risk of premature death,’ Professor Stuart Biddle of Loughborough University, told Congress. Research on ‘low sitters’ and ‘high sitters’ had revealed a startling correlation between sedentary behaviour and adverse health outcomes. This was of serious concern, especially considering the amount of time people spent in front of televisions and computers. Exercise science had traditionally focused on the health benefits of vigorous physical activity, but promoting moderate physical activity could be of equal importance, he thought. Health professionals should consider encouraging patients not only to exercise but also to increase simple activities, such as walking and household chores. ‘We need to be moving much more,’ said Professor Biddle. ‘The key is to get people to sit less and to look for opportunities to be more active.’ But in order to do this physical activity needed to be more accessible and available. Signs encouraging people to use the stairs, for example, had often produced ‘pretty robust’ effects.

Exercise ‘key to long life’

The UK population is facing ‘a slow mass suicide’ unless people exercise, according to Dr John Searle, the Fitness Industry Association’s chief medical officer. He called for a new health agenda focusing on exercise for disease prevention and the treatment of disease in old age. Warning that the UK was under severe threat from the diseases of western affluence and an ageing population, Dr Searle added ‘We currently have a sedentary, overweight population, costing the NHS billions of pounds every year and heading for dementia and nursing homes.’ The solution was to make physical activity a normal part of healthcare. Exercise reduced the risk of developing many diseases and should be integral to treatment plans.  This would require a culture change amongst health professional and more engagement with fitness professionals, however. The CSP and FIA had set up a joint working group to facilitate more collaboration between the two groups, Dr Searle said. Referral guidelines would be available in the New Year, with advice on when it was appropriate to refer between the two professions. The guidelines would also advise GPs and health professionals about informing patients about local gyms and refering them to qualified instructors. Dr Searle said his personal vision was to see ‘fitness instructors not confided to gyms but working in primary care alongside doctors, nurses, physios and counsellors’. He suggested GPs and health professionals be given a financial incentive to prescribe exercise and engage with the fitness industry.

‘Deliver exercise to the fit and well’

A significant number of future jobs will need staff who can deliver tailored preventive exercise programmes for fit and well people, and physiotherapists must position themselves to do that, a physio who has been working with the CSP and the Fitness Industry Association told Congress. Glenn Withers, a private sports physiotherapist, said physios needed to ensure they were able to deliver the preventive healthy agenda. ‘As a profession we need to stand up and state the value of exercise, and the value of physiotherapists delivering exercise programmes,’ he added. ‘We need to be more vocal in our belief in exercise-based therapy.’

Physios can lead workforce health

Physiotherapists must look ‘within themselves’, and at their teams if the health of workforces inside and outside the NHS are to be improved, said Steve Boorman. Dr Boorman, whose review of the NHS workforce’s health and wellbeing was published in November last year, told delegates that while the recommendations of his report had been widely welcomed, as the anniversary of its publication approached it was time to start introducing measures that would make a real difference. ‘Physiotherapists are ideally placed, and with campaigns such as Move for Health, there are excellent examples of how physios can champion this agenda,’ he said. ‘I challenge physiotherapists to look within themselves and at their team and ask whether they are taking their own approach to a healthy lifestyle seriously.’ Dr Boorman said physio managers should listen to their staff, because that has been shown to make a significant difference to absence rates, and he said there was good evidence that physiotherapy for staff also made a difference, but that it must be organised, supported and prioritised. His report found that schemes were often introduced, but support then waned. CSP members can go the Society’s website for a number of policy documents including its response to the White Paper, the Physiotherapy Works campaign and resources on effective practice. seewww.csp.org.uk.

Julia Brandon, Graham Clews, Lynn Eaton, Robert Millett and Sally Priestley

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