The CSP’s 2010 Annual Representative Conference took place in Glasgow last month. Here we present Frontline’s coverage of some of the debates, with more reports to follow in the 17 March issue and on the website. The event is an important debating forum for members and a fundamental strand of the Society’s democratic structure. The conference brings together delegates from across the four home countries, representing a wide cross-section of the members. A discussion and vote on the motions on the primary agenda for debate also took place on interactiveCSP, the Society’s member networking website. Delegates were encouraged to take part in these online debates and to study the views expressed to inform their decision-making. Motions passed at ARC are later debated by CSP Council and may inform the Society’s work, although the motions are not themselves policy. You can find a complete list of ARC 2010 motions and the results of all votes on our ARC page
Please click on the links below to view the content:
Call to counteract pension myth
The CSP must lobby the next government to ensure that a final salary pension scheme for NHS staff is maintained.
Conference also called on the Society and the TUC to counter some media stories that suggest that public sector pensions were ‘gold-plated’. It heard that some subtle changes to the NHS pension scheme had already been introduced, and that the current difficult financial climate could tempt whichever party won the election to use the NHS pension scheme as a way
to claw back money spent propping up the banks.
Iain Loughran, for North East stewards, proposing the motion, said: ‘If you read some newspapers you might read about gold-plated public sector pensions, but the reality is a bit different from that. NHS pensions are comparable to a modest private sector pension.
‘Our pension is as important as our other terms and conditions of employment. What we want is clear and simple. Maintain the current scheme so that we can look forward to a comfortable retirement that is financially stable.’
Motion 1 was carried on the conference floor (and also on iCSP)
Choice can backfire for rehab
Patient choice, a flagship policy in the NHS in England, is interfering with patients’ rights to seamless rehabilitation after they have been treated away from their home area, delegates heard.
They called on the CSP to raise the issue with strategic health authorities, the Department of Health and other relevant bodies, and to campaign to ensure that patients requiring rehabilitation receive a seamless service following their right to choose.
Specialist centres in particular were facing difficulty in referring to other trusts locally, near where the patient has lived – with some requiring patients to travel hundreds of miles for rehabilitation. Patient choice was also leading to increased workload for local physiotherapy departments, when patients who had exercised their choice to be treated elsewhere sought rehabilitation nearer home.
Eirian Jones, from the West Midlands, said she knew of a patient who had surgery in Shropshire but lived in Wales and worked in Cheshire. When the Shropshire hospital tried to arrange ongoing rehab in Cheshire, near where the patient worked, it was refused because they only accepted referrals from local consultants.
She said: ‘Choice is good, but post-operative rehabilitation is equally important.’
Phil Hulse, from West Midlands, added that there was also a problem because money did not genuinely follow the patient.
Motion 6 was carried on the conference floor (and also on iCSP
Two-hour window not enough for job ads
NHS physiotherapy jobs are sometimes advertised online for just two hours, severely limiting potential candidates’ chances of completing a suitable application, delegates heard.
The CSP was urged to work with NHS Jobs, physiotherapy managers, human resources networks and other agencies to ensure there was a minimum time that posts were available.
Margaret McDowell, Cheshire/Mersey and Isle of Man, said it was frustrating for applicants, but also for employers because they did not receive appropriate applications.
Opposing the motion, Sarah Stewart, Chartered Physiotherapists Interested in Massage and Soft Tissue Therapies, said that an advert from her service for a band 5 post had attracted 700 applicants in three hours, so had to be closed.
After initial screening, however, only 12 were found to be suitable.
She said that universities should teach students how to fill in application forms, but student rep Clare Apsden said they did learn how to do it, and it took longer than two hours.
Motion 7 was carried on the conference floor (and also on iCSP
‘User beware on Facebook and Twitter’
A call for the CSP to provide advice to members on good practice when using online social networking sites such as Facebook and Twitter was rejected.
Delegates heard that there was a very real danger of disciplinary action being taken against physiotherapists because of information they had provided on internet social networking sites. Jim Fahie (pictured left), for South East Coast stewards, said he personally knew of three ongoing disciplinary cases that had been prompted by individuals’ use of Facebook.
Jenna Brassington, for North West students, who is a mature student, said: ‘Most of my student cohort are around 19 and their common sense is not always evident on Facebook. Education is always a good thing, and even if we do this only for the student physio population, and only warn them of how it could affect the rest of their career – it is a no-brainer.’
The motion prompted widespread debate, with a number of delegates arguing that it should not be part of the CSP’s remit to provide advice in this area. Nick Clode, for North West stewards, said: ‘If people are stupid enough to put things on social networking sites then I think they should be exposed. I don’t think we need to protect them.’
Motion 9 was defeated on the conference floor (but carried on iCSP
Action call on women’s health
More should be done to implement self-referral physiotherapy services for women’s health, and continence rehabilitation in particular, conference agreed.
It called on the CSP to scope what was already happening in this area, and develop specific resources and a network of ‘champions’ to aid implementing such services. Kate Lough, (pictured left) representing the Association of Chartered Physiotherapists in Women’s Health, said self-referral services for women’s health could lead to substantial cost reductions in the NHS.
A third of women would experience some degree of urinary incontinence at some point in their lives, she said, and although awareness was increasing, more needed to be done to encourage people to seek expert help early.
Motion 11 was passed on the conference floor (and also on iCSP
‘Sell wider benefits of physio’
Promoting the value of physiotherapy to the broader health and well-being of the population and of the NHS should be a priority both for the CSP and for physiotherapists themselves, conference decided.
Gethin Kemp, on behalf of the Welsh Board, said that physiotherapists had to demonstrate their worth to save their jobs and their services. ‘We need to show that we’re effective for patients and the health service, that we have an impact on quality of life and other healthcare utilisation,’ he said.
Physiotherapists could be judged on measures such as whether they prevented hospital admissions and re-admissions, whether patients could cope at home and whether they had facilitated self-management. ‘We need lots of tools to demonstrate effectiveness,’ he added.
Sue Rees, speaking for Council, said that demonstrating the difference made by physiotherapists was even more important when budgets were getting tighter. ‘We need to show we have an impact on the wider healthcare agenda, and we need to have indicators that are meaningful to commissioners and to patients,’ she said. Physiotherapists made a real difference in keeping people in work, she added, which also had a wider economic benefit.
Andrew Merriman, a steward/safety representative from Yorkshire, said that physiotherapists had to be equipped to promote their value to those commissioning services.
Conference called on the CSP to identify a comprehensive strategy that would promote the value of physiotherapy within a wide range of patient pathways to commissioners. It also said the Society should find and demonstrate the value of a range of indicators and measures to help show the worth of physiotherapy and ensure its long-term growth and survival.
Motions 12 and 13 were carried on the conference floor (and also on iCSP)
Apprenticeships mean a great chance for associates
Apprenticeship schemes, being developed across parts of the UK with government funding, are a potentially ‘huge’ opportunity
for associate members, conference heard.
Delegates backed a call for the Society to work with the government, professional bodies, employers, trade unions and Skills for Health to ensure that apprenticeships in health and well-being services are open to support workers and provide for their development and career progress. They also urged the Society to provide information, guidance and, if necessary, training for managers, stewards and associates to ensure apprenticeships work within physiotherapy.
Margaret McDowell, from Cheshire/Mersey and Isle of Man, said: ‘Apprenticeships provide training on the job and for the job. Support workers need to be able to access the scheme in a fair and equable way. We need to promote apprenticeship schemes among potential candidates. And anyone taking part in the scheme should be able to participate wherever they live.’
Motion 16 was passed on the conference floor (and also on iCSP)
Scots students should not have to pay to register
Scottish physiotherapy students should not have to pay to be registered on the Scottish ‘protecting valuable groups scheme’, when they are on clinical placements, conference said.
Delegates heard that the new scheme for people who work with vulnerable groups would require most health professionals to be registered and that the NHS would meet the costs for employees, but not for students.
The scheme is aligned to the Independent Safeguarding Authority scheme being introduced in England, Wales and Northern Ireland. The CSP was urged to campaign strongly to ensure that Scottish students would not face this additional financial burden at a time when they could ill afford extra expenditure.
Nicola Whatley, student representative, said: ‘This will be an extra financial burden on already stretched student budgets. In the current economic climate parental contributions are also tighter, which will make things even more difficult for physiotherapy students.’
Motion 19 was carried on the conference floor (and also on iCSP
Fears over NI graduate jobs
Graduate unemployment among physiotherapists in Northern Ireland is getting worse, year-on-year, and the CSP must work closely with the relevant parties in the country to address this shortfall in jobs, conference agreed.
Despite the success of CSP campaigning to tackle graduate unemployment, the situation in Northern Ireland remained severe, delegates heard. The problem was becoming accumulative and the recent comprehensive spending review in the country had led to a recruitment freeze, likely to make the problem worse.
Emer Hopkins, for Northern Ireland stewards, said short-term contracts were being offered to graduates to tackle waiting list blackspots, but that this was not helpful in developing young physios’ careers.
‘We know the work is there and we need to remove the barriers and get these graduates into work. We need long-term workforce planning,’ he said.
Mark Quinn, student representative, said around 60 or 70 physiotherapy positions had been left unfilled in Northern Ireland, with no reason given. He said students were also failing to find placements because physiotherapy departments did not have the capacity to offer the required level of training and education.
Motion 22 was carried on the conference floor (and also in iCSP
‘Yes’ to uniform
The CSP should campaign for a nationally recognised physiotherapy uniform to be worn throughout the NHS, conference agreed.
Michael Pearson, for East Midlands stewards, told conference that there was a move to introduce generic corporate uniforms among trusts within the NHS, which left patients struggling to distinguish between physiotherapists and other healthcare professionals.
‘In my experience it is not conducive to a happy and productive workforce, or to a better patient experience,’ he said.
The conference agreed that a national uniform for physiotherapists would promote a clear physiotherapy identity that was easily recognisable for staff, patients and visitors.
The motion was carried on the conference floor (and also on iCSP)
Take a stand on bullying
Bullying at work is an ongoing problem for many physiotherapists, despite CSP efforts to address it, and growing numbers of students are reporting to the student executive committee that they feel bullied while on clinical placement, conference heard.
Patrick McCarthy, SEC chair, proposed a motion calling on the Society to support universities in tackling bullying, and to encourage students to speak up and not feel they should tolerate bullying in their placements.
He said he had encountered numerous cases where students had reported feeling bullied, including one – a mature student – who heard herself referred to as ‘the inconvenience’ within a few days of starting her placement and felt constantly patronised and excluded. After qualifying, she had decided not to pursue her career as a physio because of staff attitudes.
Julia Tabrah, North West steward/safety rep, seconding, said that since the motion had been posted she had been inundated with calls from physios outlining their experiences, including one manager who had left because she felt bullied by her line manager and another who was off work with a nervous breakdown.
Speaking from the floor, Rachael Pope, South West South steward/safety rep, said that bullying permeated delivery of care in the NHS and too little was done to address the problem. She added: ‘Negative behaviour does need to be curbed for the benefit of staff and patients. We need to create communities and leaders who are kind. I am sick and weary of hearing about damaged people in the NHS.’
Delegates called on the CSP to devise and implement effective solutions to ‘the very serious problem’ of bullying.
Motion 26 was carried on the conference floor (and on iCSP)Feature on bullying coming up in Frontline, 17 March
Physios could be involved in a ‘death service’
Physiotherapists would be involved in helping patients to die if assisted suicide became legal in any part of the UK, conference was warned.
Baroness Finlay of Llandaff, CSP president and a palliative care specialist, raised the issue when she addressed the conference. Referring to proposed legislation currently before the Scottish Parliament, which would allow health professionals to help people to die in certain circumstances, she warned: ‘This would involve every person in healthcare – not just the doctors, not just the nurses; it would involve everyone.’
She said that physiotherapists should be thinking not about whether the move was something that should happen but rather should ask themselves ‘is this something I’m prepared to do?’
‘My personal view is that this is not something for healthcare,’ she said. ‘It would be a death service; it should be outside healthcare.’
Such a move would take health professionals in two directions. On the one hand, they would be trying to enable and help patients, but on the other they could be shortening their lives. It would have a damaging effect on staff morale, apart from anything else, she said. Health workers in Belgium had told her they felt pressure to get quick results or patients would be pushed towards euthanasia.
In a wide-ranging speech, Baroness Finlay also warned physiotherapists that healthcare budgets were likely to fall, whatever the result of the general election. ‘You have to fight job cuts, or the jobs are gone for good,’ she said.
Protest over pay freeze
Delegates carried an emergency motion proposed by Scottish stewards, protesting about the Chancellor’s announcement
in his pre-budget report that public sector pay would be capped at one per cent for two years from 2011.
NHS employers, trade unions and government have used the independent pay review body for negotiating pay since 1984, said the motion, which called on the CSP to work with the TUC and other trade unions to ensure that the PRB process was maintained in the NHS.
Paula Green, representing the national group of regional stewards, seconded the motion, saying: ‘I ask you, can you live
with a maximum 1 per cent increase on your current wage, as the rate of inflation sits at 2.4 per cent and is increasing steadily month by month? I guarantee your answer will be no, but this is what our government is expecting.
‘The PRB has been instrumental in providing equality in pay awards across the four countries. The PRB appraises written and oral evidence from the health departments of the four UK countries, the NHS employers and the health unions before making its recommendation to government, thus making a realistic appraisal of the pay increase that would be appropriate for the current economic climate we live in.’
Emergency motion 1 was carried
Emergency call on standards wins approval
Conference backed an emergency motion calling on the CSP to define minimum standards of physiotherapy based on
proper clinical assessment, diagnosis and treatment. The Society should also spell out why limiting treatment to telephone advice only, or single face contact and discharge, posed a risk to patients.
The motion signalled that health services UK-wide faced significant financial challenges. This posed a real risk that physiotherapy services throughout the UK would be cut to below minimum standards to save money. CSP members must therefore campaign at all levels to maintain the treatment standards that patients needed.
Proposing the motion, Philip Hulse, West Midlands, said: ‘Physiotherapy could easily become the soft target as reductions in standards would not grab headlines or the hearts and minds of the general public compared to reduction in cancer or children’s services.’
He added: ‘Services that are restricted to telephone treatment, or that cap treatments against the treating physiotherapist’s judgement are not physiotherapy. At what point do services designed to cost less become worthless? And at what point does the profession say, “Stop” to such services?
‘If significant numbers of the general public experience poor quality physiotherapy they will believe their own experience is all the profession has to offer. This will impact on NHS and private practice as patients seek treatment from other professions.’
Paula Green, representing Scottish stewards and seconding the motion, said that vital frontline services were already being targeted in a bid to try to meet current efficiency targets.
But Council member Catherine Pope, speaking against the motion, said: ‘I think we have standards and if we agree minimum standards that is what people will get.’
Nicola Hunter, from the Association of Chartered Physiotherapists in Occupational Health and Ergonomics, said ‘you can do a lot of good with telephone based services’.
Emergency motion 2 was carried
‘The door to prosthetics stays at manual’
The role of a professional army physio is to keep soldiers in the front-line or return them there as soon as possible, physiotherapist Captain Skye Manton of the Royal Army Medical Corps, told a crowded fringe meeting.
In other words, the aim was effective treatment that prevented acute problems becoming chronic, she said.
The wounded – some with horrific injuries – were taken first to the field hospitals, where admissions included UK troops, members of multinational forces, prisoners of war and local civilians. Conditions varied massively, from pneumonia to dislocated shoulders, though the hospital was predominantly an ITU setting, she said.
The most seriously injured military patients are airlifted to Selly Oak hospital in Birmingham and then from there are transferred to Headley Court Defence Medical Rehabilitation Centre in Surrey, where Captain Manton is lead member of the complex trauma team. The injuries included multiple amputations, multiple fractures to lower limbs, spinal injuries and burns. But the skills the team used were generalist, not specialist, and the patients now at Headley Court would need on-going care from professionals throughout the NHS, she said.
Mental health problems were a major issue and could be severe following serious injury, which might include patients having to adjust to the inability to have children, she said. ‘It sounds harsh, but at all times we have to provide a military role. We still have to discipline a double amputee. We have to give them physical and psychological goals.’
She added: ‘The only door at Headley Court that isn’t automatic is that to the prosthetics department. But they [the patients] want to keep it [manual] because it is their goal, to open it themselves.’
Graham Clews, Joy Ogden & Jennifer Trueland