A decade at the top

This is all going to sound a bit altruistic,’ begins Karen Middleton, CSP’s outgoing chief executive officer, as she explains what originally motivated her to become a physiotherapist, ‘and it feels a bit odd saying it but there was something about being of service…’

Aged 14, Karen was thrown a curveball by the results of a careers questionnaire. She was sporty, into football (a life-long Hammers fan), and already volunteering as a British Red Cross first aider as well as going into hospitals and care homes supporting quite vulnerable people. It’s no surprise really that one of the four career suggestions for her was physiotherapy. 

Karen can’t remember the other three but that might be because the idea of becoming West Ham’s physio had now crossed her mind. Despite no one in her family having any knowledge of physiotherapy, she found herself arranging work experience at Old Church Hospital, Romford (now Queen’s Hospital). ‘They organised for me to spend a day in different departments and that was it really,’ she states matter-of-factly.

Out went her plans to go on and study French at university and, although she didn’t consider herself a natural scientist, she switched tracks. A few years later she completed her physiotherapy diploma training at St Mary’s Hospital School of Physiotherapy in Paddington, London. 

With a catch in her throat, Karen continues: ‘I can honestly say that I have loved every single job I’ve had. What a privilege to be able to say that.’

When she was appointed as the CSP’s chief executive, her predecessor described her in two words – brave and feisty. An understatement. Her career boasts far more than her decade at the CSP. 

Karen worked clinically at first but soon moved into management and leadership positions, including as chief allied health professions officer at the Department of Health. Becoming the first physiotherapist and the first woman to lead the CSP, she’s shattered a few glass ceilings too. She knows that the chief executive position is a niche role, and very different from the CSP Council’s leadership roles, but she says it’s a great role for those in the profession to aspire to. It looks like that trend is set to continue as John Cowman, who trained as a physiotherapist, takes charge of the CSP in the new year.

Tough calls

While she has loved every job, there have been tough times and tough calls to make along the way. Karen talks of supporting members through the recent pay disputes and leading the organisation during Covid-19. 

Discussing the pay strikes, she notes: ‘Physiotherapy has never been the most well-paid profession but when I was on the picket line earlier this year, it was hard seeing the low morale and the pressure members were under. I knew how angry they were about the level of pay and the level of vacancies. And yet those same people said “I love being a physio” or a support worker, and that I understood. That’s how I feel about this profession. I love it, I’ve always loved it, and I always will.’ 

Of the pandemic, Karen was confident that CSP was agile. Following the announcement of the first national lockdown, the CSP switched to fully remote working overnight, while staff teams instantly reconfigured themselves to best help members and universities deal with the unfolding crisis. But, even as she recounts the adrenaline-filled focus that was required to provide that level of sustained support, she acknowledges the human cost with both staff and members losing loved ones. As validating as it was to know that the CSP delivered, there is no celebration in her voice. 

Patient stories 

It’s impossible to ignore the notes of pride, both in her profession and for the teams/staff she’s worked with throughout her professional life, as Karen shares her career highlights. 

The first of these, gaining independent prescribing rights for both physiotherapists and podiatrists in the UK, was a huge achievement. Karen recalls the resistance that had to be overcome and the hard work behind the scenes at the Department of Health, CSP and the College of Podiatry. She talks of a fight, overcoming prejudice, overcoming professional protectionism and taking a leap of faith. Brave and feisty indeed, given that there was no available data to refer to – as nowhere else in the world had tried this.

What kept Karen focused throughout the process was the involvement of a patient on her steering group at the Department of Health, as her input kept Karen and her team focused on patient stories. Karen notes it was a great achievement for the professions, but more importantly it was the best outcome for patients. The leap was finally made in 2013 and that much fought for legislative change altered the scope of practice for both professions overnight. 

Karen adds that even now she hears about the fruits of that achievement: ‘Quite recently I heard about a physio team in the north-east working with children with cystic fibrosis,’ she says.

‘The children didn’t have to be taken out of school or make hospital appointments in order to change their prescriptions, because the physios could just do it. I thought that’s why we did it.’

She also discusses an earlier project supporting people with severe, complex disabilities. A simple act of interviewing people in their homes, their pubs, their clubs, and in hospital opened her eyes to how healthcare is geared towards the professions or the professional. 

It was the first time she had worked collaboratively across health and social care, showing how powerful that can be, but what stayed with her most was the need to listen to patients and valuing their voices. 

With that, Karen offers a caution about what happens when the patient is forgotten. Reflecting on her experience with the Francis Inquiry during her time at the Department of Health, her voice cracks for only the second time in the interview as she confides ‘some of those stories will stay with me forever’.

Joining the CSP

For someone who didn’t really have a relationship with the CSP, Karen surprised herself and others when she applied for the job. ‘I thought rather than banging on about the CSP, I could roll up my sleeves and see what I could do,’ she recalls.

‘What the CSP needed was someone experienced in organisational development to unlock staff talent and that’s where my skills lay.’ 

She already knew that myths about her views on trade unions would quickly need dispelling, despite her being a steward and union treasurer earlier in her career. She talks also of her good fortune of being on a lecture tour in New Zealand during the period between being offered the CSP chief executive job and starting. The physiotherapy membership body there simply wanted to know how the CSP became a trade union.

‘It was fascinating to me, this view they had, that their influence was compromised or could have been greater had they also been a trade union,’ she notes.

‘Good employment conditions lead to better clinical outcomes. I have no doubt in my mind that the power of the CSP is as a trade union and as a professional body.’ 

Her goal was never to diminish the trade union function, instead she wanted the practice and education functions to have the same level of influence as the trade union. 

Reflecting again on the pandemic she talks of that combined strength. By working and influencing across the directorates, the CSP was able to strengthen the support it offered to its members. 

Organisational development

Karen is unequivocal that the key to achieving her goal was in unlocking the CSP’s great staff, empowering them to achieve their full potential. And that meant change, both in culture and in structures, by streamlining reporting mechanisms to strike the balance between appropriate oversight and agility, flattening hierarchies, and empowering staff thereby enabling them to take risks and innovate. 

Although she’s quick to remind me that the skill required for any chief executive is that of organisational development, she credits being a physiotherapist with helping her to empathetically navigate some of the more difficult changes. 

I thought rather than banging on about the CSP, I could roll up my sleeves and see what I could do 

Under her watch, council streamlined from 28 members to 12, and the CSP office moved from Bedford Row, its London home since the 1960s, to a smaller, modern open-plan space down the road in Chancery Lane, with the majority of staff now working at home and located throughout the UK. 

The connection she felt herself, as a physiotherapist, spurred her to pick up the phone and call individuals personally to talk about the changes being proposed.  Of the office move in particular Karen was surprised, the overriding feedback from many was ‘what took you so long!’  

Karen talks often about the talented CSP staff, she also talks about her relationships with council, particularly the chairs. Working over the years with different chairs, including Sue Rees, Catherine Pope, Alex MacKenzie and Ishmael Beckford, she confirms that working with such exceptional leaders was a gift.

Personal learning

Unsurprisingly, for someone who has championed the CSP’s learning culture, Karen becomes more reflective as she shares her personal journey since initiating its equity, diversity and belonging (EDB) work. 

The strategy is close to her heart, and she knows the work will continue as she passes that baton onto her successor John. 

Her voice takes on a different tone when we begin to discuss Black Lives Matter and trans rights. The murder of George Floyd in 2020 affected her profoundly. She recalls trying to address the news in her weekly staff bulletin. Feeling unsure about her position and privilege, she removed the paragraph, put it back, then eventually removed it again. She talks with regret about her silence, and again on social media recently with other’s transphobic tweets. 

She regrets it took a staff member asking why the CSP wasn’t saying anything about Mr Floyd for her to understand the need to be an ally and speak up. But it’s a result of that salutary experience that promoted Karen to start reading and educating herself, and to start listening to the stories of staff and members who freely shared their experiences. 

‘The more I learn from those with lived experience, and I appreciate they’ve had to tell their stories so many times, the more I learn about privilege and power.’ 

She explains that after Mr Floyd’s death, ‘There were so many organisations posting statements, I did not want to simply post something and not follow through.’

She expands: ‘We were already doing work on equality, diversity and inclusion, but it wasn’t meaningful, and it certainly wasn’t transformational.’ 

It’s why it became important to Karen that the CSP developed a EDB strategy that underpins all workstreams.

The next chapter

Our conversation unsurprisingly turns to the future. Karen has no plans to slow down any time soon, but the time is right to switch her focus to family, and with a glass of wine in hand she considers her options. She expects to continue offering leadership coaching, and she’s already been approached with offers of non-executive roles. There’s even talk of a novel…

And with regards to the CSP, and the future of the profession, she smiles and says: ‘There’s so much opportunity – rehab is on the map, first contact practitioners are everywhere, and independent prescribers.

‘The CSP is an influential organisation. We’re invited to have a seat at the table - we’re respected and listened to. There’s the EDB strategy to embed and the staff here are so talented and committed.

‘These are exciting times. I feel envious,’ but she confirms, ‘It’s the right time to step aside and be a member cheering on from the sidelines.’ 

What a great way for a career in service to end, leaving behind an agile and influential CSP, with a foundation of talented people ready to support the incoming chief executive, as they collectively champion you the members and the profession.