Karen Middleton: going that extra mile

CSP’s chief exec, Karen Middleton, travelled nearly 700 miles to meet members in one of the most remote parts of the UK – and had an unexpected surprise.


I am very fortunate to visit CSP members most weeks and when I was invited to visit the physiotherapists working on the Western Isles, I did not hesitate to accept – not least because marking the UK map in my office with a pin that far up and that far across was quite impressive!

I am going to be quite honest with you, I was a little prejudiced about what I expected to find. Living in south east England, I naively thought practices in such a remote part of the UK might be a little dated. Far from it.

The challenges of living and working in a totally different environment – and the way physios respond to those – proved not only an eye opener, but a real challenge to me personally and knocked a few of my assumptions on the head.

I spent two days with some of the most inspirational physiotherapists I have met in my tenure as CEO, whose practice was informed by the most up-to-date guidance, who used technology to their best advantage, whose work was ‘wrapped’ around the patient and who worked at the top of their licence. It was impressive!

For those of you not familiar with the islands, also known as the Outer Hebrides, they lie off the west of Scotland beyond Skye. The largest settlement is Stornoway, on Lewis, which has a population of around 8,000. Compare that with the 200,000 people living in the London borough of Islington.  

As I became more familiar with the islands – and some of the most beautiful scenery I have seen in the UK – I realised that these members had no choice but to be leading edge, because remote island life meant they had to be.

The struggle to recruit GPs in the Western Isles means there is a need for first contact practitioners and for independent prescribers; the cost of transporting patients off the islands for investigations and procedures means clinicians need to advance their practice to offer an alternative; people living in isolated, rural settings require a strong inter-disciplinary ethos and integrated working and island CPD and supervision necessitates creative thinking, that’s for sure!

My visit got me thinking about change and innovation again. When there’s a driver, such as island life or running out of money, there is an imperative for innovation and change. 

However, what if there is no external critical pressure or burning platform? What generates innovation and change then and why does it matter?

I have found two essential ingredients for driving change in the services that I visited: leadership and professionalism.

If you have read one or two of my In Person columns, you will know about my passion for leadership and the difference it can make. The biggest difference is to be gained through leading change and creating an environment where innovation is actively encouraged, one where staff are encouraged to look outwards, to question and to remain curious, and where risks can be taken safely.

And then there is professionalism. As physios, we need not only stay up to date, but to constantly question our practice, to challenge ourselves and to seek out innovation. Just because there is no external driver for change, it does not mean we shouldn’t, as individual members of our profession, be the drivers of change.

We can never afford to be blinkered about our services. All too often I hear physiotherapists describe their practice as the best or the most evidenced-based relative to someone else’s. That’s all great and may well be the case, but I often want to challenge them by asking: ‘are you sure, or are you simply defending the status quo, rather than considering a different way which would require change?’

I was blinkered about the Western Isles and I had made assumptions -– such arrogance! I was wrong. I am indebted to the CSP members that I met for helping me overcome my in-built bias. And I congratulate them all for the work they do in such a beautiful but challenging environment. 

Do check out their next recruitment adverts!  

Contact Karen: enquiries@csp.org.uk


Karen Middleton Chief Executive Officer CSP

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