Public health expert Muir Gray, a key speaker at CSP’s annual conference, tells Graham Clews that physiotherapy staff need to become a knowledge business.
Sir Muir Gray talks about the future of physiotherapy
As one of the most influential figures in public health in the UK over the past 40 years, Professor Sir Muir Gray says physiotherapy can help people to take a path that will lead to better health.You might have come across his popular books on living well, with the attention-grabbing titles of ‘Sod 60!’ and ‘Sod 70!’
Professor Gray is convinced that physiotherapists are central to his public health message that more movement by people at all levels of society will result in a healthier, more productive population. And as a former chief knowledge officer at the NHS, Professor Gray wants the physiotherapy profession to use data and state-of-the-art technology to cement its role as a key player in the battle against lifestyle-related poor health.
When he delivers the Founders lecture at this autumn’s Physiotherapy UK conference in Birmingham, Professor Gray will tell physios that their profession can flourish in the coming years, but only if they adapt the way in which they currently work. ‘If you ask most people what a physiotherapist does, they will say they are pretty hands-on with an individual,’ Professor Gray says.
‘But if we look ahead we can see that demand for physiotherapy is going to increase – principally because of population ageing.’ This will outpace the available resources, both financial and human, he says. ‘So without changing what physiotherapists are doing at the moment we have to ask what is the future for the profession. And what I say is that the profession has to see itself not only as a one-to-one. Hands-on profession, but also as a knowledge business.’
Professor Gray’s day job, even though he is now in his 70s himself, is with a firm he started called Better Value Healthcare. He draws on his years in public health, his pioneering role in introducing screening and IT in the NHS to advise health systems on how to cut inequity, waste and patient harm. They can do this, he suggests, while meeting rising need and demand – but without spending huge amounts of extra money.
Professor Gray likes to draw parallels with the business world and quotes motor manufacturer Toyota’s adage that it is a knowledge business as much as a motor car one. ‘They say that what is important for them is not only knowledge of steel and plastics and everything else you need to build a car, but also knowledge of what their competitors are doing, how the world is changing, environmental pressures on motor manufacturers, and so on,’ he says.
‘In terms of physiotherapy, you have to see who is getting physiotherapy at the moment, and it is not necessarily the people who will benefit most.
‘If you have a severe stroke you will go into hospital and see a physiotherapist, of course, but there are lots of people – millions probably – with various musculoskeletal disorders who are getting weaker and weaker while they are sitting in a chair and who will end up in an old people’s home.’
Professor Muir recommends a two-pronged attack. First, physiotherapy needs to become population based, by which he means that a small number of physiotherapists in every hospital or department must analyse the department’s work. They might put a map on the wall and spend some time each week studying where in their area they are treating patients, and why.
Second, there needs to be some thought on how physios can reach people who they don’t see in the traditional one-to-one manner. Professor Gray suggests that more could be done by care assistants who have been trained by phsyios or by exploiting the internet more.
‘Some physiotherapists are doing this already. But the profession as a whole needs to think about how many people are benefiting from their knowledge and how many people physiotherapists are seeing – because the sums don’t, and will never, add up,’ he says.
‘If you take one hospital department it just needs one or two physiotherapists to have a couple of days a week to ask questions such as how many people we are seeing with back pain, how many people locally have back pain. Are they seeing the right people? What does the local GPs think is the appropriate referral pattern for back pain, how many people in the geriatric ward need help standing up, what do all the care assistants in the old people’s homes think is the right thing to do?’
The next question might be: ‘Why don’t we have a music and movement programme for all old people’s homes backed by the local physiotherapy department?’ Physio staff might offer training and also have a role in telling everyone locally that they think this is a good thing, he explains.
‘Some people will already be doing this kind of work, so it may be possible to set up a casebook of examples, and the CSP could play a leading role in that.
‘But the profession has to ask: “What do mean by high value use of physiotherapy? Who is doing it like this at the moment? How can we spread this across the NHS?”’
Professor Gray ends with a challenging thought. ‘If I were in business, I would probably give it a brand name and call it “Physiotherapy 2.0”, or something like that.‘fl
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