Rough cuts

Many physiotherapists are facing ‘efficiency savings’, or, depending on your standpoint, cuts. Lynn Eaton looks at what the CSP is doing to help members and examines what members can do at local level.

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Supporting members: use the links in this feature to download resources

Times are tough, we all know. There has been considerable investment in the NHS in recent years. Now – under the coalition government – it’s payback time.

In England alone, the NHS faces £20 billion efficiency savings by 2015, even though the government claims that NHS spending is being increased in that time.

In Scotland, despite promises to protect the devolved health budget, overall public expenditure is falling. Scottish patients can expect to see a 1.1 per cent drop in health spending this year.

The Welsh government has cut its health and social services budget by 7.6 per cent this year and expects 7 per cent efficiency savings this year alone, to start to meet an expected shortfall of £1.3bn to £1.9bn in the next five years.

Northern Ireland, meanwhile, faces a £4bn cut over four years in its block grant from the UK government. Despite this, it has allocated an extra £120m over the next four years to health, but CSP officials say the figure falls way short of what is required by 2015.

All of which adds up to a pretty grim picture for physios working in the NHS throughout the UK.

There is very little evidence, as yet, of physiotherapists being made redundant. But there is growing anecdotal evidence of vacant posts being stripped out or frozen, posts being advertised at lower rates of pay, and terms and conditions of service being affected for all staff.

‘The main cuts we’re hearing about,’ says Claire Strickland, unit head of CSP’s practice division, ‘are of vacant posts not being filled, of maternity leave not being covered, and of existing posts being downbanded to save money.’

But, with the support of the CSP, members can do something to challenge decisions that might erode patient care – as some members have shown.

Challenging the cuts

It is possible to make a difference, despite everything. CSP members at one trust recently fought successfully to reverse a decision by Basildon-based South West Essex Community Services.

The trust faced a massive cut earlier this year after the primary care trust that was commissioning their service decided it had to save £134,000 from its musculoskeletal services.

The PCT tried to cut the physio service to one assessment only, with no follow-up treatment. Chronic patients would merely be issued with a care plan, but given no follow-up treatment by qualified staff. Local physios were furious.

The decision was reversed after CSP members successfully argued that such a move was counterproductive, and would only lead to greater costs further down the line.

Lee Matthews, CSP steward at the primary care trust, explains how they did it:

‘Physios challenged this decision, but didn’t just oppose it,’ he says. ‘We made constructive suggestions to find a way forward to save money but without the huge rationing that was planned.’

Following their intervention, managers reviewed the patterns of MSK treatment in the area over the last year. It revealed that a small number of patients were being seen more often than was necessary.

‘The physios suggested they could make savings by reducing the use of non-essential equipment, seeing more patients in groups, and having a maximum of five contacts per patient,’  Mr Matthews said. 

Positive note

It’s vitally important that CSP members are aware of such positive results, says Natalie Beswetherick, CSP’s director of practice and development.

‘As professionals, members can employ evidenced solutions to counter such arguments to ensure patient services are protected,’ she said.

Ms Beswetherick urges members to find out more about how the government’s Quality, Innovation, Productivity and Prevention plans (known as QIPP) are working in their area – and to get in there, and influence them.

It’s not just about making across-the-board cuts in existing services, she says. ‘It’s about transforming services that maintain or improve quality whilst releasing resources to assist the final push towards making efficiency savings.

‘You can do things differently in order to save money, like developing self-referral programmes,’ she suggests. ‘It’s a no-brainer. Cutting spending alone is merely a short-term quick-fix. Transforming services brings long-term benefits to your patients and saves money.

‘The important thing is that members need to be engaged locally with the QIPP programme.’

Details of the programme, including local initiatives, can be found on the NHS Institute for Innovation and Improvement website at www.institute.nhs.uk

Where members want to launch a local campaign to protect services, the CSP will support them with advice, including tips from the communications team on how to use the media.

Decisions on jobs and services are being taken locally, so members need to be aware of what is being planned for their own service and the impact this will have on them locally – and what they can do about it.

And while patient services are potentially at risk, so are the terms and conditions of physios’ jobs. And often the two are linked.

One CSP member from Scotland reports that the neurological rehabilitation unit in Aberdeen has been carrying two maternity leaves, one period of unpaid leave and two vacancies over the last year.

Only limited cover was provided and a recent audit revealed that, of the 63 per cent of patients admitted to their stroke rehabilitation centre who were able to participate in a physiotherapy programme, patients were only treated two or three times a week on average during their admission period.

Lesley Mercer, director of CSP’s employment relations and union services (ERUS), understands that individual physios may be feeling scared to speak openly about what has happened to their departments.

‘But,’ she says, ‘as the Basildon example has shown, members can find acceptable ways of making their voices heard when they speak as a united, professional group, through the CSP.’ 

A two-pronged approach

The CSP is tackling the issue of cuts at all levels throughout the organisation, through member involvement. At national level, CSP officials are working hard to protect patient services and members’ jobs.

Chief executive Phil Gray and chair of council Ann Green are working, along with ERUS staff, members of the press and policy team and Frontline staff, to influence UK-wide debates about policy – including the Hutton review of pensions, pay negotiations with the NHS Pay Review Body and negotiations with NHS Employers on the Agenda for Change agreement.

As a TUC-affiliated union, the society is also pressing, with other health bodies, for members’ concerns to be heard.

More than 700 CSP members joined the TUC-organised march for the alternative earlier this year, for example. And London CSP rep Vickie Yeardley was among those speaking at the rally in Hyde Park at the end of the march. 

Beyond borders

CSP Scotland sent a full delegation to the Scottish Trades Union Congress in April, where it proposed the main motion, opposing the cuts to NHS and public services.

‘These are challenging times ahead,’ says Kenryck Lloyd-Jones, policy officer for Scotland.

Philippa Ford, policy officer for Wales, echoes the view that, no matter what is done nationally, local CSP members need to recognise the potential impact on them individually.

‘What’s concerning is where people don’t think the financial situation is going to affect them,’ says Ms Ford. ‘The Welsh Board has tried help members realise that they all have a part to play in providing the evidence for the value of physiotherapy and the reasons for certain grades of staff carrying out certain activities and tasks. The power of the professional arguments will need to be made ever stronger as financial times get even tougher.’

Tom Sullivan, policy officer for Northern Ireland, adds: ‘Like other trades unions and professional bodies the CSP has raised the devastating impact these cuts could have on the delivery of frontline services.’

Supporting CSP stewards

The CSP has a network of 900 local stewards who have been trained on how to respond to the cuts. But members have to be willing, at local level, to act on their concerns, says Ms Mercer.

The stewards need our members’ support,’ she says. ‘This has got to be a response from the whole profession, from managers through to support workers. It can’t be left to the stewards alone.

‘One thing we do know: if we do nothing, then we get nothing.’

CSP’s assistant director of employment relations, Peter Finch, explains how members can make the most of the resources available from the society.

‘The first point of contact would usually be your local CSP steward as they are familiar with your workplace and can offer advice, support and representation,’ he says.

‘They are not, however, experts on all health issues. It is the staff whose service is being reorganised or whose jobs are at risk who are best placed to provide the arguments and alternative solutions to proposals which threaten services.

‘The steward is only part of the team. Members – individually and collectively – are the CSP. ‘

He advises that as soon as a physio becomes aware of proposed ‘efficiency savings’ they should speak to their colleagues and suggest a meeting is held, organised by the manager of the service.

Is it really that bad?

The staff at the CSP know that members are feeling under threat, but the society is not an organisation to cry wolf: it won’t pretend that massive redundancies are taking place among physiotherapy staff when at present that’s not happening.

But what is happening is that as a result of job freezes and other steps being taken at local level to cut costs, patient services are being rationed in many areas.

A survey of CSP members in March showed that 74 per cent of members were seeing rationing in services, 87 per cent feared patients would have fewer sessions with a physio and 81 per cent feared longer waiting times.

Patients would be in pain for longer, and had a greater chance of being readmitted to hospital, according to two-thirds of respondents.

It’s this kind of information that the CSP can use to raise awareness of the impact of ‘efficiency savings’ on patients.

The Observer, for example, reported the CSP survey, highlighting the impact on patients with chronic conditions, such as cystic fibrosis, severe asthma and multiple sclerosis. 

Neil Churchill, chief executive officer of Asthma UK, told The Observer that some patients were having to wait up to six months for specialist physiotherapy services.

Another CSP survey, of physio managers about the impact of the savings on waiting times, workload and workforce, is currently under way.

Pay and conditions

  • The effect of wider public sector cuts is real.
  • The proposed changes in the Hutton pensions review alone will have an enormous impact on physios.
  • Members face having to pay more from their salaries towards their pension fund, having to work longer, and ending up with a worse pension than they had planned for.

On top of this, access to the state provision is getting worse. Half a million women aged 56–57 will have to  work more than an extra year before getting their state pension of whom 33,000 born between 6 March and 5 April 1954 will have to work for two years longer.

This is particularly bad news for women in this age group, who will have very little time to prepare, or amend, their existing pension provision in order to cover the gap.

Current law means that, between 2034 and 2036, state pension won’t be paid until people reach the age of 67. Between 2044 and 2046 people will have to wait until they reach 68.

The government is considering further revision to these age bands.

Supporting one another

CSP is aware that many physios are being stretched to their limits. At times like this, it’s important to support one another.

‘The key thing is not to suffer in silence,’ says CSP‘s unit head Claire Strickland.

Remember that, as a health professional, you have a duty to provide a safe service to your patients and you cannot delegate your responsibilities to someone else (or do them for someone else) unless it is within that person’s scope of practice.

‘Don’t bury your head in the sand,’ says Ms Beswetherick. ‘As a chartered physio, you are personally accountable for your practice, regardless of your employer’s and others’ possible culpability.

If you’re put in a position where you believe you are being compromised as a health professional, talk to your manager, CSP steward or safety rep and enlist their support.’

Supporting members: resources

As a CSP member you are not on your own. The CSP offers advice and support including:

  • Local stewards are the first people to contact if you work in the NHS and have a problem. Find your local steward by by getting in touch with the CSP’s Enquiry Handling Unit.
  • Support from senior staff. At national level, the senior negotiating officers work with stewards to support members. Legal support is available in some cases. The CSP recently joined with other health unions to fight for pay protection in Taunton and Somerset, for example, although taking an issue like this to an employment tribunal is a very unusual step.
  • Communications support. CSP press and policy officers can advise members on how best to use their local press and to lobby MPs or elected representatives and local councillors.
The CSP also produces a range of briefings and tools, available to download or access via this website:

  • Physiotherapy Works: This series of briefings demonstrate the cost-effectiveness arguments around specific physio services. Intended mainly to influence planners and commissioners, they cover cardiac rehab, chronic obstructive pulmonary disease, fragility fractures and falls, multiple sclerosis, musculoskeletal disorders, occupational health, stroke, and urinary incontinence.
  • Calculating the economic value of a physio service: a series of guides covering stroke, lower back pain and chronic obstructive pulmonary disease
  • Policy into practice briefings: these are also available on the CSP website and give scenarios for different clinical settings, explaining how various policy initiatives impact on physios.
  • Survival guides for managers: a series of workshops and a published guide showing the information managers need to gather to protect services and present a case to service planners and commissioners.
  • The next workshops are on 5 and 12 September in London and 28 September in Darlington. Download the guide, Surviving the NHS Changes.
  • Briefings on vacancy freezes and terms and conditions, a guide to campaigning and a briefing on downbanding. This series of briefings include: how to challenge vacancy freezes and staff cuts, respond to attacks on employment terms and conditions; members’ rights regarding redundancy; campaigning; and, the most recent of all, on downbanding. You can download these reports on the work ERUS has done and what support it offers at www.csp.org.uk/financialchallenge
  • Stress advice sheets. There are six advice sheets, including dealing with change, available to download.
  • Access to professional advisory service.
  • Frontline/CSP website/e-bulletin. Frontline and the society’s website keep members abreast of what is going on around the UK, both nationally and locally.
  • The e-bulletin sends fortnightly alerts about what is going on in the physio world; 20,000 members are already signed up to it.

Tracking the cuts

National staff in all four countries are monitoring the cuts locally. They can’t get involved in each case, but they are keeping abreast of what is happening.

The CSP is collecting data from regional ‘Managers’ survival’ workshops, including some held outside England, on the impact of the cuts locally.

Managers throughout the UK have been asked to contribute their comments on the impact of the savings on waiting times, workforce and workload. Details are currently being collated. A separate survey is being carried out among managers in London following specific concerns by members in that area.

In Wales, the CSP has set up a ‘Professional Readiness’ group and briefed members on the impact of the financial situation and measures they can take. The Welsh group has also sent in Freedom of Information requests to health boards to help keep abreast of jobs awaiting recruitment, potential cuts in the service and other vacancy-related information.

The NHS Information Centre has agreed to give the CSP quarterly information on workforce levels in England and approaches have been made to relevant bodies in the other three countries to do the same.

CSP carried out a survey in February which sought information from members on the cuts in their area and was subsequently covered in The Observer (10 March) and Herald Scotland (23 March).

influencing Government policy

CSP officers have made members’ concerns clear at meetings with the NHS Staff Council, the England NHS Social Partnership Forum and country equivalents and directly with government ministers and senior civil servants.

In Northern Ireland, staff are working on a campaign around graduate unemployment and cuts to the workforce.

CSP staff have submitted evidence to the Centre for Workforce Intelligence in England, the England White Paper consultation on workforce planning and the linked health select committee inquiry.

The CSP, as a TUC-affiliated union, is part of the ‘All Together for Public Services’ campaign and supports the ‘False Economy’ website, http://falseeconomy.org.uk, where examples of cuts in public services are being posted, to help raise awareness.

Author
Lynn Eaton

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