Across a range of conditions, and in a range of settings, physiotherapy and rehabilitation are highlighted within the NHS Long Term Plan for England.
Specific commitments include; increasing the number of physios in primary care, rolling out first contact physios and improving access to rehab in a wide range of areas including frailty, stroke, pulmonary and cardiac conditions.
Here is some reaction from the physiotherapy profession:
CSP Fellow Sally Singh, professor of cardiac and pulmonary rehabilitation at University Hospitals of Leicester NHS Trust, said:
'It is great news, and very exciting, to have both cardiac and pulmonary rehab services endorsed and recognised as being important and part of this ten-year plan.
The plan identifies and confirms cardiac rehabilitation as an important intervention for patients with cardiovascular disease.
In addition, it sets out a target of providing cardiac rehab to 85 per cent of those who are eligible, which is quite an ambitious target, so we are obviously going to have to work hard to achieve that as part of a broader, multidisciplinary team.
But it’s good to see that it has been recognised as a valuable intervention for those groups of patients.
Pulmonary rehab, which is a largely physio-led service, is also highlighted in the plan as an important intervention.
The CSP has conducted a lot of work around pulmonary rehab for people with chronic lung disease, and this report outlines that 13 per cent of patients currently take up the offer of pulmonary rehabilitation – so there is clearly a huge amount of work to do to expand that service and potentially look at different ways of delivering care.
And there is a lot of interesting work, looking at new models of how to provide rehabilitation. This includes digital interventions and examining how resources can be maximised by combined models of rehabilitation - particularly for breathless patients.
The plan does present challenges for us, both in terms of making sure patients have access to these services and around workforce issues as well, but there are also opportunities to look at how we can improve the offering to patients with cardiac and respiratory disease.
Part of that may involve looking at digital solutions, and we have some experience of that already with cardiac rehabilitation. For instance, Frontline has previously profiled a digital intervention at our trust, called Activate your Heart, as well a breathlessness programme open to people who have a diagnosis of heart failure and chronic obstructive pulmonary disease. Hopefully, there will be much more interest in those sort of models now, which allows us to develop programmes that support a wider group of patients.'
Ian Culligan, chair of the Association of Chartered Physiotherapists in Respiratory Care, said:
'The ACPRC are delighted to see that the plan places a priority on respiratory care. It raises the profile of respiratory care in general, which is long overdue given the disease burden it places, both on individual patients and in terms of its impact from a cost and healthcare resource point of view. We also welcome the increased profile and proposals around the roles of allied health professionals and physiotherapists in delivering care across these specialities, and specific recommendations relating to pulmonary rehabilitation.
It is fantastic to see that it highlights such an evidence-based and effective approach as one of the NHS’s key priorities, as well as challenging how we run our services operationally. The plan talks about the merger of cardiac and pulmonary rehabilitation and we know that some services already do this with great success.
The integration of services, where there is crossover, is not only an efficient use of resources it is also clinically effective as well, and this has been shown, both in clinician trials and research and in the day-to-day delivery of services. This type of approach can also help to address the comorbidities and overlapping factors, such as mental health, that often come with chronic disease.
The recommendations also tie in nicely with the Taskforce for Lung Health’s recently published five year plan, which sets out more than 40 recommendations for lung health – of which physiotherapy is again a key component.
Overall, this plan raises the profile of physiotherapy and recognises the value of respiratory care and physio being involved together. Interlinked services is a good thing and a very sustainable way forward.
But while this plan represents an incredibly positive step-change and raises our profile, we must not become complacent. It is important that we as a profession continue to have our voice heard and that we keep the pressure on to ensure delivery of the plan and to make sure it goes from being words on a page into action in a clinical setting.
Emily Stowe, chair of the Association of Chartered Physiotherapists in Oncology and Palliative Care, said:
'ACPOPC are pleased to see a focus on earlier diagnosis and improved screening for cancer in the Long Term Plan, as well as improvements in access to treatments such as proton beam and more targeted radiotherapy. However there is limited acknowledgement that earlier diagnosis and improvements in survival rates will increase the requirement for rehabilitation for people living with and beyond cancer. The specialist cancer physiotherapy workforce will need to be considered to ensure appropriate access to specialist input for those living with complex symptoms associated both with cancer and with the side effects of treatment. ACPOPC believe that specialist physiotherapists can help to fill the gap in the cancer nurse specialist workforce to ensure everyone gets access to a holistic needs assessment and health and wellbeing information and support, as described in the Long Term Plan.
The commitment to work alongside voluntary sector partners, in particular hospices, is encouraging to those of us working in this area, as is the stated intention to improve access to personal health budgets for those at end of life. This may provide opportunities for physiotherapists in palliative care to consider what they are offering and how this could be funded for those using these budgets. An improvement in personalised care for those at the end of life will also be beneficial, however the government now needs to set out how it aims to deliver on this, particularly with current funding limitations for adult hospices. The increasing funding available to clinical commissioning groups for children’s hospices is positive and will help to improve the lives of the most seriously ill young people.
ACPOPC welcomes the increased focus on allied health professional input in the community but calls on NHS England to recognise that the generalist community AHP teams need specific training to be able to support people with cancer and palliative care needs.
We look forward to more detail from NHS England about how their ambitious plan will be delivered and will continue to support physiotherapists working with people with cancer and palliative conditions.'
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