Helpers In 1987 the Association of District and

Superintendent Chartered Physiotherapists had set up a working party to examine the role of physiotherapy helpers. This had split into two groups, one (which included two members of the Organisation of District Physiotherapists and a member of the CSP staff) to consider physiotherapy helpers and a smaller group to look at generic helpers.

Sue Jackson, chairman of the second group and a member of the first, and a member of the NHS Training Authority Professional Advisory Group, presented the report. It set out in detail the role of physiotherapy helpers and outlined the training and management of generic helpers. ADSCP recommended that the report should be adopted as the Society’s policy, and Mrs Jackson urged that this should be done because the NHSTA could then incorporate it in the arrangements it was about to make for training helpers, so that physiotherapists would be acknowledged as responsible for, and involved in, their education.

Council discussed the document at length, some members feeling that the formula prescribed was too rigid, and others fearing that it would allow helpers to take over some of the role of physiotherapists. The level of supervision and the relationships between professions in management of generic helpers also caused concern.

The general consensus was that the document was too important to be adopted on first reading and that it should be discussed by standing committees and reconsidered at the next Council meeting,

and Council finally voted to do this. To help to overcome the problem of

urgency David Teager suggested that the NHSTA should be informed that this was under way.

1988 Annual Discussion Meeting Members considered the motions

jiscussed at the last Annual Discussion Meeting and the outcome of debate, with suggestions by the Secretary as to how some of them could be taken forward. It was agreed that these should be published as set out overleaf.

WCPT 1991 Congress Council received a report of a special

meeting for representatives of Specific interest Groups on November 1 at which their involvement in the World Confederation for Physical Therapy Congress was sought. It was agreed that as well as specialties, geographical areas would be an influence on the structure of the Congress so that it would not appear entirely London-based.

Brief information was given on preparation for and promotion of the event.

Educational Funds Committee Joyce Wise reported on the committee’s

meeting on November 15, at which 39 applications had been considered. The committee awarded grants amounting to €11,080 to 28 members, research grants amounting €1,600 to two members, and offered loans from the Lesley Constance Green Loan Fund amounting to a total of €2,000 to four members towards the cost

of the following courses: Manipulation 4; Bobath 1; other skills 1; MSc/MEd/MA 11; Master’s degree in Business Administration 1; postgraduate diploma 1; first degree 5; travel 1; higher degree qualifying course 3; research - PhD 2.

Fellowship Advisory Board Sheila Philbrook reported that she had

been elected chairman of the Board, with Dr Cecily Partridge as vice-president.

Some changes to its terms of reference were approved. The Board was considering the system by which honorary Fellows were selected, and the protocol with which they were awarded.

Two vacancies remain on the Board and anyone who would like to be co-opted, or to nominate a colleague, is invited to contact the CSP director of professional affairs, Penelope Robinson.

Members’ Benevolent Fund Committee It was reported that the following appoint-

ments were made for the year 1988/89: chairman Miss A C Pennefather; vice- chairman and honorary treasurer Mrs E M Oakley; honorary secretary Miss P M Grastv.

It had been agreed to make a Christmas gift of f200 to several beneficiaries and €125 to one.

Three new cases were considered and six Nere reviewed.

Donations, commission and interest received during the three months ended September 30, 1988, amounted to €4,407.68.

Relationship Between the Physiotherapy and Occupational Therapy Professions Responses to Consultation

A summary of the responses to the consultation document prepared by CATHY LEY BSC, assistant to the CSP Secretary

I The aim of this paper is to summarise the flavour of the comments received from members of the Society on the consultation document. Several letters stressed that it would be important to poll members on these proposals, especially if the possibility of adopting option (cl or (d) arose. But the aim of this consultation process was not intended to record votes for any of the options.

THE consultation paper provoked a large response. About 400 letters were received at the Society’s offices. Many letters described meetings of Chartered physiotherapists on this topic, some joint meetings between occupational therapists and physiotherapists. Responses were received from Boards and Branches of the Society, from hospital and District-wide meetings, from teachers and students at schools of physiotherapy and many from individual physiotherapists. Some occupational therapists also responded directly to the Society. A few people’s views may have been recorded twice; for example as part of a Specific Interest Group discussion and as part of a Branch debate.

A number of respondents praised the Society for taking the initiative in opening up debate on the relationship between the occupational therapy and physiotherapy professions. It was said that while this was a controversial method of starting discussions, it provided a necessary catalyst. Others said that occupational

therapists were alienated by the way in which the document was released and some physiotherapists commented on an initial deterioration in relationships with occupational therapists. In many instances these relationships have picked up again following discussion around the document. The accuracy of the description of the practice of occupational therapy was also questioned.

The four options put forward in the discussion document, in summary, were to: (a) Do nothing. (b) Establish distinct identities for the physiotherapy and occupational therapy professions. (c) Amalgamate their professional bodies but keep separate the identities of practitioners. (d) Merge the two professions completely.

Listed below are the responses to each in turn. It would be fair to say that some people felt that no option was preferable nc. could they suggest any alternatives. Many respondents saw links between the options and some proposed an alternative approach. There was some questioning of the impetus behind this paper and concern that it should be in response to a real need at grassroots level. However, others thought it essential to maintain professional autonomy by raising this topic as a Society rather than having changes proposed or imposed by external bodies, like the Department of Health. Most reports suggested a high level of interest in the document and many people wanted discussion to continue.

Option (a) was not well supported. It was thought that the release

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of this document and the holding of workshops with the members of the British Association of Occupational Therapists meant that some strategy was needed for the development of future relationships. There was a suggestion that a half-way position between options (a) and (b) might be adopted; to analyse and understand the current relationship between physiotherapists and occupational therapists.

Option (b) was best favoured, although a large proportion of respondents were concerned that the creation of rigid boundaries might hinder the professional development of the two professions and that gaps in provision might appear due to staff shortages. A local distribution of tasks was supported with perhaps national guide lines for arriving at this. The notion of teamwork and the establishment of a key worker system were stressed. Central to this would be education as to each professional's role and perhaps the concept of professional boundaries and overlaps might be introduced as part of the education of occupational therapists and physio- therapists. Some concern was expressed that professionals might be taking on tasks in overlap areas which they have not been trained to perform.

The combination of (b) with (c) was also well supported. Particularly popular was the suggestion that the trade union funcfion might be combined for the two professions. It was thought that (c) to share a professional body could help to develop understanding between occupational therapists and physiotherapists. However, concern was expressed at how this might filter down to the membership in general. The notion of a single set of Rules of Professional Conduct for the two professions was considered to be helpful. The creation of managerial posts covering both professions was mainly opposed although others saw this as a logical rationalisation. Some fears were expressed that amalgamating the professional bodies might increase friction between the two professions and it was emphasised that a lot of goodwill would be needed from both occupational therapists and physiotherapists. A joint professional body might be confusing for patients, other professionals, and occupational therapists and physiotherapists themselves. Some commented that option (c) was a half-way house to (d) and as such should not be considered as an option in its own right. Particular concern was expressed on the matter of title; most people wanted to remain Chartered physiotherapists.

The proposal to merge the two professions completely, option (d), was supported by a majority of the Association of Chartered Physiotherapists with a Special Interest in Elderly People and by a small number of individuals. A few more saw this as a long-term aim but envisaged the evolution of a new professional - not a joint occupational therapist and physiotherapist. Others saw a merged profession adopting a structure analogous to the broad medical profession with separate specialties within it. Opposition to this centred on the loss of skills in developing a generalist which coulo

be detrimental to patient care. The difficulty in constructing an appropriate education for the new

professional was stressed, including post-registration education. Some educationists saw this as a challenge; an opportunity to develop a modular course aimed at producing a therapist for the health services of the future. Respondents were worried that merger might lead to infernational isolation, although it was suggested that Third World countries might well be keen to follow the lead in developing a 'therapist'. The suspicion that this option was particularly expedient to NHS management, wanting to solve manpower difficulties, was expressed.

Generally, this option was not liked. The need for both occupational therapy and physiotherapy and the advantages of having different types of therapist were emphasised:The difficulty stemming from the different relationships between helpers and the professional body (occupational therapy helpers and technical instructors have associate membership of BAOT) was mentioned. Finally, the merged profession might not be attractive to potential students at a time when recruitment difficulties are already envisaged.

Other suggestions made during the consultation process included that of starting official talks between the BAOT and the CSP aimed at exploring further the matter of future relationships. The merging of occupational therapy and physiotherapy Specific lnterest Groups especially in overlap areas was mentioned, as was the development of further joint post-registration courses. An independent commission on physiotherapy to match that on occupational therapy was suggested. It was proposed to establish a rehabilitation or community therapisf in addition to occupational therapists and physiotherapists, following specialist training post-qualification. Another suggestion was to create an umbrella body, 'Association of Rehabilitation Therapists', involving occupational therapists, physiotherapists, speech therapists and others as separate professions.

Another option might be to divide professions along the lines of physical and psychological therapists. Very much a minority view was to 're-absorb' over a period of time the occupational therapy skills into physiotherapy, psychology, social work and speech therapy.

It appears that from the responses received, a consensus exists around option (b) modified to be much more flexible in application and to develop further each profession's understanding of each other's roles. Certainly, a dialogue between the two professions at all levels should be continued and an extension of co-operative ventures would help to improve relationships. There was some indication that if the goodwill exists on both sides, moves might be made towards amalgamating the professional bodies. However, this latter would certainly require a poll of all members and would be a longer-term project.

ANNUAL DISCUSSION MEETING: MOTIONS The motions discussed at the Annual Discussion Meeting are set out below, with the outcome of debate.

Where appropriate, the action approved by Council is also indicated.

1. That in view of the impending reduction in the 18-year-old population, it is essential that physiotherapy schools consider recruiting from non-traditional student groups. Carried. This was referred to the Education Committee which is studying alternative modes of qualification and promoting equal opportunities in recruitment to physiotherapy courses. 2. That more encouragement should be given to postgraduate iraining and that it should be a condition of service that at least ten days paid study leave should be available each year. Carried. The PT'A' Whitley Council Committee is already considering a claim from the Staff Side for study leave. 3. That completion of specified courses should be a pre-requisite for promotion within the National Health Service. Not carried. 4. That the CSP must actively oppose the privatisation of any physiotherapy services within the National Health Service. Carried. This was referred to the Industrial Relations and other Committees for action as needed. 5. That the CSP should issue a policy statement reaffirming its commitment to the National Health Service and its philosophy of health care free at the point of delivery. Carried. Council agreed that the motion did indeed express the Society's policy. Evidence had been submitted by the CSP to the House of Commons Select Committee on the Social Services in this

sense (Physiotherapy, March 1988, page 140). Future opportunities would be sought of making the point, possibly in the Society's responses to the expected NHS review. 6. That the Government's proposals in the White Paper 'Promoting Better Health', for the employment of physiotherapists by GPs, pose a threat to the autonomy and status of physiotherapists. Consideration should be given to District physiotherapists providing services to GP practices as an alternative to the traditional hospital base. Carried. The Chartered Society wrote to the DHSS at the time of the White Paper, and will write again reiterating its concern. 7. That in order to provide a better service to NHS patients, full physiotherapy services should be extended beyond the traditional five-day week model. Not carried. 8. That in the interests of the client, the physiotherapy profession should be developing physiotherapy specialties which may not necessarily follow the medical college model. Carried. This was referred to the Professional Practice and Education Committees for further study. 9. That the projected manpower shortages of qualified physiotherapists will alter the role and use of support workers. Carried. Council considered a paper on helpers at its December 1988 meeting and will do so again in March.

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