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The National Health 3ervice: Changes and Challenges

Those of us who work in the NHS are living through what one commentator has called ’continuous revolution‘. Change, change and yet more change. Like all such changes, this government’s reforms, which started in earnest last year, bring opportunities and challenges for the CSP and its members.

The Society, working with all its members involved in the NHS, is determined that the governrnent should listen to the views and concerns of physiotherapists and assistants. The Society is determined that physiotherapy will be strengthened as a result of the government’s shake-up of the NHS. We are determined to seize the opportunities and meet the challenges.

(:eritral to working with change is ensuring that all members of the Chartered Society are well informed about the reforms. By the start of this month, July, the N t I S Executive had issued some 150 Health Service (hculars. New initiatives, new guidance and consultation papers rain down on u s like confetti.

In response to this, the Society has produced a series of bricfing papers, freely available t o all members on application to the Industrial Relations (IR) department, on all the key issues arising out of the reforms. Topics include Health Action Zones, Health Improvenient P ro gram m es , C 1 in i c al Govern an c e and Prim a ry Care Groups. Ste.cu(irds News and the new Managers Nnuslettpr, along with Frontline, regularlly include articles on the reforms. T h e recently launched CSP Primary Care Network provides a means fbr members involved in the primary care sector to receive up-to-date information about this rapidly developing network.

I n 19!48 a total of 400 members representing managers, the stewards network, Specific Interest Groups and private practitioners attended a series of one-day workshops o n responding to the reforms. A number of managers’ and stewards’ training days were also organised and at the end of the year the IR department launched a course specifically for stewards looking at the IR implications of the refi)rnis - the first course of its kind in the NHS.

The ( S P has responded to a11 the relevant consultation papers issued by the Department of Health from b;xtm (h t rnc . tua l ReJivmIs to Public Health and A First Clnss Srv-vire. Overseeing this work is the NHS Bill Group, established by the Policy and Resources Committee, which includes a wide range of member expertise and interests. The appointment of CSP Policy Officers in Wales and Scotland will allow the Society to sharpen further its response to the development of hcalth care in these countries. In 1998 the Society, working with members in Nor the rn I re land , r e sponded to t h e Northern Ireland Office of Health Green Paper.

Networking T h e Society directly, o r t h rough the TU<:, me t government ministers, including Frank Dobson, five

times during 1998. Meetings with opposition health spokespeople occur regularly, as do meetings with senior civil servants. The CSP was the only PAM organisation to secure a seat on the Primary Care Refkrence Group and was one o f jus t five unions on the Social Partnership Primary Care Group.

Through these meetings the Society seeks actively to promote the interests of members. We are pleased this government is willing to listen to us, but it must do more than .just listen. The government has to understand that it must allow physiotherapists and other professions allied to medicine (PAMs) to be actively involved in thc reforms. We ask for no special favours, but why were we excluded from the boards of Primary Care Groups (PCGs) in England? This makes no sense. There are fonr times as many PAMs working in the primary care sector as GPs. We have much to contribute and simply ask for the opportunity to be involved.

It seems, following lobbying and campaigning by the CSP, that the government is beginning to listen and we are hopeful that PAMs will have a bigger say in PCGs. 1,obbying also ensured that a physiotherapist obtained a place on a National Service Framework Working Group. T h e profession is also represented o n the National Institute for Clinical Excellence.

Working Together The issue of PAMs working together was the theme of the conferent e organised by the CSP arid held in Westrninster last summer, at which Frank Dobson spoke. The CSP now regularly meets with other PAM organisations, to share information, pool ideas and maximise influence. Locally, we are aware that many members are working closely with other PAM professions.

Ensuring that commissioners, such as GPs, are aware of thc value o f physiotherapy is as important now as it ever was. Last year the CSP sent copies of its leaflet ‘The Difference is Physiotherapy’ to la rge numbers of commissioners, and it has just been reprinted.

In last year’s budget the governmen1 announced a near 6% increase in NHS funding - some &21 billion. This is welcome. For too long the NHS has been starved of cash.

by Claire Strickland MCSP

Senior Physiotherapist, St Bartholomew’s Hospital, London

Chairman, CSP Industrial Relations Committee

We would like to see more of this money finding its way to fund continuing professional development, student training allowances and - let us all hope - discretionary points!

T h e CSP continues to monitor carefully the development of the Private Finance Initiative (PFI) and its impact on members. In 1998 we submitted evidence to the government’s review of the PFI in which we called for publicly funded capital investment.

Trust mergers and reorganisations continue. In some areas the human consequences of these are still handled

Challenges For Managers

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appallingly. The Industrial Relations department seeks to protect the interests of members.

1998 saw the start of a momentous agenda of NHS reforms. These reforms will continue for the foreseeable future. The Society, working across departments and functions, and bringing together different membership groups, has risen to the challenges this agenda creates. So have members locally.

We are confident that by working together, physiotherapy will be even stronger in the new NHS than it was in the old.

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by Rosemary Woodley i GradDipPhys MCSP MAACPT

i Physiotherapy Manager, Dartford and i Gravesham Acute NHS Trust i Member, Professional Practice i Committee

Managers have been facing enormous and varied challenges in the past year, and the Society has responded in many ways to their needs. Many mergers have taken place up and down the country and some disaggregations of services have meant another upheaval in the planning of treatment delivery. These mergers have posed threats to jobs, as very often management posts are lost, though we know this is a false economy!

Managers face a lack of a clear physiotherapy career progression, and there are threats to physiotherapy power bases within trusts as more physiotherapy services are managed by non-physiotherapy staff. The challenge is to maintain and develop a positive profile within the employment organisation. Managers have suffered a loss of pay differential and received no special recognition within this year’s pay award.

We must organise the provision of services in an ever- changing environment, for example, within Health Improvement Programmes and working with Primary Care Groups. The shape of physiotherapy services is also changing as we work as part of a team with occupational therapists, speech and language therapists and others. The challenge is to manage the physiotherapy provision with a workforce whose core skills and work patterns are being challenged from all quarters. In meeting the challenge of joint working we must demonstrate the flexibility of services to meet the needs of the community -- but we have to be given the chance to show our effectiveness; we need to promote the profession.

Another problem for managers is the task of motivating and leading a staff group which suffers from ever- increasing stress levels.

These leading articles are both based on introductory speeches given at the Annual Representative Conference held in Glasgow in May.

What Has the CSP Done to Help? A new professional adviser post has been established for the support of managers with responsibility for analysing government initiatives with regard for giving support to managers, looking at future models of service provision and the changing shape of the workforce.

A database of managers has been set up, giving a broader network in which to disseminate information. A newsletter for managers is being published, with the aim of giving timely information specific to managers’ needs.

We are developing communication tools such as the leaflet ‘The Difference is Physiotherapy’ (mentioned by Claire Strickland above), to help managers in the promotion of the profession and their services. A series of these documents is planned.

A section of the CSP website is designed for the support of managers.

Links with the Association of Chartered Physio- therapists in Management have been increased, to ensure appropriate joint working and that support is given to managers’ needs, by regular meetings and by the inclusion of managers on working parties and by the link with the CSP’s professional advisers.

We have been reassured that managers’ pay will be taken up specifically in this year’s pay round. Managers are being given the tools they need to succeed in workforce planning. A research project has been set up to formulate a modern approach to calculate appropriate staffing levels. For managers, as for all other sectors of the CSP membership, the Society’s support is guaranteed.

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