hamburgers and princes

So HRH Prince Charles thinks that a famous worldwide hamburger chain should be banned. Presumably he does not like fast food but there is a big threat to liberty when governments start banning things they do not like on the basis of potential health risks. Unfortunately by suggesting that hamburgers are banned the prince is confusing something which has a potential to cause ill health if abused as opposed to something which is a threat to health. The problem is not eating an oocasional hamburger but excessive consumption and in terms of social problems attention should be focused on the risks posed by alcohol and not thosed cause by a Big Mac. In democratic societies it is better to influence public behaviuor through taxation and education rather than banning something as innocent as food.

What NHS funding crisis ?

Channel 4 Dispatches has just finished inthe last few minutes and it provided a more complete analysis of the NHS financial crisis than the last blog. As well as the major funding incentives in primary care it highlighted the experience of all NHS staff who everyday are confronted with squandering of resources. This includes the plans for a massive computer system which costs billions but which really fails to serve any purpose and could have been provided for a fraction of the cost using alternative low tech. systems. Clinicians working in the NHS feel sickened with the talk of massive investment because there has been little sign of the money and every day there is the unrelenting pressure on a cash startved system. Physiotherapists are probably more aware than most of the failures because of the total lack of planning evidenced by the growing graduate uneployment in physiotherapy with the vast majority of last years' graduates still unable to find their first posts and it now being only 5 months away from the next group of graduates.According to Channel 4 things are going to get worse, because soon the money will start slowing down even further so if things seem bad now what are they going to be like in the future?

NHS funding rises

It has just been anounced that there will be a drop in the funding rises given to the NHS. It appears that since 2002 funding has been rising by 7% per year but in 2008 it will go down to 3.5% per year. The reality of this is the fact that those working in the NHS have failed to see the so called 7% rises in funding because 4 years on things are only getting worse. There should be some very hard questions being asked about where all this extra money has gone. It probably has been taken up by the growing amounts of money being paid out in primary care as well as changes in medical contracts, with the lesser part being used to fund Aganda for Change. It is a myth to believe that there has been a major expansion of NHS services over the last 4 years because the reality is a daily struggle against increasingly difficult problems. In effect this is an anouncement of a funding cut to the NHS and will come as no consolation to the large numbers of unemployed phyiotherapy graduates or qualified staff facing threats of redundancy. The Kings Fund seems to think that with good planning should be possible to avoid problems but at present the situation is one where financially solvent trusts are having to give up money to balance the books of overspent trusts so in the current NHS success or failure is not a matter of financial prudence but the whims of ministers and Department of Health managers.

hospital acquired infection

A recent report has highlighted that there has been a 69% rise in reported cases of C.Diff and MRSA. This should come as no surpise to anyone who works in the NHS. Once an issue becomes fodder for politicians then very close attention is paid to the slightest change so since MRSA went live then it was inevitable that it would become a growing problem within the NHS. To a certain extent politicians need to create a problem so that they can then be seen to be doing something by addressing the problem. In part some of the rising figures for hospital acquired infection come from the political nature of the problem so that there is now an incentive to report it. The problem has not developed overnight but in the past it was ignoreed and expecially on death certificates it would not have appreared as a cause of death. The other big factor is the major problem in the NHS . An all out push to shrink waiting lists is the main prority. This high turnover, low investment NHS comes at a cost, and part of this cost is the risk of greater infection. The other big factor is NHS staffing policies and the present attempts to cut staffing to a minimum. Hospital staff are an easy target for politicians who want to blame someone for MRSA ("it's because staff don't wash their hands") but the real issue is that a whole system constantly run at close to breaking point is inevitably going to beging to fail and MRSA/C Diff. is evidence of this failure. Instead of politicians treating the symptoms of these infections they should seek to treat the cause.

physiotherapy regulation

see below

physiotherapy regulation

It has been announced that the medical profession is now to have external regulation. Perhaps we should be asking "what took you so long?" The allied health professions have been regulated by the Health Professions Council (HPC) for a number of years and before that by the CPSM. It seems strange that doctors have remained under their own regulation for so long depite the fact that quite a few years have passed since the the terrible events which led to plans for regulation (Harold Shipman, organ scandals and so on). As with the allied health professions, the principle of regulation is a sound one but the application of the principle is full of difficulties. The HPC takes disproportionate amounts of fees from those it regulates and shows signs of serious inefficiencies. Examples include having to repeat a physiotherapy office election due to mistakes in the election process, delaying of registration renewal of those on the register and lack of accountability. And this last point is key. Who regulates the regulator and to whom are they accountable?

Street Doctors and Street Physios

There has been a recent BBC series called Street Doctors where a group of 4 doctors has done consultations with the general public on the streeets of UK cities instead of doing this in hospitals or surgeries. It was surprising how many times they said that the person consulting with them needed physiotherapy. Perhaps the BBC should do a series called "Street Physios" because there would be no shortage of potential candidates to act as consultants nor a lack pf people wanting advice. On one occasion they gave some sightly misleading advice about clicking joints saying that these arose from nitrogen gas formation. Whilst true in a general sense for benign clicks, repeated painful clicks can indicate some form of joint pathology, a point that the BBC did not make. Your average Street Physio would have know this. However as a profession it is interesteing to speculate what sort of image that physios would project. Would Street Physios be excessively bogged down by obscure, unproven theories or would they be able to provide reassurance and education in a positive manner?

smoking and physiotherapy

The British government is going to give large amounts of money to environmental health departments around the UK to enforce it's smoking ban. No doubt this will also have some impact on hospitals as well. There will soon be a total ban on smoking on NHS sites. There is an irregularity in the current attitude to health promotion and the creation of a public health agenda in the UK. on the one hand smoking is singled out as one of the greatest health risks facing society but on the other hand there is uncontrolled access to alcohol with an increasing problem of alcohol related crime and social dysfunction. What should we conclude from this? Why this almost fanatical oppression of smokers but on the other hand the increasing liberalisation of alcohol consumption? Alcohol is a growing health problem but somehow this has been missed.

art vs. science in physiotherapy

There is a conflict within physiotherapy between art and science. On the one hand the professions seeks to promote itself as modern, scientific and international but on the other hand it is heavily dependent on unproven methods introduced by charismatic individuals such as Maitland and Bobath. And charisma rather than science is the way that new ideas tend to be promoted. Usually what happens is that an individual will come to prominence through teaching their methods and then as popoularity for the methods grows someone decides that there needs to be research into why the method works for its enthusiastic pratitioners . In the past research has tended to be very much "after the event" taking place after the particular school of thought has already gained a lot of followers and usually after it is being promoted in post graduate courses.

There is a massive flaw in the profession's way of developing new practice. New ideas tend to spread on on the basis of their apparent effectiveness but initally this is never subjected to rigorous evaluation and the early perception of effectiveness is based on the subjective impression of the theraist using the techniques.There is a natural bias in interpreting outcomes [if this was not the case there would be no need for blinding in reseach trials]. Clinicians will tend to over-estimate outcome effectiveness. This is because something else is going on in the clinical situation, something which up to now has received very little attention in research. Therapists' behavior in the clinical setting is affected by their need to feel self esteem about their performance as a clinician. This means that the decision making process about clinical effectiveness is not an entirely rational process and there is something to be gained at an emotional level if the therapist thinks she is exercising great skill using a particular technique. The "emotional reward" achieved through clinical technique will create bias towards techniques which produce a high level of emotional satisfaction even if that technique might lack objective research to show it works; the combination of emotional satisfaction and perceived effective outcome ensures that the technique is continued. The charismatic promoter of techniques trades at an emotional level of acceptance before the rational processes are fully engaged. This emotional engagement creates a pathway for later acceptance at a rational, conscious level.

Uk physiotherapy crisis

Uk physiotherapy crisis

Is there a crisis in UK physiotherapy? I think so. There's a serious problem with the number of new graduates qualifying when there's nearly no new physiotherapist posts in the whole of the UK. I think there is the serious possibility that the next thing we will see is the closure of university training departments because in the short to medium term there will be no growth in the number of new jobs available. The other thing to look out for is the downward pressure on job gradings. Because of the surplus in potential candidates for jobs and the prevailing crisis in finances there will be a growing tendancy to lower the grade of jobs to make financial savings and take advantage of the surplus in the labor market. There is a fundamental problem with job grading levels because there is no objective measure of the grade a given job should be. Ultimately the grading given is what an employer was willing to pay. Knowledge and Skills Framework reveals how arbitrary the grading system is and how it isopen to wide local interpretations. The final thing we might see is the gradual abolition of the rotational post. And just one question to finish with. If a band 5 physiotherapist is non-rotational, in a post for a number of years, supported with good post graduate training, how will their level of skills and clinical outcomes be different to someone doing the same post for the same time at a higher grade?

start of a new blog

this is the first page of a new blog. i hope that you stick with it. over the weels i hope to discuss all ther major issues affecting physical therapy