disability rights

The UK is to sign up to a Unitied National agreement on disability rights.The areas it covers include participation in culture and non-discrimination . I've got really mixed feelings about this. It seems in our society that those who shout the loudest are the ones who get what they want as far as disability is concerned. I read this to mean that there will be more pressure on employers to take quotas of people who are disabled but little attention will be given to the suitability of these people or the ways that their colleagues might have to carry them in competitive situations where they cannot cope as well because of their disability. On the other hand there are thousands of people with long term disabilities which get absolutely nothing from society and whose carers get absolutely nothing. This includes families with profoundly disabled children and elderly carers who look after relatives with chronic health problems. In reality both these groups of disabled people are getting less and less care as councils withdraw what little suppport or respite services there used to be. What I'm saying is not politically correct but in my job I've come across loads of long term disabled who are struggling to survive yet all the effort is going to go into helping a relatively small group of disabled people who are always complaining about their rights. No one is interested in those who cannot work or will never work. The irony is that 20 years ago some groups of disabled people were better supported than they are now. Non-discrimination is a myth; all that is happening is that the discrimination is being moved to a different group. The definition of discrimination is being changed to make it seem as if it has gone. It's not gone away. The loud mouthed millitants might be stopped from shouting but for the silent majority of disabled their needs are ignored.In fact their needs are not even acknowledged because we no longer have disabililty discimination.

staff confidence in NHS

There's been a lot of interesting news in the last 24 hours. Results of a Health Commission survey show that the majority of NHS workers questioned said they would not be happy to have treatment in their part of the NHS. Maybe this is something to do with the fact that their GP won't be getting a discharge report (see the last blog entry). More likely it's due to staff awareness of the flaws in NHS service. However as with all media reoprting there's likely to be a bias in this information. Might it be that staff would chose not to go to their local hospital because they want treatment at somewhere that they are not known ? It might have nothing to do with care standards and everything to do with avoiding receiving treatment from colleagues. Would you really want to be working with your colleague who has just performed your colonoscopy or D&C? I'm not so sure that physios would mind receiving physiotherapy from collagues. During training we seemed to spend large amounts of time going around in just our underwear so few of us would have an issue with the dignity side of things (if that's the correct term for it!) However it would be interesting to find out just how confident we would all be about our collagues abilities to treat a problem.

Another bit of news is about NHS staff being attacked. It would again be interesting to know how physios fit within this. It's hard to envisage this happening in hospitals under normal circumstances (Emergency Rooms/A&E Depts excepted). Physios who do home visits are at risk and we should be asking wht forms of protection these vulnerable workers are being given. Someone might phone you if you don't turn up for wotk the next day but who knows what could have heppened before then

discharging NHS responsibilty

A recent support suggests that there is a national problem with discharging patients from hospital. Apparently GPs are not getting enough information when patients are going home. And why might this be? There’s not been a study into it yet but I think that it’s the usual suspects : lack of staff time, high turnover in wards and inexperienced junior medical staff. The NHS machine is constantly being run at maximum so it’s inevitable that communication will at times suffer. There’s also an issue with clerical support. If the discharge report goes into the usual pile of medical secretarial work then it might take weeks to be done. Perhaps we should also be asking what staff are doing when it comes for a patient to go home. There’s a near iconic status given to a patient’s ability to do stairs and also all those nice little things that occupational therapists look at like dressing practice but it might be time to overhaul the discharge process and ask if it’s time for it to be brought up to date with the 21st century.

A NICE day in court

The National Insitute of Clinical Excellence (NICE) is facing a court action because of it's refusal to authorise the routine use of certain drugs to treat Alzheimer's disease. This is an interesting new development in the provision of free healthcare in the UK. Success in the court action would have major implications for many other clinical areas in the event of a service being withheld or withdrawn. It is the ulitmate expression of patient choice. Maybe in the future we might see court actions about the failure to provide physiotherapy. However. there's one problem with physiotherapy. When it comes to courts there will be few areas of physiotherapy practice which have sufficient evidence to justify their use. Which is an interesting parallel with another piece of news from the last few days; nationally there is pressure on ante-natal classes, some being reduced and even some services being withdrawn. Tise has the potential to affect physiotherapists as they are often involved in delivering the service. However, if someone decided to go to court over the withdrawl of classes they would be sadly disappointed with the outcome. As with other areas of physiotherapy I suspect there is a lack of hard evidence that these classes make a major difference to what happens later and it would be hard to prove that their reduction has any major impact as long as there is still a sufficient packageof care in place.

the genie in the bottle

I heard this week that there are plans to use genetically modified mosquitos to fight malaria. These new insects are unable to carry the malaria parasite and therefore will compete with the malaria carrying mosquitos ,the plan being that through this competition the baddies will be ousted by the goodies. However this last phrase indicates why there should be a cause for concern over this. The scheme seems too simplistic and full of dangers. Think back over the last 50 years to where species have been introduced artificially outside their natural habitat and it is possible to see a record of unparalleled disasters. The problem with a genetically modfied specied is that it is unnatural, and being unnatural we do not know what to expect. Always in the past there have been overwhelming reasons why a certain action should be taken and assurances given but once something has gone wrong it's too late. A scientist can resign or be fired but the genie won't go back into the bottle.

boom and bust in the NHS

Those of us working in the NHS realised long ago that there's something seriously wrong with the way that staffing is planned and now the Paliamentary Select Committee for Health has said the same thing, saying at present there is a "boom and bust" approach. Not so long ago there was an issue with the ethics of recruiting staff from overseas to make up for the shortfall in British staff available but now nationally there are redundancies and the cutting of posts. The whole process of staff planning is a random event and nowhere is it more evident than in the huge mess up in physiotherapy training. It's now old news how the vast majority of graduates are unable to get a job and come July there will be yet another wave of newly qualified physiotherapists looking for jobs which do not exist. It will be no comfort to them to learn that less that 3 years ago staff were being sought from overseas to fill the gaps in the labor-market. It's interesting to look at the role of the professional bodies and trade unions in all this. Maybe the time has come for them all to stop being campaigning organisations and to begin looking further than their narrow interest group agendas. Although they ultimately cannot be blamed for the shameful mess in workforce planning their past complaints about vacancies and shortages in staff to fill posts now look very naive.

physiotherapy and inactivity

A study just out has confirmed something we all already know; inactivity is bad for you. Oxford University have just published research suggesting that 3% of deaths in the UK are a direct result of inactive lifestyles. This is an area where physiotherapy could take a massive lead in affecting but the issue of inactivity does not only affect patients but can also an institutional attribute of health planning. Because healthcare in the UK is now largely driven by short term goals it seems unlikely that anyone is seriously likely to commit large amounts of phyiotherapy resources to treating something which needs a long term approach and also needs a wider strategy than just local health commissioning. Central to trying to help this problem is the quick fix, short term politically motivated way that healthcare is run because trying to change health through lifestyle will be slow and give results over years. Unfortunately this will not make good material for political speeches or manifestos. Maybe it's time for healthcare worker in the UK to start to make the case for a new approach to health, one not based on the waiting list as the absolute indicator of success, something which looks ahead further than the next election. If we can move away from the inactivity in health planning then it is likely that the physiotherapy profession can be key in promoting healthier lifestyles.

hospital car parking

It's now something of an assumption that hospital parking is something that patients and visitors have to pay to use but what's shocking is the amounts of money being made on it. Some hospitals make nearly £2.5 million and it has become a major source of revenue. What's really galling is that often hospital managers get priority parking whilst the rest of the staff have to make do with inadequate amounts of staff parking. The irony is that whereas it is unlikely to much of an effect if many managers are late in to the office if most clinicians are late it has an immediate impact on patients. Most hospitals now have staff parking which requires parking permits so staff have to pay to park their cars at work. In some places there is good public transport so there is a real alternative to driving but in many the public transport is inadequate or staff commute from over a very large area making personal transport a necessity. So what's really happening? Many clinical staff including (most physiotherapists) have to pay to use parking at work which is inadequate and they get a lower priority to use the limited parking whilst staff working in non-clinical capacities often get first choice of the parking. Something's not right .

Home held physiotherapy notes

The body responsible for information technology in the NHS, Connecting for Health, has announced that they will be running a trial study of giving patients access to computerised versions of their hospital records from home. This seems further evidence of the loss of direction with the NHS information technology programme. It sound a really nice idea to be able to look up records from home but it seems a bit of a waste of time.It's going to make little or no difference to patient care and carries with it a huge security threat. It will be only a matter of time before a determined person will compromise the security of the system and confidential records will be available to unauthorised people. There's also an issue with the rules being changed (all in the interests of national security of course) whereby the police and other government agencies will be allowed to access the computer to find people or get personal details. If this is linked with some sort of pin number or swipe card which will have to be used every time a patient sees their doctor or goes to hospital then we will always be under survailence. It will be interesting to see how this move could affect physiotherapy records and record keeping in general. It will "dumb down" records because in effect they will be on display to patients and it will force further changes in attitude to documentation. The one ray of hope is that at present it will be possible to "opt out" of the system. No one has clearly explained how the computerisation of records will be an advantage. The idea of any member of a healthcare team being able to access the record is good but that has to be offset against the inevitable paralysis of the health system on those days the computer system fails combined with the massive costs in setting up and running plus the security risk. It looks like the people who initiated this have been so seduced by the technolgy that they have lost sight of its purpose.

Health promotion

Understanding long term health problems is crucially important in the future of health services in the UK. Important long term conditions include heart disease, cancer and diabetes. In the last 2 years there has been a lot of attention given to childhood obesity as a long term health issue but it has come to light that the current short term priorities in health planning are threatening a long term study into activity and diet in children with diabetes. a study being undertaken in Plymouth will be forced to stop at less than its half way point because the Government funding body does not want to commit to long term projects yet there has been no shortage in projects on which public money has been wasted. There is serious shortsightedness in healthcare planning when something which could make such a difference to the understanding of children's health problems such as this study faces being closed down whilst so many meaningless projects are funded. This is yet one more example of how healthcare funding priorities in the UK are driven by short term political objectives rather than a real desire to change health. At the best the desire for improving health is confused and short sighted. At its worst it deliberately manipulates public fears and aspirations for narrow political gain.

media health scares

It seems that the media are always on the lookout for a health scare to fill out the contents of the evening news or the front page and the latest of these in the last few days is additives in children's medicines. A few years ago it was media scare mongering about the MMR vaccine. The main problem is that often popular reporting of health issues is distorted, sometimes deliberately to produce a good story. The last thing a journalist wants is for viewers or readers to ignore the item and go to do something else. With the latest thing about additives it's not clear if this is just a case of the reporting lacking balance or it there has been deliberate distortion to create an emotive news item. As with the MMR hype the problem with this health scare is that it ignores the problem that the treatment aims to solve. In the case of additives the idea is to make children more likely to take the medicine. If anyone has experienced the bitter taste of adult paracetamol tablets it is easy to undestand why there might be the need to improve the taste of children's medication. Which is more important, for a child to take the medicine or the child to avoid tiny amounts of additive taken on an occasional basis? It seems possible that if there is a push to make medicines additive free then things will resort to Victorian methods of having to use a teaspoon of sugar to help the medicine go down, or else brute force. Being logical about this the whole issue is somewhat contradictory; there is a fuss about children taking tiny amounts of additive on an irregular basis but no one questions the effects of the chemicals that the additive is meant to disguise.

Time to call time on the NHS?

Amongst all the pressure on the NHS and the privatisation by stealth there has just been a radically new idea suggested for regenerating a Surrey Hospital. Apparently Epsom District Hospital could be bought up by a millionaire and turned into a charitable trust. This is probably only one step away from NHS foundation trusts. It would be interesting to see if running a hospital as a charity would be any more effective than via government funding. The problem with the current funding system is that it is complex beyond belief, subject to the whims of politicians and fails to reward good practice. One idea which at the moment has not been aired but is a "fourth way" in NHS structure is having a totally independent NHS, free from Dept of Health control, a bit like the BBC where it would receive an allocation of money but it would be up to the organisation to plan it's own services without significant Government involvement. It's hard to say if this 4th way would work any better because at the heart of the problem is trying to meet infinite demand without always increasing the resources. This is something that politicians are not willing to admit.

Job losses and over regulation

The NHS crisis continues to deepen. News out today reports concern by senior NHS managers about duplicated regulation within the NHS. Also annonunced today is the loss of 100 NHS jobs in Warrington. There are myths being put about to support the over regulation and cutbacks in the NHS. Regulation is meant to bring about safer, better healthcare but it can be called another name;bureaucracy. The current levels of regulation are ineffective because they are essentially a bureaucratic process. The mistake made a long time ago by politicians is to think that healthcare is like any other service industry when in fact it is unique because of its complexity and its lack of standardisation.With the latter features millions of decisions are made daily on the basis of judgement not a predetermined set of criteria. The lapse of regulation into bureaucracy comes about because regulation is applied as if healthcare is something standardised and easily measurable. The tragedy of job losses in the NHS is underpinned by the myth that this is part of restructuring into better, more community based hospitals with patients needing shorter stays and much more being treated as day cases. That's the explanation that's give when jobs are being cut. What is totally unclear is why have these hospitals trusts and other NHS organisations gone on knowing all along that they could provide their services in a much more efficient way and it needed a crisis in the funding to make them be more efficient? Why have they only just decided that what they were doing was so inefficient that they can cut large numbers of jobs AND make their services better?

Skin cancer

Recent reports highlight the growing munbers of people getting skin cancer especially in younger age groups. Perhaps the time has come for the physiotherapy profession in the UK to embrace a wider health education role and instead of restricting its education to mainly postural and exercise education it promotes health in the widest sense. UV skin damage through sunbathing is a long recognised risk but what many members of the profession do not realise is that physiotherapists at one time undertook ultraviolet treatment, themselves not doubt contributing to patients' UV damage to their skins although in a worthy cause (usually trying to treat psoriasis or acne ) Physiotherapists being a fun loving bunch, are also are at risk of skin cancer from summer holidays spent on the beach. maybe we will be facing a situation in the future where smoking declines and with it lung cancer to be replaced by skin cancer as a higher risk. The problem is that it is possible to tax or ban smoking but you cannot do that with the sun.

NHS protests

Up to now the physiotherapy profession in the UK has been rather ineffective in its protests about the adverse effects of NHS changes. These impact on the profession in a number of ways including job losses, reorganisation and graduate unemployment. However in the last few weeks ther has been a growing amount of protest by many other workers in the NHS and it will be interesting to see how physiotherapists respond. Reading some of the things written within the profession one could almost believe that the profession is in its high summer rather than facing the biggest crisis since the foundation of the NHS. There are many outstanding individuals within the profession who are achieving massive amounts but as a group within the public sector there is a growing threat posed by managers wishing to save money and for whom physiotherapy means little because they originally were nurses or accountants. The growing voice of dissatisfaction amongst NHS staff needs to include the concerns of physiotherapists.