working for a healthier tomorow

When I wrote Physiotherapy Blog on 17 March referring to the issuing of "fitness notes" by GPs I did not realise that on the same day a report was being published. Working for a Healthier Tomorrow , published 17 March, reviews occupational health within the UK. The principles it tries to address are correct but as with much political discussion about health it fails in the details because of a fundamental limitation in the understanding of the complexities of healthcare and the contradictory priorities which exist. Unless there is a willingness to intiate reform which crosses over multiple government depertments then there is the risk that this report will initiate a knee-jerk reaction in the formulation of new policies which fail to address the issue of long term sickness and return to work. In particular there needs to be a coordinated approach between the health and social security systems in the same way that the report states the need for cooperation between the different agencies in the healthcare system. If my reading of the executive summary is correct then its proposals seem to excessively focus on the "micro management" of long term sickness and return to work without sufficiently looking at the ways that government agencies also are failing to address the problem. A regular annoyance for me is having to fill out Work and Pensions agencies forms for patients. I am annoyed on two counts. Firstly (and the minor complaint) is that I am not allocated time within my workload to do these forms so the whole system is inefficient because they have to wait for theit turn within my order of priorities, so if there is a conflict between doing an urgent letter to a doctor reporting a patient's progress or one of these Work and Pensions agency forms then the former will always get m time. However my biggest dislike of these forms comes from the fact they ask the wrong questions both in terms of what I can answer about the claimant and in terms of trying to address disability. It is without a doubt that physiotherapists have a huge potential role in helping return to work but their input will be limited unless there is a shift within the national culture regarding long term sickness and claiming benefit. In this there needs to be a central govenment lead not only in terms of telling health agencies that they have to work better together but also in putting their own house in order.

To see the report go to:

http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf

physiotherapy blog offers op art

© 2008

Government crackdown on sickness

Physiotherapy Blog has touched on some of the following issues before. An item on the BBC website says that the UK Government wants to crack down on the growing numbers of people on long tern sickness benefit. There are proposals for the NHS to promote return to work in people who are claiming sickness benefit and the suggestion that GPs give "fit notes" to say what people can and can not do when they are going back to work. Physiotherapists are ideally placed to facilitate return to work and could also support any scheme to assess fitness but there are some huge problems which i have touched on before. Probably the biggest problem is that assessment within a hospital or consulting room is not the same as performance in the workplace. It is impossible to determine the specifics of a work activity within the short period of time in a physiotherapy appointment. The other big issue is the subjective perception of the claimant, especially if it is a pain problem. We probably all know the now old saying "pain is what the patient says it is" but that become a barrier to return to work. Now the NHS exists almost like a machine which tries to move atients through as fast a possible it is no longer well placed to address long term issues such as return to work. The idea that all interventions can be provided as short interventions just does not fit with this model. An approach to physiotherapy based on average episode of care in Britain of 6 physiotherapy sessions breaks down when faced with return to work problems. At present no one is really addressing the contradiction of a Health Service which in the last 10 years has placed waiting time above all other priorities yet isunable to sort out the sickness which is costing the country dear.

The public view of physiotherapy

I read a review in a newspaper today about complementary therapies. To physiotherapists this probably means things like reflexology and the like but this reviewer lumped together acupuncture, Alexander technique, chiropractic and in with these included physiotherapy. What those outside the profession do not understand is the wide diversity of practice within physiotherapy so that now acupuncture is widely practiced by physiotherapists. And this is one of the contrasts between physiotherapy and other "physical" healthcare practitioners, be they regulated like osteopaths or borderline quacks. Physiotherapy has an expanding sphere of practice whereas the "complementary" professions are often build on theories and practices which are in a fossilised state of stagnation. Often these theories are based on clinical experience and nothing else. I've previously writen about the shortcomings within physiotherapy when it comes to evidence based practice. Go into most "alternative" or "complementary" healthcare and you will find there is next to no evidence underpinning practice and in some cases practices continue after there has been evidence of no effect. Usually the "evidence" of results is what is cited as proof that it works a common story being something along the lines "I has a patient with condition X (fill in this blank with a non-acute condition) who had treatment with drug Y (fill in ccommonly used drug) and saw Z (fill in NHS profession) but it made absolutely no difference so Z said they could not do any more for them but I did (A,B,C- fill in with quack treatments) and now they are completely better thanks to MY treatment". (No doubt the complementatry practitioner's bank balance is a lot better as well).

Recipe for complementary practitioner success :
Long appointment time + convinced practitioner + natural recovery process+ psychological influence on condition = patient gets better

What i want to be sure is that the recipe for physiotherapy uses better ingredients.

physiotherapy blog on top?

Physiotherapy Blog was in the top slot on Google under "physiotherapy blog" earlier this week and i was mildly pleased by this but i've learnt something about how this whole blogging game works. Things do not stand still and today Physiotherapy Blog is ranked number 2. I think there's a 3 to 4 week time lapse because this has been pushed out of the top space by a blog written in February telling everyone of its own closure. I'm still looking around for interesting physiotherapy blogs but not having much success. However critics of this blog will say it's not a physiotherapy blog and i would wholeheartedly agree with them because i want to do something bigger than just writing about the best ways to treat sciatica, what to do for shin splints etc etc. Any physiotherapist working in the UK and member of the CSP should not have any need for the clinical type of blog because there is iCSP, one of the best physiotherapy sources on the intenet if you're registered.

I'm not certain where Physiotherapy Blog is heading because unlike what i see in some general blogs, I don't want to sit down every day in front of the screen putting my thoughts down so eveyone in the world can read them. I'm interested in creating writing, interestedin evidence based practice and even after rather a lot of early ranting in this blog, I still get mad about the self deception displayed by some members of the profession when it comes to the effectiveness of their interventions.

So here's a few ideas of what I want to do in the next few months. I'd like to do some better cartoons and will take off the one about Appendix (I know it's not good but I wanted to see the resolution of the graphics ). I'd like to create links to other sites totally irrelevant to physiotherapy (possibly shopping sites). I somethimes think about promoting the blog; I know that is not the original idea with blogs but who is to say that the rules cannot be re-witten? the final most anarchic idea is to get rid of the blog and to spend the time doing something more useful instead. Unfortunately this option is the least likely because now I've see it on Google it's a bit of a competition to make sure i keep producing content to keep it there.

physiotherapy blog reaches Google top spot

Physiotherapy Blog has just reached top on Google. I'm not sure how I feel about this. Doing a blog about just physiotherapy becomes difficult after a while because I started out thinking that I would be able to write heaps but some of the time I can't be bothered with it and at times I think about closing the blog down. This is why quite some time ago i diversified away from what seemed like endless ranting about the shortcomings of physiotherapy in the UK. But today is different. I think that when I first started the blog it first appeared on Google as a "Googlewack" a one hit listing but now it has the dubious glory of outranking some of the more established so called blogs. I'm thinking about adding a hit counter (not sure if Google will allow it) as i know from checking sources outside Google that people do read Physiotherapy Blog, although I'd like to know how many.

As I'm feeling dizzy headed with the honor of all this I'd like to reflect , as i have done before, on some of these other so called blogs.Quite frankly some of them are not worth reading. There's one class which is just a type of free commercial for physiotherapy clinics. They don't contain any thoughts about anything and exist to persuade you to use their clinic or service. There are some which seem to be on a mission to tell the world about physiotherapy treatments and conditions. Just a few out there are a blog in the original sense of the word. But let's get real. There's no grand set of rules which say what you can or cannot put into a so called blog. All I hope is that more physical therapists will start doing blogs not because they have a mission or commercial interest but because they enjoy writing.

physiotherapy cartoon #3

When all the organs were boasting about their importance Appendix began to feel inferior...
© 2008

Social services are ineffective

Occasionally I come across situations which make me wish that I did not work in the NHS and a recent one made me realise the serious shortcomings in the way health and social care is now structured. The problems began a long time ago with the move called "care in the community" when there was the all out push to get patients out of long stay hospital beds and into the community because this was meant to be better for people but to the senior managers and politicians the greatest attraction was the fact it appeared cheaper than keeping the elderly and patients with chronic conditions in an NHS bed. More recent emphasis has been on eliminating waiting time and thereby reducing every patient into a financial commodity which is moved through the system as fast as posible. The idea of waiting list elimination was devloped around planned admissions for conditions with a clearly defined outcome (mainly surgical treatments) but despite this it has gradually become the overriding model adopted within NHS today even though for many conditions it is not an approprite way of addressing the problems. Now after years of "care in the community" and pushing the NHS to maximum bed turnover the idea of having facilities for residential rehabilitation seems far fetched and outdated. Out patient rehabilitation is meant to be a better alternative. However in reality it can never provide as intensive input as a residential facility which potentially can deliver therapy to one idividual for up to 8 hours per day. The out patient substitute can only provide a fraction of this. And this is why at times I wish I did not work in the NHS because I can see rehabilitation potential in patients which can never be achieved through the high turnover, "care in the community" health and social care system. The limited amount of input which can be provided in home visits, the unnecessary bureaucracy, the narrow minded and unsubstantiated assumptions of the professionals. I have met people whose health and quality of life could be turned around if only there was the chance to see them daily twice a day in an environment set up to provide rehabilitation insead of them receiving "care" in the community, where their rehabilitation potential is never reviewed and wherer Social Services would rather provide loads of expensive equipment to encourage dependence and disability rather than better use their funding on getting people better