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the NHS to maximum bed turnover the idea of having facilities for residential rehabilitation seems far fetched and outdated.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

Physiotherapy cartoon #2

She could tell it was an exclusive hospital by the theatre gowns
© 2008

Physiotherapy cartoon #1

51 Uses For a Zimmer Frame # 1 Avant-garde fountain © 2008

Evidence for Physiotherapy

OK so last post said that physiotherapy blog is going graphic. I've not forgotten this and I'm working on it, but having just visited a few blogs which talk about evidence based practice .I have a number of points to make. Firstly evidence based practice (EPB) is hard to put into practice within physiotherapy (at least in the UK) because these's a strong tide to fight against, and that tide is the (probably dominant) view that within clinical practice results are the most important thing; as long as people get better when we are "doing" something then we must be doing things correctly. There is also an uncomfortable issue with so called evidence There's evidence for everything within physiotherapy but the problem is the evidence is poor when weighed against the standards being used for evidence quality within other areas of healthcare. Often it's only professional opinion that's the evidence.Significant amounts of physical therapy theory lacks evidence but often what happens is an enthusiast for a treatment technique conducts a "trial" using a small sample , biased selection or fails to blind assessors to intervention and then when the results come back positive it it presented as proof that the technique or approach works. There's another weakness in EBP and that is often the poor critical appraisal skills of therapists. There's a willingness to accept anything which is "evidence" regardless how good the research methodology is. Perhaps the biggest problem is a relucatance to change clinical practice when good evidence becomes available, because the old practices "worked" and in the worst situation no one is aware that the latest evidence strongly supports a change in direction. Let's face it, no one (except an unethical clinician) would spend large amounts of time doing those things which obviously made no difference. The challenge for EBP is to extract the subtle changes and interactions which are occurring within the clinical situation and differentiate them from those changes and interactions which would occur in the absence of a specific clinical intervention. No small feat!

physiotherapy blog goes graphic

blog blog blog
glob glob glob
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Im tired of all these blog words
Im going to do pictures instead

physiotherapy websites

Can't think of anything happeing within the profession in UK that's worth commenting on other than those things I have already covered. I am adding more websites as much for my own use as for evryone else

LIST OF PROFESSIONAL ORGANISATIONS (English Speaking)
American Physical Therapy Association http://www.apta.org/Education
Australian Physiotherapy Association http://www.physiotherapy.asn.au
Chartered Society of Physiotherapy http://www.csp.org.uk
Singapore Physiotherapy Association http://www.physiotherapy.org.sg
Canadian Physiotherapy Association http://www.physiotherapy.ca
New Zealand Society of Physiotherapy http://www.physiotherapy.org.nz
South African Society of PPhysiotherapy http://www.physiosa.org.za

Warped funding priorities

It said on the BBC news yesterday that the Government will be putting £2 billion into the tube (subway) system in London. I did not hear of any adverse comments being made about this. Yet only a year or so ago when the same Government put just £1 billion more than this into the NHS (an organsation which is vastly bigger than the London tube system) there were statements by politicians implying that the NHS was fortunate to be getting so much money, that the staff had to improve productivity etc.etc. It's the same with physiotherapy inside the NHS.Vast amounts of money are spent on other areas of healthcare (including huge amounts wasted by managers on office refurbishment, useless management seminars and free lunches during management events) and yet physiotherapists are greatful if they get fully funded to do training courses which enable them to do their jobs. Funding priorities are warped!