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.