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Physiotherapy Helpers and Other Support Workers
UPDATE
Physiotherapy Helpers and Other Support Workers Introduction
4. The debates at the Society's 1989 Representatives Conference about physiotherapy helpers.
support workers. The competencies so far identified as specific t o physiotherapy are those relating t o the use of electrical equipment, hot and cold applications and hydrotherapy. Not all physiotherapy helpers will be required t o possess these competencies. The logical extension of this raises the possibility of utilising staff in addition to physiotherapy helpers, such as nursing assistants, occupational therapy helpers and others, t o complement the provision of physiotherapy services t o patients, where this is appropriate in terms of availability of staff and adequate training and in the interests of effective teamwork. This more flexible approach to the human resources used by physiotherapists will, by increased access and use of other support workers, increase the number of people w h o can benefit from the physiotherapists' range of skills. Some other professions in health care feel there is no way t o avoid developing a two-tier profession. It is clear that physiotherapists believe it is not necessary nor appropriate t o develop a two-tier profession in order t o deliver our services. We undoubtedly look for the assistance of physiotherapy helpers and other support workers, but there is no place for the higher skilled physiotherapy technician. If there is no occupational requirement for such a technician, then we believe it is appropriate t o leave a gap in vocational qualifications at Level 4 and possibly Level 3. However, general managers will need t o be persuaded that there is no role for this level of worker. The criteria laid down by the National Council for Vocational Qualifications for levels are as follows:
In this article the Society recommends a development in its approach t o the training of physiotherapy helpers and includes further information on vocational qualifications.
Level I: Competence in the performance of work activities which are in the main routine and predictable or provide a broad foundation, primarily as a basis for progression.
Delivery of Physiotherapy Services
Level II: Competence in a broader and more demanding range of work activities involving greater individual responsibility and autonomy than at level I.
READERS will remember that in May 1989 an article entitled 'Physiotherapy Helpers and Community and Other Support Workers' was published in Physiotherapy. It reported statements, agreed by Council, which reflected the views of the Society. Some background was given as t o why and how the statements were drawn up. Information was given t o set the statements in the context of other policies and activities within and outside the National Health Service. This background is not repeated in this article, but rather it focuses on an update of the Society's views and reports progress in other relevant areas. The Society, through its Helper Working Party, has continued t o consider its relationship with physiotherapy helpers and other support workers in the light of recent and complex issues including: 1. The NHS Review, 'Working for Patients', which states that 'local managers, in consultation with their professional colleagues, will be expected t o re-examine all areas of work t o identify the most cost-effective use of professional skills'.
2. The National Health Service Training Authority (NHSTA) Health Care Support Worker Project which is developing a system of vocational qualifications for support workers, including physiotherapy helpers. 3. The CSP's statement on the role and training of physiotherapy helpers, published in the May Journal.
The existing well-established relationship of the physiotherapist in the community, with families and paid and unpaid carers, wh o often act, in effect, as 'physiotherapy helpers' was emphasised in the paper on the community support worker, published in the May Journal. These carers help physiotherapists by reinforcing physiotherapy programmes in addition t o their many other tasks with the people w i t h whom they work or live. This model has been effective in extending the physiotherapy programme into the individual's lifestyle. It is also found in some priority care units in hospitals. The Society believes that the use of this model should be extended and that this has a direct influence on training for helpers. The NHSTA Health Care Support Worker Project team and in particular, the physiotherapists and helpers involved w i t h the development of competencies specific t o physiotherapy helpers, believe that most competencies are, in fact, common to a wide range of 'caring support workers', although clearly expertise of individuals in some will be higher than in others, depending on the job role. For example, all support workers have a role in mobility and exercise but the extent of skill will be greater in the physiotherapy helper than in other
Level Ill: Competence in skilled areas t h a t involve performance of a broad range of work activities, including many that are complex and non-routine. In some areas, supervisory competence may be a requirement at this level. Level IV: Competence in the performance of complex, technical, specialised and professional work activities, including those involving design, planning and problemsolving, w i t h a significant degree of personal accountability. In many areas competence in supervision or management will be a requirement at this level. However, in Scotland, SCOTVEC does not report its qualifications in terms of levels. This philosophy may well be further supported if, as seems likely, some vocational qualifications will, in the future, be linked to client groups. This again will demonstrate that skills are common across a number of professions at support worker levels within a particular client group so that, say, in a paediatric setting a physiotherapist could seek support from a nursing assistant, nursery nurse or physiotherapy ~
Physiotherapy, February 1990, vol 76,no 2
79
helper t o aid in the delivery of physiotherapy services, with added benefit t o the child. Similarly, the physiotherapist would provide a 'specialist' service in assessing the needs of elderly people, but may wish to delegate tasks to a variety of support workers rather than only t o the physiotherapy helper, as well as involving relatives, thus extending the care programme over a 24-hour period. Training for Physiotherapy Helpers All good employers are expected t o provide appropriate training to enable staff to undertake their job more effectively. Physiotherapy managers should, therefore, ensure that relevant training is available for physiotherapy helpers. If it is recognised that physiotherapy helpers need t o develop core competencies common to all support workers w h o work with caring professionals, it is clear that multidisciplinary training courses will be more efficient. A number of technical colleges as well as health authorities are already running such courses on basic 'caring' and it would seem appropriate that physiotherapy helpers are encouraged t o attend these wherever possible. Equally, physiotherapists should be encouraged locally t o become involved in the teaching of such courses in those areas appropriate t o their skills, eg in lifting, handling and mobility. In this way the physiotherapy helper benefits from attending a wide-ranging course and the patients (and physiotherapists) benefit from a wide range of support workers being taught well those areas of care that can help physiotherapists deliver effective services t o patients. Additional training for physiotherapy helpers working w i t h i n t h e physiotherapy service and specific t o physiotherapy, can be provided 'on the job'. Vocational Qualifications The NHSTA Health Care Support Worker Project is moving into a new phase of piloting assessment methodologies for vocational qualifications and testing out the appropriateness of the identified competencies in the workplace. Work is about t o start on developing the structure of vocational qualifications, t o which the Society will be contributing. There is likely t o be a range of qualifications relevant t o physiotherapy helpers. Some will reflect the general 'caring' skills, some will be specific t o a client group - for example, people with learning difficulties - some t o the provision of clerical and reception support, and some specific t o physiotherapeutic modalities.
These qualifications will give physiotherapy helpers recognition for the very wide range of skills many of them already possess and this, in turn, will give physiotherapy helpers greater opportunities in employment. Transferability is a key element of vocational qualifications which the Society believes will give physiotherapy helpers more opportunities than at present. For some, vocational qualifications may form one of a number of criteria required for entry into professional training. The Society's view is that it should not become an awarding body for vocational qualifications for support workers, including physiotherapy helpers. However it will be developing close links with any awarding body offering such qualifications, t o ensure the 'finished product' of all care workers, ie the qualifications, reflect the philosophy of the profession. The aim will be that physiotherapists have a degree of influence on training for health and social care staff and the assessment of physiotherapy helpers, as well as the future refinement and modification of competencies and qualifications which are of relevance t o the profession. Conclusion Physiotherapy helpers are, and will continue 'to be, essential contributors t o the delivery of physiotherapy services. Physiotherapists should, however, also look for opportunities t o utilise other appropriately trained support workers, in addition t o physiotherapy helpers, t o assist with the delivery of services t o patients. This will increase the resources of the physiotherapy service and provide more comprehensive patient care. The Society believes that the tasks which are appropriate for physiotherapists t o delegate are not those of a high level technician but rather those of the 'informed carer'. Physiotherapists should actively involve themselves w i t h multidisciplinary training courses for support workers and facilitate the attendance at these of physiotherapy helpers. Structured but 'on the job' training specific t o physiotherapeutic modalities should be provided for physiotherapy helpers. The Society will continue t o work to influence the on-going NHSTA Health Care Support Worker Project and any other relevant project which seeks t o provide qualifications for support workers. Any comments or requests for further information about the Society's approach should be addressed t o Judy Mead MCSP, Professional Affairs Officer, Chartered Society of Physiotherapy, 14 Bedford Row, London WCIR 4ED, who would also be pleased t o hear of local initiatives.
PeriodicaI Review
The Association of Chartered Physiotherapists with a Special Interest in Elderly People
This feature outlines the principal contents of journals and newsletters of Specific Interest Groups. To obtain the publications, please contact the honorary secretary of the appropriate group. Addresses were given in the Annual Report published with the May issue of Physiotherapy.
Newsletter, January 7990
B Hollinrake
Newsletter, no 53, November 1989 'Water-works'
In Touch, no 54, winter 7989
80
S Knight A Bennett
Association of Paediatric Chartered Physiotherapists
Association of Chartered Physiotherapists in Private Practice The clinical recognition of epiphyseal injury Children's patellar problems: Mechanics and correction The use of Cliniband in the rehabilitation of tennis elbow
My role (specialist social worker with the elderly) A chiropodist's point of view Creative movement and drama with elderly people Circuit exercises
J Riddell
V Grisogono J Scott
The Halliwick swimming method Parent and child water awareness The Ron Moore wilderness trek Cardiff water babies Swimming and the asthmatic child Aquatots
J C Ness, E Bell C A Hicks F de Rijke L Horrocks P Roquette J McKinlay
physiotherapy, February 1990, vol76, no 2
Physiotherapy Helpers and Other Support Workers Introduction
4. The debates at the Society's 1989 Representatives Conference about physiotherapy helpers.
support workers. The competencies so far identified as specific t o physiotherapy are those relating t o the use of electrical equipment, hot and cold applications and hydrotherapy. Not all physiotherapy helpers will be required t o possess these competencies. The logical extension of this raises the possibility of utilising staff in addition to physiotherapy helpers, such as nursing assistants, occupational therapy helpers and others, t o complement the provision of physiotherapy services t o patients, where this is appropriate in terms of availability of staff and adequate training and in the interests of effective teamwork. This more flexible approach to the human resources used by physiotherapists will, by increased access and use of other support workers, increase the number of people w h o can benefit from the physiotherapists' range of skills. Some other professions in health care feel there is no way t o avoid developing a two-tier profession. It is clear that physiotherapists believe it is not necessary nor appropriate t o develop a two-tier profession in order t o deliver our services. We undoubtedly look for the assistance of physiotherapy helpers and other support workers, but there is no place for the higher skilled physiotherapy technician. If there is no occupational requirement for such a technician, then we believe it is appropriate t o leave a gap in vocational qualifications at Level 4 and possibly Level 3. However, general managers will need t o be persuaded that there is no role for this level of worker. The criteria laid down by the National Council for Vocational Qualifications for levels are as follows:
In this article the Society recommends a development in its approach t o the training of physiotherapy helpers and includes further information on vocational qualifications.
Level I: Competence in the performance of work activities which are in the main routine and predictable or provide a broad foundation, primarily as a basis for progression.
Delivery of Physiotherapy Services
Level II: Competence in a broader and more demanding range of work activities involving greater individual responsibility and autonomy than at level I.
READERS will remember that in May 1989 an article entitled 'Physiotherapy Helpers and Community and Other Support Workers' was published in Physiotherapy. It reported statements, agreed by Council, which reflected the views of the Society. Some background was given as t o why and how the statements were drawn up. Information was given t o set the statements in the context of other policies and activities within and outside the National Health Service. This background is not repeated in this article, but rather it focuses on an update of the Society's views and reports progress in other relevant areas. The Society, through its Helper Working Party, has continued t o consider its relationship with physiotherapy helpers and other support workers in the light of recent and complex issues including: 1. The NHS Review, 'Working for Patients', which states that 'local managers, in consultation with their professional colleagues, will be expected t o re-examine all areas of work t o identify the most cost-effective use of professional skills'.
2. The National Health Service Training Authority (NHSTA) Health Care Support Worker Project which is developing a system of vocational qualifications for support workers, including physiotherapy helpers. 3. The CSP's statement on the role and training of physiotherapy helpers, published in the May Journal.
The existing well-established relationship of the physiotherapist in the community, with families and paid and unpaid carers, wh o often act, in effect, as 'physiotherapy helpers' was emphasised in the paper on the community support worker, published in the May Journal. These carers help physiotherapists by reinforcing physiotherapy programmes in addition t o their many other tasks with the people w i t h whom they work or live. This model has been effective in extending the physiotherapy programme into the individual's lifestyle. It is also found in some priority care units in hospitals. The Society believes that the use of this model should be extended and that this has a direct influence on training for helpers. The NHSTA Health Care Support Worker Project team and in particular, the physiotherapists and helpers involved w i t h the development of competencies specific t o physiotherapy helpers, believe that most competencies are, in fact, common to a wide range of 'caring support workers', although clearly expertise of individuals in some will be higher than in others, depending on the job role. For example, all support workers have a role in mobility and exercise but the extent of skill will be greater in the physiotherapy helper than in other
Level Ill: Competence in skilled areas t h a t involve performance of a broad range of work activities, including many that are complex and non-routine. In some areas, supervisory competence may be a requirement at this level. Level IV: Competence in the performance of complex, technical, specialised and professional work activities, including those involving design, planning and problemsolving, w i t h a significant degree of personal accountability. In many areas competence in supervision or management will be a requirement at this level. However, in Scotland, SCOTVEC does not report its qualifications in terms of levels. This philosophy may well be further supported if, as seems likely, some vocational qualifications will, in the future, be linked to client groups. This again will demonstrate that skills are common across a number of professions at support worker levels within a particular client group so that, say, in a paediatric setting a physiotherapist could seek support from a nursing assistant, nursery nurse or physiotherapy ~
Physiotherapy, February 1990, vol 76,no 2
79
helper t o aid in the delivery of physiotherapy services, with added benefit t o the child. Similarly, the physiotherapist would provide a 'specialist' service in assessing the needs of elderly people, but may wish to delegate tasks to a variety of support workers rather than only t o the physiotherapy helper, as well as involving relatives, thus extending the care programme over a 24-hour period. Training for Physiotherapy Helpers All good employers are expected t o provide appropriate training to enable staff to undertake their job more effectively. Physiotherapy managers should, therefore, ensure that relevant training is available for physiotherapy helpers. If it is recognised that physiotherapy helpers need t o develop core competencies common to all support workers w h o work with caring professionals, it is clear that multidisciplinary training courses will be more efficient. A number of technical colleges as well as health authorities are already running such courses on basic 'caring' and it would seem appropriate that physiotherapy helpers are encouraged t o attend these wherever possible. Equally, physiotherapists should be encouraged locally t o become involved in the teaching of such courses in those areas appropriate t o their skills, eg in lifting, handling and mobility. In this way the physiotherapy helper benefits from attending a wide-ranging course and the patients (and physiotherapists) benefit from a wide range of support workers being taught well those areas of care that can help physiotherapists deliver effective services t o patients. Additional training for physiotherapy helpers working w i t h i n t h e physiotherapy service and specific t o physiotherapy, can be provided 'on the job'. Vocational Qualifications The NHSTA Health Care Support Worker Project is moving into a new phase of piloting assessment methodologies for vocational qualifications and testing out the appropriateness of the identified competencies in the workplace. Work is about t o start on developing the structure of vocational qualifications, t o which the Society will be contributing. There is likely t o be a range of qualifications relevant t o physiotherapy helpers. Some will reflect the general 'caring' skills, some will be specific t o a client group - for example, people with learning difficulties - some t o the provision of clerical and reception support, and some specific t o physiotherapeutic modalities.
These qualifications will give physiotherapy helpers recognition for the very wide range of skills many of them already possess and this, in turn, will give physiotherapy helpers greater opportunities in employment. Transferability is a key element of vocational qualifications which the Society believes will give physiotherapy helpers more opportunities than at present. For some, vocational qualifications may form one of a number of criteria required for entry into professional training. The Society's view is that it should not become an awarding body for vocational qualifications for support workers, including physiotherapy helpers. However it will be developing close links with any awarding body offering such qualifications, t o ensure the 'finished product' of all care workers, ie the qualifications, reflect the philosophy of the profession. The aim will be that physiotherapists have a degree of influence on training for health and social care staff and the assessment of physiotherapy helpers, as well as the future refinement and modification of competencies and qualifications which are of relevance t o the profession. Conclusion Physiotherapy helpers are, and will continue 'to be, essential contributors t o the delivery of physiotherapy services. Physiotherapists should, however, also look for opportunities t o utilise other appropriately trained support workers, in addition t o physiotherapy helpers, t o assist with the delivery of services t o patients. This will increase the resources of the physiotherapy service and provide more comprehensive patient care. The Society believes that the tasks which are appropriate for physiotherapists t o delegate are not those of a high level technician but rather those of the 'informed carer'. Physiotherapists should actively involve themselves w i t h multidisciplinary training courses for support workers and facilitate the attendance at these of physiotherapy helpers. Structured but 'on the job' training specific t o physiotherapeutic modalities should be provided for physiotherapy helpers. The Society will continue t o work to influence the on-going NHSTA Health Care Support Worker Project and any other relevant project which seeks t o provide qualifications for support workers. Any comments or requests for further information about the Society's approach should be addressed t o Judy Mead MCSP, Professional Affairs Officer, Chartered Society of Physiotherapy, 14 Bedford Row, London WCIR 4ED, who would also be pleased t o hear of local initiatives.
PeriodicaI Review
The Association of Chartered Physiotherapists with a Special Interest in Elderly People
This feature outlines the principal contents of journals and newsletters of Specific Interest Groups. To obtain the publications, please contact the honorary secretary of the appropriate group. Addresses were given in the Annual Report published with the May issue of Physiotherapy.
Newsletter, January 7990
B Hollinrake
Newsletter, no 53, November 1989 'Water-works'
In Touch, no 54, winter 7989
80
S Knight A Bennett
Association of Paediatric Chartered Physiotherapists
Association of Chartered Physiotherapists in Private Practice The clinical recognition of epiphyseal injury Children's patellar problems: Mechanics and correction The use of Cliniband in the rehabilitation of tennis elbow
My role (specialist social worker with the elderly) A chiropodist's point of view Creative movement and drama with elderly people Circuit exercises
J Riddell
V Grisogono J Scott
The Halliwick swimming method Parent and child water awareness The Ron Moore wilderness trek Cardiff water babies Swimming and the asthmatic child Aquatots
J C Ness, E Bell C A Hicks F de Rijke L Horrocks P Roquette J McKinlay
physiotherapy, February 1990, vol76, no 2