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private medical insurance would raise a substantial sum. ‘We need your Society to tell us how you feel that we can deal with these issues in relation to the private sector, knowing that many of your members are operating in part or in whole within the private sector.’ He did not think the Labour Party could go in!o the next election promising more taxes. However, ‘I have long believed that we could persuade people to pay tax if there was a contract with the electorate and they knew where it was going.’
NVQs Another speaker asked for his comments on physiotherapy education and national vocational qualifications. On NVQs, Mr Blunkett pointed out that the Society had now welcomed physio-
therapy helpers. He thought the primary aim should be to avoid diluting the standard of education for chartered physiotherapists while allowing others to make a positive contribution by gaining NVQs. They could provide an opportunity for people who develop to the point where they could undertake professionaltraining, but it was necessary to be confident that there would be no changes in the grade mix. There must be guidelines on appropriate work for each team member. ‘It seems to me that the securing of the title and the way in which we can lift the status and recognition of physiotherapy protects you against the dangers while allowing you to be open and committed to encouraging other people to work positively with you and I think that would be a great gain for everybody, not least patients.’
Northern Ireland The final questioner asked if Mr Blunkett was in favour of mobilising the Labour Party in Northern Ireland in support of TUC thinking. He replied that individuals in Northern Ireland could be members of the Labour Party although it was not organised there. If peace were established there it would be possible to agree with Labour’s sister party, the SDLP, on how to move as a party there. But the Labour Party did not organise outside its territory on the grounds that other countries could develop parties of their own. Powever, it could and would give support and encouragement to NI members because the overall campaign to improve the service, to restore the NHS, to secure the title and recognition for physiotherapists’ work, was the same throughout the United Kingdom.
Annual Representative Conference Ronnie Paul chaired the 1994 Annual Representative Conference, with Angle Emmott and Wendy White as vice-chairs. It was held at the wellappointed International Convention Centre, Birmingham, on September 20 and 21, 1994. Report by Bernadette Friend.
Introductory Debate Conference opened with a call to remove several motions from the agenda. Pinky Mlllward on behalf of the ACPM moved that the report of the Agenda Committee should be referred back. She said the Conference should be concerned with issues directly relating to the physiotherapy profession, not to political issues. Many representatives from groups within the profession had not been given a remit to take a political stance, she said, and would therefore have to abstain from voting on these issues. Avls Glimore, North Western stewards, said members could not possibly pass this motion. The CSP was a professional body and a trade union and the trade union function was becoming more important. As a trade union, she said, ‘we need to express views to the outside world’. The financial and political agenda in the NHS was determined by the Government, said Claire Sulllvan, NW Thames. Members could no longer just go to work, treat their patients and go home again. Members lived and worked in a political world. Wendy Whlte, vice-chair, said that many of the motions on the agenda had a political emphasis. If there was a move to omit political motions, then there would be few motions left to debate. Mark Potter, OCPPP, supported the motion, saying that there were better things for members to discuss which directly affected their clinical skills. Not to discuss political issues at Conference was an absurdity, according to Tom Donnelly, Glasgow. Health care was a political issue and members should be involved. Conferenceagreed to confirm the agenda.
Avls Gllmore of North Western stewards moved reference back of Council’s report on resolution C8 from last year’s Conference which asked for the ARC to be moved foward to earlier in the year. As a delegate to the TUC Congress, she said it was difficult to represent the views of the CSP because many of the issues they were discussing had not yet been debated by members. She urged the CSP Council to take immediate steps to organise the 1995 Conference earlier in the year. Reference back was agreed. The ACPP and Yorkshire stewards asked for the report on resolution F22 to be referred back because the action taken had been neither adequate nor in the spirit of the resolution. Mlck Skelly from ACPP explained that it called on the CSP to take political action on the causes of ill health. He had urged that a high profile and ‘contentious’ stance be taken regarding government policies which had the effect of promoting ill health. He asked what the Society had done about the mismanagement of the nation’s health over the last 14 years. At the least, the CSP was guilty of a collective bystander apathy, at worst it had an unspoken policy of appeasement, combined with covert political support for the Government, he said. The CSP should appoint as a priority a parliamentary officer to ensure that position of the CSP on the political decisions which affected health was widely publicised in the media. The motion to refer back Council’s report on F22 was carried.
Health and Safety THESE MOTIONS WERE GROUPED FOR COMMON DEBATE Al. Conference notes with concern the Increasing number of Instances of violence at work, In particular the fatal assault on an occupational therapist last year. It calls on the CSP to conduct a survey to dlscover the extent of vlolence at work towards CSP members, In order to facilitate the development of preventive strategies. We also ask the CSP to specify how It Intends to support any member who Is subject to any violence. South West and Scottish stewards A2. Conference believes that the CSP should encourage health care trusts to provide a safer working environment for community physlotheraplsts by the provlson of personal self-defence training, personal alarms and mobile telephones. Trent stewards Shirley Ralney, for South West Stewards, said members were shocked by the death of an occupational therapist in Torbay. What made the incident more traumatic was the reported attitude of the unit managers. It was implied that she had left herself open to such risk by being on the unit alone with a client. Violence cannot and must not be tolerated. She said the Patients Charter might have added to the problems by increasing patient expectations. When these are not met, patients can become threatening. She called on health and safety representatives to collect incidents of violence to be used as evidence to make employers take action. At no time should employers be allowed to compromise the safety and well-being of their staff. For Trent stewards, Rob Almond asked whether employers had adequate safety policies and training for community physiotherapists for w h m the potential of violence had become a reality. He said it
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798 was necessary to ensure all employers had approved safety policies covering training, equipment and support. Phlllppa Ford, for Welsh stewards, supported the use of personal alarms and mobile telephones, and wanted to see training in management of aggressive situations. Ian Duguid, Scottish stewards, said action must be taken to ensure the tragedies of the past did not happen again. He said it was incumbent upon hospital and trust board managers to ensure that a safe working environment was established. He suggested that by surveying the membership, managers could be shown the seriousness and prevalence of violence at work. Mark Potter, OCPPP, said training or equipment should be provided for by hospitals or trusts. He asked what security arrangements were in place now for nursing staff and whether this could be extended to other members of staff. If there was an assault, he asked whether the CSP could provide a disability pension. Both motions were carried unanimously. Tom Donneily, Council member, said the real cost of illness and injury at work was f16 billion a year. He said the CSP Industrial Relations Department had re-published the Health and Safety Handbook. The IR Department also runs an extensive training campaign for health and safety representatives. THESE MOTIONS WERE GROUPED FOR COMMON DEBATE 83. The ARC Agenda Committee asks Conference to accept a change to the constltutlon of Conference in order that the numbers of representatives are altered, bringing them back Into the original state of equality that existed when the original constltutlon was drawn up In 1986. Agenda Committee 84. in view of current changes in the NHS, the CSP should consider whether the present assembly of the ARC is the best way to bring together a true representatlon of the membership in order to present and encourage the debate of clinical Issues. APCP Ronnie Paul, representing the Agenda Committee, reminded Conference that in
1986 its constitution was drawn up with 50% stewards, and 50°/o representatives
from Branches, Clinical Interest and Occupational Groups and students. Changes had led to an imbalance, and he suggested the constitution should be changed to redress this. For the APCP, Carole Hurran asked members to debate whether the annual conference was the best way to bring together a true representation of the membership. She said the APCP believed there was a need to look carefully at the constitution of Conference, so that there was a fair balance of clinical as well as industrial and professional issues. Flona Hawklns, for Trent stewards, asked for the CSP officers to clarify the numbers because there seemed to be some discrepancy. Deborah Gates, South West Thames stewards, pointed out that she did not stop being a clinician when she became a steward. She said she was angry that it was felt that stewards did not reflect the views of members. Toby Simon, CSP Secretary, said the total number of places was 108 for stewards, 140 for others. He said the original intention of the constitution was that representatives of Branches and Specific interest Groups should be roughly equal to the number of stewards; but that the students would not be included in that total. By deducting the students, the figures were 132 Branches and Specific Interest Group representatives and 108 stewards, with six to eight students. David Williams, North East Thames steward, said the only representation that junior members of staff had where he worked was through the stewards. He said the steward network was strong and representative. It was apparent, said Karen Bruce, Scottish stewards, that Specific Interest Groups and Branches had not been forthcoming with their opinions. She said stewards were not at conference for personal gain, but for the Society’s benefit. Catherlne Elliman, Northern Ireland regional steward, said many motions were about clinical and professional issues. If the Clinical Interest Groups thought there were not enough clinical issues being debated they should put more forward. The first motion was carried. and the second was lost.
Key to Acronyms ACPIN ACPM ACPP APCP ARC CSPAE NVQ OCPPP PACE RCACP RMT TUC
Association of Chartered Physiotherapists in Neurology Association of Chartered Physiotherapists in Management Association of Chartered Physiotherapists in Psychiatry Association of Paediatric Chartered Physiotherapists Annual Representative Conference Chartered Society of Physiotherapy Association of Educators National Vocational Qualification Organisation of Chartered Physiotherapists in Private Practice Physiotherapy Access to Continuing Education Respiratory Care Association of Chartered Physiotherapists Rail Maritime and Transport union Trades Union Congress
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85. Conference believes that the standing orders for the ARC should provide that Council should inform Conferenceof the financial Implications of motions which will involve significant expenditure, to enable more informed debate to take place. Organisation of Chartered Physiotherapists in Private Practice If the Conference was made aware by Council of the anticipated budget available for the relevant departments for the coming financial year, motions could be discussed with a more realistic view of the possible outcomes and probable implementation, Carol Owen of OCPPP proposed. ‘If we don’t know how much things are going to cost and we don’t know the funds available, how are we going to make informed choices?’ she asked. Sharon Lynn, from Northern stewards, urged members to vote against the motion, which she thought would interfere with the role of Conference which was to represent the widest number of views from the membership. Conference was informed by what was important to members, not by financial considerations. OCPPP representative Mark Potter said the motion was relevant and reminded members that last year they voted against the purchase of a Centenary statue, only to find out that the money had already been spent. The motion would prevent this sort of thing happening in future. The motion was lost. Emergency motlon 2. This Conference Is appalled at the disparity between the accommodation provided for Council members and that provided for the delegates at the ARC. Conference believes that In future years the same standard of accommodation should be provlded for both groups. North Western sfewards Avis Gllmore, North West stewards, said she was appalled at the accommodation. ‘We’re bad in the north west’, she told delegates, ‘But we don’t live like that’. She said members were not asking to stay in a ’posh’ hotel and were not expecting Council members to stay in the appalling conditions they were staying in, but somewhere in between would be right for both groups. Tom Donnelly said it was his first year at conference as a Council member. ‘It’s not all beer and skittles’, he joked. It was hard work wading through ankle-deep carpets and coping with a jacuzzi at the wrong temperature. For North East Thames stewards, Anju Jaggl said there had been problems with delegates not being able to get into their rooms due to confusion. The motion was carried unopposed. Toby Simon, CSP Secretary, said that steps would be taken in future to try and achieve similar accommodation. He said there were financial implications but that it was important to ensure that those attending Conference were able to contribute to it properly. Flona Hawklns, Trent stewards, said the main issue was that there should be parity in accommodation.
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Education Emergency motion 1. This conference condemns the Government’s proposals to devolve responsibility for nonmedical education to consortia of health authorities and trusts, which will result in the disintegration of undergraduate physiotherapy education. The CSP should promote workable strategies for funding undergraduate education and raise these directly with the Government. Council Physiotherapywas under direct threat, Julia Lamb, chairman of the Education Committee, told Conference. She said the disastrous results of the policy to devolve the initial education for physiotherapy from regional health authorities to consortia of health authorities and trusts could not be over-stated. It would lead to disintegration of undergraduate physiotherapy education. Decisions would be taken on a parochial and ad hoc basis without any awareness of wider educational or labour market implications. The Society, she said, planned to continue its campaign against the proposals. ‘Physiotherapy deserves something better than a rickety fragmented system, held together by the sticky tape of overviews, checks and balances.’ Angie Emmott, Trent stewards, said Government proposals for funding undergraduate physiotherapytraining were ‘yet another nail in the coffin of the profession.’ To virtually tout out the education of future fellow professionals in a meaningless form of competitive tendering was an indicator of the Government’s lack of understanding of the profession as a whole and the ethos of the NHS. The motion was carried unopposed.
C8. In view of the present economic climate and the proposed use of generlc and maintenance therapists, the CSP should revise its policy of an allgraduate profession on the grounds that honours degree courses are overeducatlng physiotheraplsts for their new role. Grampian Branch Ann Quirk, on behalf of Grampian Branch, asked whether physiotherapists were being over-educatedfor their role in the new NHS. As more emphasis was given to the cost of treatment, physiotherapists faced a problem because few of their techniques or practices had been scientifically proven. She questioned why there was a need for so much theory when what patients wanted was a ‘friendly, helpful, smiling therapist with sound clinical skills’. For Cambridge Branch, Nicola Higgins said she was surprised and amazed at the suggestion that an honours degree course would over-educate the profession for its new role. Surely, she said, what the profession should be doing was accepting that members should educate themselves to the highest possible standards, not to conform to the new role mapped out for them, but to formulate their own role within the service. Grahame Pope, Nottingham Branch,
urged members to reject the motion. He said that physiotherapists had to be encouraged to be able to say why they did something, not just how they did something. Neil Robinson, for Grampian Branch, said changes had meant that physiotherapists have had to adapt to the best of their ability in order for patients to benefit. He believed that with care in the community, experienced general therapists would be required to meet the demands of clients. Student representative Mark Philpott said he was amazed that a suggestion could be made that degree level training would be detrimental to physiotherapy. The profession was trying to educate people who would be thinkers and caring professionals. Phlllippa Ford, for Welsh stewards, said that in order to prove their effectiveness, physiotherapists needed to have a research grounding and they needed to be recognised scientifically by fellow health care professionals. Denise Hayes, also speaking for Welsh stewards, said she was astonished that a fellow professional could say she was happy to ‘roll over and play dead for the GP’. Where, she asked, was the profession going if it could support a motion which called for physiotherapists to be less qualified. Marion Tidswell, for the CSP Association of Educators, said that for many years the quality and standard of pre-registration physiotherapy courses were considered to be equivalent to a degree, but there was no recognition. Physiotherapists needed the research and confidencethat degree courses brought to be able to argue their case with other professionals in the health service, for the benefit of patients. Teresa Cook, Norfolk Branch, said physiotherapists were being trained to have the research knowledgewhich could then be used to prove the value of the skills that physiotherapists were using daily. In exercising her right of reply, proposer Ann Quirk urged members to vote against the motion, but said that while physiotherapists had argued their case well, it was the GPs and general managers who had to be convinced of their worth.
of hair. Ultimately, she said, the CSP had to represent these people, and had to take responsibility to guide universities to use the most appropriate selection tool. Mark Phiipott, student representative, said he was diappointed to learn that some universitiesno longer conduct interviews. Perhaps the reason for this, he said, was that the number of applicants had dramatically increased, putting tremendous strain on the application process. As a vocational course, caring professional qualities were necessary as well as academic ability. He called on the CSP to look at ways of improving the selection process. Welsh steward Liz O’Sullivan asked the CSP to consider other measures in the screening process, like personality or aptitude tests. CSP director of education Alan Walker said the Society advised universities to carry out interviews, wherever this was practicable. Physiotherapywas becoming increasingly popular with the proportion of those applying, to those being accepted, running at 10 to one. Pat McCoy, chair of Council, said that from her experience as a teacher the number of applicants continued to rise. In the past, interviews were held but that had become impossible in recent years. The cost of interviewing large numbers of candidates was prohibitive. in Ulster the correlation between academic and clinical ability had been examined and was found to be extremely strong. Those students with first-class honours also had the highest grades on clinical placements. There was no evidence that not interviewing students was leading to lessening of standards or commitment. The motion was carried.
C10. Conference calls upon the CSP to clarify its involvement in the development of NVQs I V and V and to ensure there i s regular updating of the membership through the Journal and other appropriate channels. North West Thames stewards Jane Harrison for North West Thames stewards, said NVQ levels IV and V related directly to professional standards and qualifications. But what was not clear, she said, was how they would develop. There were many implications for the profession and she called on the CSP to clarify its involvement with NVQs and to keep the The motion was lost. membership informed as levels IV and V developed. C9. Conference demands that the CSP Alan Walker, CSP director of education, should urgently issue guidelines to said discussions on NVQ levels IV and V all universities on the necessity for were at a very early stage and there was interview for potential physiotherapy no real clarity or consensus in any students. Academic abilities are occupational sector on what they would essential but only in conjunction with look like. The CSP would almost certainly practical and communication skills. Will favour an integrated system in which we be able to say ‘two hundred years existing honours degrees would be able of physiotherapy in good hands’? to gain accreditation as NVQs at the Cambridge Branch appropriate level. Mary Ross, a co-opted Council member, On behalf of Cambridge Branch, Nichola Higgins said it had become told Conference that as a member of the apparent that universities were happy to NVQ working party she had tried through rely on academic qualificationsand written all the available networks to talk to applications, rather than asking potential members about NVQs and on many physiotherapy students to attend for occasions had found there was little interviews. The motion was not about interest. checking candidates’ fingernails, or length The motion was carried.
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C14. The CSP should formally accredit some physiotherapy departments and practices, both NHS and private, as post-registration training placements licked to PACE. This should be based on the standards of continuing education and experience provided. Birmingham Branch Every workplace should be seen to be working towards a structured support system for continuing education, Liza Masters argued on behalf of the Birmingham Branch. Therapists needed continuing education opportunities that related directly to patient care. Formal accreditation of physiotherapy practices and dapartments would not only recognise and validate these learning opportunities, it would confer standardised qualitative and quantitative continuing education, ensuring that the professional image was seen to be positive in safeguarding standards. Trent steward David MacLeilan. giving a personal view, pointed out that to accredit some departments would be to the detriment of others. Avis Gilmore, North Western stewards, suggested that accredited departments would be able to attract staff, while others would have recruitment problems. The motion was lost.
C l l . This Conference proposes that the CSP should ensure that the implementation of NVQ levels 1-111 is adequately funded by trust managers so that the time taken by health care professionals in assessment of NVQs is not to the detriment of the service. Trent stewards Fiona Hawklns, for Trent stewards, said NVQs were here to stay. in taking on NVQ assessments, physiotherapists have had to withdraw more time from patient care. Surely, she suggested, this meant they were doing neither job properly. in the Armed Forces money had been set aside and NVQs had been wccessfully adopted. if it was possible within the forces it must be possible within health care. Council member Fiona Jenkins, giving a personal view, said that although the CSP could campaign it could not ensure that the implementation of NVQ levels 1-111 would go ahead as stated in the motion. ACPM representative Teresa Dawson agreed in principle with the motion but said the CSP did not have authority over trust managements and could therefore only make recommendations. The motion was remitted to Council.
in the business plan, the provision of education and training. Hilary Dickle from Stockport Branch said she overheard two physiotherapists queueing to register for the conference. One mentioned a figure of around f 1,000 to attend the courses needed to do the job. ‘We no longer are sons and daughters of rich families - that was their comment’, she said. Maggie Hoimes, Northern Ireland steward, pointed out that quite often the criteria for senior posts were attendance on major courses, costing a lot of money. Joop Tanis, Council member but speaking as an out-patient department manager, said the costs, including those for training, had to be included in the contract made with purchasers. However, he said problems could occur with neighbouring trusts, if one included funds for training in the costs and the other did not. It was important to ensure that there was not uneven competition between trusts. ACPM representative Pinky Miilward said the people to influence were the purchasers. The motion was carried as amended.
C12. The CSP should look Into ways of ensuring employers fund Continuing education properly Instead of physiotherapists using their own time and money on courses. Trent stewards For many years physiotherapists have had to put their hands in their own pockets for courses they wanted to attend, said Trent steward Paul Stanton. Increasingly, seif-funding appeared to be the norm as employers refused to pay for courses. The situation which often occurred, he explained, was that physiotherapistswere told there was no money available for them to attend a course. They would then pay to go on the course and no sooner had they returned they were asked to give an inservice lecture or assess a patient using their newly-acquired skills.
C13. The CSP should devise and make mandatory a scheme of Continuing professional development. Evidence of C15. it is imperative for the CSP to show participation in recognised modes of more serious commitment to research study should be recorded by each by creating a separate department and member In a professional development committee devoted to researchdevelopdiary and the CSP should introduce ment. This is in order to attract funding a system for monitoring the records. into the profession to facilitate the East Essex and Birmingham Branches undertaking of research initiatives and For East Essex Branch Rosalind optimise the career structure. BirmingGunning acknowledged that continuinQ ham Branch professional development did exist in Jane Davies said the Birmingham the Society. It was up to members to prove Branch was not questioning the CSP’s that it was happening. Serious lack of commitment to research but asking professional development, she argued, whether it was enough. Would it be enough went unchallenged. She urged the intro- for the next 100 years to go forward with duction of a formal system of continuing only one full-time officer, no separate professional education so that it would research department within the CSP, and demonstrate the commitment to high no separate standing research committee? standards of professional practice. A research department with its own budget Liza Masters, for Birmingham Branch, would be the way to facilitate clinically said every member had a responsibility based physiotherapyresearch; it would put to maintain levels of professional the CSP in a better position to collaborate competence. The CSP should devise and for outside financial support and would make mandatory a scheme of continual raise its profile within the profession, professional development. enabling all physiotherapists to evaluate Welsh stewards representative Phiiippa their work. Ford warned that the motion could prove Grahame Pope from Nottingham to be expensive. More important, she Branch said the CSP should demonstrate said, was the need for research within its commitment to recent recommendaphysiotherapy. The motion smacked of tions on research in the health service by ’Big Sister is watching you’. creating a separate department and Julia Lamb, chairman of the Education committee devoted to both the support Committee, said a scheme of continuing and development of research. professional development was currently Pat McCoy, chairman of Council, said being considered. However, the policy so the CSP was totally committed to the far was that the scheme should not be development of a research culture within mandatory. Like the CSP’s PACE scheme, the profession. She said there was a the feeling was that physiotherapists Research Development Group within the should take responsibility for their own committee structure, with representatives learning. A mandatory scheme would from education, professionalpractice and require a large commitment of resources the research community. The CSP’s within the Education Department. it comprehensive research strategy was in could lead to a call on the CSP to fund the final stages of preparation and would continuing education directly which be published in the New Year. This would was a commitment the Society was in no be the blueprint for how to take the position to afford. research initiatives forward. During the year the CSP successfully obtained two The motion was lost.
Avis Giimore, North Western stewards, proposed the following amendment: ‘The CSP should look into ways of encouraging employers to fund Continuing education properly, instead of physiotherapists using their own time and money on courses. Natalie Beswetherick, member of Council and of the Industrial Relations Committee, said the CSP had been campaigning through the PTA Whitley Council for improvements to the study leave agreement. However, she said the Department of Health was very reluctant to expand the current study leave or to make it more prescriptive. She said the DOH was unwilling to make any agreements nationally, other than its own, like the moves towards performance related Pay. Speaking on behalf of students, Mark Philpott suggested that a screening process could be set up for physiotherapists wishing to attend a c w s e , to show that there would be a benefit to the service. Kathryn Delpak, ACPM, said that physiotherapy managers had a responsibility to identify ‘clearly and robustly’
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801 new sources of research funding - from the Hospital Saving Association and the publishers Churchill Livingstone. The CSP had also appointed a research development officer full-time. Within the College of Occupational Therapists and the College of Speech and Language Therapists, the CSP was in discussion with the Department of Health on the implementation of the recommendations in the position statement on research for the professions. She said there was no evidence that creating a department and further layers of bureaucracy would be any better at ‘delivering the goods’. The motion was carried. C16. The CSP should produce a standard of physiotherapy practice for post-reglstratlon courses. Standards are presently very variable In terms of quallty, content and value for money. Stockport Branch Hllary Dlckle, for Stockport Branch, said the guidelines for good practice covering all aspects of physiotherapy had been
excellent. But now ‘the world and his wife’ were running courses and guidelines were needed for course organisers to maintain the high professional standards. She also thought there should be consideration given to what would be a fair cost. Alison Skinner, from the Education Committee, said about 30 courses were accredited through the CSP PACE system and there was input into many more through the university modular system. This involved a tremendous amount of work. There was a large variety of courses at many different levels. Individuals, she said, could make their own inquiries about courses. It would be impossible for the CSP to produce standards for each course advertised. Paul Stanton, Trent stewards, giving his own view, said this would be a huge, timeconsuming exercise to set up and monitor. He said members looking at a course in the Journal made up their own mind and if they had concerns, they could contact the Specific Interest Group. The motion was carried with 99 for and 63 against.
General Issues D17. Conference deplores the abolltlon of the Wages Counclls and calls on the CSP to joln wlth other trade unions In campalgnlng for the relnstatement of Wages Councils to protect and support lower-paid workers, the majorlty of whom are female. Scottish stewards Wages Councils, said Scottish steward Heather Hall, were set up to stop low earners being paid slave wages. Threequarters of the workforce controlled by Wages Councils were women. Since their abolition, rates of pay had fallen in more than a third of the jobs which were previously regulated. She said that the Government argument was that setting minimum wages priced people out of jobs. Increasingly more low-paid workers, many of them women, were being forced to struggle to make ends meet. The abolition of Wages Councils affected two million women. The CSP, with its 93% female membership, should join in the campaign for the re-instatement of Wages Councils. Claire Strickland, chair of the Industrial Relations Committee, said the CSP through the TUC had added its voice to the campaign to oppose abolition. She said the IR Department would continue to support any TUC campaign on this issue. Tom Donnelly, Glasgow, said there was no evidence that Wages Councils caused unemployment. Abolishing Wages Councils removed protection for millions of workers; caused downward pressure on wages; dragged more of the lower-paid many of whom worked in the NHS into poverty, cut demand in the economy; created unemployment and increased the social security bill. For the ACPM, Pinky Mlllward asked the CSP to collect information on the impact on staff of not having a minimum wage. She told delegates she had lost two helpers because they were better off on benefit than on the salary being offered. The motion was carried.
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D18. Conference belleves that the CSP, on behalf of Its members and alongslde other working groups, should lobby Parliament to effect a change In Its pollcy on the Social Chapter, In view of the prospect of an open job market In an integrated European community. South West stewards Brldget McDonald, representing South West stewards, told delegates of Prime Minister John Major’s journey to Edinburgh to sign the Maastricht Treaty. Unfortunately, she supposed, on his way north he stopped at a service station and left the Social Chapter on the table next to his coffee cup. The Social Chapter, she reminded delegates, was concerned with many policies involving the rights of individuals, the rights of workers, equal opportunities for men and women, racial equality, employment opportunities for people with disabilities, maternity rights, sick pay, and rights for the elderly and the very young. She urged full membership of the European community, rather than associate membership, and called on the Conference to lobby Parliament to change its policy on the Social Chapter. The motion was carried. D19. The CSP condemns any changes to the Criminal lnjurles Compensation Scheme which existed before April 1, 1994, and should actively support other unions which act to oppose these changes. Wolverhampton Branch West Midlands steward Sheena MacKay outlined changes to the Criminal Injuries Compensation Scheme and the introduction of a new tariff system of paying compensation. There was no special treatment for cases which were difficult to assess like post-traumatic stress disorder or child abuse. As a result of these changes, many people will receive much less compensation than they would have previously. The system disregarded
differences in financial losses relating to an injury, she explained, so a broken ankle would be treated in the same way for an office worker as it would be for a member of the emergency services, and both would receive €5,000. She urged the CSP to condemn the changes. The motion was carried. Toby Simon, CSP Secretary, said the CSP had joined other unions in opposing the changes. He shid the House of Lords had passed an amendment to the Criminal Justice Bill which would result in bringing into effect the old scheme. He said CSP members might want to bring the issue to the attention of their MPs before it came back to the House of Commons in the autumn, when the Government was likely to try to revoke the Lords’ amendment. D20. The CSP should joln wlth other trade unions to campalgn against the unfair legislation which resulted In the lntroductlon of the Child Support Agency. North Western stewards Putting children first was the aim of the Child Support Act, said Beverley Stansfleld, for North Western stewards. It was designed to make the natural parents responsible for maintaining their children. But the children had not been put first. The Act and its implementation by the Child Support Agency could disadvantage the caring parent, the absent parent and all the children caught up in the situation. She said the legislation had not done what it purported it would do and the distress caused was evident from the number of reported suicides. She urged the CSP to be part of the campaign to repeal the Act. Jayne Wlndus, for North Western stewards, asked why, if the Government really wanted to put children first, it had targeted only the ‘easy prey’, those already paying agreed maintenance and those on means-tested benefit. The legislation must change, she said, to stop the lack of appeals procedure, the gross anomalies, the loopholes, the assaults on staff and the suicides. Tom Donnelly said the CSP should join the long list of organisations who wanted to see the Act scrapped and legislation produced which would put the welfare of children before the aims of the Treasury. The motion was carried. Emergency motlon 3. Following moves by the RMT to re-open negotlatlons yesterday and In keeping wlth the sentiments of motions passed at previous CSP conferences to support other public sector unions, the Society should send a motion of support to the striking RMT signal workers. National Group of Regional stewards Avls Gllmore, speaking on behalf of the National Group of Regional stewards, said the signal workers were engaged in the fight that physiotherapists would be involved in next year. Like physiotherapists, the signal workers provided a service to the whole community; they were fighting about how productivity could be measured in a service industry: they were trying to have their productivity from previous years recognised and they were having to negotiate their terms and
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802 conditions with a body that was dictated to by the Government. ‘If the RMT lose this fight, ours will be so much harder in 1995’, she warned. Scottish steward Karen Bruce, Trent stewards, said members must oppose the erosion of public sector pay. Fiona Hawkins, Trent stewards, said
members must oppose the erosion of public sector pay. Jan Williams, for South West stewards, urged members to support the signal workers by not travelling on trains on strike days. The motion was carried. A subsequent collection raised more than f 150.
Professional Affairs E21. Conference believes that the acceptance of a ‘grandfather clause’ is too high a price for the profession to pay for the additional protection of a profession which Is already protected through its unique and proud title of ‘chartered physiotherapist’ and that Council should consult ail members on this issue. OCPPP Mark Potter, OCPPP, said at the outset that the OCPPP was not against the principle of the protection of title but questioned the process by which this might be achieved. What had to be established, he said, was who would become eligible to use the title ’physiotherapist’ under the grandfather clause, and the numbers involved. He said the OCPPP believed the estimates of a few hundred to be ‘wildly inaccurate’. Applications to use the title could be expected from a number of organisations and could be in the region of 5,000. This could lead to 20% of the new physiotherapists being non-chartered. Registration with a General Physiotherapy Council would provide a measure of control. But, Mr Potter pointed out, a council had yet to be formed and it was not known how much, if any, influence the CSP would have. To award others our hard-earned title ‘would diminish our integrity in the eyes of our medical colleagues’, he said. Pauline Betteridge, for Yorkshire stewards, said the grandfather clause would take in a finite number of people who would have to work to the CSP’s codes of professional practice. ‘Surely this is a small price to pay to protect our profession and the general public from these untrained people.’ For the National Group of Regional stewards, Claire Sullivan urged members to look ahead and achieve protection of title for the good of the profession now and in the future. Joop Tank. chairman of the Ethical and Regulatory Issues Committee, told members that if they wanted to stop people practising as untrained physiotherapists, they would initially have to accept those practitioners who were currently legitimately practising under the title. However, he said, the numbers would be limited by very strict criteria. They would not include the vast numbers of sports trainers who do ‘physio’ once a week for their football club. The best estimates were around 500. Catherine Dougherty, North West stewards, said this was the chance to shape the future. She urged members not to forego the opportunity. Maggie Morris for South West stewards, said if the protection of title issue was
delayed further, there would be an even greater number of untrained practitioners claiming to be physiotherapists. At the moment there was no control over non-chartered physiotherapists, said Avls Gilmore. National Group of Regional stewards. She said the inclusion of a grandfather clause was a requirement in law and she could not see how protection of title could be achieved without it. Pinky Millward, ACPM, asked the CSP Council to concentrate on competence when considering its criteria for accepting people into the profession. She thought that the code of practice was not specific enough about clinical standards and suggested this would have to be altered. Tom Donnelly, Glasgow, said protection of the title was protection of the patient. The motion was lost. E22. Conference calls upon the CSP to highllght the threat to the specific role of the physiotherapy helper by the increasing use of health care assistants. North West Thames stewards In the current NHS environment, managers were keen to create a flexible, low-paid workforce, said Kate Mackinnon, for NW Thames Ltewards. The result was that health care assistants were being given broad, non-specific job descriptions. This had led to the situation where health care assistants could be requested to carry out the role of physiotherapy helper. One fear was that as health care assistants undertook a variety of duties, those normally carried out by physiotherapy helpers would take less priority. Physiotherapists would also have to spend more time teaching the skills and routines to new assistants. She said: ‘It is my belief that the most cost-effective route to high quality care lies with the one or two well-trained and motivated physiotherapy helpers, rather than an unknown number of health care assistants.’ Jo FurnivaCDoran,speaking on behalf of Welsh stewards, said she knew that where health care assistants were already present, they were often given a lastminute change of duty and were called away from the physiotherapy department, and this affected continuily. The motion was carried. E23. The respiratory role of physiotherapy has been proven by research to be limited and so specialised that consequently junior physiotherapists no longer have suitable experience to be competent in this field. The CSP must address this problem or consider withdrawing the respiratory role from the
scope of professional practice and have a post-registration qualification for a resplratory physiotherapist. Stockport Branch Hilary Dickie, for Stockport Branch, said the motion was a plea for something to be done for a role which was at risk. In the past six months only 18 out of 751 courses were respiratory. Three years ago, she said, the ACPRC proposed two motions relating to concerns about the standard of physiotherapy, particularly on-call work. She asked whether junior physiotherapists were qualified to treat these respiratory patients. What was needed was a post-registration respiratory validation or approved competence for junior physiotherapists, for when they have appropriate experience. She said the ACPRC also warned Conference about the role of members being taken over by respiratory specialist nurses. Voting for this motion, she said, was to ask the CSP ‘to do something’. Kate MacKinnon, for NW Thames stewards, said she was very concerned about the motion. Was it suggesting that when physiotherapists left college they were not adequately trained? It could be argued that in all aspects of physiotherapy - neurology, paediatrics - that postregistration qualifications would be required before being allowed to carry out treatment. For Trent stewards Tony Deakln said that if it was the case that students were not reaching the required standards of respiratory care, perhaps the CSP could explore ways of influencing course content. David MacLellan, Trent stewards, said that as a senior physiotherapist, he sometimes felt less adequately prepared to deal with some of the respiratory problems than the junior physiotherapists. Fiona Hawkins, from Stockport Branch, said that what members were being asked for was a critical review of their role in respiratory care. The research had to be looked at; there needed to be clinical audit of the role. Karen Yeomans, representing the Student Executive Committee, argued that at a time when a holistic approach to care was paramount, removing this very necessary area of practice from basic experience would only hinder the achievement of this objective. Experience in respiratory care was essential at all levels of practice. ACPIN representative Julie Baldry said more information was needed and that the next step had to be very carefully considered. If a physiotherapist was unable to practise in one area, how would it be possible to go on and gain expertise? Mark Phiipott, student representative, said that even after qualifying, the learning curve for physiotherapists was steep. Competence could improve only with further training and experience. Caroline Roskell, ACPRC, said members were very much under threat, with other professions moving in. The scope of practice had to be addressed. If members were not careful they could be in danger of ridding themselves of respiratory physiotherapy altogether. The motion was lost.
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private medical insurance would raise a substantial sum. ‘We need your Society to tell us how you feel that we can deal with these issues in relation to the private sector, knowing that many of your members are operating in part or in whole within the private sector.’ He did not think the Labour Party could go in!o the next election promising more taxes. However, ‘I have long believed that we could persuade people to pay tax if there was a contract with the electorate and they knew where it was going.’
NVQs Another speaker asked for his comments on physiotherapy education and national vocational qualifications. On NVQs, Mr Blunkett pointed out that the Society had now welcomed physio-
therapy helpers. He thought the primary aim should be to avoid diluting the standard of education for chartered physiotherapists while allowing others to make a positive contribution by gaining NVQs. They could provide an opportunity for people who develop to the point where they could undertake professionaltraining, but it was necessary to be confident that there would be no changes in the grade mix. There must be guidelines on appropriate work for each team member. ‘It seems to me that the securing of the title and the way in which we can lift the status and recognition of physiotherapy protects you against the dangers while allowing you to be open and committed to encouraging other people to work positively with you and I think that would be a great gain for everybody, not least patients.’
Northern Ireland The final questioner asked if Mr Blunkett was in favour of mobilising the Labour Party in Northern Ireland in support of TUC thinking. He replied that individuals in Northern Ireland could be members of the Labour Party although it was not organised there. If peace were established there it would be possible to agree with Labour’s sister party, the SDLP, on how to move as a party there. But the Labour Party did not organise outside its territory on the grounds that other countries could develop parties of their own. Powever, it could and would give support and encouragement to NI members because the overall campaign to improve the service, to restore the NHS, to secure the title and recognition for physiotherapists’ work, was the same throughout the United Kingdom.
Annual Representative Conference Ronnie Paul chaired the 1994 Annual Representative Conference, with Angle Emmott and Wendy White as vice-chairs. It was held at the wellappointed International Convention Centre, Birmingham, on September 20 and 21, 1994. Report by Bernadette Friend.
Introductory Debate Conference opened with a call to remove several motions from the agenda. Pinky Mlllward on behalf of the ACPM moved that the report of the Agenda Committee should be referred back. She said the Conference should be concerned with issues directly relating to the physiotherapy profession, not to political issues. Many representatives from groups within the profession had not been given a remit to take a political stance, she said, and would therefore have to abstain from voting on these issues. Avls Glimore, North Western stewards, said members could not possibly pass this motion. The CSP was a professional body and a trade union and the trade union function was becoming more important. As a trade union, she said, ‘we need to express views to the outside world’. The financial and political agenda in the NHS was determined by the Government, said Claire Sulllvan, NW Thames. Members could no longer just go to work, treat their patients and go home again. Members lived and worked in a political world. Wendy Whlte, vice-chair, said that many of the motions on the agenda had a political emphasis. If there was a move to omit political motions, then there would be few motions left to debate. Mark Potter, OCPPP, supported the motion, saying that there were better things for members to discuss which directly affected their clinical skills. Not to discuss political issues at Conference was an absurdity, according to Tom Donnelly, Glasgow. Health care was a political issue and members should be involved. Conferenceagreed to confirm the agenda.
Avls Gllmore of North Western stewards moved reference back of Council’s report on resolution C8 from last year’s Conference which asked for the ARC to be moved foward to earlier in the year. As a delegate to the TUC Congress, she said it was difficult to represent the views of the CSP because many of the issues they were discussing had not yet been debated by members. She urged the CSP Council to take immediate steps to organise the 1995 Conference earlier in the year. Reference back was agreed. The ACPP and Yorkshire stewards asked for the report on resolution F22 to be referred back because the action taken had been neither adequate nor in the spirit of the resolution. Mlck Skelly from ACPP explained that it called on the CSP to take political action on the causes of ill health. He had urged that a high profile and ‘contentious’ stance be taken regarding government policies which had the effect of promoting ill health. He asked what the Society had done about the mismanagement of the nation’s health over the last 14 years. At the least, the CSP was guilty of a collective bystander apathy, at worst it had an unspoken policy of appeasement, combined with covert political support for the Government, he said. The CSP should appoint as a priority a parliamentary officer to ensure that position of the CSP on the political decisions which affected health was widely publicised in the media. The motion to refer back Council’s report on F22 was carried.
Health and Safety THESE MOTIONS WERE GROUPED FOR COMMON DEBATE Al. Conference notes with concern the Increasing number of Instances of violence at work, In particular the fatal assault on an occupational therapist last year. It calls on the CSP to conduct a survey to dlscover the extent of vlolence at work towards CSP members, In order to facilitate the development of preventive strategies. We also ask the CSP to specify how It Intends to support any member who Is subject to any violence. South West and Scottish stewards A2. Conference believes that the CSP should encourage health care trusts to provide a safer working environment for community physlotheraplsts by the provlson of personal self-defence training, personal alarms and mobile telephones. Trent stewards Shirley Ralney, for South West Stewards, said members were shocked by the death of an occupational therapist in Torbay. What made the incident more traumatic was the reported attitude of the unit managers. It was implied that she had left herself open to such risk by being on the unit alone with a client. Violence cannot and must not be tolerated. She said the Patients Charter might have added to the problems by increasing patient expectations. When these are not met, patients can become threatening. She called on health and safety representatives to collect incidents of violence to be used as evidence to make employers take action. At no time should employers be allowed to compromise the safety and well-being of their staff. For Trent stewards, Rob Almond asked whether employers had adequate safety policies and training for community physiotherapists for w h m the potential of violence had become a reality. He said it
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798 was necessary to ensure all employers had approved safety policies covering training, equipment and support. Phlllppa Ford, for Welsh stewards, supported the use of personal alarms and mobile telephones, and wanted to see training in management of aggressive situations. Ian Duguid, Scottish stewards, said action must be taken to ensure the tragedies of the past did not happen again. He said it was incumbent upon hospital and trust board managers to ensure that a safe working environment was established. He suggested that by surveying the membership, managers could be shown the seriousness and prevalence of violence at work. Mark Potter, OCPPP, said training or equipment should be provided for by hospitals or trusts. He asked what security arrangements were in place now for nursing staff and whether this could be extended to other members of staff. If there was an assault, he asked whether the CSP could provide a disability pension. Both motions were carried unanimously. Tom Donneily, Council member, said the real cost of illness and injury at work was f16 billion a year. He said the CSP Industrial Relations Department had re-published the Health and Safety Handbook. The IR Department also runs an extensive training campaign for health and safety representatives. THESE MOTIONS WERE GROUPED FOR COMMON DEBATE 83. The ARC Agenda Committee asks Conference to accept a change to the constltutlon of Conference in order that the numbers of representatives are altered, bringing them back Into the original state of equality that existed when the original constltutlon was drawn up In 1986. Agenda Committee 84. in view of current changes in the NHS, the CSP should consider whether the present assembly of the ARC is the best way to bring together a true representatlon of the membership in order to present and encourage the debate of clinical Issues. APCP Ronnie Paul, representing the Agenda Committee, reminded Conference that in
1986 its constitution was drawn up with 50% stewards, and 50°/o representatives
from Branches, Clinical Interest and Occupational Groups and students. Changes had led to an imbalance, and he suggested the constitution should be changed to redress this. For the APCP, Carole Hurran asked members to debate whether the annual conference was the best way to bring together a true representation of the membership. She said the APCP believed there was a need to look carefully at the constitution of Conference, so that there was a fair balance of clinical as well as industrial and professional issues. Flona Hawklns, for Trent stewards, asked for the CSP officers to clarify the numbers because there seemed to be some discrepancy. Deborah Gates, South West Thames stewards, pointed out that she did not stop being a clinician when she became a steward. She said she was angry that it was felt that stewards did not reflect the views of members. Toby Simon, CSP Secretary, said the total number of places was 108 for stewards, 140 for others. He said the original intention of the constitution was that representatives of Branches and Specific interest Groups should be roughly equal to the number of stewards; but that the students would not be included in that total. By deducting the students, the figures were 132 Branches and Specific Interest Group representatives and 108 stewards, with six to eight students. David Williams, North East Thames steward, said the only representation that junior members of staff had where he worked was through the stewards. He said the steward network was strong and representative. It was apparent, said Karen Bruce, Scottish stewards, that Specific Interest Groups and Branches had not been forthcoming with their opinions. She said stewards were not at conference for personal gain, but for the Society’s benefit. Catherlne Elliman, Northern Ireland regional steward, said many motions were about clinical and professional issues. If the Clinical Interest Groups thought there were not enough clinical issues being debated they should put more forward. The first motion was carried. and the second was lost.
Key to Acronyms ACPIN ACPM ACPP APCP ARC CSPAE NVQ OCPPP PACE RCACP RMT TUC
Association of Chartered Physiotherapists in Neurology Association of Chartered Physiotherapists in Management Association of Chartered Physiotherapists in Psychiatry Association of Paediatric Chartered Physiotherapists Annual Representative Conference Chartered Society of Physiotherapy Association of Educators National Vocational Qualification Organisation of Chartered Physiotherapists in Private Practice Physiotherapy Access to Continuing Education Respiratory Care Association of Chartered Physiotherapists Rail Maritime and Transport union Trades Union Congress
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85. Conference believes that the standing orders for the ARC should provide that Council should inform Conferenceof the financial Implications of motions which will involve significant expenditure, to enable more informed debate to take place. Organisation of Chartered Physiotherapists in Private Practice If the Conference was made aware by Council of the anticipated budget available for the relevant departments for the coming financial year, motions could be discussed with a more realistic view of the possible outcomes and probable implementation, Carol Owen of OCPPP proposed. ‘If we don’t know how much things are going to cost and we don’t know the funds available, how are we going to make informed choices?’ she asked. Sharon Lynn, from Northern stewards, urged members to vote against the motion, which she thought would interfere with the role of Conference which was to represent the widest number of views from the membership. Conference was informed by what was important to members, not by financial considerations. OCPPP representative Mark Potter said the motion was relevant and reminded members that last year they voted against the purchase of a Centenary statue, only to find out that the money had already been spent. The motion would prevent this sort of thing happening in future. The motion was lost. Emergency motlon 2. This Conference Is appalled at the disparity between the accommodation provided for Council members and that provided for the delegates at the ARC. Conference believes that In future years the same standard of accommodation should be provlded for both groups. North Western sfewards Avis Gllmore, North West stewards, said she was appalled at the accommodation. ‘We’re bad in the north west’, she told delegates, ‘But we don’t live like that’. She said members were not asking to stay in a ’posh’ hotel and were not expecting Council members to stay in the appalling conditions they were staying in, but somewhere in between would be right for both groups. Tom Donnelly said it was his first year at conference as a Council member. ‘It’s not all beer and skittles’, he joked. It was hard work wading through ankle-deep carpets and coping with a jacuzzi at the wrong temperature. For North East Thames stewards, Anju Jaggl said there had been problems with delegates not being able to get into their rooms due to confusion. The motion was carried unopposed. Toby Simon, CSP Secretary, said that steps would be taken in future to try and achieve similar accommodation. He said there were financial implications but that it was important to ensure that those attending Conference were able to contribute to it properly. Flona Hawklns, Trent stewards, said the main issue was that there should be parity in accommodation.
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Education Emergency motion 1. This conference condemns the Government’s proposals to devolve responsibility for nonmedical education to consortia of health authorities and trusts, which will result in the disintegration of undergraduate physiotherapy education. The CSP should promote workable strategies for funding undergraduate education and raise these directly with the Government. Council Physiotherapywas under direct threat, Julia Lamb, chairman of the Education Committee, told Conference. She said the disastrous results of the policy to devolve the initial education for physiotherapy from regional health authorities to consortia of health authorities and trusts could not be over-stated. It would lead to disintegration of undergraduate physiotherapy education. Decisions would be taken on a parochial and ad hoc basis without any awareness of wider educational or labour market implications. The Society, she said, planned to continue its campaign against the proposals. ‘Physiotherapy deserves something better than a rickety fragmented system, held together by the sticky tape of overviews, checks and balances.’ Angie Emmott, Trent stewards, said Government proposals for funding undergraduate physiotherapytraining were ‘yet another nail in the coffin of the profession.’ To virtually tout out the education of future fellow professionals in a meaningless form of competitive tendering was an indicator of the Government’s lack of understanding of the profession as a whole and the ethos of the NHS. The motion was carried unopposed.
C8. In view of the present economic climate and the proposed use of generlc and maintenance therapists, the CSP should revise its policy of an allgraduate profession on the grounds that honours degree courses are overeducatlng physiotheraplsts for their new role. Grampian Branch Ann Quirk, on behalf of Grampian Branch, asked whether physiotherapists were being over-educatedfor their role in the new NHS. As more emphasis was given to the cost of treatment, physiotherapists faced a problem because few of their techniques or practices had been scientifically proven. She questioned why there was a need for so much theory when what patients wanted was a ‘friendly, helpful, smiling therapist with sound clinical skills’. For Cambridge Branch, Nicola Higgins said she was surprised and amazed at the suggestion that an honours degree course would over-educate the profession for its new role. Surely, she said, what the profession should be doing was accepting that members should educate themselves to the highest possible standards, not to conform to the new role mapped out for them, but to formulate their own role within the service. Grahame Pope, Nottingham Branch,
urged members to reject the motion. He said that physiotherapists had to be encouraged to be able to say why they did something, not just how they did something. Neil Robinson, for Grampian Branch, said changes had meant that physiotherapists have had to adapt to the best of their ability in order for patients to benefit. He believed that with care in the community, experienced general therapists would be required to meet the demands of clients. Student representative Mark Philpott said he was amazed that a suggestion could be made that degree level training would be detrimental to physiotherapy. The profession was trying to educate people who would be thinkers and caring professionals. Phlllippa Ford, for Welsh stewards, said that in order to prove their effectiveness, physiotherapists needed to have a research grounding and they needed to be recognised scientifically by fellow health care professionals. Denise Hayes, also speaking for Welsh stewards, said she was astonished that a fellow professional could say she was happy to ‘roll over and play dead for the GP’. Where, she asked, was the profession going if it could support a motion which called for physiotherapists to be less qualified. Marion Tidswell, for the CSP Association of Educators, said that for many years the quality and standard of pre-registration physiotherapy courses were considered to be equivalent to a degree, but there was no recognition. Physiotherapists needed the research and confidencethat degree courses brought to be able to argue their case with other professionals in the health service, for the benefit of patients. Teresa Cook, Norfolk Branch, said physiotherapists were being trained to have the research knowledgewhich could then be used to prove the value of the skills that physiotherapists were using daily. In exercising her right of reply, proposer Ann Quirk urged members to vote against the motion, but said that while physiotherapists had argued their case well, it was the GPs and general managers who had to be convinced of their worth.
of hair. Ultimately, she said, the CSP had to represent these people, and had to take responsibility to guide universities to use the most appropriate selection tool. Mark Phiipott, student representative, said he was diappointed to learn that some universitiesno longer conduct interviews. Perhaps the reason for this, he said, was that the number of applicants had dramatically increased, putting tremendous strain on the application process. As a vocational course, caring professional qualities were necessary as well as academic ability. He called on the CSP to look at ways of improving the selection process. Welsh steward Liz O’Sullivan asked the CSP to consider other measures in the screening process, like personality or aptitude tests. CSP director of education Alan Walker said the Society advised universities to carry out interviews, wherever this was practicable. Physiotherapywas becoming increasingly popular with the proportion of those applying, to those being accepted, running at 10 to one. Pat McCoy, chair of Council, said that from her experience as a teacher the number of applicants continued to rise. In the past, interviews were held but that had become impossible in recent years. The cost of interviewing large numbers of candidates was prohibitive. in Ulster the correlation between academic and clinical ability had been examined and was found to be extremely strong. Those students with first-class honours also had the highest grades on clinical placements. There was no evidence that not interviewing students was leading to lessening of standards or commitment. The motion was carried.
C10. Conference calls upon the CSP to clarify its involvement in the development of NVQs I V and V and to ensure there i s regular updating of the membership through the Journal and other appropriate channels. North West Thames stewards Jane Harrison for North West Thames stewards, said NVQ levels IV and V related directly to professional standards and qualifications. But what was not clear, she said, was how they would develop. There were many implications for the profession and she called on the CSP to clarify its involvement with NVQs and to keep the The motion was lost. membership informed as levels IV and V developed. C9. Conference demands that the CSP Alan Walker, CSP director of education, should urgently issue guidelines to said discussions on NVQ levels IV and V all universities on the necessity for were at a very early stage and there was interview for potential physiotherapy no real clarity or consensus in any students. Academic abilities are occupational sector on what they would essential but only in conjunction with look like. The CSP would almost certainly practical and communication skills. Will favour an integrated system in which we be able to say ‘two hundred years existing honours degrees would be able of physiotherapy in good hands’? to gain accreditation as NVQs at the Cambridge Branch appropriate level. Mary Ross, a co-opted Council member, On behalf of Cambridge Branch, Nichola Higgins said it had become told Conference that as a member of the apparent that universities were happy to NVQ working party she had tried through rely on academic qualificationsand written all the available networks to talk to applications, rather than asking potential members about NVQs and on many physiotherapy students to attend for occasions had found there was little interviews. The motion was not about interest. checking candidates’ fingernails, or length The motion was carried.
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C14. The CSP should formally accredit some physiotherapy departments and practices, both NHS and private, as post-registration training placements licked to PACE. This should be based on the standards of continuing education and experience provided. Birmingham Branch Every workplace should be seen to be working towards a structured support system for continuing education, Liza Masters argued on behalf of the Birmingham Branch. Therapists needed continuing education opportunities that related directly to patient care. Formal accreditation of physiotherapy practices and dapartments would not only recognise and validate these learning opportunities, it would confer standardised qualitative and quantitative continuing education, ensuring that the professional image was seen to be positive in safeguarding standards. Trent steward David MacLeilan. giving a personal view, pointed out that to accredit some departments would be to the detriment of others. Avis Gilmore, North Western stewards, suggested that accredited departments would be able to attract staff, while others would have recruitment problems. The motion was lost.
C l l . This Conference proposes that the CSP should ensure that the implementation of NVQ levels 1-111 is adequately funded by trust managers so that the time taken by health care professionals in assessment of NVQs is not to the detriment of the service. Trent stewards Fiona Hawklns, for Trent stewards, said NVQs were here to stay. in taking on NVQ assessments, physiotherapists have had to withdraw more time from patient care. Surely, she suggested, this meant they were doing neither job properly. in the Armed Forces money had been set aside and NVQs had been wccessfully adopted. if it was possible within the forces it must be possible within health care. Council member Fiona Jenkins, giving a personal view, said that although the CSP could campaign it could not ensure that the implementation of NVQ levels 1-111 would go ahead as stated in the motion. ACPM representative Teresa Dawson agreed in principle with the motion but said the CSP did not have authority over trust managements and could therefore only make recommendations. The motion was remitted to Council.
in the business plan, the provision of education and training. Hilary Dickle from Stockport Branch said she overheard two physiotherapists queueing to register for the conference. One mentioned a figure of around f 1,000 to attend the courses needed to do the job. ‘We no longer are sons and daughters of rich families - that was their comment’, she said. Maggie Hoimes, Northern Ireland steward, pointed out that quite often the criteria for senior posts were attendance on major courses, costing a lot of money. Joop Tanis, Council member but speaking as an out-patient department manager, said the costs, including those for training, had to be included in the contract made with purchasers. However, he said problems could occur with neighbouring trusts, if one included funds for training in the costs and the other did not. It was important to ensure that there was not uneven competition between trusts. ACPM representative Pinky Miilward said the people to influence were the purchasers. The motion was carried as amended.
C12. The CSP should look Into ways of ensuring employers fund Continuing education properly Instead of physiotherapists using their own time and money on courses. Trent stewards For many years physiotherapists have had to put their hands in their own pockets for courses they wanted to attend, said Trent steward Paul Stanton. Increasingly, seif-funding appeared to be the norm as employers refused to pay for courses. The situation which often occurred, he explained, was that physiotherapistswere told there was no money available for them to attend a course. They would then pay to go on the course and no sooner had they returned they were asked to give an inservice lecture or assess a patient using their newly-acquired skills.
C13. The CSP should devise and make mandatory a scheme of Continuing professional development. Evidence of C15. it is imperative for the CSP to show participation in recognised modes of more serious commitment to research study should be recorded by each by creating a separate department and member In a professional development committee devoted to researchdevelopdiary and the CSP should introduce ment. This is in order to attract funding a system for monitoring the records. into the profession to facilitate the East Essex and Birmingham Branches undertaking of research initiatives and For East Essex Branch Rosalind optimise the career structure. BirmingGunning acknowledged that continuinQ ham Branch professional development did exist in Jane Davies said the Birmingham the Society. It was up to members to prove Branch was not questioning the CSP’s that it was happening. Serious lack of commitment to research but asking professional development, she argued, whether it was enough. Would it be enough went unchallenged. She urged the intro- for the next 100 years to go forward with duction of a formal system of continuing only one full-time officer, no separate professional education so that it would research department within the CSP, and demonstrate the commitment to high no separate standing research committee? standards of professional practice. A research department with its own budget Liza Masters, for Birmingham Branch, would be the way to facilitate clinically said every member had a responsibility based physiotherapyresearch; it would put to maintain levels of professional the CSP in a better position to collaborate competence. The CSP should devise and for outside financial support and would make mandatory a scheme of continual raise its profile within the profession, professional development. enabling all physiotherapists to evaluate Welsh stewards representative Phiiippa their work. Ford warned that the motion could prove Grahame Pope from Nottingham to be expensive. More important, she Branch said the CSP should demonstrate said, was the need for research within its commitment to recent recommendaphysiotherapy. The motion smacked of tions on research in the health service by ’Big Sister is watching you’. creating a separate department and Julia Lamb, chairman of the Education committee devoted to both the support Committee, said a scheme of continuing and development of research. professional development was currently Pat McCoy, chairman of Council, said being considered. However, the policy so the CSP was totally committed to the far was that the scheme should not be development of a research culture within mandatory. Like the CSP’s PACE scheme, the profession. She said there was a the feeling was that physiotherapists Research Development Group within the should take responsibility for their own committee structure, with representatives learning. A mandatory scheme would from education, professionalpractice and require a large commitment of resources the research community. The CSP’s within the Education Department. it comprehensive research strategy was in could lead to a call on the CSP to fund the final stages of preparation and would continuing education directly which be published in the New Year. This would was a commitment the Society was in no be the blueprint for how to take the position to afford. research initiatives forward. During the year the CSP successfully obtained two The motion was lost.
Avis Giimore, North Western stewards, proposed the following amendment: ‘The CSP should look into ways of encouraging employers to fund Continuing education properly, instead of physiotherapists using their own time and money on courses. Natalie Beswetherick, member of Council and of the Industrial Relations Committee, said the CSP had been campaigning through the PTA Whitley Council for improvements to the study leave agreement. However, she said the Department of Health was very reluctant to expand the current study leave or to make it more prescriptive. She said the DOH was unwilling to make any agreements nationally, other than its own, like the moves towards performance related Pay. Speaking on behalf of students, Mark Philpott suggested that a screening process could be set up for physiotherapists wishing to attend a c w s e , to show that there would be a benefit to the service. Kathryn Delpak, ACPM, said that physiotherapy managers had a responsibility to identify ‘clearly and robustly’
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801 new sources of research funding - from the Hospital Saving Association and the publishers Churchill Livingstone. The CSP had also appointed a research development officer full-time. Within the College of Occupational Therapists and the College of Speech and Language Therapists, the CSP was in discussion with the Department of Health on the implementation of the recommendations in the position statement on research for the professions. She said there was no evidence that creating a department and further layers of bureaucracy would be any better at ‘delivering the goods’. The motion was carried. C16. The CSP should produce a standard of physiotherapy practice for post-reglstratlon courses. Standards are presently very variable In terms of quallty, content and value for money. Stockport Branch Hllary Dlckle, for Stockport Branch, said the guidelines for good practice covering all aspects of physiotherapy had been
excellent. But now ‘the world and his wife’ were running courses and guidelines were needed for course organisers to maintain the high professional standards. She also thought there should be consideration given to what would be a fair cost. Alison Skinner, from the Education Committee, said about 30 courses were accredited through the CSP PACE system and there was input into many more through the university modular system. This involved a tremendous amount of work. There was a large variety of courses at many different levels. Individuals, she said, could make their own inquiries about courses. It would be impossible for the CSP to produce standards for each course advertised. Paul Stanton, Trent stewards, giving his own view, said this would be a huge, timeconsuming exercise to set up and monitor. He said members looking at a course in the Journal made up their own mind and if they had concerns, they could contact the Specific Interest Group. The motion was carried with 99 for and 63 against.
General Issues D17. Conference deplores the abolltlon of the Wages Counclls and calls on the CSP to joln wlth other trade unions In campalgnlng for the relnstatement of Wages Councils to protect and support lower-paid workers, the majorlty of whom are female. Scottish stewards Wages Councils, said Scottish steward Heather Hall, were set up to stop low earners being paid slave wages. Threequarters of the workforce controlled by Wages Councils were women. Since their abolition, rates of pay had fallen in more than a third of the jobs which were previously regulated. She said that the Government argument was that setting minimum wages priced people out of jobs. Increasingly more low-paid workers, many of them women, were being forced to struggle to make ends meet. The abolition of Wages Councils affected two million women. The CSP, with its 93% female membership, should join in the campaign for the re-instatement of Wages Councils. Claire Strickland, chair of the Industrial Relations Committee, said the CSP through the TUC had added its voice to the campaign to oppose abolition. She said the IR Department would continue to support any TUC campaign on this issue. Tom Donnelly, Glasgow, said there was no evidence that Wages Councils caused unemployment. Abolishing Wages Councils removed protection for millions of workers; caused downward pressure on wages; dragged more of the lower-paid many of whom worked in the NHS into poverty, cut demand in the economy; created unemployment and increased the social security bill. For the ACPM, Pinky Mlllward asked the CSP to collect information on the impact on staff of not having a minimum wage. She told delegates she had lost two helpers because they were better off on benefit than on the salary being offered. The motion was carried.
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D18. Conference belleves that the CSP, on behalf of Its members and alongslde other working groups, should lobby Parliament to effect a change In Its pollcy on the Social Chapter, In view of the prospect of an open job market In an integrated European community. South West stewards Brldget McDonald, representing South West stewards, told delegates of Prime Minister John Major’s journey to Edinburgh to sign the Maastricht Treaty. Unfortunately, she supposed, on his way north he stopped at a service station and left the Social Chapter on the table next to his coffee cup. The Social Chapter, she reminded delegates, was concerned with many policies involving the rights of individuals, the rights of workers, equal opportunities for men and women, racial equality, employment opportunities for people with disabilities, maternity rights, sick pay, and rights for the elderly and the very young. She urged full membership of the European community, rather than associate membership, and called on the Conference to lobby Parliament to change its policy on the Social Chapter. The motion was carried. D19. The CSP condemns any changes to the Criminal lnjurles Compensation Scheme which existed before April 1, 1994, and should actively support other unions which act to oppose these changes. Wolverhampton Branch West Midlands steward Sheena MacKay outlined changes to the Criminal Injuries Compensation Scheme and the introduction of a new tariff system of paying compensation. There was no special treatment for cases which were difficult to assess like post-traumatic stress disorder or child abuse. As a result of these changes, many people will receive much less compensation than they would have previously. The system disregarded
differences in financial losses relating to an injury, she explained, so a broken ankle would be treated in the same way for an office worker as it would be for a member of the emergency services, and both would receive €5,000. She urged the CSP to condemn the changes. The motion was carried. Toby Simon, CSP Secretary, said the CSP had joined other unions in opposing the changes. He shid the House of Lords had passed an amendment to the Criminal Justice Bill which would result in bringing into effect the old scheme. He said CSP members might want to bring the issue to the attention of their MPs before it came back to the House of Commons in the autumn, when the Government was likely to try to revoke the Lords’ amendment. D20. The CSP should joln wlth other trade unions to campalgn against the unfair legislation which resulted In the lntroductlon of the Child Support Agency. North Western stewards Putting children first was the aim of the Child Support Act, said Beverley Stansfleld, for North Western stewards. It was designed to make the natural parents responsible for maintaining their children. But the children had not been put first. The Act and its implementation by the Child Support Agency could disadvantage the caring parent, the absent parent and all the children caught up in the situation. She said the legislation had not done what it purported it would do and the distress caused was evident from the number of reported suicides. She urged the CSP to be part of the campaign to repeal the Act. Jayne Wlndus, for North Western stewards, asked why, if the Government really wanted to put children first, it had targeted only the ‘easy prey’, those already paying agreed maintenance and those on means-tested benefit. The legislation must change, she said, to stop the lack of appeals procedure, the gross anomalies, the loopholes, the assaults on staff and the suicides. Tom Donnelly said the CSP should join the long list of organisations who wanted to see the Act scrapped and legislation produced which would put the welfare of children before the aims of the Treasury. The motion was carried. Emergency motlon 3. Following moves by the RMT to re-open negotlatlons yesterday and In keeping wlth the sentiments of motions passed at previous CSP conferences to support other public sector unions, the Society should send a motion of support to the striking RMT signal workers. National Group of Regional stewards Avls Gllmore, speaking on behalf of the National Group of Regional stewards, said the signal workers were engaged in the fight that physiotherapists would be involved in next year. Like physiotherapists, the signal workers provided a service to the whole community; they were fighting about how productivity could be measured in a service industry: they were trying to have their productivity from previous years recognised and they were having to negotiate their terms and
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802 conditions with a body that was dictated to by the Government. ‘If the RMT lose this fight, ours will be so much harder in 1995’, she warned. Scottish steward Karen Bruce, Trent stewards, said members must oppose the erosion of public sector pay. Fiona Hawkins, Trent stewards, said
members must oppose the erosion of public sector pay. Jan Williams, for South West stewards, urged members to support the signal workers by not travelling on trains on strike days. The motion was carried. A subsequent collection raised more than f 150.
Professional Affairs E21. Conference believes that the acceptance of a ‘grandfather clause’ is too high a price for the profession to pay for the additional protection of a profession which Is already protected through its unique and proud title of ‘chartered physiotherapist’ and that Council should consult ail members on this issue. OCPPP Mark Potter, OCPPP, said at the outset that the OCPPP was not against the principle of the protection of title but questioned the process by which this might be achieved. What had to be established, he said, was who would become eligible to use the title ’physiotherapist’ under the grandfather clause, and the numbers involved. He said the OCPPP believed the estimates of a few hundred to be ‘wildly inaccurate’. Applications to use the title could be expected from a number of organisations and could be in the region of 5,000. This could lead to 20% of the new physiotherapists being non-chartered. Registration with a General Physiotherapy Council would provide a measure of control. But, Mr Potter pointed out, a council had yet to be formed and it was not known how much, if any, influence the CSP would have. To award others our hard-earned title ‘would diminish our integrity in the eyes of our medical colleagues’, he said. Pauline Betteridge, for Yorkshire stewards, said the grandfather clause would take in a finite number of people who would have to work to the CSP’s codes of professional practice. ‘Surely this is a small price to pay to protect our profession and the general public from these untrained people.’ For the National Group of Regional stewards, Claire Sullivan urged members to look ahead and achieve protection of title for the good of the profession now and in the future. Joop Tank. chairman of the Ethical and Regulatory Issues Committee, told members that if they wanted to stop people practising as untrained physiotherapists, they would initially have to accept those practitioners who were currently legitimately practising under the title. However, he said, the numbers would be limited by very strict criteria. They would not include the vast numbers of sports trainers who do ‘physio’ once a week for their football club. The best estimates were around 500. Catherine Dougherty, North West stewards, said this was the chance to shape the future. She urged members not to forego the opportunity. Maggie Morris for South West stewards, said if the protection of title issue was
delayed further, there would be an even greater number of untrained practitioners claiming to be physiotherapists. At the moment there was no control over non-chartered physiotherapists, said Avls Gilmore. National Group of Regional stewards. She said the inclusion of a grandfather clause was a requirement in law and she could not see how protection of title could be achieved without it. Pinky Millward, ACPM, asked the CSP Council to concentrate on competence when considering its criteria for accepting people into the profession. She thought that the code of practice was not specific enough about clinical standards and suggested this would have to be altered. Tom Donnelly, Glasgow, said protection of the title was protection of the patient. The motion was lost. E22. Conference calls upon the CSP to highllght the threat to the specific role of the physiotherapy helper by the increasing use of health care assistants. North West Thames stewards In the current NHS environment, managers were keen to create a flexible, low-paid workforce, said Kate Mackinnon, for NW Thames Ltewards. The result was that health care assistants were being given broad, non-specific job descriptions. This had led to the situation where health care assistants could be requested to carry out the role of physiotherapy helper. One fear was that as health care assistants undertook a variety of duties, those normally carried out by physiotherapy helpers would take less priority. Physiotherapists would also have to spend more time teaching the skills and routines to new assistants. She said: ‘It is my belief that the most cost-effective route to high quality care lies with the one or two well-trained and motivated physiotherapy helpers, rather than an unknown number of health care assistants.’ Jo FurnivaCDoran,speaking on behalf of Welsh stewards, said she knew that where health care assistants were already present, they were often given a lastminute change of duty and were called away from the physiotherapy department, and this affected continuily. The motion was carried. E23. The respiratory role of physiotherapy has been proven by research to be limited and so specialised that consequently junior physiotherapists no longer have suitable experience to be competent in this field. The CSP must address this problem or consider withdrawing the respiratory role from the
scope of professional practice and have a post-registration qualification for a resplratory physiotherapist. Stockport Branch Hilary Dickie, for Stockport Branch, said the motion was a plea for something to be done for a role which was at risk. In the past six months only 18 out of 751 courses were respiratory. Three years ago, she said, the ACPRC proposed two motions relating to concerns about the standard of physiotherapy, particularly on-call work. She asked whether junior physiotherapists were qualified to treat these respiratory patients. What was needed was a post-registration respiratory validation or approved competence for junior physiotherapists, for when they have appropriate experience. She said the ACPRC also warned Conference about the role of members being taken over by respiratory specialist nurses. Voting for this motion, she said, was to ask the CSP ‘to do something’. Kate MacKinnon, for NW Thames stewards, said she was very concerned about the motion. Was it suggesting that when physiotherapists left college they were not adequately trained? It could be argued that in all aspects of physiotherapy - neurology, paediatrics - that postregistration qualifications would be required before being allowed to carry out treatment. For Trent stewards Tony Deakln said that if it was the case that students were not reaching the required standards of respiratory care, perhaps the CSP could explore ways of influencing course content. David MacLellan, Trent stewards, said that as a senior physiotherapist, he sometimes felt less adequately prepared to deal with some of the respiratory problems than the junior physiotherapists. Fiona Hawkins, from Stockport Branch, said that what members were being asked for was a critical review of their role in respiratory care. The research had to be looked at; there needed to be clinical audit of the role. Karen Yeomans, representing the Student Executive Committee, argued that at a time when a holistic approach to care was paramount, removing this very necessary area of practice from basic experience would only hinder the achievement of this objective. Experience in respiratory care was essential at all levels of practice. ACPIN representative Julie Baldry said more information was needed and that the next step had to be very carefully considered. If a physiotherapist was unable to practise in one area, how would it be possible to go on and gain expertise? Mark Phiipott, student representative, said that even after qualifying, the learning curve for physiotherapists was steep. Competence could improve only with further training and experience. Caroline Roskell, ACPRC, said members were very much under threat, with other professions moving in. The scope of practice had to be addressed. If members were not careful they could be in danger of ridding themselves of respiratory physiotherapy altogether. The motion was lost.
This report will be continued in next month’s issue of Physiotherapy. Physiotherapy, November 1994, vol80, no 11