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Fighting in Fresh Fields
ISSN 0031 9406
MARCH 10, 1991 VOLUME 77, No 3
JOURNAL OF THE CHARTERED SOCIETY OF PHYSIOTHERAPY
14 BEDFORD ROW, LONDON WClR 4ED TELEPHONE 071-242 1941 FAX 071-831 4 5 0 9
FIGHTING IN FRESH FIELDS THE NHS is currently undergoing the most radical changes since its conception. There are those who feel the reforms are long overdue and others who feel they are not the answer to the main problem, which is underfunding. Whatever our views, the infamous ‘White Paper’ is no longer and we are presented with an Act of Parliament which is supposed to put the NHS ‘back on its feet’. This is to be achieved by the introduction of Self-governing Trusts (SGTs) with the promotion of internal marketing, increased flexibility and more accountability leading to greater efficiency. In order to succeed in this new era we physiotherapists are going to have to change our attitudes and ways of working. We will have to sell our services to purchasers and patients, and ourselves to our employers. The advent of clinical audit is already focusing our minds on the importance of continually assessing our practices. It is providing us with facts and figures which will not only help us in delivering a quality service and developing new skills but it should fuel the fire in our argument for our methods of selection of rehabilitation techniques. The compilation of business plans has highlighted the areas in which current resources are wasted, eg the cost to the NHS of non-attendance for physiotherapy out-patient appointments or from all those unused, unreturned walking aids. The concept of internal marketing is new to most of us. Competition is being positively encouraged by the Government. Up to now we have all insisted that one department is run very much as another; and Health Service Units have not overtly advertised their expertise. Will this be changing (within the constraints of our Rules of Professional Conduct)? During my short career we have developed the co-ordination of District services with all its benefits. This is being steadily fragmented, not only back to Units but, in some areas, into inappropriate clinical directorates, where already we are seeing competition between physiotherapists of different specialties for scarce resources, time and facilities. Under the SGT system employers no longer have to abide by Whitley Council agreements and some may not even recognise the CSP as a negotiating body, so we may all have to learn to sell ourselves and acquire negotiation techniques. The structure of physiotherapy staffing may also change, moving towards a more American style, with a few specialists heading teams of generalists or - even more economically - health care assistants. This may solve the current staff shortages but what happens to quality‘? We have come a long way since I qualified in 1984, when we were still fighting for clinical autonomy and the right to diagnose clinically. In order to develop further the service we provide, by the new rules, physiotherapists must now move forward by developing skills in fields which we never imagined we would need. But we must also fight those aspects of the reforms which will try to make us bow to the pressures of providing a financially viable business which would force us to lose the quality of our professionalism.
DIANA BUDDS
GradDipPhys MCSP
North East Thames Board Representative to Council
Journal Committee: Mrs E 0 5 Ricketts MBE MCSP (chairma!)), Miss C R Smith MSc MCSP (vicechairman), Dr P Arnell PhD BSc(PT) MCPA MCSP, Mrs J Brooks MCSP, Miss A M D Grimley MCSP, Miss J Y James BA MCSP, Mrs M A Page GradDipPhys MCSP, Mrs B Richardson MSc MCSP DipTP, Mrs P A Roberts MCSP, Mrs M R Wood MCSP.
CONTENTS An Evaluation of Crutches J Hall, A K Clarke A Review of Low Level Laser Therapy S S Kitchen, C J Partridge Guide Lines for the Safe Use of Lasers in Physiotherapy Low Level Laser Therapy: Current Clinical Practice in Northern Ireland G D Baxter. A J Bell, J M Allen, J Ravey Calibration of Physiotherapy PPAM aids A W Hadley, A D McDowell. B D Whitlock A Curriculum for the Future P McCoy Physiotherapy Education in the European Community P McCoy Bioelectricity and Electrotherapy - 8 R A Charman Bioelectromagnetics Bookshelf R A Charman Capturing the Basics: The Development of an Expert Computer System for Physiotherapists A Parry, S Stone TENS for Pain in Multiple Sclerosis V F Pert Physiotherapy in the Maldives B Blair Walking Aids - A Survey of Suitability and Supply C Sirnpson. L Pirrie
156 161 169
17l 179 181 209 2U 217
222 227 229 231
Equipment Notes A Trouser Leg Adaptation L Soderberg 234 for Amputees Cycloidal Vibration E J Bell 234
Regular Features Periodical review News Letters CSP Events Courses and conferences Branch news Noticeboard Personal Books in brief Salary scales Book reviews
160 183 187 189 w)
206 207 208 208 221 235
155
MARCH 10, 1991 VOLUME 77, No 3
JOURNAL OF THE CHARTERED SOCIETY OF PHYSIOTHERAPY
14 BEDFORD ROW, LONDON WClR 4ED TELEPHONE 071-242 1941 FAX 071-831 4 5 0 9
FIGHTING IN FRESH FIELDS THE NHS is currently undergoing the most radical changes since its conception. There are those who feel the reforms are long overdue and others who feel they are not the answer to the main problem, which is underfunding. Whatever our views, the infamous ‘White Paper’ is no longer and we are presented with an Act of Parliament which is supposed to put the NHS ‘back on its feet’. This is to be achieved by the introduction of Self-governing Trusts (SGTs) with the promotion of internal marketing, increased flexibility and more accountability leading to greater efficiency. In order to succeed in this new era we physiotherapists are going to have to change our attitudes and ways of working. We will have to sell our services to purchasers and patients, and ourselves to our employers. The advent of clinical audit is already focusing our minds on the importance of continually assessing our practices. It is providing us with facts and figures which will not only help us in delivering a quality service and developing new skills but it should fuel the fire in our argument for our methods of selection of rehabilitation techniques. The compilation of business plans has highlighted the areas in which current resources are wasted, eg the cost to the NHS of non-attendance for physiotherapy out-patient appointments or from all those unused, unreturned walking aids. The concept of internal marketing is new to most of us. Competition is being positively encouraged by the Government. Up to now we have all insisted that one department is run very much as another; and Health Service Units have not overtly advertised their expertise. Will this be changing (within the constraints of our Rules of Professional Conduct)? During my short career we have developed the co-ordination of District services with all its benefits. This is being steadily fragmented, not only back to Units but, in some areas, into inappropriate clinical directorates, where already we are seeing competition between physiotherapists of different specialties for scarce resources, time and facilities. Under the SGT system employers no longer have to abide by Whitley Council agreements and some may not even recognise the CSP as a negotiating body, so we may all have to learn to sell ourselves and acquire negotiation techniques. The structure of physiotherapy staffing may also change, moving towards a more American style, with a few specialists heading teams of generalists or - even more economically - health care assistants. This may solve the current staff shortages but what happens to quality‘? We have come a long way since I qualified in 1984, when we were still fighting for clinical autonomy and the right to diagnose clinically. In order to develop further the service we provide, by the new rules, physiotherapists must now move forward by developing skills in fields which we never imagined we would need. But we must also fight those aspects of the reforms which will try to make us bow to the pressures of providing a financially viable business which would force us to lose the quality of our professionalism.
DIANA BUDDS
GradDipPhys MCSP
North East Thames Board Representative to Council
Journal Committee: Mrs E 0 5 Ricketts MBE MCSP (chairma!)), Miss C R Smith MSc MCSP (vicechairman), Dr P Arnell PhD BSc(PT) MCPA MCSP, Mrs J Brooks MCSP, Miss A M D Grimley MCSP, Miss J Y James BA MCSP, Mrs M A Page GradDipPhys MCSP, Mrs B Richardson MSc MCSP DipTP, Mrs P A Roberts MCSP, Mrs M R Wood MCSP.
CONTENTS An Evaluation of Crutches J Hall, A K Clarke A Review of Low Level Laser Therapy S S Kitchen, C J Partridge Guide Lines for the Safe Use of Lasers in Physiotherapy Low Level Laser Therapy: Current Clinical Practice in Northern Ireland G D Baxter. A J Bell, J M Allen, J Ravey Calibration of Physiotherapy PPAM aids A W Hadley, A D McDowell. B D Whitlock A Curriculum for the Future P McCoy Physiotherapy Education in the European Community P McCoy Bioelectricity and Electrotherapy - 8 R A Charman Bioelectromagnetics Bookshelf R A Charman Capturing the Basics: The Development of an Expert Computer System for Physiotherapists A Parry, S Stone TENS for Pain in Multiple Sclerosis V F Pert Physiotherapy in the Maldives B Blair Walking Aids - A Survey of Suitability and Supply C Sirnpson. L Pirrie
156 161 169
17l 179 181 209 2U 217
222 227 229 231
Equipment Notes A Trouser Leg Adaptation L Soderberg 234 for Amputees Cycloidal Vibration E J Bell 234
Regular Features Periodical review News Letters CSP Events Courses and conferences Branch news Noticeboard Personal Books in brief Salary scales Book reviews
160 183 187 189 w)
206 207 208 208 221 235
155