- Email: [email protected]
The Brighton Run
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CONFERENCE REPORTS
The Brighton Run The Organisation of Chartered Physiotherapists in Private Practice celebrated a centenary of physiotherapy at its annual conference in the Grand Hotel, Brighton. Such a prodigious venue seemed only fitting for the profession of which they are justly proud.
OCPPP in National Back Pain Week by employing PR consultants Chalcot Communications proved so successful that the whole business of marketing and PR was put out to tender. The result was that Associates in Marketing (AIM) under the direction of Tony Walsh has been awarded the task of bringing OCPPP into the market place with increased recognition in all quarters patients, insurance companies and medical practitioners. As always the trade exhibition was a great attraction to all - our thanks to those who took part, and gave sponsorship or draw prizes.
By tradition the OCPPP conference is a This scheme can only benefit the whole mixture of high standard clinical content, profession and ensure we stand with current business matters and social heads held high in the professional market place. It could also be seen as a way of activities. the general public being protected from The Olive Sands Memorial Lecture was non-chartered therapists. given by Viv Grisogono and entitled ‘Lower At the time of writing at least 538 limb injuries: Old methods, new concepts’. practices have applied for the relevant This topical subject coincided with the information to become accredited. London Marathon and the publication of her new book. Marketing ‘Anatomy of the knee joint’ by Dr M C The appreciation of the need to market E Hutchinson MB BS prepared everyone OCPPP has now come to fruition. The Social Round for the lecture on ‘Recent trends in anterior cruciate ligament surgery’ by Mr John amount of extra media coverage gained by The Brighton fun came in both proIreland FRCS. grammed and unThe programming official events. of the anatomy A civic reception in lecture meant delegthe Brighton Pavilion ates had a good by the Mayor of revision session prior Brighton was fully to the intricacies of subscribed and some members were dissurgery, and the appointed, but they lecture on ‘Anterior enjoyed a good knee pain’ by Mr T Wilson MSc dinner at the Grand Hotel. GradDipPhys MCSP. The clinical lectTo be taken ures worked their around the Pavilion way anatomically by a very entertaining downwards to ‘Podand well informed iatry’ on the Sunday guide made an evenmorning - a very ing to remember. informative session The sumptuous surgiven by Mr Barry roundings prompted Francis. one member to On the business remark ‘I do like the front Stuart Skyte, feel of opulence’. CSP director of They were certainly public relations, gave Above: Ms Vivian Grisogono and Dr Michael Hutchinson who both lecturedon the most ornate sura delightful talk aspects ofthe lower limbs. Below: Dr Harry Brunjesspeakingat the banquet roundings in which I entitled ‘Many hands have eaten poached make Skyte work’. salmon and peanuts! His ‘advert’ slides made us realise The banquet on Saturday evening saw chartered physiotherapists ‘probably are the chairman of the CSP Council, Patricia the best’ of ‘pure genius’ that patients are McCoy, proposing the toast to OCPPP and likely to encounter. our top table guests entertaining the The two major business factors affecting gathering with succinct speeches. Dr OCPPP at present are accreditation of Brunjes made us ache with laughter. practices and marketing. The unofficial social events included early morning swimming and exercise routines, and a water polo match - the Accreditation result of which appears to be unknown to The accreditation scheme was launched both sides. by chairman Jean Kelly who, in conjuncAn olive stone projection competition tion with the working party of Erica Nix, was won by a Bristol physiotherapist who Jacqueline Morris, Jenny Archer and shall remain nameless. Despite the hilarity Melanie McAinsh, has worked tirelessly to of the ’fringe’ events, the conference was bring the concept of accreditation to the a serious success story. membership. Some 35 practices took part Conference chairman Margaret Rees in a pilot scheme and now the process is and her colleagues (Wendy Blythe, Ann available to all OCPPP practices. It is McLaughlin, Joanna Macfarlane, and Mark perceived that in future health insurance Potter) along with Jane Morrison and companies will require some accredited Sarah Durham of CSP Events Unit, put on assurance that their subscribers can be a celebration of 100 Years of Physioguaranteed high standards and quality therapy that was a credit to chartered of treatment and surroundings.
Physiotherapy, June 1994, vol80, no 6
404
physiotherapy and of benefit to all delegates who attended. The moral is - book early for Glasgow in 1995. At the AGM the new vice-chairman, Sue England, and the new honorary editor of In Touch, Sally Roberts, were elected. A collection was, as always, made for the CSP Members’ Benevolent Fund. It is reported that the donation by OCPPP members at annual conference is usually the largest single donation that the Fund receives in one year.
OCPPP officers and guests, left to right: Ruth Wood, OCPPP vice-chairman; Philip Racle, OCPPP president; Patricia McCoy, chairman of the CSP Council; Jean Kelly, OCPPP chairman; David Lepper, the Mayor of Brighton; Ann McLaughlin, member of OCPPP Congress Organising Committee; Shirley Purves, OCPPP Secretary; and Jeane Lepper, Mayoress of Brighton
Health and Safety Risk Warning at Scottish TUC
REPORT BY
Elizabeth Bewley-Jones PHOTOGRAPHS BY
William Preston
Further Information on OCPPP Administrative officer - Mrs Rita Puncher, Suite 8, Weston Chambers, Southend on Sea, Essex SS1 1AT (tel 0702 392124). Marketing and PR - Mr Tony Walsh, Associates in Marketing (AIM), Union Business Centre, 288 Harrowgate Road, Bradford, West Yorkshire BD2 3SP (tel 0274 626475).
or Mrs Elizabeth BewleyJones, Owls Retreat, 6 Washabrook Way, Kingsbridge, Devon TQ7 1RJ (tel 0548 857130).
Honorary Executive Officers President - Philip Racle Chairman - Jean Kelly Vice-chairman - Sue England Secretary - Shirley Purves Treasurer - David Ramsbottom PRO - Elizabeth Bewley-Jones Sally Roberts Editor, In Touch
-
The regional officers’ names may be obtained from Rita Puncher.
Physiotherapy,June 1994, vol80, no 6
Health care employers are ignoring new legislation on health and safety at work, leaving hospital and community staff at risk, the Scottish Trades Union Congress conference heard from the CSP. Karen Bruce, north of Scotland regional steward, said the onus was on managers to ensure that violence at work policies were developed and implemented. New regulations which came into force last year stated that risk assessments, including the risk of violent attack in the workplace, had to be carried out and violence at work policies developed. But she said financial constraints meant that some trusts were not applying the legislation and staff were still ‘very much’ at risk. She said there were many examples where health care staff had been attacked, including the two doctors who were killed in Yorkshire and an occupational therapist killed in Devon.
Working Alone The motion from the Union of Communication Workers, which was seconded by the CSP and supported by the National Association of SchoolmasterslUnion of Women Teachers, expressed alarm at the ‘growing number of staff who work alone
Celebrating the Past
in the community or in jobs which leave them vulnerable to violent attacks and are not receiving adequate support or protection from employers. The motion added that it deplored the ’apparently growing trend to analyse the security of staff from a cost benefit perspective and not to view it as a necessary right for all employees to be protected from violent abuse’.
Charter The communication union called on the STUC to draw up a charter of demands for employers to ensure that all possible steps were taken to prevent violence at work. The motion was passed unanimously. A motion on the NHS from Unison warned that the basic principle - that treatment be given according to need rather than ability to pay - was being undermined. That motion, which was also seconded by the CSP, was carried unanimously.
. . . Shaping the Future
Don’t miss the CSP Annual Congress in Birmingham, September 20-23, 1994. See programme and application form at the front of this Journal.
405
Therapists Must Decide on Research The gap between recognising the need for research and having the opportunity to carry it out was highlighted at a major Departmentof Health conference in London on the contribution of the therapy and nursing professions to NHS research and development (see this month’s leading article). Bernadette Friend reports. At the conference attended by senior physiotherapists and other leading professionals, Dr Sally Byng, vicepresident of the College of Speech and Language Therapists, gave the response of the therapy professions to the Department of Health’s research strategy. Dr Byng said the therapy professions had ‘largely been excluded’ from the decision making process and that therapy research had not generally been identified as a ‘funding priority’. Exclusion from decision making and the need to create a well-established research infrastructure within the therapy professions were the main reasons, she said, for the gap between ‘our awareness of the need for such research and our opportunities to implement it’. She said the physiotherapy,occupational therapy, and speech and language therapy
professions were calling for greater representations on the research and development committees at central and regional levels of the NHS Executive. These professions were also recommending an increase in the number of research awards to therapists and the setting up of post-doctoral therapy Fellowships, as well as asking research councils to launch initiatives for more research awards for the therapy professions.
Structure for Progress Career opportunities needed to be developed. These were limited at the moment and those available carried some ‘positive disincentives’, said Dr Byng. ‘It has been consistently observed that research experience does not advance careers in the therapy professions as it
does in medicine. Clinician researchers may have to take a drop in salary while undertaking research and return to a lower grade clinical post after its completion.’ She said the current practice of managers emphasising clinical contact with patients at the expense of all other professional activities was ‘counterproductive’ to supporting and encouraging therapists who wanted to pursue research careers and was not in line with the NHS research and development strategy aim of creating a research based health service. The need for research design and methodologyto fit the nature of therapists’ work was also highlighted. Dr Byng said: ‘It is our conviction that the NHS must involve all of its workforce if it is to succeed in creating a’ research based service.’ And she concluded: ‘For the therapy professions we believe this can be achieved through increasing our involvement in decision making structures, increasing management support for research initiatives and systematic improvements in the career infrastructure for therapist researchers.’
Planning and Practice in Exercise Health service managers have yet to be convinced of the benefits of exercise for psychiatric patients, members were toid at a CSP workshop on exercise in mental health on May 9. Bernardette Friend flexed her muscles alongside the participants. The link between physical fitness and psychological well-being was wellestablished,said Tina Everett, chair of the Association of Chartered Physiotherapists in Psychiatry. Despite this, those in charge of the purse-strings were not always aware of the ‘enormous research base’ on the benefits of exercise, she said. ‘It is part of our job to get that message across to them.’ One study, she said, had shown that inactive women were twice as likely to develop depression as active women. Another study concluded that non-aerobic exercise was as effective as an antidepressant as aerobic exercise. A third, a large-scale study of GPs in the United States in the early 199Os, found that 85% were regularly prescribing exercise as a treatment for depression.
the term ‘holistic’ had become rather hackneyed but he believed that physiotherapists, and in particular those working in psychiatry, were working in a ‘very
Prescribing Exercise Delegates to the conference said they knew of areas where exercise on prescription was being tried out in the UK. Mrs Everett said that in a new building in Oxford a quarter of the space for psychiatry had been given over to ECT and there was little room for exercise. She believed that physiotherapists should have an input at the planning stage to ensure adequate provision was made for exercise. Mick Skelly, a physiotherapist working in community mental health in Hull , said
Tina Everett and Mick Skelly demonstrate a T’ai Chi Ch’aun exercise - ‘sticky hands‘
global way by acknowledging that there is no separation of mind and body. They are two ends of the same piece of string.’ Through anecdotes and demonstrations, he told the conference how it was possible that by changing the way a person thinks, you can influence their physical behaviour.
Policeman’s Ball To illustrate this he gave a brief case history. He was seeing a policeman who had been referred for depression. Initially, when asked if he had any physical problems, the officer said no. Later he told Mr Skelly that he was waiting to see a consultant for an exploratory knee operation. He was very worried that if he could not walk, he risked losing his job a>d home. The policeman walked very heavily on his feet. Mr Skelly offered him this image - that his centre of gravity was a ball of mercury in his abdomen, gradually getting lighter and travelling up through his body until it was floating above his head. The policeman helped with the analogy and conjured up for himself the thought that the balloon of mercury was tied to his helmet. ‘He literally became lighter on his feet’, explained Mr Skelly. ‘You could hear the difference down the corridor. He had changed the whole way he moved. There was nothing there but his imagination but it managed to change the whole way his body worked.’ Within a month he was feeling better and asked for his operation to be postponed. The story goes that when he later saw the consultant, he was asked if he had any
Physiotherapy, June 1994, vol80, no 6
406
pain. He proceededto bend down and told the doctor that it only hurt when he squatted. The consultant said he too had a pain when he squatted and sent the policeman home.
Handling Intentions Mr Skelly said he was often asked when teaching handling: ‘When do you touch the patient?’ ‘Before they come into the room’, is his stock reply. He reminded delegates that their ‘intentions’ towards their patients
were important. He said he had seen nursing staff moving patients, trying to ‘control’ rather than ‘enable’ them. During a practical demonstration he asked one of the physiotherapiststo place her hand on his shoulder and to resist as ‘hard as he could’ his attemptsto force her arm to bend. She failed. In the second demonstration with the same person, he told her to reach her arm out towards the wall opposite. This time she was able to resist the pressure. And as the physio-
Under-funding Slammed at Welsh TUC CSP delegates at the Wales TUC annual conference won backing for a motion which condemned the ‘scandalous level of underfunding’ in the NHS. Ruth Jones, CSP delegate from Nevill Hall Hospital, Abergavenny, said the Government’s reforms were in conflict with the philosophy of free health care for all. The conference in Llandudno said it would resist local pay bargaining and the attempts of self-governing trusts to undermineterms and conditions of service and to de-recognise unions. Delegates said they would oppose unjustifiable hospital closures as a result of the current city reviews, as well as any attempts to limit comments on matters of public interest by staff. Ms Jones - backed by delegate Joe
Davies from Whitchurch Hospital, Cardiff, also won support for better child-care facilities in the UK, which are among the worst in the European Union. The conference called for a fully-funded national policy on childcare to ensure facilities were available to all families that required them. The two delegates also proposed an amendment to a motion on upper limb disorders. The conference supported their call for legislation to ensure employers take adequate preventive measures. The delegates, together with colleague John Pestle, also helped to carry a motion asking for better ways to combat dark-room disease, suffered by some radiographers and technicians.
A touch of ageism hit the Department and kept us all scurrying around. It is a fact that Chinese walls turn fact into most amazing fiction, but of course, all of us a t some time have prioritised using age as a guideline. However, it was an opportunity to come up with some interesting facts to refute any claim that we do not care about older people. The latest Korner statistics show that our initial contacts have increased by 3% and that over half are for people aged 55 or over. They have also increased by 15% since 1989 for those people who are 65 and above, all of which at long last justifies collecting statistics. Membership of the Association of Chartered Physiotherapists with a Special Interest in Elderly People has risen by 16% since 1989 and represents 3% of all chartered physiotherapists. Further data show that approximately €17 million is spent on physiotherapy in day hospitals and a further €33 million on disabled adults with osteo-arthritis although I cannot verify these figures.
Current Issues
clinical co-ordinators over the last year or so. Anna Farrar has been invited to take up the new PAMs place, and as a speech and language therapist with wide experience in working with other professions and quality work, we hope that she will bring a fresh voice to the committee. 2. We will be allocating the Research Training Awards soon and are always optimistic that the bright and the best will apply. These are for PhD students who will be promulgating research for the profession in future years, so we need to choose the right candidates. We were very pleased with the response which broke down equally between the three professions on the initial trawl and short listing for interview. The next round will be advertised in the Journal in January, but there is some doubt as to whether the Department will continue funding these awards in the long term, so we will have to see what happens. 3. The Hospital Episode Statistics for 1990/91 have just been published in two volumes as has the NHS Workforce in England 1981 -1991.
1. The Clinical Outcomes Group has a new professions allied to medicine member and we have to thank Judy Mead for representing PAMs and the regional
4. Nursing and Therapy Clinical Audit will have been distributed to managers as should Just for the Record, a n extremely useful workbook for all levels
Physiotherapy,June 1994, vol80, no 6
therapists set about trying the two methods, one commented: ‘The more I relax my arm, the stronger it becomes.’ Mr Skelly spoke about yin and yang and the balance between the soft and hard sides. ‘Very often in our society you get a place by trying harder and harder.. Sometimes we use force to get where we are going.’ But he suggested that sometimes the most effective way was to be soft. ‘If in doubt be soft, it is easier on yourself and everyone else.’
CSP POLICY STATEMENT
Productivity Pay The Chartered Society of Physiotherapy does not believe that productivity is an appropriate way of determining physiotherapists’ pay. The CSP reaffirms its commitment to nationally bargained and fully funded pay awards based on factors such as comparability, motivation and the cost of living, and the Pay Review Body system. The CSP is concerned that the problems associated with measuring productivity will result in a concentrationon crude throughput measures, which take no account of quality, could result in undesirable cost cutting, and have a detrimental effect on patient care. Frequently, in health care, what is meaningful is not measurable and what is measurable is not meaningful.
of staff on record keeping. The latter is available through the NHSTD, St Bartholomew’s Court, 18 Christmas Street, Bristol BS1 5BT.
5. There are two important guidelines now in circulation. HSG(94)22 gives guidance on the new Regional Health AuthoritiedRegional Offices and BL(94)40 covers Codes of Conduct and Accountability which I mentioned last month. Another, EL(49139, is on the review of central requirements for information - uses made of information collected from the NHS.
Conclusion The NAO Report on Day Hospitals should be published soon and issues around disability continue to come and go. The launch of the therapy response to the Nursing Taskforce document on research is much welcomed and hopefully will give a boost to multidisciplinary research in the future. I also hope that all of you who are interested in research are being extremely pushy with regional research directors so that physiotherapy is well represented in next year’s projects.
Nicky Cogan MCSP Physiotherapy Offcer
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CONFERENCE REPORTS
The Brighton Run The Organisation of Chartered Physiotherapists in Private Practice celebrated a centenary of physiotherapy at its annual conference in the Grand Hotel, Brighton. Such a prodigious venue seemed only fitting for the profession of which they are justly proud.
OCPPP in National Back Pain Week by employing PR consultants Chalcot Communications proved so successful that the whole business of marketing and PR was put out to tender. The result was that Associates in Marketing (AIM) under the direction of Tony Walsh has been awarded the task of bringing OCPPP into the market place with increased recognition in all quarters patients, insurance companies and medical practitioners. As always the trade exhibition was a great attraction to all - our thanks to those who took part, and gave sponsorship or draw prizes.
By tradition the OCPPP conference is a This scheme can only benefit the whole mixture of high standard clinical content, profession and ensure we stand with current business matters and social heads held high in the professional market place. It could also be seen as a way of activities. the general public being protected from The Olive Sands Memorial Lecture was non-chartered therapists. given by Viv Grisogono and entitled ‘Lower At the time of writing at least 538 limb injuries: Old methods, new concepts’. practices have applied for the relevant This topical subject coincided with the information to become accredited. London Marathon and the publication of her new book. Marketing ‘Anatomy of the knee joint’ by Dr M C The appreciation of the need to market E Hutchinson MB BS prepared everyone OCPPP has now come to fruition. The Social Round for the lecture on ‘Recent trends in anterior cruciate ligament surgery’ by Mr John amount of extra media coverage gained by The Brighton fun came in both proIreland FRCS. grammed and unThe programming official events. of the anatomy A civic reception in lecture meant delegthe Brighton Pavilion ates had a good by the Mayor of revision session prior Brighton was fully to the intricacies of subscribed and some members were dissurgery, and the appointed, but they lecture on ‘Anterior enjoyed a good knee pain’ by Mr T Wilson MSc dinner at the Grand Hotel. GradDipPhys MCSP. The clinical lectTo be taken ures worked their around the Pavilion way anatomically by a very entertaining downwards to ‘Podand well informed iatry’ on the Sunday guide made an evenmorning - a very ing to remember. informative session The sumptuous surgiven by Mr Barry roundings prompted Francis. one member to On the business remark ‘I do like the front Stuart Skyte, feel of opulence’. CSP director of They were certainly public relations, gave Above: Ms Vivian Grisogono and Dr Michael Hutchinson who both lecturedon the most ornate sura delightful talk aspects ofthe lower limbs. Below: Dr Harry Brunjesspeakingat the banquet roundings in which I entitled ‘Many hands have eaten poached make Skyte work’. salmon and peanuts! His ‘advert’ slides made us realise The banquet on Saturday evening saw chartered physiotherapists ‘probably are the chairman of the CSP Council, Patricia the best’ of ‘pure genius’ that patients are McCoy, proposing the toast to OCPPP and likely to encounter. our top table guests entertaining the The two major business factors affecting gathering with succinct speeches. Dr OCPPP at present are accreditation of Brunjes made us ache with laughter. practices and marketing. The unofficial social events included early morning swimming and exercise routines, and a water polo match - the Accreditation result of which appears to be unknown to The accreditation scheme was launched both sides. by chairman Jean Kelly who, in conjuncAn olive stone projection competition tion with the working party of Erica Nix, was won by a Bristol physiotherapist who Jacqueline Morris, Jenny Archer and shall remain nameless. Despite the hilarity Melanie McAinsh, has worked tirelessly to of the ’fringe’ events, the conference was bring the concept of accreditation to the a serious success story. membership. Some 35 practices took part Conference chairman Margaret Rees in a pilot scheme and now the process is and her colleagues (Wendy Blythe, Ann available to all OCPPP practices. It is McLaughlin, Joanna Macfarlane, and Mark perceived that in future health insurance Potter) along with Jane Morrison and companies will require some accredited Sarah Durham of CSP Events Unit, put on assurance that their subscribers can be a celebration of 100 Years of Physioguaranteed high standards and quality therapy that was a credit to chartered of treatment and surroundings.
Physiotherapy, June 1994, vol80, no 6
404
physiotherapy and of benefit to all delegates who attended. The moral is - book early for Glasgow in 1995. At the AGM the new vice-chairman, Sue England, and the new honorary editor of In Touch, Sally Roberts, were elected. A collection was, as always, made for the CSP Members’ Benevolent Fund. It is reported that the donation by OCPPP members at annual conference is usually the largest single donation that the Fund receives in one year.
OCPPP officers and guests, left to right: Ruth Wood, OCPPP vice-chairman; Philip Racle, OCPPP president; Patricia McCoy, chairman of the CSP Council; Jean Kelly, OCPPP chairman; David Lepper, the Mayor of Brighton; Ann McLaughlin, member of OCPPP Congress Organising Committee; Shirley Purves, OCPPP Secretary; and Jeane Lepper, Mayoress of Brighton
Health and Safety Risk Warning at Scottish TUC
REPORT BY
Elizabeth Bewley-Jones PHOTOGRAPHS BY
William Preston
Further Information on OCPPP Administrative officer - Mrs Rita Puncher, Suite 8, Weston Chambers, Southend on Sea, Essex SS1 1AT (tel 0702 392124). Marketing and PR - Mr Tony Walsh, Associates in Marketing (AIM), Union Business Centre, 288 Harrowgate Road, Bradford, West Yorkshire BD2 3SP (tel 0274 626475).
or Mrs Elizabeth BewleyJones, Owls Retreat, 6 Washabrook Way, Kingsbridge, Devon TQ7 1RJ (tel 0548 857130).
Honorary Executive Officers President - Philip Racle Chairman - Jean Kelly Vice-chairman - Sue England Secretary - Shirley Purves Treasurer - David Ramsbottom PRO - Elizabeth Bewley-Jones Sally Roberts Editor, In Touch
-
The regional officers’ names may be obtained from Rita Puncher.
Physiotherapy,June 1994, vol80, no 6
Health care employers are ignoring new legislation on health and safety at work, leaving hospital and community staff at risk, the Scottish Trades Union Congress conference heard from the CSP. Karen Bruce, north of Scotland regional steward, said the onus was on managers to ensure that violence at work policies were developed and implemented. New regulations which came into force last year stated that risk assessments, including the risk of violent attack in the workplace, had to be carried out and violence at work policies developed. But she said financial constraints meant that some trusts were not applying the legislation and staff were still ‘very much’ at risk. She said there were many examples where health care staff had been attacked, including the two doctors who were killed in Yorkshire and an occupational therapist killed in Devon.
Working Alone The motion from the Union of Communication Workers, which was seconded by the CSP and supported by the National Association of SchoolmasterslUnion of Women Teachers, expressed alarm at the ‘growing number of staff who work alone
Celebrating the Past
in the community or in jobs which leave them vulnerable to violent attacks and are not receiving adequate support or protection from employers. The motion added that it deplored the ’apparently growing trend to analyse the security of staff from a cost benefit perspective and not to view it as a necessary right for all employees to be protected from violent abuse’.
Charter The communication union called on the STUC to draw up a charter of demands for employers to ensure that all possible steps were taken to prevent violence at work. The motion was passed unanimously. A motion on the NHS from Unison warned that the basic principle - that treatment be given according to need rather than ability to pay - was being undermined. That motion, which was also seconded by the CSP, was carried unanimously.
. . . Shaping the Future
Don’t miss the CSP Annual Congress in Birmingham, September 20-23, 1994. See programme and application form at the front of this Journal.
405
Therapists Must Decide on Research The gap between recognising the need for research and having the opportunity to carry it out was highlighted at a major Departmentof Health conference in London on the contribution of the therapy and nursing professions to NHS research and development (see this month’s leading article). Bernadette Friend reports. At the conference attended by senior physiotherapists and other leading professionals, Dr Sally Byng, vicepresident of the College of Speech and Language Therapists, gave the response of the therapy professions to the Department of Health’s research strategy. Dr Byng said the therapy professions had ‘largely been excluded’ from the decision making process and that therapy research had not generally been identified as a ‘funding priority’. Exclusion from decision making and the need to create a well-established research infrastructure within the therapy professions were the main reasons, she said, for the gap between ‘our awareness of the need for such research and our opportunities to implement it’. She said the physiotherapy,occupational therapy, and speech and language therapy
professions were calling for greater representations on the research and development committees at central and regional levels of the NHS Executive. These professions were also recommending an increase in the number of research awards to therapists and the setting up of post-doctoral therapy Fellowships, as well as asking research councils to launch initiatives for more research awards for the therapy professions.
Structure for Progress Career opportunities needed to be developed. These were limited at the moment and those available carried some ‘positive disincentives’, said Dr Byng. ‘It has been consistently observed that research experience does not advance careers in the therapy professions as it
does in medicine. Clinician researchers may have to take a drop in salary while undertaking research and return to a lower grade clinical post after its completion.’ She said the current practice of managers emphasising clinical contact with patients at the expense of all other professional activities was ‘counterproductive’ to supporting and encouraging therapists who wanted to pursue research careers and was not in line with the NHS research and development strategy aim of creating a research based health service. The need for research design and methodologyto fit the nature of therapists’ work was also highlighted. Dr Byng said: ‘It is our conviction that the NHS must involve all of its workforce if it is to succeed in creating a’ research based service.’ And she concluded: ‘For the therapy professions we believe this can be achieved through increasing our involvement in decision making structures, increasing management support for research initiatives and systematic improvements in the career infrastructure for therapist researchers.’
Planning and Practice in Exercise Health service managers have yet to be convinced of the benefits of exercise for psychiatric patients, members were toid at a CSP workshop on exercise in mental health on May 9. Bernardette Friend flexed her muscles alongside the participants. The link between physical fitness and psychological well-being was wellestablished,said Tina Everett, chair of the Association of Chartered Physiotherapists in Psychiatry. Despite this, those in charge of the purse-strings were not always aware of the ‘enormous research base’ on the benefits of exercise, she said. ‘It is part of our job to get that message across to them.’ One study, she said, had shown that inactive women were twice as likely to develop depression as active women. Another study concluded that non-aerobic exercise was as effective as an antidepressant as aerobic exercise. A third, a large-scale study of GPs in the United States in the early 199Os, found that 85% were regularly prescribing exercise as a treatment for depression.
the term ‘holistic’ had become rather hackneyed but he believed that physiotherapists, and in particular those working in psychiatry, were working in a ‘very
Prescribing Exercise Delegates to the conference said they knew of areas where exercise on prescription was being tried out in the UK. Mrs Everett said that in a new building in Oxford a quarter of the space for psychiatry had been given over to ECT and there was little room for exercise. She believed that physiotherapists should have an input at the planning stage to ensure adequate provision was made for exercise. Mick Skelly, a physiotherapist working in community mental health in Hull , said
Tina Everett and Mick Skelly demonstrate a T’ai Chi Ch’aun exercise - ‘sticky hands‘
global way by acknowledging that there is no separation of mind and body. They are two ends of the same piece of string.’ Through anecdotes and demonstrations, he told the conference how it was possible that by changing the way a person thinks, you can influence their physical behaviour.
Policeman’s Ball To illustrate this he gave a brief case history. He was seeing a policeman who had been referred for depression. Initially, when asked if he had any physical problems, the officer said no. Later he told Mr Skelly that he was waiting to see a consultant for an exploratory knee operation. He was very worried that if he could not walk, he risked losing his job a>d home. The policeman walked very heavily on his feet. Mr Skelly offered him this image - that his centre of gravity was a ball of mercury in his abdomen, gradually getting lighter and travelling up through his body until it was floating above his head. The policeman helped with the analogy and conjured up for himself the thought that the balloon of mercury was tied to his helmet. ‘He literally became lighter on his feet’, explained Mr Skelly. ‘You could hear the difference down the corridor. He had changed the whole way he moved. There was nothing there but his imagination but it managed to change the whole way his body worked.’ Within a month he was feeling better and asked for his operation to be postponed. The story goes that when he later saw the consultant, he was asked if he had any
Physiotherapy, June 1994, vol80, no 6
406
pain. He proceededto bend down and told the doctor that it only hurt when he squatted. The consultant said he too had a pain when he squatted and sent the policeman home.
Handling Intentions Mr Skelly said he was often asked when teaching handling: ‘When do you touch the patient?’ ‘Before they come into the room’, is his stock reply. He reminded delegates that their ‘intentions’ towards their patients
were important. He said he had seen nursing staff moving patients, trying to ‘control’ rather than ‘enable’ them. During a practical demonstration he asked one of the physiotherapiststo place her hand on his shoulder and to resist as ‘hard as he could’ his attemptsto force her arm to bend. She failed. In the second demonstration with the same person, he told her to reach her arm out towards the wall opposite. This time she was able to resist the pressure. And as the physio-
Under-funding Slammed at Welsh TUC CSP delegates at the Wales TUC annual conference won backing for a motion which condemned the ‘scandalous level of underfunding’ in the NHS. Ruth Jones, CSP delegate from Nevill Hall Hospital, Abergavenny, said the Government’s reforms were in conflict with the philosophy of free health care for all. The conference in Llandudno said it would resist local pay bargaining and the attempts of self-governing trusts to undermineterms and conditions of service and to de-recognise unions. Delegates said they would oppose unjustifiable hospital closures as a result of the current city reviews, as well as any attempts to limit comments on matters of public interest by staff. Ms Jones - backed by delegate Joe
Davies from Whitchurch Hospital, Cardiff, also won support for better child-care facilities in the UK, which are among the worst in the European Union. The conference called for a fully-funded national policy on childcare to ensure facilities were available to all families that required them. The two delegates also proposed an amendment to a motion on upper limb disorders. The conference supported their call for legislation to ensure employers take adequate preventive measures. The delegates, together with colleague John Pestle, also helped to carry a motion asking for better ways to combat dark-room disease, suffered by some radiographers and technicians.
A touch of ageism hit the Department and kept us all scurrying around. It is a fact that Chinese walls turn fact into most amazing fiction, but of course, all of us a t some time have prioritised using age as a guideline. However, it was an opportunity to come up with some interesting facts to refute any claim that we do not care about older people. The latest Korner statistics show that our initial contacts have increased by 3% and that over half are for people aged 55 or over. They have also increased by 15% since 1989 for those people who are 65 and above, all of which at long last justifies collecting statistics. Membership of the Association of Chartered Physiotherapists with a Special Interest in Elderly People has risen by 16% since 1989 and represents 3% of all chartered physiotherapists. Further data show that approximately €17 million is spent on physiotherapy in day hospitals and a further €33 million on disabled adults with osteo-arthritis although I cannot verify these figures.
Current Issues
clinical co-ordinators over the last year or so. Anna Farrar has been invited to take up the new PAMs place, and as a speech and language therapist with wide experience in working with other professions and quality work, we hope that she will bring a fresh voice to the committee. 2. We will be allocating the Research Training Awards soon and are always optimistic that the bright and the best will apply. These are for PhD students who will be promulgating research for the profession in future years, so we need to choose the right candidates. We were very pleased with the response which broke down equally between the three professions on the initial trawl and short listing for interview. The next round will be advertised in the Journal in January, but there is some doubt as to whether the Department will continue funding these awards in the long term, so we will have to see what happens. 3. The Hospital Episode Statistics for 1990/91 have just been published in two volumes as has the NHS Workforce in England 1981 -1991.
1. The Clinical Outcomes Group has a new professions allied to medicine member and we have to thank Judy Mead for representing PAMs and the regional
4. Nursing and Therapy Clinical Audit will have been distributed to managers as should Just for the Record, a n extremely useful workbook for all levels
Physiotherapy,June 1994, vol80, no 6
therapists set about trying the two methods, one commented: ‘The more I relax my arm, the stronger it becomes.’ Mr Skelly spoke about yin and yang and the balance between the soft and hard sides. ‘Very often in our society you get a place by trying harder and harder.. Sometimes we use force to get where we are going.’ But he suggested that sometimes the most effective way was to be soft. ‘If in doubt be soft, it is easier on yourself and everyone else.’
CSP POLICY STATEMENT
Productivity Pay The Chartered Society of Physiotherapy does not believe that productivity is an appropriate way of determining physiotherapists’ pay. The CSP reaffirms its commitment to nationally bargained and fully funded pay awards based on factors such as comparability, motivation and the cost of living, and the Pay Review Body system. The CSP is concerned that the problems associated with measuring productivity will result in a concentrationon crude throughput measures, which take no account of quality, could result in undesirable cost cutting, and have a detrimental effect on patient care. Frequently, in health care, what is meaningful is not measurable and what is measurable is not meaningful.
of staff on record keeping. The latter is available through the NHSTD, St Bartholomew’s Court, 18 Christmas Street, Bristol BS1 5BT.
5. There are two important guidelines now in circulation. HSG(94)22 gives guidance on the new Regional Health AuthoritiedRegional Offices and BL(94)40 covers Codes of Conduct and Accountability which I mentioned last month. Another, EL(49139, is on the review of central requirements for information - uses made of information collected from the NHS.
Conclusion The NAO Report on Day Hospitals should be published soon and issues around disability continue to come and go. The launch of the therapy response to the Nursing Taskforce document on research is much welcomed and hopefully will give a boost to multidisciplinary research in the future. I also hope that all of you who are interested in research are being extremely pushy with regional research directors so that physiotherapy is well represented in next year’s projects.
Nicky Cogan MCSP Physiotherapy Offcer