National Assembly for Wales
Health and Social Services Committee
Review of Cancer Services for the People of
Wales
Response from the Chartered Society of Physiotherapy (CSP) in Wales
1.
Introduction
1.1 The Chartered Society of Physiotherapy (CSP) is pleased to provide a submission to this Health and Social Services Committee led Review.
1.2
The CSP represents around 1,500 physiotherapists, technical instructors, assistants and students in Wales. CSP members work primarily in the NHS but also in the independent sector, education, research, the voluntary sector, industry and occupational health.
1.3
The CSP is the professional, educational and trade union body for its 47,000 members in the UK, physiotherapy being the third largest health profession after doctors and nurses. 98-99% of all registered physiotherapists are members of the CSP.
1.4
Chartered physiotherapists, their technicians and assistants provide treatment and support for their patients, clients and carers in a variety of different clinical environments in the course of NHS treatment. These include intensive care, acute and rehabilitation
hospital wards, palliative care, outpatient departments, hydrotherapy pools and multidisciplinary clinics. Physiotherapists also work in community settings, within schools, GP practices, health centres and in people’s own home.
1.5
'Physiotherapy is a health care profession concerned with human function and movement and maximizing potential. It uses physical approaches to promote, maintain and restore physical, psychological and social well being, taking account of variations in health
status. It is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgement and informed interpretation is at its core.’ (Chartered Society
of Physiotherapy (2002) Curriculum Framework for Qualifying Programmes in Physiotherapy. CSP, London).
2.
Details Required
2.1 Name of Respondent:
Philippa Ford MCSP
2.2 Are you responding on
behalf of an organisation?
Yes.
If so please give the name.
The
Chartered Society of Physiotherapy (CSP) in Wales.
2.3 Address:
1 Cathedral Road
Cardiff
CF11
9SD
2.4 Tel:
029 2038 2429
2.5
Would you be willing to give oral evidence to the Committee?
Yes - but we are recommending that the Wales Therapy Advisory Committee should be invited to give
evidence.
2.6 Content for evidence to the published.
Yes
3.
Consultation Questions
3.1 How can information technology be used more effectively to track and facilitate the patient’s journey?
The
CSP believes the electronic patient record will assist in the clinicians having far better access to information on the patient throughout their journey. This links to work on the unified assessment and both informing social care and informing healthcare strategies
will need to be successful. All clinicians need access. Many physiotherapists have limited access to IT.
The
profession believes that effective information technology will decrease duplication and data collection can be used effectively to improve performance and thus the patient experience. It is also important to note that many of the patients in cancer care will
move between NHS Trusts regularly and therefore accurate information must be easily available.
3.2
How effectively is research and good practice being integrated with service delivery? What can be done and by whom to improve this?
The
CSP believes that this area must not be the sole domain of medical practitioners. There is a need for involvement of all professions involved in cancer service provision and research and good practice should be multi-disciplinary and multi-agency. Staffing levels
for therapists remain too low for meaningful engagement in research.
Physiotherapists
are required to practice competently and are registered with the Health Professions Council. HPC will be expecting evidence of CPD and learning which will involve ensuring research and good practice, as they develop, are incorporated into service delivery where
resources allow. Investing in the whole range of cancer services will be required and direction to become involved and supported in research.
3.3
What are your views on the complexity of commissioning services? Is the process hampered by the involvement of the Local Health Boards, cancer networks and Health Commission Wales?
The
CSP believes all stakeholders mentioned have important roles in the commissioning of cancer services. However, the process is hampered by the complexity of the range of organisations and their own agendas.
A
simple solution would be for the LHBs and HCW to devolve the decision making to the networks. These networks would need to have LHB and HCW representatives on them. The networks would then be able to identify commissioning needs, workforce needs etc and, with
the LHBs and HCW on board, commission these services from the various providers. It would be essential for the networks to be fully inclusive of all the stakeholders and receive appropriate advice from professions such as therapists.
If
this model is not possible, then the networks and HCW must be purely advisory to the LHB who will commission with the providers.
Commissioning
must take into account the variety of routes that patients may access care. Patients may not always be picked up by the specialist cancer centres and may be treated in outpatient facilities or within community service provision. Appropriate links to the centres
and support via the networks is required. From a therapy perspective, this would clearly be assisted by therapy involvement in the clinical networks - not currently the case.
3.4
What evidence is there of the value of screening and immunisation?
The CSP has no comment on this issue.
3.5
What are the barriers to the NHS in Wales keeping abreast of, and responding to, developing technologies and therapies? How might these barriers be overcome?
The
profession believes the barriers are staffing - levels are too low and work with patients must be prioritised; time - staff do not have enough time to spend 'down time’ away from patients researching and accessing information or training (CPD) on new
technologies or techniques; training budgets - these are low and treating patients will be the top priority for over stretched physiotherapy service budgets in relation to cancer care. Lack of access to IT - physiotherapy services have limited resources for
IT development and access to IT for research and keeping abreast of technology, NICE guidance etc. will therefore be restricted.
It
is also important to note that in non-cancer centres there can be an issue of relative isolation as some therapists may see cancer patients occasionally as part of a mixed case load in, for example, community physiotherapy service provision. Training for cancer
care will be part of the training programme for these therapists and they will need to keep up to date on a range of specialty areas, not just cancer care.
3.6
How can the NHS and the voluntary sector work together more effectively to deliver services?
Cancer service provision is indebted
to Macmillan, Tenovus and other crucial cancer charities and organisations such as the Big Lottery Fund/New Opportunities Fund. The CSP feels there is a real need for the NHS in Wales to fully recognise this reliance and look to strengthen the relationship between
the two sectors. Concordats and clear funding protocols are essential and standard setting and CPD support for staff clearly identified. The NHS must be clear about what it will deliver and the voluntary sector must be clear about what it can provide. There
is a need to ensure enhancement and not duplication.
3.7
How can the collection and use of data on where the terminally ill spend their last weeks or months be improved better to inform service provision for these people?
The
profession believes this is dependent on communication between all those who are working with a family with a terminally ill person, be that a hospice, the palliative care physio, the GP, the social worker etc. There should be one 'key worker’ for
the person and their family. Any information about wishes should go to that person and planning put in place to try and achieve those wishes.
The
CSP believes the importance of rehabilitation is sometimes lost in the attempt to provide services for the terminally ill. People are living with cancer and managing it as a chronic disease with the amount of time concentrated on 'last days/months’
being minimised. The patient’s wishes must be central and an emphasis on rehabilitation and 'Living well with cancer’ must be the philosophy. This requires investment.
3.8
There are a number of issues around prescribing and the cost of drugs:
3.8.1 What should be done and by whom to reduce continued prescribing of inappropriate
drugs?
The Society supports key involvement of the pharmacy profession, working in partnership with GPs, consultants and others
who can, and will be able to, prescribe. This is a work area for the clinical networks.
3.8.2
Should people who are prepared to pay privately for drugs not available to them on the NHS, be able to do so without having to become private patients and having to pay for all their treatment?
The
CSP has no definitive view on this - members are divided.
There is a view that healthcare should be free to all at the point of delivery and that if some can
access drugs but others cannot then a two-tier service is created. Equally, there are views that such drugs may not necessarily be appropriate but perhaps are being offered as a very expensive 'last straw’. The cost of treatments and resulting side
effects are then extortionate but yet with a poor prognosis. Others take the view that nobody should be denied drug treatment and if the patient is prepared to pay for a drug, which is not available on the NHS, then they should be able to pay just for the drug
part of the treatment and not have to become a private patient for the whole episode.
3.8.3
Do doctors, pharmacists and other health professionals have adequate access to independent advice and guidance on the prescribing of drugs?
Physiotherapists
are not yet independent or supplementary prescribers so the CSP has no view at present. Once physiotherapists are supplementary prescribers, there will be advantages for those who work in the field of cancer care to be able to develop the role and it will be
essential for them to have appropriate training, advice and guidance.
3.9
Are services centred on the patient, with service users consulted? If not what are the reasons for this and how might patient involvement be improved?
The
CSP believes the intentions of the professionals working in cancer care and strategy developers are very much to put the patient at the centre of service provision and future service planning. However, structures and processes that are clearly evident in the
NHS make this a difficult to achieve goal. Services must be provided and commissioned and it will be for patient groups and advocates to say how for they feel they have been consulted in the provision and development of services.
Perhaps
a solution might be to have a patient reference group as a sub-group of the cancer network and a patient or their advocate on the network group.
4.
Additional Comments
4.1 The CSP does not feel the Committee has fully addressed the first point of its terms of reference (i) To review equality of provision and equity of access to the full range of
high quality services that meet the National Cancer Standards, by the questions asked. A baseline audit, against the standards is required to achieve this. The Society believes there is a grave lack of therapy services in cancer care and this should be borne
out by an effective audit.
4.2
The profession also has concerns about the level of advice on therapy service provision that the networks receive. The networks will not perceive there to be a problem for therapy services if there are no therapists involved in the network groups. There are
so few therapists 'on the ground’ that they are unable to spend time away from patients to provide crucial input to the networks.
4.3
Provision of services will include the provision of aids, appliances and adaptations. This is an issue not referred to in the questions but part of terms of reference (i). The danger will be that the issues of aids and appliances and adaptations will only be
raised in relation to question 7. The issues around equipment are relevant at all stages and funding problems, protocols and other considerations will need to be explored.
4.4
The CSP believes the therapy professions will need an opportunity to raise issues provide intelligence across a wide range of the aspects covered by the terms of reference. The CSP suggests the Health and Social Services Committee should invite the Wales Therapy
Advisory Committee to present oral evidence to the Committee.
5.
Concluding Remarks
5.1 Whilst there was support for the Health and Social Services Committee taking expert advice, the CSP was very disappointed not to see a therapist on the expert reference group.
The profession has concerns about the levels of therapy provision across Wales and this would have provided an opportunity to guide Committee members in the questions to ask and services to see.
5.2
The profession has been pleased to play an active part in this consultation process and will continue to do so.
5.3
If the Committee wishes for any further information, do not hesitate to contact the CSP’s Cardiff Office.
Philippa
Ford MCSP
CSP Policy Officer for Wales
In association with:
The Welsh Board
of the Chartered Society of Physiotherapy
The All Wales Physiotherapy Managers
The CSP Wales Palliative Care and Oncology Network Group
