SUPPLEMENT

l989 Salary Negotiations for Physiotherapists

Introduction

FOR the sixth year the PT'A' Staff Side and the Chartered Society of Physiotherapy have submitted evidence to the Pay Review Body. The PT'A' Staff Side produced t w o papers: Paper 1: 'Demand, Shortages, Recruitment and Retention of Staff', and Paper 2: 'Pay, Allowances and Related Issues'; and the CSP produced its own separate paper.

0 A growing crisis in recruitment and retention of physiotherapists in the NHS.

A wide and unjustified gap between the pay of nurses and the professions allied to medicine (PAMs).

PAM professions are inadequeately remunerated in comparison with jobs requiring similar qualifications in the economy as a whole.

0 Helpers and technical instructors are severely underpaid for the work the NHS is requiring them to do.

The gap between supply and demand for physiotherapists has become critical. The vacancy level in physiotherapy is 9.1%, and the number of frozen posts is double that of last year, making an overall shortfall of 10%. More physiother- apists are leaving the NHS - many to work abroad. The already high turnover rate for physiotherapy staff has increased from 18.3% in 1987 to 19.5% in 1988.

A number of major reports by health and social services organisations are referred to in the evidence. All draw attention to the effects of shortages in the PAM professions and the impact of demographic change in increasing demand for the services they provide. Our survey information shows that District physiotherapists estimate the shortfall in funded posts to meet current workload at 23%.

With the drop in the number of school leavers forecast for the 1990s and competition from other, better-paid profes- sions for recruits, at the same time as the increased need for NHS services, the gap between supply and demand will continue to grow unless the NHS takes more positive steps to expand the number of student places; retain its existing staff; and recruit back the large number of qualified staff who are not practising in the NHS.

Results of the CSP student survey, included in the CSP evidence, show that a small (8.5%) but significant proportion of newly qualified physiotherapists do not obtain employ- ment in the NHS. There are also serious shortages of teachers of physiotherapy.

Other PAM professions are also experiencing severe difficulties. For example in occupational therapy, there is a very high proportion (16.5%) of vacant posts. In radiography although there is currently a low level of vacancies, 4 0 % of their student places are unfilled for lack of recruits, which will cause major problems in the next few years if action is not taken.

A major report by Price Waterhouse has shown that pay has a major role in recruiting and retaining nurses, and the

The evidence shows:

Staff Side suggests that pay has a similar priority for the PAMs. Paper 2 of the PT'A' evidence details the implications for PAMs of the 1988 PRB report on nursing salaries. It shows that a gap of almost 10% between nurses and PAM staff has been suddenly opened up in one report, wi th damaging effects on morale.

We welcomed the salary increase for nurses as recognition that nurses (like PAM staff) have been badly paid for their responsibilities in the past and should be better rewarded in the future. Yet equally strongly we do not believe that there is evidence to suggest that the salaries of the PAM staff for their im port ant responsibilities s hou Id be severely disadvantaged in comparison to nursing salaries as a result of the 1988 Report.

In relative terms the salary gap between the t w o groups will get larger each year if swif t action is not taken to pull up the salaries of PAM staff. If in future years, nurses and PAM staff were to receive the same percentage increase, because it is a percentage of a larger nursing salary, the monetary gap would get larger each year. It could then get to a point where the size of PAM increase required t o catch up with the nurses became so large that it would be politically impossible either for the PRB to recommend it, or for the Government to implement it.

The evidence emphasises that it is vital for PAM starting salaries to offer appropriate rewards for the professional training and commitment required and, subsequently, for salaries to remain comparable wi th other professions in the public and private sectors. Comparisons are made with a number of careers.

PAM starting salaries are clearly uncompetitive. Graduate starting salaries offered by other employers are 2 5 % more than PAM starting salaries. Comparisons with other occupations (which have similar or lower educational entry requirements) confirm this disadvantage for PAM staff. The 1988 evidence on the low earnings potential of the PAM professions in their careers has not changed this year.

PAM managers are also clearly disadvantaged in comparison with their counterparts. The evidence shows that they are some 30% to 6 0 % behind their comparators in the rest of the economy. PAM teachers' salaries in the NHS compare unfavourably both wi th PAM teachers in higher education institutions and with other NHS teachers.

The evidence urges the Review Body to take a radical approach in 1989 and substantially increase the salary rewards for helpers and technical instructors. Last year helpers got increases of up to 9.5% and helpers in London got increases of 14.5%. This was better than the increase for physiotherapists, but in previous years the reverse has been the case. Helpers over the last five years have done much better than other NHS non-Review Body staff, but helpers remain severely underpaid for their responsibilities. The evidence shows that their salaries compare badly w i th

63 Physiotherapy, January 1989, vol75, no 1

others in similar jobs. The weekly salaries of most helpers and technical instructors are still well below current definitions of low pay. Rising inflation has a disproportionate effect on those on lower incomes. Large rises in average earnings in the country as a whole could mean that these staff will fall relatively further behind in the general earnings league unless substantial action is taken. A t the same t ime the NHS is placing additional pressures on them. We argue that for their skills and responsibilities t o be inadequately rewarded as well, is exploiting the commitment of these staff working in caring jobs in the Health Service.

A final report to the Pay Review Body discussed the breakdown in the negotiations for a revised salary structure (see Physiotherapy, December 1988, pages 635-636). The Staff Side told the Review Body that it no longer had any basis of trust or confidence in the Management Side's intentions, and that it would not re-start negotiations in the foreseeable future.

The PRB evidence is researched and written by the CSP Industrial Relations Department Staff on behalf of the PT'A' Staff Side, whose Secretary is Phillip Gray, the CSP's director of industrial relations, who is assisted by Kate Moran and Sally Simpson. The research into the recruitment and retention problems for PAM staff, undertaken by Di Hall, CSP senior research officer and Maryam Boroumand, CSP research officer, has been central to our evidence.

This year again we provided a comprehensive manpower survey and report for March 31, 1988, despite the problems caused by the Government's announcement that the Review Body must submit its report three months earlier, in January 1989 instead of April 1989. Most of the PT'A' statistical evidence is based on the results of individual manpower surveys by the six larger professions, including results for helpers and technical instructors. The surveys had a high rate of return and cover most health authorities in Great Britain. They were carried out t o a common format (wi th the exception of occupational therapy whose survey was carried out for its independent commission), and results were amalgamated across all the professions where appropriate. Much of the CSP's separate evidence is a more detailed investigation of the growing staffing crisis in physiotherapy. This evidence is the most comprehensive information currently available on physiotherapy manpower. No other such detailed source exists.

In addition to survey data, our research includes detailed economic evidence t o back up our salary arguments. We compile data on pay movements in the economy generally and on comparative pay in the public and private sectors, and detailed demographic information affecting recruitment and retention of PAM staff.

The sound research base for our evidence is the strong foundation for our argument for substantial pay increases for physiotherapists. With the breakdown of the grading negotiations, it is crucial for the Review Body this year t o make awards that will make NHS PAM salaries more attractive in order t o avert !he' crisis in recruitment and retention and to close the sudden large gap with nurses' pay. Unless the Review Body responds positively, patient services wil l suffer.

6 9 PTA Staff Side Evidence to the Pay Review Body for the Professions Allied to Medicine

and Related Grades of Staff - N89

This summary highlights the main conclusions of the 183 pages of the 1989 PT'A Staff Side evidence. There were two papers - Paper 1: 'Demand, Shortages, Recruitment and Retention of Staff', and Paper 2: 'Pay, Allowances and Related Issues'. (The summary of the CSP's separate evidence is in the next section.)

Paper 1: Demand, Shortages, Recruitment and Retention of Staff

OUR first paper of evidence for 1989 is devoted to the growing crisis in recruitment and retention of staff in the professions allied t o medicine and related grades. It shows a growing number of vacancies, alongside a continued expansion of the demand for an increased number of posts by health authorities to meet NHS operational plans. The future demographic problems, the number of qualified staff not practising in the NHS, and the evidence of the uncompetitive nature of the NHS salaries, give a solid basis for substantial improvements in salary in the 1989 PRB Report. The previous PRB Reports have helped to prevent the recruitment crisis getting worse but radical action is needed now if the NHS is to be able to recruit the number of PAM staff which it needs for its patient services. A policy of increasing salaries in line w i th the increase in average earnings wil l not be enough to make the NHS salaries competitive w i th alternative sources of employment for PAM staff.

Effects of Demographic Changes on Recruitment and Retention of PAM Staff

The drop in the number of 18-year-olds between now and 1994 wil l have an impact on the ability of the professions to recruit to

the training schools. But the Staff Side believes that this can be overcome by urgent action to retain existing staff; to attract back qualified staff; and to recruit mature students. Increases in salaries will play a major part in this strategy.

Despite the overall drop in the number of 18-year-olds t o 1994, we feel that it makes sense t o maintain the current 2/3 A-level entry standards because the proportionate drop in the numbers of 18-year- olds w i th these qualifications wil l be significantly smaller than in less qualified groups (a 12% drop compared w i th a 3 0 % reduction in overall numbers). To reduce entry standards would plunge the PAM professions into direct competition wi th nurses for those with lower qualifications where the shortfall wil l be much greater. That is also the group of school leavers for which there is likely to be the highest level of competition from other employers.

The overall working population will increase to 1994 at the same time as the drop in 18-year-olds will take place. The professions will increasingly need to seek mature entrants to training.

Currently the highest numbers of females in the workforce are in the 23-30 age group but by the turn of the century this band will constitute the lowest point in the working population. It therefore

64 physiotherapy, January 1989. vol75, no 7

should be an essential part of the NHS strategy to retain as many as possible of the current population of PAM staff to provide a buffer for the approaching trough in 1994 and beyond. Salary levels will be crucial to this.

SupplylDemand for PAM Staff and Influence of Pay The demand for the PAMs continues to increase at a faster rate

than any other group in the NHS. The numbers of new posts being created are increasing at a faster rate than in the Regional Health Authority ten-year projections. Demand is outstripping supply not because there are not enough qualified staff in the population, but because the NHS cannot retain its staff or attract back qualified staff in sufficient numbers. We suggest that salary levels are the major reason for this.

A large number of reports has appeared in the last year backinc up the demand for PAM staff, particularly in the areas of communit) care, mammography screening and the vital role played by PAM stafi in increasing through-put of patients in NHS hospitals.

Estimates from District heads would indicate that most of the professions are considerably under-staffed to deal with the curren workloads and demands. This will undoubtedly lead to a furthei expansion of posts in the future.

The paper stresses the importance of pay. It points out that therc is a net loss of 5.5% more qualified PAM staff leaving the NHS thar there are joining. The service cannot afford to lose staff in thest numbers.

This chapter also contains evidence to back our contention tha, there are large numbers of qualified staff outside the NHS who coulc be attracted back if the salaries and conditions of service were competitive. Participation rate data show that 20% of qualifiec physiotherapists are working outside the NHS in the UK, and thal of the whole population of qualified physiotherapists under the agt of 65, 46% are either not working or not working in the NHS. Ir radiography the numbers are very similar with 19% working outsidt the NHS and 40% of the qualified staff under the age of 65 eithei not working or working outside the NHS. We believe that the positior of the other professions is likely to be similar. These figures provide the target for a radical improvement in the NHS strategy to attrac' them back to the NHS. These numbers do not cover the staff whc are working abroad who could be another source of recruitment

There appears to be a serious loss of newly qualified staff whc do not take up jobs in the NHS after qualification or who leave agair shortly afterwards. In some professions this may be as much as 50% of the output in any year. Uncompetitive NHS salaries must pla) a major role in this loss, at considerable cost to the NHS and the taxpayer.

Participation rate in England: All State registered physiotherapists

Under 65

54.0%

Under 65 in employment

Working in the NHS Not working in the NHS

Vacancies, Recruitment Difficulties, Leavers and Joiners The evidence on vacancies provides a bleak picture with the level

of vacancies showing a significant rise on last year and with a high proportion of vacancies occurring in more than half the Regions in Great Britain. The vacancy rate for PAM staff as a whole, at March 1988, was 8.1% compared to 7.4% in March 1987.

In addition the number of temporarily frozen posts has risen substantially in 1988 to 1% of funded establishment. Together with the vacancy rate, it represents a total shortfall of approximately 9% in 1988 for the group as a whole. Occupational therapy and physio- therapy have the highest vacancy levels among the PAM professions, with radiography having the lowest.

There is a wide variation of length of time PAM posts are vacant across the Regions. London has serious problems but there are also

significant problems in a number of other Regions including Wales, Trent and the West Midlands. In physiotherapy, the highest shortages are in North East Thames, Wales, Oxford and South East Thames.

In London, the overall pattern for PAMs is that the shortages are high across London but that in a number of the professions they appear to be highest in Outer London and the Fringe. This may be because of the high cost of housing. However, in some of the professions, such as physiotherapy, Inner Londcn appears to have very high turnover rates, of up to 30% pei year.

The turnover rates in most of the professions throughout the

Vacancy levels for PAM professions on March 31, 1988: Great Britain

'* 1 15

c 12

5 .= 9

6

3

0

District PAM managers' estimates of shortfall of their funded posts to deal with current workload demands at March 31, 1988. It does not include current vacancies

Whole-time ?6 on funded equivalents establishment

Chiropodists 402.0 Dietitians 684.8 Orthoptists 127.4 Physiotherapists 2,583.4 Radiographers

(diagnostic and 558.1 therapeutic) 106.9

23.8 66.7 22.0 23.8

7.5 10.8

Areas o f work in which particularly high shortfalls occur ~ ~~ ~~~~

Radiography Dietetics

Chiropody Phvsiotheraw - Mental illness, mental nandicaa communitv

- All major areas, especially ultrasound - Geriatrics, mental illness, mental handicsp,

paediatrics, community - Elderly in the community

Source: Professions' Surveys

Whole-time equivalent vacancies by area of work on March 31, 1988: Great Britain

11.7% 28.1 Yo _ _ ource: Prcfessions' Surveys

Occupational therepy

Physiotherapy 18.4%

0 a a m @

i Acute

Geriatrics

Mental illness

Mental handicap

Paediatrics

Community

Others/unspecified

33.8 %

2.8%

.6%

i.4%

65

country appear to be increasing, particularly in physiotherapy (up from 18.3% to 19.5%). Given the comparative stability of part-time staff, this would indicate a growing rate of turnover among full-time staff.

An increasing number of staff are going abroad. This is particularly the case in physiotherapy where one-third of all those leaving the NHS are going abroad. Radiography also appears to have developed a high export of qualified staff. There is a large gap between the numbers leaving the country and the small number who are returning. There are significant differences of alternative employment between the professions. For example, 75% of occupational therapists who leave the NHS to take up another job are working elsewhere in the UK (probably local authorities); whereas 6 3 % of physiotherapists leaving the NHS to go into other jobs, are going abroad.

Our evidence also shows that teachers continue to be significantly more difficult to recruit in NHS schools than in schools in higher education.

Conclusion The overall conclusion is that radical action is needed in thz Review

Body's 1989 Report. We believe that the effect of the previous increases in pay by the PRB has been to prevent the recruitment crisis getting considerably worse, but salaries are not at a competitive rate to reverse this recruitment crisis. An essential part of any strategy to deal wi th the demographic changes leading to 1994 must be for substantial improvement in salaries and conditions today t o minimise or eliminate any damage from those changes. Effective patient care is dependent upon the Review Body getting this right in 1989.

Destination of staff in all PAM professions leaving in the year ended March 31, 1988: Great Britain

Source: Professions' Surveys 23.8%

10.7% Leaving NHS

Leaving current District

54.9%

0 Within NHS

Non-NHS (in UK)

Maternity

Non-NHS (abroad)

Retirement/ill health IU. I70

Other

Paper 2: Pay, Allowances and Related Issues FOR PAM staff, the 1989 PRB Review is possibly the most crucial since the establishment of the Review Body in 1983. We are facing a crisis in recruitment and retention of PAM staff and a crisis in morale because of the sudden large gap in the rewards to nurses and PAMs which appeared in the 1988 Reports. While the PAMs have accepted this gap on a temporary basis, there will be a very severe reaction if it is perpetuated. Urgent action in 1989 is therefore necessary if severe damage is not to be done to the provision of patient services.

In this paper we have aimed to draw attention to the still substantial differences between the salaries of most PAMs and groups with comparable entry qualifications and training, both inside and outside the NHS. We have emphasised the increasing level of competition faced by the NHS in the labour market, particularly for school leavers, and the consequent need for salaries of PAM staff to become more competitive and for the career structure to be attractive.

We have drawn attention to the differentials which now exist between the salaries for nurses and those of PAMs, particularly for skilled clinicians. There wil l almost certainly be a catastrophic drop in morale if PAMs do not receive increases in 1989 to match the responsibilities the NHS requires them to carry out. The expanding role of staff in the related grades and the additional pressures placea on them by shortages of qualified staff should also be recognised by substantially increasing their pay.

Salary Proposals for April 1989 The table (right) gives details of our salary proposals for April

1989. It shows the current maximum of salaries for a selection of PAM grades, together w i th the salaries which our research shows are indicated by external comparisons. These external comparator figures (drawn from 1988 salary surveys) have been up-rated by 8.5% to take account of one projection of growth in average earnings to April 1989 (Phillips and Drew). Our final proposals are on the whole in line with the figures suggested by the external comparisons although we have made some additional upward adjustments in the proposals for PAM teachers to compensate for the very unfavourable conditions of service they enjoy in the NHS compared to their colleagues in polytechnics.

Conclusions Comparison with Nurses

The 1989 PRB is probably the most crucial since the establishment of the Review Body in 1983. We are facing a crisis in the recruitment

Salary proposals (f 1

Current Salary Final Salary indicated proposal

to April 7988 by external comparison

1.4.89' 1.4.89

Helper (aged 19+ Max 6,300 7,333 8 ,082 t

Technical instructor I1 Max 8,620 - 12,500 Qualifying grade Min 8,000 9,732 10,000

Max 9,510 12,500 Senior I Max 13,025 17,400 17,400 Superintendentihead/

chief 1 1 1 Max 14,120 18,800 18,800 Superintendent/head/

chief I Max 17,225 23,300 23,300 District I Max 19,700 27,175 27,200 Senior teacher Max 17,125 19,662 23,000* Principal 24+ Max 20,455 24,158 27,200*

All external comparators have been uprated by 8.5% in line with the predicted growth in average earnings to April 1989 (source: Phillips and Drew). t Based on estimated April 1989 Low Pay Unit definition of low pay. * Uprated to compensate for less favourable conditions of service.

under supervision)

and retention of PAM staff and there will be a catastrophic drop in morale if the differentials which now exist between the salaries of nurses and those of PAMs are not substantially closed.

Restorative action is needed in 1989 or the monetary gap between the PAMs and nurses will become so large that it wil l be politically impossible to rectify. There can be no justification for paying PAM staff less for their responsibilities to patients than nurses. In fact the higher standards of PAM education and the consequent differences in clinical autonomy and accountability put the practice of PAMs into a higher class than that of nurses. Furthermore, despite media attention which concentrates mainly on nurses, the recruit- ment crisis for PAMs is worse than that for nurses.

We have also stressed that the nurses have had a re-grading, not a re-structuring exercise. Most of the nurses have not had a change of duties. They have been slotted into the new grading structure on the basis of the work they were undertaking on April 1, 1988.

66 Physiotherapy, January 1989, vol75, no 7

Physiotherapists and other PAM staff will therefore have good reason to feel unfairly treated if i t appears that the Review Body has suddenly changed its mind about the comparative worth of nurses and PAM staff without any evidence to justify this approach.

We have asked the Review Body to take immediate steps in the 1989 Report to close this gap in salaries.

Recruitment and Retention Paper 1 presents our detailed case on recruitment and retention.

Although we believe that this is not the only issue which should determine pay, it does form an important part of our case. All the evidence in Paper 2 should be viewed against increasing demand for PAMs, increasing shortages and turnover, losses of staff abroad, and failure to attract back those who have left. Added to this are the declining number of school leavers and the general tightening of the graduate labour market.

Inflation and Average Earnings Inflation rose to 5.7% in August 1988 and was predicted to rise

to over 6.0% in October. The annual increase in average earnings for August has just been announced at 9.25% and leading forecasters suggest that high levels of inflation and earnings wil l continue for at least the first quarter of 1989.

Equal Pay Despite the Review Body's comment in its 1988 Report that the

question of equal pay for work of equal value should be resolved by the PAM (PT'A') Council, we respectfully ask the Review Body to make its own judgement on the NHS's legal obligations and to recommend salaries accordingly.

London Supplements Although we would prefer the problems of London weighting to

be settled through the GWC London Weighting Consortium, in the absence of any substantial offer from management, we will support the continuation of the new London supplements and hope that the PRB will keep them under regular review.

Regional Pay We remain strongly opposed to Regional pay. We are convinced

that management has not thought out the implications or likely effects of such a system for the PAMs where there are considerable shortages on a national scale. We feel that a far better alternative is for a substantial improvement in the salaries and conditions of service for all PAM staff which may help to attract back qualified staff not working in the NHS and retain existing staff.

Morale The NHS is going through a period of almost unprecedented

uncertainty. Although we have not undertaken a morale survey this year, anecdotal evidence indicates that current pay levels have only

- 2 24- m m 3 0

18- w, m a,

m .- L

m 12- m

6 -

0 -

Current starting salary of PAMs and other professions in the public sector

10 5

10 2

9 9

9 6

; 9 3 e 9 0

5 8 4

; 8' 2 7 8

: 7 5

2 R J

L.

7 2

6 9 6 6

6 3 6 0

prevented morale from dropping further. The Health Departments recognised the problems of lowering morale in their 1988 evidence. The continued uncertainty about the future of the NHS adds to the insecurity of staff and the lower morale.

Helpers and Technical Instructors New areas of responsibility are being created for the staff related

to the PAMs. The traditional work of these staff is being extended and is becoming more complex, yet they are still very poorly paid. The salaries are well below those doing broadly comparable work in local authorities and their average earnings are well below a range of unskilled and semi-skilled occupations in the New Earnings Survey.

The Pay Review Body should also note that the current rapid rise in inflation wil l have a disproportionate effect on those w i th low incomes, and that most helpers and technical instructors receive salaries below the current definitions of low pay.

The Staff Side is asking for substantial increases in salaries for helpers and technical instructors.

Clinicians PAM starting salaries are clearly uncompetitive w i th the starting

salaries of alternative occupations. Graduate starting salaries offered

Salaries of PAM managers compared with basic salaries and total earnings of managers in the economy as a whole: 1988

30 361

I

Max imum salary for PAM managers ,g Basic salary - Lower quartile [I] Basic salary - Median

Basic salary - Upper quartile 0 Total annual earnings -- Average

Function head Senior mnn.igement I Senior management II Middle management I Middle management II - 67 Physiotherapy, January 1989. vol 75, no 1

by employers, other than the NHS, are substantially more than €8.000. The latest data for 1388 from the Central Services Unit show that 90% of the 29 different types of employer offered average salariss above €9,000. Comparisons w i th a range of other occupstions (which have similar or lower educational entry require- ments) in the public sector confirm this disadvantage. Graduate teachers now start on a minimum of €8,235 while a professional and technical officer in the Civil Service wil l start 01: E8,751.

Salaries paid to qcalified PAMs in industry are far better than those in the NHS. Better salaries abroad, particularly in the USA, Canada and Australia, may be encouraging PAMs to work abroad.

The NHS must ensure that starting salaries for PAMs are competitive wi th the saiary of graduates generally, in order to attract sufficient nunibers into training. It must also ensure that salaries and career prospects for experienced PAMs are sufficiently attractive to retain them within the NHS and attract back those who have left.

and retention issues and the need for substantial increases in pay to help overcome general and widespread shortages of physiotherapists.

Managers All superintendents/chiefs!heads have a significant managerial

coqocnetit: to their work. Their current salaries are comparatively low and continue to coJnpa;.e unfavourably w i th the salaries paid to managers in the economy as a whole, as indicated by the British Institute of Management's survey this year.

PAM managers within the Health Service are obliged to cope with many conflicting pressures. They are frequently responsible for deciding who wil l receive treatment and how quickly. They have to maintain morale and help resolve the growing workload pressures on their staff.

Ditferentiais for PAM managers have contracted over the last nine to ten years, whereas those of managers in the economy generally have increased. Furthermore PAM managers do not receive bonuses or cars, which are an important part of the overall remuneration package in other sectors.

PAM managers are 30%-60% behind their comparators in the rest of the economy. This is clear evidence of the need to increase their salaries substantially.

Teachers l h e Staff Side believes that teachers in the NHS should have

salaries and conditions of service equivalent to those in the higher education sector. Failure to match NHS salaries wi th those in higher education wil l be to run the risk of a continuing loss of teachers from NHS schools. Evidence in Paper 1 shows that for occupational therapy, physiotherapy and radiography, the level of shortages and frozen posts in NHS schools is almost twice as high as in higher education.

Len Peach has stressed that the maintainance of the supply of newly-qualified PAM staff is essential to the NHS. This supply is dependent on adequate numbers of senior clinicians being attracted into teaching and retained in teaching. If the NHS is to compete effectively for these staff i t must offer salaries at the same level as those in further and higher education.

Furthermore the salary scale for qualified nurse teachers (grade I in the new nursing structure) is significantly higher than that for PAM teachers, despite the fact the work of PAM teachers is mote advanced. This anomaly is a further reason for pressing for a substantial rise for the PAM teaching grades.

Finally, we ask i h e Review Body to recommertd the adoption of the pay and conditions of service for polytechnics and colleges, for PAM teachers, although we recognise that the negotiations on conditions have to take place in the Whitley Council, not the PRB.

Britain have risen to 9.1% of funded establishment and that temporary frozen posts account for a further 1.1%. Thus there were mgre than 10% of physiotherapy posts unfilled at March 31, 1988.

Allowances We remain strongly in favour of retaining separate allowances for

PAM staff because they are an incentive and reward to individual members of staff who undertake additional hours of duty or carry additional responsibilities. Allowances should be significantly improved and thereafter their value maintained by a link to annual salary increases.

Emergency duty: Our members have heavily criticised the current low rate which they feel is totally inadequate compensation.

Special duty: We ask that these be restored to 1 % and 1% in line with the pattern in most of industry.

Student training: This allowance is essential to the quality and organisation of student clinical training. Its retention and increase in line w i th the national agreement is vital if the NHS is to train the numbers of PAM staff it urgently needs.

Differentials and Career Progression We believe that differentials between the grades in each of these

professions have been compressed too far and that generally progression up the career structure is slow. This progression is far slower than that of the typical graduate. Other groups within the NHS, eg dentists, although they have broadly similar entry and length of training, because they are historically 'male' professions are paid substantially more than PAMs which are historically 'female'

We comment on particular allowances as follows:

professions.

Comparison of salaries for teachers in NHS ''1 and higher and further education: 1988

27.

24-

NHS schools 8 Universities

Furtherlhigher education Central institutions

Promoted post Principal of school/ Lecturer Hesd of department

The Chartered Society of Physiotherapy I988 Evidence to the Pay Review Body

68 physiotherapy, January 1989, vol 75, no

We also know that demand for physiotherapists is continuing '0 expand.

We remain extremely concerned about these shortages not only because of the detrimental effects they are having on patient services but also because of the detrimental effects on existing staff. Our evidence shows that these shortages are general and widespread, and not confined to particular locations or specialties.

We have not been able to undertake a survey of morale among physiotherapists this year because of the constraints placed upon us by the revised timetable for early submission of PR8 evidence. However we have a wealth of anecdotal evidence pointing to the depressing effects on staff of ever-increasing workloads. We do not think that morale has improved during 1988 but we believe that had it not been for the Review Body's award this year, it would have been substantially worse. The effect of the continual resource problems in the NHS and uncertainty about its future should not be under-estimated. The NHS is a particularly stressful organisation in which to work at present.

The Society fully supports the PT'A' Staff Side's proposals. The main conclusions of the Society's evidence are:

Demand and Demographic Change There is a growing imbalance between the demand for and supply

of physiotherapists. As a demand forecast, the 28% overall increase in physiotherapy posts for the decade 1984-1994 forecast in Regional Strategic Plans is a conservative estimate. We estimate that even on modest assumptions, funded establishments wil l probably have increased by 4 0 % in the decade to 1994. Growth of staff in post will however be slower unless substantial efforts are made to improve supply.

The drop in the number of school leavers will mean more competition between professions to attract these school leavers into training. The NHS will also be facing more competition for physio- therapists as the private sector expands and more physiotherapists go abroad.

There are three urgent requirements if the NHS is to have sufficient physiotherapists for the future: 1. To maximise the output of trained physiotherapists. 2. To retain more physiotherapists in the NHS. 3. To attract back qualified physiotherapists into the NHS.

Work already carried out by the Manpower Planning Advisory Group suggests that the NHS employs only 54% of all qualified physiotherapists under 65.

Although pay is not the only issue which needs t o be addressed to improve the supply of physiotherapists, it is of major importance. Substantial improvements in salaries are required if the NHS is to stand any chance of meeting its need for physiotherapists.

Recruitment and Retention We do not believe that the Health Departments are justified in

being apparently so complacent about recruitment of physio- therapists. There is now a greater number of vacant posts in physiotherapy than in occupational therapy. Vacancies and frozen posts for physiotherapists have continued to rise this year to over 10% of funded establishment.

The major source of recruitment of physiotherapists is from the newly qualified, but our evidence shows these are now insufficient to make good the number leaving the NHS each year. More attention should be paid to retaining and recruiting back qualified physio- therapists. Improved pay is a crucial element in this strategy.

Regional Pay We do not accept that the discretionary payment of local premia

will help correct physiotherapy shortages. Our evidence shows that vacancies for physiotherapists are widespread and not confined to a particular Region, grade of staff or area of work. Local discretionary payments would inevitably lead to large-scale poaching of staff from one NHS employer t o another.

Funded Vacancies and Frozen Posts Funded vacancies and frozen posts for physiotherapists have

increased over the last three years, both on a matched and unmatched basis. The combined level as at 31.3.88 stands at 10.2%. Just under half of the vacancies are in the newly qualified grade with most of the others in the senior I and senior II grades.

Over 45% of vacant posts have been vacant longer than 13 weeks and most Regions show a similar pattern of vacancies over time. All Regions have problems of very long-term vacancies, ie over 38 weeks.

Staff Recruited and Staff Leaving Staff leaving health authorities as a proportion of funded

sstablishment have been steadily rising since 1985/86. We think :hat it has now reached a proportion which could be damaging to :he effectiveness of departments. The number of physiotherapists eaving the NHS to go abroad continues to increase, with the greatest osses occurring from the physiotherapist grade. There are further osses t o other employment as well as permanent losses due to retirement and ill-health. Most recruitment to the NHS comes from the newly qualified, and only comparatively few experienced physiotherapists are attracted back.

We believe there is ample evidence of serious and widespread recruitment and retention problems for physiotherapists which point to the need for substantial improvements in their salaries.

Teachers Our survey of physiotherapy teaching manpower shows that the

serious shortages of NHS teachers worsened again this year. Maintaining student intakes despite these shortages means that NHS teachers' workload pressures are increasing. Yet their pay is less than their counterparts in higher education, where shortages are less serious. There is no justification for this difference in pay.

Throughout our evidence we have emphasised the pressing need to boost the supply of qualified physiotherapists. Training adequate numbers of students is impossible without adequate numbers of teachers. It is crucial to reverse the national shortage of teachers. Improved pay will encourage moves into teaching, and the retention of skilled teachers in the NHS.

Newly Qualified Staff The preliminary results of our student survey show that a small

but significant proportion (8.6%) of newly qualified physiotherapists do not obtain employment in the NHS. With the high cost of training each student, such losses are expensive. Competitive starting salaries are essential to attract the maximum number of newly aualified recruits to the NHS.

Funded vacancies by grade at March 31, 1988

Grade Whole-time As a percenfage of

District I 2.0 5.3 District II 7.0 5.5 District 111 2.0 9.1 Superintendent I 0.0 0.0 Superintendent II 3.2 2.5 Superintendent 111 32.0 4.3 Superintendent IV 13.7 2.7 Senior I 198.7 6.1 Senior II 250.0 8.2 Physiotherapist 479.8 16.6

Total 988.4 9.1

equivalent funded establishment

Funded vacancies by area of work at March 31, 1988

Area of work Vacancy whole-time equivalents

Hospital based: Acute Geriatrics Mental illness Mental health Paediatrics Obstetrics Out-patients

Total hospital

Total community

Unclassified (includes rotational posts)

277.4 115.4 48.3 61.5 38.8

7.2 100.1

648.7

49.2

290.5

Grand total 988.4

03 03 z rc: z cd m

CO

03 03 z h w g cd z 00

.. C 0 .- En B r v)

v) 0

C a N

y.

y.

n c

n

2 0 Q 0) m C a c

2 r?

+ - z X 0

0 a cn 0 Y I-

ln

- 2 E a

2 r?

VI

$ c

W ln

VI

$ I-

1 1 1 / i l l 1 1 I I / / I 1 i l I I I I I I I I I I I I I I I I I I I I I I I I I I I I T " p?

m m - C

w a

l l l l l J I I l l l al

w l c m m m m

I 1.

70 Physiotherapy, January 1989, vol 75, no 1