REPRESENTATIVES' CONFERENCE This is a report of the second half of the Annual Representatives' Conference held in Blackpool in September. The first part was published in the November issue of Physiotherapy. The chairman, Mary Murphy, congratulated all speakers on the delivery of their speeches, and thanked her vice-chairs, the CSP Events Unit Staff and the students of the Salford School of Physiotherapy who had stewarded the Congress. Paul Lynch, who was elected chair of next year's Conference, thanked Mrs Murphy for her expert leadership.

Industrial 34. It should become Council policy that any change in working practices in any hospital department must only be brought about following consultation and negotiation wi th the CSP accredited staff representative.

There should be a formal network of communica t ion be tween staf f and physiotherapy managers through the accredited staff representative to discuss any changes to their existing industrial and professional practice, said Hector Walker for Mersey stewards.

In today's climate change was an everyday occurrence. To cope with this there had to be a new forum for discussion. Managers had brought in their own arrange- ments by introducing local bargaining t h rough self-governing Trusts .

Currently he said there was a 'widening rift ' between physiotherapy managers and staff, having a detrimental effect on staff morale and motivation.

Mark Draper for Mersey stewards saia behind-closed-doors discussions between physiotherapy managers, senior staff and directors of physiotherapy to change working practices could only lead to mistrust and insecurity of staff. Stewards should be involved at every stage of these discus- sions.

Speaking for the ADSCP Avril lmison said she was saddened to think that the relationship between stewards and managers was so bad. She supported the motion in essence and said she always discussed matters wi th her stewards. But she objected to, in effect, Council telling her how to run meetings. Problems should be worked out locally.

Marian Morrison, for Northumberland Branch, said communication was a two- way process. Very few managers were against stewards and she urged: 'Go out there, ask questions and get yourself a high profile.'

For Scottish stewards Wendy White said a policy like the one proposed would be enabling, not restricting.

The motion was carried.

Relations 35. With the loss of statutory rights that occur when working for fixed-term contracts the CSP should actively discourage its members from undertaking work under such contracts.

Judith Turner for South West stewards pointed out the danger of fixed-term contracts through the loss of statutory rights. With the rapid turnover in staff that these contracts encouraged, the chance of individual appraisal and objective assessment of the quality of care were limited. The CSP should, while maintaining responsible use of fixed-term contracts, limit their expansion.

Sally Adams, for Trent stewards, said she was working in a research unit and everyone was on a fixed contract. In some situations fixed-term contracts were the only option.

Speaking for the ADSCP, Janette Ryder said some of the changes in the NHS could provide advantages for physiotherapists. Opportunities were opening up for physio- therapists to negotiate what they wanted.

Val Noble from Plymouth Branch said that without fixed-term contracts, staff would be working a 24-hour day.

Gerard Hargreaves representing Northern stewards, asked how rank-and-file members would be expected to know exactly what their terms and conditions were. 'I am sure everybody doesn't know their own.'

Audrey Smith from Croydon community services told of a physiotherapist who returned to work after maternity leave and was offered only a six-month contract. At the end of this six months there might not be funding for the post. ' I think this is very unacceptable.'

On a point of order, Tom Donnelly said on behalf of the Industrial Relations Committee that if fixed-term contracts were being used in place of and to remove posts that already existed, this was unacceptable. But in other circumstances there were technical reasons why such contracts might be appropriate. He asked that the motion be remitted to Council.

The motion was remitted to Council.

Key to Acronyms AACP ACPIN

ACPOG

ACPRC ADSCP

OCPPP

Acupuncture Association of Chartered Physiotherapists Association of Chartered Physiotherapists w i th an Interest in Neurology Association of Chartered Physiotherapists in Obstetrics and Gynaecology Association of Chartered Physiotheraists in Respiratory Care Association of District and Superintendent Chartered Physiotherapists Organisation of Chartered Physiotherapists in Private Practice

36. This conference is concerned about the erosion of employment rights within the 'new look' NHS. We urge the CSP to forge links and support groups w i th other health care workers' representatives, both locally and nationally, to safeguard employment rights and conditions of service within the National Health Service.

Karen Bruce, on behalf of Tayside Branch, called for the barriers between different health care groups to be broken down. She asked for guide lines from the CSP on how to forge further links. Locally, she urged physiotherapists to become aware of and involved in how other groups were facing up to the changes in the Health Service.

For North East Thames stewards Sarah Thorley said she would like to think that as a steward for four years she had been doing what the motion suggested. ' I would hate to think there are other stewards who aren't doing exactly the same thing as well.'

Ronnie Paul from East Essex Branch, speaking as a District steward, supported the motion because there should be strong links with other groups. However, he pointed out that a number of formal links already existed.

Scottish steward representative Tom Donnelly said there had to be as much co- ordination and co-operation as possible.

The motion was carried with three votes against.

37. With Trusts having policies that will eventually lead to pay and conditions of service being negotiated locally, the Chartered Society of Physiotherapy should promote uni ty between physiotherapy managers and stewards t o ensure that the skills and knowledge of both are fully utilised in these negotiations.

In the new Trust environment, Shirley Rainey for South West stewards said stewards had difficulty with the changes and were unsure about things like business plans, budgets, and forecasts. Physiotherapy managers knew about these things. But were they poachers or gamekeepers? Were they representatives of the profession or senior managers of the Trusts?

Stewards needed to be able to negotiate on as equal a footing a's possible. There should be no conflict between the role of physiotherapy managers and CSP stewards.

Suporting the motion, Avril Imison, ADSCP, said managers did have a dual role and they were under pressure to follow the strategic plan of the Trusts. The vast majority, however, recognised h o w important it was that staff were happy and motivated.

From the Industrial Relations Committee, Catherine van de Ven said a recent committee briefing paper advised managers always to speak to their stewards.

Joyce Davison, a CSP senior industrial relations officer, said four workshops had been set up specifically for managers and stewards in the second wave of hospital Trusts.

The motion was carried unanimously.

839 Physiotherapy, December 1991, vol 77, no 12

Other Conditions 38. The Society should strongly resist the imposition of confidentiality clauses in contracts which affect the members’ rights of free speech.

Tom Donnelly of Scottish stewards, said staff being offered new contracts under Trusts were being asked t o sign a confidentiality clause. Every professional body had its own code of conduct to protect patient confidentiality. The inclusion of the clause in contracts came down to gagging individuals from stating what was wrong with the service.

Health authorities were public bodies and their business should be in the public domain. Confidentiality clauses were infringements on the right of free speech.

From a personal point of view, Janette Ryder, ADSCP, said that because of the new competitive element in the health service, senior managers might be asked to sign such a clause relating to business matters. ‘However, I think it would be inappropriate to ask staff to take on board the same sort of confidentiality clause.’

The motion was carried unanimously.

39. The CSP should campaign for NHS hospitals t o promote better staff develop- ment and improve staff morale by improving long-service leave, sabbaticals and staff exchanges.

South West stewards’ representative Maggie Morris said the present emphasis in the Health Service was to get someone to do the job as cheaply as possible. Improved staff development would help maintain profes- sional standards of care and do much to boost morale.

Speaking against the motion Avril Imison, ADSCP, said the problem with long-service leave and sabbaticals was that short-term contracts had to be brought in to cover when staff were away. Physiotherapists had to be very careful about the amount of leave they asked for and the use it would be put to. While agreeing with the principle, she cautioned that it could have disadvant- ages.

Avis Gilmore of North West stewards pointed out that w i th the advent of local bargaining and some of the existing agreements, physiotherapists already had the mechanism t o negot iate staf f development improvements. The motio’n was carried.

CSP Organisation

Industrial Relations 41. Conference warmly welcomes the decision by Council to have an open and considered debate on TUC affiliation and strongly urges that the membership be balloted as early as possible.

TUC affiliation was too big an issue to be decided by Council alone, Scottish stewards’ representative Tom Donnelly proposed. It had to be decided by members. The issue was not whether the CSP should be affiliated but that there should be a vote. A ballot should be held soon so that the CSP knew what its strategy would be when the second wave of Trusts came into being. ’If we don’t actually get a seat at the table then we really are in trouble. Membership of the TUC would help us get in there.’

Giving a personal view, Pat Sutton, ACPOG representative, said the TUC supported the election of a socialist government, had an anti-NATO, uni-lateralist defence policy and on some conference decisions relating to Japanese companies, she said, it was a racist organisation. ‘Do you want to be associated with a movement that has a disgraceful record of collaboration with Russia‘s KGB-run unions?’ Representatives clearly disagreed and on a point of order it was suggested that these arguments were irrelevant to the motion.

Avis Gilmore of North West stewards said it was unbelievabie that there could be disagreement over whether members were to be balloted on such an important issue. She urged that a a ballot should be be held as soon as possible.

Speaking on behalf of Mid-Essex stewards, Kirsty McCarthy said there was everything to gain and nothing to lose.

The motion was carried.

42. The time is now appropriate for the Chartered Society to consider the necessity of separating the functions of the profes- sional body, which should be neutral in its support for the whole membership, from its trades union function, which, by definition, is limited t o supporting only those physio- therapists who are employed.

Organisation of Chartered Physiotherapists in Private Practice representative Frances Harris said the Industr ia l Relations Department had displayed leaflets at the conference on such topics as transfer and promotion, car users, mileage allowances, but not about working in a contracted-out hospital or how to employ an assistant in a private practice. The motion should not be seen as demanding a change of stance of industrial relations. It was not about weakening the strength of its stewards. It was not a threat but a development.

She urged that a fully representative working party be set up to review how best the Society could offer what members needed to know, how this information could be delivered and to consider alternative strategies to satisfy the needs of the membership.

Fiona Jenkins, for Welsh stewards, said members had gained greatly from having a Chartered Society as the united voice of the professional body and the trade union.

The motion was about the management of change said Jean Kelly, speaking for the OCPPP. She asked members not to be defensive. ’If you feel threatened in your world, consider how we feel as independent practitioners.’

The strength of the CSP was in its unity, Avis Gilmore of North West stewards believed. If the t w o funct ions were separated, would physiotherapists want

to join and pay membership to both? She urged rejection.

Jan Williams, from Cornwall, said it was dangerous to suggest that individual practitioners would have any power in the market place. The political climate had been to divide and rule. She urged that the professional body and the trade union parts of the Society stay as one.

As a private practitioner in Wales, Trudy Hills said she wanted to see private practitioners, which made up about 10% of CSP membership, having a fair share of the resources.

The motion was lost.

43. The CSP should become actively involved in distance learning, t o enhance the stewards’ ability t o negotiate.

Stewards needed to be kept up-to-date wi th the rapid changes taking place in the Health Service, said Alun Davies on behalf of Wessex stewards. The CSP training days were excellent but they relied on stewards being able to attend. The original proposer of the motion, who had t w o staff on sick leave and t w o staff vacancies, could not leave the department to be at the Representatives’ Conference. Many stewards were daunted by the prospect of pay and conditions negotiations. The suggestion was for a correspondence learning package to be established. This would also help consolidate learning for stewards who had attended courses. While recognising that this would not be as good as face-to-face tuition, it could be the answer to a problem that looked set to increase.

Fiona Jenkins, Welsh Regional steward, said the General Whitley Council gave stewards the right to time off for meeti gs In Wales some stewards had to travel 2vei four hours to attend. Correspondence had a place but it could not replace regular meetings.

Speaking for Manchester Branch Janette Standring said she appreciated the problems with time off but stressed that negotiating skills could not be learned in a corres- pondence learning package.

Jan Williams, from Cornwall, said she was involved in a distance learning course that was very helpful. The motion was about enhancing learning.

Linda Austin, CSP industrial relations training officer, explained that time off for trade union duties and training applied only where the CSP had been recognised. The CSP was fully committed to providing appropriate training for stewards, particularly those involved in local bargaining. The CSP was also committed to and was developing further distance learning packages. She said the CSP wanted to encourage stewards to attend courses to learn the negotiating skills they so vitally needed.

Janette Ryder, ADSCP, said most managers would welcome their stewards attending training courses as there was no th ing worse than an i l l - informed steward.

The motion was carried.

~~~~ _______

840 Physiotherapy, December 1991, vol 77, no 72

Subscriptions and Services 45. In these times of change within the NHS, physiotherapists are demanding more from their professional body. The CSP should increase subscriptions to enable it to fulfil this need. (Composite motion.)

Chris Mercer, for South West London and Kingston Branch, said an increase in subscriptions would be money well spent. A rise would help fund an expanded, well- staffed Industrial Relations Department. What was needed, he said, was a massive injection of funds to train and maintain a forceful, vocal industrial relations front.

’You only get what you pay for,’ said Anne Alder for the Northern stewards. ‘If we want to keep our local stewards well supported we all are going to have to pay for it.’

Wendy White, Scottish stewards, said that if Conference supported the motion, then representatives must educate the staff they worked with on the good job being done by the CSP.

Jean Kelly, OCPPP, said she agreed w i th the increase in subscriptions but that the debate was centring only on the work of the Industrial Relations Department.

From London, Elaine Pye pointed out that many of the motions voted on previously placed extensive demands on the Society. The officers and standing committees needed to have the means to address these issues.

Patricia Kehl, of East Surrey Branch said that no matter how much money was put in there would always be more work to be done. There was a danger that the membership of part-timers would be lost through increased subscriptions.

The motion was carried.

46. The CSP should consider the devel- opment of a management department at Bedford Row to assistladvise and work with physiotherapy managers in a positive manner t o support the devolution of management of physiotherapy t o a lower level of superintendent.

Carolyn Roskell of the Association of Chartered Physiotherapists in Respiratory

Representatives fortify themselves between sessions

Care proposed suspension of standing orders to allow an amendment to the motion, which had been proposed by the Association of District and Superintendent Chartered Physiotherapists. This was agreed and the amendment was carried so that the motion read:

The CSP should consider the development of a management department at Bedford Row to assist and advise and work w i th physiotherapy managers in a positive manner to support those staff, regardless of grade, who find themselves in a manage- ment role due to structure changes (eg absence of District physiotherapists or a higher level of superintendent).

Proposing the new motion, Janette Ryder, ADSCP, said physiotherapists had always shared skills, knowledge and expertise, which had been the foundation of good professional, clinical and management practice.

The CSP should provide an opportunity for physiotherapists to network and pool knowledge and resources. The current expertise of physiotherapy managers must be retained in the profession.

The new department would be a resource centre, providing management information and education in resource management, financial management, marketing, manage- ment of change, professional and staff development and interviewing.

Jean Kelly said the OCPPP had been asking for exactly this sort of assistance from the CSP for years to help independent practitioners. Requests had been refused, she said, unless independent practitioner members met half the cost of the staff that would be involved.

For West Midland stewards, Sandra Hicken said managers should be supported to have a high profile within the NHS. ’But we should not be allowing senior Is to be in such management positions that they are in change of whole departments and services.’

Susan Jackson, ADSCP chairman, said the Society had been guilty in the past of trying to fight issues and not supporting those members who were already facing the problems. They needed more support than could be offered by the ADSCP.

The motion was carried.

47. The Chartered Society should review the insurance cover and legal support provided for i ts membership.

The majority of NHS physiotherapists do some work outside the Health Service, either for a fee or salary or on a voluntary basis, said Philip Racle for the Organisation of Chartered Physiotherapists in Private Practice.

In these areas there was no health authority vicarious liability. In the current climate of increased litigation, the question of adequate cover was more pertinent than ever. Cover offered for treatment risks was not a problem. Difficulty arose with the possibility of criminal or civil action.

Currently €4.80 of subscriptions was spent on insurance. For a physiotherapist to be a member of the Medical Defence Union, the cost was €250. As well as the tnental anguish suffered during litigation,

there could be the added possibility of financial ruin, which would result in a ’personal disaster of some magnitude’. The problem was much greater now than when i t was first raised 23 years ago.

Toby Simon, CSP Secretary, said that Council was happy to accept the motion. The Society was arranging to meet the MDU to talk about the services it offered. He said the CSP offered a legal advice and assistance scheme for risks other than those covered by the professional liability insurance. This included defence against civil or criminal allegations of impro- priety in practice.

Mr Simon warned that CSP had not undertaken, however, to write a blank cheque that it would pay any damages awarded: but he understood that the MDU did not do this either. Decisions were made on a discretionary basis in both cases.

The motion was carried.

Emergency Mot ion 1. Council should reinstate the International Affairs Committee and look again at its methods of reviewing the structure of its standing committees in order that decisions taken can be seen t o be fair and for the advantage of the membership.

Moving the motion, Devon Branch represen- tative Frank Martin, former vice-chairman of the International Affairs Committee, said the Branch felt the disbandment of the group had been unfair and was not in members’ best interests. There was now no central reference point and the fear was that international affairs would not maintain a high profile. The timing of the disbandment around the time of the World Confederation for Physical Therapy Congress, hosted by the CSP, was embarrassing.

’To reinstate the International Affairs Committee would show that Council is acting in a credible way both nationally and internationally.’

Susan Jackson said international affairs pervaded the whole of physiotherapy practice and needed to be on the agenda of every single committee. International affairs had been put high on the agenda of the committees and she urged that these important issues should not be relegated to a small, minority committee.

Sasha Mayes, student member of Council said that after she gave a speech to the WCPT, representatives from about 20 countries had told her they looked to the UK as an example. They could not believe the committee was being disbanded. ’What happens t o the concentrated nucleus of experience that was gained in that committee?‘ she asked.

Speaking against the motion, Janette Ryder, ADSCP, said she understood that international affairs would have a high priority on the other committees.

North East Thames steward, Claire Strickland, believed the committee should not be re-instated.

Tom Donnelly, for Scottish stewards, believed the Council view that international affairs should be spread throughout the committees was correct. Flexibility was needed, and if necessary, a sub-committee could be set up to look at particular issues but that a standing committee was not necessary.

The motion was lost. ~~~

Physiotherapy, December 1991, I/o/ 77, no 72 841

Council, Branches and Boards 50. With the abolition of District physio- therapists and the arrival of director of therapy services posts within the NHS, the CSP should bar any Chartered physio- therapists who fill these posts from holding NHS seats on Council.

North East Thames steward Sarah Thorley said it was important to have a fair representation of members who work i r i the NHS on the CSP Council At present oirly eight seats were guaranteed for the vast majority of physiotlierariists tiistoricallv these had beer1 taken by seriior irianagers She suggested that i f a post could be he ld by someone other than a physiotherapist, then the postholder should not have an NtiS seat on Council ’Let us try and ensiire that the voice Council hears is the one of the working physiotherapist.’

Susan Jackson, District physiotherapist. Warrington, was concerned by the motion. Stipulating that a Council seat should be held by someone wliose lot) rould orily b~ done by a physiothsrapi\t ~ o i ~ l r l [,iit a t risk the representation of some members There were areas of work, i i i wheelchair or hand therapy, where the work was being done by physiotherapists and occiupational therapists.

Speaking i i i favour, Fiona McGrath, a North East Thames steward, said that for directors of therapy services to take up NHS seats on Council was unfair. The grassroots of the inrofession ~ the clinical grades of staff needed representation.

Patricia Kehl, East Surrey Branch, said that as a democratic Society the membership voted for Council She said members should not be considering a ban on anyone.

Speaking as a steward, Ronnie Paul, from Fdst Fssex Branch said the motion was coiicerried w i th directors of therapy services, who oil one day would be at a Council nieetiny representing physio- therawsts and on another making a decision 011 whether to make an occupational therapist or a physiotherapist redundant. This was not promoting physiotherapy within the NHS.

Avis Gilmore of North West stewards questioned the relevance of the motion. She said there was ti discussion paper on the structi iw of Co mril in circulation.

At the suggestion of the Secretary the rriotion was remitted to Council for consideration as part of the review of the strcirrrire of (-0iii1ciI

-~ ___I.. - - ”

THE FOLLOWING TWO MOTIONS WERE GROUPED FOR COMMON DEBATE

51. The 1990 survey showed that members of the CSP believe that the Branch system is important. If the system is to remain active and healthy, more central support should be available to the Branches so that they can appear as professional as the parent body.

Ronnie Paul of East Essex Branch said the Branch system could crumblc. without more support from the CSP. Brarich members undertook many roles, including book keeping, secretarial work and comn-iittee business. They worked tirelessly for no reward and needed help. To be more professional they needed better and more frequent Branch officer courses, more help from the Public Relations Department, more pre-registration information for students to encourage them to attend Branch meetings, increased space in the Journal and increased funds for Branches, perhaps through a Branch levy.

52. Due to the increased workload and greater commitment asked of Branch officers, the CSP should consider part-time reimbursement for physiotherapists who could then offer more time to Branch administration. This would allow Branches to become more professional and run more profitably

For too long people carrying out Branch work had been relied on to be good sports and to muddle through said Ronnie Paul from Fast Essex Branch Considfwtiori stinold be q ivw to providing them with a small reiinbuise ment of expenses

Debate On behalf of the Shropshire Branch

Gail Woodmansey said that froni personal experience she joined tier Brdiicli dnd within six months became chairman She said she

felt out of her depth and that it was vital that Branches were given more assistance.

Avis Gilmore of North West stewards said that in her Branch they were pleased w i th an attendance of 25 out of a membership of 450. The whole Branch system needed to be looked at and the Branch officers should consider what they were doing and how they could attract more members.

North East students’ representative Sarah Jacklin said that there had been little contact between students and Branch, but it was students who would be running the Branches in the future.

As secretary of Teesside and District Branch, Kay Butters said part of the problem was the apathy of the members. It was up to the members to make the Branches more dynamic.

Janette Standring for Manchester Branch said that in her Branch they had tried to get a student member and could not fill the post.

The first motion was carried and the second motion was lost.

54. Branch members should not be expected to pay for public relations material and informative literature produced by the CSP. These should be funded by sponsorship.

Sponsorship should be sought to pay for public relations information and literature produced by the CSP, Sue Nottingharn of Worcester Branch proposed. It should not be funded by individual Branches or departments. She said she did not like to charge patients for information leaflets. Thousands of leaflets were bought by national and multi-national businesses and companies and she suggested any deficit could be passed on to them, leaving physiotherapists able to give patients the

information free Sponsorship, she said, was a possible way forward

But Marian Morrison, from the North umberland Branch, cautioned against physiotherapists seeming to be endorsing a product in the eyes of the public

Stuart Skyte, CSP director of public relations, outlined how difficult i t was to get sponsorship He said a new leaflet on sport was due out soon which had been sponsored by Crookes Healthcare But he asked why physiotherapists should sponsor the NHS themselves Hospitals had large health promotion budgets He also pointed out that many leaflets were available free it was mainly those related to health promotion that were charged for

The motion was lost

Specific Interest Groups 55. In order to become a member of a bona fide Specific interest Group, all persons wishing to join that Group should have completed a validated course recognised by that SIG.

There were, said Deirdre Robottom, representing Gloucester Branch. 17 Clinical Interest Groups and five Occupational Groups within the CSP. The advantages of accepting the motion would be a rise in professional standards and recognition of skills by peers and other professionals. The open access system of membership was not in any way selective. Members who had validated certificates had the same status as those who did not.

Fiona Hawkins, for North West stewar s, said most SlGs survived on the sh I er enthusiasm of their members and if entrance was limited to those with accredited courses they would become small, elitist and very lonely groups.

Supporting the motion, Theresa Bail, chairman of the Northern Branch of the MACP, said that at the moment the only way to prove a standard of care was with a paper qualification. Attendance on a course was not enough. There had to be an absorption of knowledge and evidence that practice and standards had changed to improve care.

Giving her own view, Jill Bailey, Man- Chester Branch representative, said she was prompted into doing a validated course after she had been part of a SIG for some time.

Helen Currie said ACPOG had adopted the policy outlined in the motion ten years ago. Anyone could become an associate member of the group, including other professionals, but to be a full member, Chartered physiotherapists must have completed the validated course in obstetrics and gynaecology. This has maintained a high level of knowledge, skills and credibility.

ACPIN representative Ruth Garnham said the group tried to develop professional and clinical standards for physiotherapists wi th a range of experience and promote interest and enjoyment in the specialist area. She said the group valued the contribution from therapists from all levels of experience. She could not agree with the assumption that specialist skills were purely course-based.

Chairman of ACPOG, Jill Mantle, said ACPOG Ireland had converted its foundation course to a postgraduate diploma and full

842 Physiotherapy December 1991, voi 77, no 12

membership was given only after successful completion of the course. But as a result there were few members and the group was floundering. She said the Association did not want to follow the Irish example and was considering a less daunting, modular accreditation system.

'SIGs should be involved with accredited courses but not limit their membership to those who have passed them, producing exclusive clubs for physiotherapists,' said Frances West of ACPRC.

The motion was lost.

56. The CSP should offer Specific Interest Groups professional and secretarial support proportionate to the amount of work undertaken by them on behalf of the CSP.

The role of Clinical Interest Groups was to increase and promote the clinical and professional standards of the specialism at local, national and international level, said Lesley Scurlock, representative of the Association of Chartered Physiotherapists Interested in Neurology. Many additional hours were spent organising lectures and study days, preparing clinicdl standards, c i rculat ing in fo rmat ion arid wr i t ing newsletters to keep members up-to-date. There were inevitable commitments when joining a CIG but she was concerned that the growing demands put upon them by the CSP were draining the resources of members.

Some of the ways they could be helped included the use of computer systems, secretarial support, photocopying and printing facilities, and help wi th collection of membership fees. She suggested the cost could be covered by an increase in subscriptions.

Supporting the motion Jennifer Mitchie, of the Association of Chartered Physio- therapists in Palliative Care and Oncology, said the group, which was set up two years ago had about 100 members, needed money for courses, administration and travelling expenses and had to rely on other organisations for financial help.

Carolyn Roskell agreed with the concept of support for SIGs, but was unsure about the practicalities of the motion. As secretary of ACPRC she could vouch for the many hours spent on work for the Group. But many matters had to be dealt wi th on the spot. Unless knowledgeable secretarial support was on hand, it could be more troublesome to have the work done elsewhere.

It would be better to have rumuneration for these duties, and more support from employers would also be appreciated.

Yves Dereix of the AACP also agreed with the motion. Ensuring that standards of acupuncture carried out by physiotherapists were maintained was very time-consuming.

Teresa Ball, chairman of the MACP Northern Branch, said she had heard again the argument that the MACP was elitist. The group wanted to spread the word so that everyone's standards improved. Currently MACP members were giving up their free time to train others. If they had more support, they could train more people and membership would rise.

Avis Gilmore, a North West steward, said she could not support the motion when a previous motion to help the Branches, which represented all members, had been rejected.

The motion was lost.

CSP Representatives' Conference 59. As all motions carried at conference are referred to Council, all members of Coufwil should attend conference to be fully aware of members' views.

Katherine Fairgrieve, representing Scottlsh stewards, said Council members should be present at the Conference to hear the views expressed Members, she said, relied on the Council to act on what they heard at Conference.

The motion was carried

'60. The Agenda Committee should amend the standing orders so that motions put forward but not debated at the previous Representatives' Conferences would be raised in the primary agenda in the subsequent year rather than being remitted to Council. The Cambridge Branch feels that last year time precluded important issues from being debated. (Amended moti0n.i

Jane Warrington from Cambridge Branch said that inotioiis which were not debated at Conference were dealt wi th as though they had been remitted to Council. Last year 20 motions were not debated due to lack of time. The issues should be debated at Conference level and not round a committee table. The Branch felt that motions not debated should be raised in the primary agenda for the following year. It was important that professional issues were discussed and voted on by members.

For Scottish stewards, Wendy White pointed that if the motion was accepted then motions not discussed would be put back for a whole year. Many of the motions were relevant to what was happening at the time.

Sandra Hicken, West Midland stewards, said there could be up to 18 months to wait, as motions were drafted locally, some months ahead of the conference.

'How can we leave a topic to be debated next year?' asked Pauline Betteridge, on behalf of Yorkshire stewards. She said the NHS was changing all the time, with people not knowing what would happen in six mo r i t h s.

Southampton and North West Hampshire Branch representative Nina Melville said she had proposed an emergency motion last year which was submitted to Council. This had been re-submitted in a slightly different form and had not been debated this year either because of lack of time. This illustrated there was a real problem.

Paul Lynch, chair elcct of next year's conference, said there would be a problem if the motion was passed, w i th the automatic inclusion in the fo l lowing year's agenda of motions which could well be out of date. He said there might be alternatives to automatic remission and he committed next year's Agenda Commit- tee to considering these.

The motion was lost.

61. l h e timescale for the submission of motions for the Representatives' Conference should be altered to allow for any rejection of a motion to be made in writing to the proposers. The reasons for the rejection should be stated within the written response. This would enable the motion to be re-submitted where possible and not lost for another year.

As new members might be required to draft and present motions, there was the problem of previous mistakes being repeated and motions being lost which had specific relevance at a critical moment in time, said Jean Kelly, of the Organisation of Chartered Physiotherapists iri Private Practice. A written response from the Agenda Committee on rejected motions with information about related motions would allow for better presented, more substantial motions, which reflected the needs of the profession.

Speaking personally, Janette Ryder said

that in general physiotherapists were not aware of the process of conference and she thought training should be more available.

Jane Drain, an East Anglia steward, said people who had been to the conference before should help those who had less experience.

Linda Austin, CSP industrial relations training officer, said the Agenda Committee was only too happy to give advice to Branches on the wording of motions. She said that officers could visit to help Branches and would try to give information as to why motions had been rejected. She also hoped there would be changes brought in next year to help with conipositing. 'I hope people will agree that this year things have gone better and I hope that next year's will be better still.'

Avis Gilmore of North West Stewards said it was already possible to change motions, since a draft agenda was circulated in June.

The motion was lost.

Ethical and Regulatory Issues 62. Full membership of the CSP should be conditional on attaining two years' postgraduate clinical experience.

Moving the motion on behalf of Grampian Branch, Rhona Rae said it was a widely held view that a two-year post-qualification period was required to develop and consolidate clinical skills. This should be undertaken in a setting that provided support and guidance. By initially admitting to associate membership and then to full membership after a recognised period, the Society would be coinpiyirig with

recommendations in the Citizens' and Patients' Charters and the Charter for Health.

Ruth Jones, a Welsh steward, thought it was important the CSP represented and supported its younger members.

Alun Davies of Wessex stewards asked if people coming into the profession would be put off by what would become a five-year training for the 'derogatory' junior-level salary.

Sara Jacklin of North East students asked what would happen to newly qualified physiotherapists during th is two-year period? How would they get insurance, who

Physiotherapy, December 1991, vol 77, no 12 843

would represent them and if membership was not automatic at the end of the two years, would it become too subjective?

South West stewards' representative Sarah Dann said that despite CSP guide lines, people could take up senior I1 posts in under a year. It was important to have a good t w o years' experience first, but it would be difficult not to allow full membership until after this. Newly qualified physiotherapists should have more say in what experience they were given in their first two years.

Speaking against the motion, Janet Lewis for North West Tliames stewards said students brought new ideas t o the profession. She said the CSP was also a trade union and it would mean these therapists wotild not be represented for t w o years.

Patricia Phillips, chairman of the CSP Policy and Resources Committee, made the point that membership imposed certain obligations on newly qualified therapists in respect of the ethical code. If they were not members of the CSP they would not be bound by these rules.

As a junior physiotherapist, Chris Mercer from London said he would have been very disappointed not to have become a member of the Chartered Society.

The motion was lost

63. The CSP should influence the Council for Professions Supplementary to Medicine to set standard entry examinations for overseas qualified physiotherapists before they can gain State registration.

Representing Dorset Branch, Ann Trigg argued that allowing overseas-trained physiotherapists to work in the UK without some form of examination or testing would put patients at risk, deSase the profession's qualification and put at risk the profession's world-wide respect

Ian Rutherford of Nottingham Branch said the Board was not allowed by law to do the work of physiotherapy managers. He said the motion also showed amazing faith in the examination system .

A French-trained physiotherapist, Yves

Dereix, said he had been scrutinised by the CPSM before obtaining State registration. It did a very good job, he said, even though he had already been practising for 15 years. He then had to work for another year as an associate member of the CSP.

Nicky Cogan, past chairman of the Physiotherapists Board of the CPSM, said the CPSM was not able to set examinations. It did scrutinise each individual's training and past experience. On a point of clarification she said it was up to managers, not the CPSM, to judge someone's ability to speak the language.

Frank Martin of Devon Branch, former vice-chairman of the CSP International Affairs Committee, said he had received letters from physiotherapists who wanted to be recognised overseas. If the profession wanted to be recognised throughout the world, then it had to recognise others.

Patricia Kehl of East Surrey Branch said there needed to be some mechanism to upgrade overseas physiotherapists.

The motion was lost.

American Recruiting Agencies BROWSERS through the appointments pages of recent Journals wil i have noticed the large number of agencies recruiting for jobs in USA. There is a very large gap between staff vacancies and stsff available in the States, leading to many employment opportunities, and there is money to be made by recrui t ing therapists f r o m elsewhere.

Some of the US agencies are run by physiotherapists and some are direct employers of physiotherapists; others recruit for specific hospi7als and clinics. Some of the agencies restrict their activities to a few States; others will promise jobs anywhere - but on examination these jobs may mysteriously vanish in favour of only a few locations.

An overseas-trained physiotherapist, placed by an agency for a fee on a contractual basis wi th a US healthcare facility, will have generated $60,000 to $70,000 in contractual fees to ?he recruiting agency by the end of hisiher first year of employment. From these fees the therapist's salary, benefits, fares, licensing fees and so on are paid, and the surplus goes to the agency.

Overseas applicants for licensing iie registration) have their educational trans- cripts sent to an Education Credentialling Service, which 'translates' them into equivalent USA collegiate language and compares the profile wi th the State Board requirements. Remember each State has its own Licensing Board and its own require- ments. The most common 'mismatch' between the British and American urofiles is likely to be a Iach of general school courses at a high enough level - our A-level system produces early specialisation. Some State Boards will ask applicants to take general courses like humanities before becoming eligible to take the examination, Some States also demand a test of English at this stage!

Some States are becoming incieasingly

selective - California, for example, demands A-level chemistry. Some States are very suspicioLs of diploma holders. I ln a country where you can get a degree in horse riding or characters in soap operas this is understandable, but can be frustrating to UK trained physiotherapists, who know what their diploma implies!)

Candidates wi th approved profiles can then apply to take the exam, which a few Boards will allow to be taken outside the United States. The examination - three papers, multiple choice, fail one fail all - is common to all States, but the pass mark varies; it may need to be retaken when moving to a State wi th a higher threshold.

The third paper of the examination is on the health care system in the USA, including how Medicaid and Medicare work, on the structure of the American Physical Therapy Association (APTA) and on the legal and administrative requirements of the insurance system, especially record keeping. This paper is obviously difficult to prepare for outside the USA, as experience of the system is needed, Over half of the States will issue a temporary licence to allow candidates to work in a supervised setting while studying for it.

It is this third paper that usually causes the failure of UK entrants. Some agencies are now actively coaching on this paper and this help can push the pass rate from 80% up to over 90%. Some States also insist on an oral component to the exam. Therapists wi th a temporary licence and those who have to undergo a period of supervised clinical practice even after passing the US exainination will obviously not be on salaries as high as their experience and expectations might warrant. As there is no national or State norm, it is difficult to know where to pitch one's salary demands.

Some States only set the examination once a year, others t w o or three times. On passing the exam, a permanent licence is issued out some States still require a

period of supervised experience. The immigration process is concomitant

w i th the credentialling - prospective employers file for a visa and work permit. The HI visa is good for six years.

In our experience, very few agencies are honest about the delays, hiccups and quibbles that are likely to accompany State licensing and relocation. On the other hanp, going it alone through the thicket of paperwork, government departments and so on is very time-consuming and expensive.

Occasional horror stories reach the Society of members who have given up jobs and accommodation in the UK only to find that unexplained delays or last-minute changes in job offers by their agency have seriously altered their situation. Our advice is to allow at least six months from first contact wi th the agency to leaving the UK and not to lose your nerve if the agency fails to deliver or is keener on promoting its own interests rather than yours. Remember you are a very marketable asset!

Owing to the high level of insurance litigation and settlements in the States, the Chartered Society of Physiotherapy professional liability insurance (PLII does not cover you in North America. Employers provide such insurance cover.

Members going to work in North America are therefore advised either to maintain their full practising membership (category B - the PLI component will protect them from retrospective claims) or to subscribe as members practising overseas (category 0 - which does not include PLII. We advise members who are no longer paying a category B subscription to pay the €20 single premium for the PLI cover for any retrospective claims arising from incidents which occurred while they were still practising. The importance of this is stressed as claims can be made years after the incidents to which they relate.

PAT ALLCHURCH BA MCSP

844 Physiotherapy, December 1991, vol 77, no 12