REPRESENTATIVES' CONFERENCE The third Annual Reprentatives' Conference was held o n September 19 and 20, 1991, in Blackpool. About 300 people attended. Revised standing orders were adopted and Council's report on mot ions f r o m the previous year were noted. M r s Mary Murphy was chair and M r s Natalie Beswetherick and M r Paul Lynch were vice-chairs.

Debate o n mot ions 1 t o 32 is reported here, and the reminder will be in the December issue o f Physiotherapy. The motions are printed in bold type, given in amended form where this was accepted.

Each mot ion w a s proposed by a member o f t he group f rom which it originated, and then opened for debate, although members chose n o t t o discuss some of them. Before a vote was taken each proposer had the opportunity to reply t o any points raised in debate. The motions were grouped and any which were no t reached at the end of the t ime allotted t o each section were not debated but remitted directly to Council.

Professional Affairs Treatment Modalities THESE TWO MOTIONS WERE GROUPED FOR COMMON DEBATE

1. The scope of practice should not be prescribed centrally by the CSF? In future any practice which is recognised as appropriate to physiotherapy by a responsible body of opinion within the profession should be regarded as within the scope of practice of a Chartered physiotherapist, provided that she or he has undergone the training required by Rule 1 of Professional Conduct. (Amended composite motion.)

Physiotherapists defined themselves not by what they did but by who they were. It was easier to understand why they should be free to extend their practice from that starting point. Patients were the centre of practice and it was for their benefit that it should be extended.

2. Physiotherapy department heads should support all physiotherapists who are trained in acupuncture and practising within the NHS in order to provide another beneficial treatment modality for NHS patients, which is fully approved by the csp'

Speaking to the amended motion, Jean Kelly of the Organisation of Chartered Physiotherapists in Private Practice urged DhvsiotheraDists to have the couraae and . . ., foresight to stand up as autonomous The Acupuncture Association of Chartered professionals and take responsibility not only Physiotherapists was planning to set up for current practice but also for the way the its own course, said its secretary, Val profession should develop in the future. Hopwood. In the meantime she appealed to

physiotherapy managers to support and have confidence in physiotherapists practising acupuncture. There was no real problem incorporating acupuncture into physio- therapy practice.

Debate Janette Ryder, representing the ADSCP, said support must be given to colleagues to practise all modalities they had been trained to use.

Sue Jackson, District physiotherapist for Warrington, said it was necessary to look closely a t those giving the training. She was concerned that many had no medical back- ground and said she would be disturbed if a gas fitter was teaching acupuncture to her staff (the theme of gas fitters became a standing joke at Conference).

Charlotte Watson, Cardiff and East Wales Branch, said that if someone was properly trained, physiotherapists should not be critical. The two motions were carried.

!

THESE THREE MOTIONS WERE GROUPED FOR COMMON DEBATE

3. The CSP should encourage physiotherapy managers to ensure that physiotherapists' competencies in respiratory care skills should be assessed by specialists prior to admission on the 'on-call' rota so that patients with respiratory problems are seen by physiotherapists with the appropriate skills.

Speaking for the Association of Chartered Physiotherapists in Respiratory Care, Carolyn Roskell pointed out there was no justification for providing an excellent service between 9 am and 5 pm, and then entrusting the care of critically ill patients to ill-equipped therapists. Junior staff should not have to learn by their mistakes on the 'on-call' service.

'Greater efforts need to be made to train staff post-qualification to ensure that physio- therapy can offer a credible treatment in the

management of these patients. If we do not the future for chest physiotherapy as we know it looks grim.'

4. An extended evening service should be provided by a specialist respiratory care team as an alternative to the present 'on- ca!!' service. This should be available to all patients with respiratory problems to ensure an adequate standard of management of these most deserving patients.

Physiotherapists were keen to emphasise their clinical autonomy, said Frances West of ACPRC. Yet they were willing to relinquish this a t 5 pm when decisions about who would benefit from physiotherapy were left with doctors. Decision making could not stop at 5 pm, she said. Patient needs must dictate the service.

Emergency Motion 2. In view of the policy statement issued in the Summer 1991 issue of British Thoracic Society News stating the intent to liaise with the Royal College of Nursing and the English National Board to set up courses to train nurses to become respiratory care specialists, the CSP should liaise with the BTS to ascertain what would be expected of the respiratory care specialist and take action to protect the existing role of the physotherapist working in this area.

Carolyn Roskell of ACPRC said physio- therapists were worried that other pro- fessionals seemed poised to take over their role in respiratory care. She pointed out that it would be costly to train nurses to become specialists and would mean that physiotherapists, skills in this area would be wasted.

Debate ~

Key to Acronyms Fiona Jenkins, Pembrokeshire, said junior

AACP Acupuncture Association of Chartered Physiotherapists physiotherapists should have adequate ACPOG traininq before beina allowed to ioin the Association of Chartered Physiotherapists in Obstetrics and - -

'on-call' service. For East Surrey Branch, Patricia Kehl said

its recent bad exDerience had demonstrated

Gynaecology Association of Chartered Physiotherapists in Respiratory Care Association of District and Superintendent Chartered

ACPRC ADSCP

APCP MACP

Physiotherapists the need for proper assessment for staff before joining the 'on-call' service. This Association of Paediatric Chartered Physiotherapists

Manipulation Association of Chartered Physiotherapists assessment revealed a physiotherapist, ~

776 Physiotherapy, November 1991, vol77, no 7 7

not newly qualified, was unsafe to practice. Staff working outside respiratory care should be updated annually.

Recently qualified staff were not the only problem, said Wendy White, an ACPRC member. Specialists in other areas who were out of touch with respiratory care were probably not suited to 'on-call' work.

Margaret Sinfield, a senior respiratory physiotherapist from Mersey, said she had found those who wished to do the 'on-call' service wanted further training. They had a smaller, skilled group of staff giving an out- of-hours service, while not working all hours. Updating for this small group of staff was essential.

Sarah Evans, a respiratory care specialist from London, asked that, if the emergency motion was carried, the matter be taken up urgently with the British Thoracic Society.

A recently-qualified physiotherapist, Gina Stone, Southampton and North Hampshire Branch, said: 'We are capable of managing a respiratory patient at night.' Consideration had to be given to the staffing levels and the cost of an extended evening service. There had to be a thorough and well-planned induction and a respiratory senior who could be called on for additional advice.

Janette Ryder, ADSCP, pointed out that some of the new clinical directorates must be willing to fund additional services.

For North East students, Sara Jacklin suggested that, if trained properly at college, junior physiotherapists should be able to provide a reasonable service.

Motion 3 and the emergency motion were carried and the motion 4 was lost.

Inter-professional Relations 8. The CSP must work with the College of Occupational Therapists to follow up the conclusions reached in the conference 'Working Together with Elderly People' by defining clearer roles of the two professions. (Amended motion.)

Ruth Garnham, for the Association of Chartered Physiotherapists with an Interest in Neurology, said the key message of a conference on working together with elderly people last year was that physiotherapists and occupational therapists should work together locally to identify policies and procedures which defined their roles clearly.

Papers had been published since, which desciibed successful working relationships

Health Promotion 5. The profession, in co-operation with central and local health education units, should do more to develop the role of physiotherapy in health promotion. (Composite motion.)

Most physiotherapists made poor use of health education material, were slow to initiate their own and even slower at tapping existing expertise to produce high quality work, according to Jane Kerr, representing Fife Branch.

'We need to take active steps to improve communication with health education authorities in order to influence policy and, at a local level, forge closer links between physiotherapy and health education depart- ments.'

She suggested the CSP set up an independent source of funding and called for improved training for physiotherapists for their role as health educators.

Joyce Wise, physiotherapy manager, North Tees Health, reminded physio- therapists that general practitioners had funding for health education and it was possible to convince them to spend it on physiotherapy services.

For Welsh stewards, Phillipa McWatters said physiotherapists needed a much higher profile in health education. She called on the CSP's Public Relations Department to do more in this area.

The motion was carried unanimously.

6. Physiotherapists should be actively to provide a better educated population. involved with education in advising on the 'By using physiotherapists to advise on national curriculum especially in areas of physical education, movement and disability physical education, movement and disability awareness it can also provide a fitter awareness. population.'

Jill Brownson, representing the Association of Paediatric Chartered Physiotherapists, feared the physical education needs of disabled children would not be taken into account by teachers.

Physiotherapists could make a valuable contribution to the way PE was taught in schools. The national curriculum aimed

Penelope Robinson, CSP director of professional affairs, said physiotherapists often saw patients who had no idea how their body worked. The profession had a lot to offer PE teachers so that this knowledge could be passed on. The motion was carried with two votes against.

7. There should be an accredited training But, as autonomous professionals, programme provided by the CSP for physiotherapists had to accept that Chattered physiotherapists who are involved people would take them to court if they in formal instruction to other disciplines on felt they had been damaged because of safer load movement. somethina they were tauaht.

Ann Trigg, representing Dorset Branch, said physiotherapists were becoming reluctant to pass on lifting and handling skills. Some had had complaints and even court proceedings brought against them. Litigation had reared its ugly head. Accredited or certificated courses might be one answer to the problem. Guide lines were not enough.

Penelope Robinson, CSP director of professional affairs, said she was sorry to think that physiotherapists were not taking

For the Welsh stewards, Ruth Jones spoke of a physiotherapist who was absolutely devastated when she was taken to court. The CSP should provide the most up-to-date information on lifting and handling.

Ronnie Paul, East Essex, said accredited courses would not stop litigation. It was not the lifting that was the problem but people working long hours and abusing their backs. Improved health education would help reduce litigation.

on moving and handling training. She said information and guide lines were available. The motion was carried after a counr.

between the two professions, which avoided unnecessary duplication and confusion. This local work should be augmented by further work between the professions a t national level.

Anna Culot, secretary of the Association of Chartered Physiotherapists with a Special Interest in Elderly People, stressed the importance of effective role definition. What mattered was that the person qualified to carry out the task did so to the appropriate standard. The roles of the two professions might be interchangeable in some specialist areas. If they were not interchangeable, they should be complementary, rather than repetitious.

Joyce Wise, chairman of Council, said two physiotherapists could have a 'lively discussion' when trying to define their own roles in the assessment of a particular patient. If Conference backed the motion, she said it would not be enough to re-iterate the message on the elderly; real suggestions on how the roles could be more clearly defined would be needed.

The motion was defeated by a large majority.

9. Physiotherapists should spend more time within the interdisciplinary team explaining their intervention and encouraging the support of each others' roles in order to maximise the individual's rehabilitation potential.

Ruth Garnham, ACPIN, said that too often multidisciplinary teams were teams in name only with each profession setting goals according to its own viewpoint. It would lead tq duplication and clashing of egos, lack of communication and ambiguity for the patient. Physiotherapists could not expect others to appreciate their skills if they did not communicate with them. It was also easy not to recognise the skills of other team members. Professional boundaries could stand in the way of good patient care.

Chris Mercer, a junior physiotherapist at Roehampton, said it was 'insulting' to the profession to be asked to support a motion telling people how to do their own jobs. 'We should all know that,' he said.

Elaine Nicholls, from a head injury unit, said one of the most valuable aspects of working in a multidisciplinary team was to understand other therapists' roles.

Patricia Kehl, East Surrey Branch, agreed with the need to support colleagues but not to the extent that too much time was spent talking and not on treatment.

The motion was carried.

physiotherapy, November 1991, vol77, no 1 1 777

10. The CSP should work closely with other therapy professional associations in the areas of post-registration education and managerial issues in order t o pursue optimum care for our patients.

Avril Imison, representing Association of District and Superintendent Chartered Physiotherapists, said this was not about take-overs or mergers, but about creating

structured opportunities to work in harmony. 'We need to know and understand each other's role and share ideas and issues that are common to us all,' she said. Formal, close links wi th the other therapies were now an essential part of the profession's future success.

The motion was carried without further debate.

Service Management Physiotherapy Helpers and Health Care Assistants

MOTIONS 11-15 WERE GROUPED FOR COMMON DEBATE

11. The CSP should re-affirm i ts commit- ment not t o progress beyond level t w o National Vocational Qualifications in order t o maintain the standard of entrants into the profession.

Avis Gilmore, of North West stewards, said higher-level NVQs might eventually give access to physiotherapy training and she questioned what the effect would be on those seeking to enter the profession.

Physiotherapists should be very wary of an encroachment that could lead to loss of job satisfaction and even loss of jobs. Managers might choose to pay a helper with a NVQ rather than a physiotherapist. Physio- therapists would be spending valuable time training helpers; they too would have to be trained and this would mean more time away from patient care.

'What sort of applicants will come into the profession just to pass on their hard earned skills, rather than to use them?' she asked.

12. The CSP should actively oppose any introduction of a two-year training for physiotherapy assistants, as this would lower physiotherapy standards and patient care.

Nina Melville, representing Southampton and North Hampshire Branch, said physio- therapy assistants working in the role of technician would not be able to adapt treatment as the patient improved and therefore it could lead to treatment being less efficient, less effective and more

Similiar structures in other professions had failed. Physiotherapists should be prepared t o review skill mix and recognise ioutine tasks that could be done by helpers. 'However, extending the level of training to t w o years of full-time education we believe to be not in the interest of the patient or the Health Service.'

13. The CSP should acknowledge the threat t o professional clinical standards by the development of health care assistants and take a decisive stand against it.

Physiotherapists should be worried about the question of support workers, said Nanette Smail, for Scottish stewards. She questioned the need to change the present system. On cost, one physiotherapist equated to 2 % health care assistants, which represented an 'irresistible cost-cutting exercise and job creation scheme rolled into one'.

costly.

The dangers of th is change f rom physiotherapy helpers to support workers were the abandonment of a perfectly good system; that the money to pay for i t would come from their own budgets; and that physiotherapists were going to lose jobs.

'The worst danger of all is that you will all believe that the development of health care assistants in our profession is inevitable; it is not.'

14. The CSP should discourage the employment of physiotherapy helpers in the community in place of Chartered physiotherapists.

Linda Gaskell, from the Association of Community Physiotherapists, said employ- ing unqualified helpers in place of qualified staff would not assist the service but would dilute and downgrade professional input. Working in pairs of qualified and unqualified staff in the community would discourage one of the main aims, which was to encourage clients and carers to participate in treatment.

15. The CSP should resume communica- tions with the Care Sector Consortium with regard t o training of physiotherapy helpers t o maintain high standards of patient care.

While supporting the halt of NVQs above level two, Sandra Hicken of West Midlands stewards said there had to be a degree of realism. NVQs at levels one, t w o and possibly three would be in progress soon. She said the CSP should be directly involved in the content and standards of courses which physiotherapy helpers would be required to take. The only way to have this direct involvement was to have communi- cation w i th the Care Sector Consortium.

Debate Patricia Kehl, East Surrey Branch, said physiotherapy helpers were a valuable resource in the community and it would be unrealistic not to have their help. There were tasks helpers could do which would allow Chartered physiotherapists to use their skills more cost-effectively.

Jane Langley, professional affairs officer, CSP, pointed out that the purpose of national recognition through the NVQ system was to give helpers a certificate to enable them to show what level they had reached. The CSP had issued several briefing papers. It was opposed to a two-year training course leading to a level four NVQ. She said the

CSP was in communication w i th the Care Sector Consortium.

The CSP should not try to restrict the training of other workers, said Janet Lamb, representing Mersey stewards. Physio- therapy professionalism would remain if there was the correct use of helpers and adherence to CSP standards.

Susan Jackson, District physiotherapist, Warrington, speaking as a member of the CSP Helper Working Party and the CSP Council, said the current debate was about how the physiotherapy-specific com- petencies should be assessed to ensure that i t was not the 'proverbial gasfitter' who assessed competencies.

Speaking on behalf of Scottish stewards, Wendy White said it was naive to think that the competencies and qualifications would not pose a threat to physiotherapists' professional status.

Billy Fashanu, South East Essex Branch, urged the CSP to regulate the qualifications of health care assistants and helpers.

For the North West stewards, Catherine Shipley said patients were getting a good service now from qualified physiotherapists and helpers. Helpers were doing a good job and did not feel the need for further qualification.

All five motions were carried with a large majority.

49. Physiotherapy helpers should be given the right to representation through the CSP. (Composite motion.)

Jane Stephenson on behalf of South West stewards pointed out that after a half-hour debate on what physiotherapy helpers could or could not do, helpers themselves had no representative at Congress. Given the uncertain future of the NHS, she said, physiotherapists must give them repres- entation.

For North East Thames stewards, Angela Clough said that at a time when skill mix and job evaluation were high on the agenda, physiotherapy helpers needed support and representation and the CSP was best placed, wi th the knowledge and expertise to represent them.

Jane Langley, professional affairs officer CSP, said the CSP Helper Working Party was looking again at this issue. It had written a paper discussing some sort of recognition and this was to be submitted to Council. If approved, it would go out for consultation.

Avis Gilmore, North West stewards, warned that in occupational therapy, qualified members could be outvoted by helpers and technical instructors. The CSP should definitely remain a Society for qualified physiotherapists.

Rosalind Gunning, private practitioner from Essex, said assistance should be given to helpers to set up their own organisation. Barristers valued their clerks, she said, but they did not make them members of the Bar Council.

Helen Bristow (speaking as an individual) urged Congress to support the motion to continue to look at some sort of represent- ation. Physiotherapists could not afford to survive without supporting helpers.

For South West stewards, Jan Williams said i t was time to promote solidarity in the workplace and the profession should support the helpers.

Paul Lynch, vice-chair of Conference, said

778 Physiotherapy, November 1991, vol77, no 11

i t had not looked at representation of helpers took exception to the presumptions made before. Previously it had talked about about helpers without first asking them. associate membership. The motion being 'This is exactly why they need to be discussed was about union representation for helpers.

Hilary Dickie of Stockport Branch said she

represented.'

The motion was carried after a count.

National Health Service Review 17. In the interests of job security in the NHS the CSP would best serve i ts members by advising them how t o contract out of the present system and offer their services via their own trading agencies.

From Cumbria Branch, Alison Crawford said reorganisation in the Health Service was leading to fragmentation of health care and with it the physiotherapy provision. It must remain a cohesive body, managed by the profession to protect job security, pay and conditions, the standard of care provided and the management of physiotherapists. As an example, in East Cumbria, the dismantling of the District service meant that the community physiotherapist now had t w o managers, one a senior clinical nurse and the other a speech therapist.

If physiotherapy were provided via the profession's own trading agencies, all offering the same CSP terms, it would avoid these problems. Agencies would have more freedom to develop their own business and could draw up their own contracts. They would give the profession the opportunity to bridge the gap across Units.

'In the interests of our job security we need to opt out of the current trend of having our service managed by other disciplines. We must call the tune as to how physio- therapy services are managed and delivered.'

Avril Imison, ADSCP, could not believe that by ooting out, things would get better. 'If we opted out we could find we have a service which is limited by the erroneous perceptions of the people who would be buying for the first time and have absolutely no experience.'

On behalf of Mersey stewards, Janet Lamb said the way for physiotherapists to maintain job security was for them to continue t o work within the Health Service hospitals and for them to develop a high profile service. The danger of opting out, particularly when skill mix was being discussed, was that the cheaper option would be preferred.

Tom Donnelly, for Scottish stewards, failed to see how a move towards a trading agency would provide job security. He thought the reverse would happen. 'When they decide to make cuts, if you are not on the payroll you won't be considered.' To go outside the system would be an 'act of madness'.

A lun Davies, representing Wessex stewards, said that by setting up trading agencies, the profession would be opened up immediately to market forces. With 1992 approaching, Europe probably had a better market base, which would be extremely dangerous.

Louise Ewart, from Bath Therapy Agency, explained that she was part of a provider agency, still under the umbrella of the other Units. The physiotherapists had joined with the occupational and speech therapists. So far, she said, they had the support of all the Branch members. They were in their infancy but she thought it would work.

The motion was lost.

18. If remuneration in the new National Health Service is t o be based on results the CSP should issue guide lines on what constitutes a fair day's work within the various specialties.

Alison Crawford, from Cumbria Branch, proposed that it was necessary to have a standard set down by the CSP on what constituted a fair day's work, to avoid discrepancies up and down the country.

The only people who could assess this would be physiotherapists. If they didn't do it, their managers would. It would then be too late when standards of care declined and remuneration varied throughout the country.

Speaking against the motion Janet Lewis, a North West Thames steward, said what was being discussed was performance- related pay. How would it be possible to say that one person treating 2 0 patients

should be paid more than another person treating ten? Care should not be divided down into numbers of patients treated.

Jacky Bradley, a Welsh steward, said that as an experienced physiotherapist working in a specialist field the only person who could assess her fair day's work was herself and her manager.

If the motion was adopted the profession would be digging itself into a hole, West Midlands steward Sandra Hicken warned. Physiotherapists should be supporting their professional autonomy and should not have to specify how many patients were treated and how quickly.

Leicestershire District physiotherapist Marilyn Harrison was concerned about the motion. As an autonomous practitioner she set the standard, assessed the patient and set the objective.

Janette Ryder, ADSCP, said i t was unrealistic to expect the CSP to issue guide lines on what constituted a fair day's work.

Myra Osborn, a North West Thames steward, said that as a paediatric physio- therapist she was involved in the total care of the children and their family and could not see how anyone could determine what a fair day's work would be.

The motion was lost.

Other Issues 20. The CSP should t ry t o increase the profile of the physiotherapy officer at the Department of Health in order that the members may become more aware of the job this officer does. It may also be possible for the officer t o have a regular article in the Journal as a means of increased communication.

Louise Newlove, for North East Thames stewards, said the profile of the professional full-time officer at the Department of Health was not very high. Many physiotherapists did not know the post existed. She said it would be useful to members to know more about the officer's role and the best platform for this would be the CSP Journal.

Vice-chairman of Council, Patricia Phillips,

said that two-monthly meetings were to be set up between the incoming officer and the chairman of Council, as the best way of increasing communication between the Department of Health and the CSP.

Fiona Jenkins, representing Welsh stewards, said that if the officer at the Department of Health were given a higher profile this could increase the chances of getting a physiotherapy representative at the Welsh office.

Nicky Cogan, physiotherapy officer at the Department of Health, said she welcomed any opportunity to raise the profile of the job. She said she was dependent on physio- therapists for their views on how to make the job effective.

The motion was carried unanimously.

Education Pre-registration Education MOTIONS 21 AND 2 2 WERE GROUPED FOR COMMON DEBATE

21. The CSP should press for adequate funding from the Regional Health Authorities t o cover the implications of pre-registration clinical education. Without this the clinical placements are in jeopardy

Jane Warrington, representing Cambridge Branch, said the system should be changed to ensure total financial support to local health authorities by funding clinical supervision at Regional level This would ensure equal financial investment within a Region and promote high standards across the board

Without a change there was a danger that clinical placements would be in jeopardy 'If we don't act soon we could lose our placements and our future physiotherapists will become highly theoretical but not highly skilled '

22. The CSP should press the Department of Health to place the training allowance for clinical instructors within the budget of training schools and not the individual health authorities. This would benefit the schools, the clinicians and the students. (Amended moti0n.l

Janette Standring, physiotherapy teacher at Manchester Royal Infirmary, said the present system offered little flexibility for the school, the student or the clinical instructor. Placing funding in the hands of the schools would benefit all concerned.

Nigel Palastanga, principal at the Cardiff School of Physiotherapy, said one advantage of a changed system would be that money would go to the right people, which did not happen at present. It would allow him to calculate the real cost of physiotherapy

Physiotherapy, November 1991, vol 77, no 1 1 779

education and to ask the Welsh Office for urged those involved in negotiations to Scottish stewards. All candidates should be the money.' ensure that physiotherapists were not left in treated equally and physiotherapy schools

the Position they found themselves in at must be free to choose their candidates the motion because, in her District, PEsent, with an 'inaccurate, inappropriate without outside interference. physiotherapists had been toid that those and misinterpreted student training As chairman of the CSP Education undertaking clinical supervision could not albwance national agreement'. Committee, Pat McCoy said she was not receive the allowance because of a lack of Both motions were carried. aware that moves were being made to funds in the education budget. reserve places for these groups. She said

Pat McCoy, chairman of the CSp 23. The Society should actively oppose that admissions tutors should be trusted to Education Committee, said it was believed any attempt to reserve allocations of places Select People who had a reasonable chance that the Department of Health would on physiotherapy training courses for of completing the course. She said they recommend that clinical placements candidates wi th National or Scottish would withstand any Pressures towards ought to be costed and subjected to the Vocational Qualifications. positive discrimination.

Kathryn Delpak, chairman of the Pro- contracting process. She hoped it would Automatic allocation of a place to an NVQ, fessional Practice Committee, urged physio- also omme mend that money be earmarked or Scottish Vocational Qualification, could therapists to say ,education, not ,training,. for the clinical education of students. prevent a suitable candidate from

Teresa Fearn, ApCp, said she supported

ADSCP representative Janette Ryder entering training, said Wendy White for The motion Was carried.

Post-registration Study MOTIONS 24-27 WERE GROUPED FOR COMMON DEBATE

24. The CSP should continue with the principle of Physiotherapy Access to Continuing Education (PACE) but suspend the Diploma in Advanced Physiotherapy Studies until something more academically rewarding can be arranged.

Avis Gilmore for North West stewards said the objective of PACE to encourage all physiotherapists to continue their education throughout their career was to be applauded. However, the diploma was not a fitting pinnacle to this continuing education. At present it had no academic standing outside the profession and it attracted no added rewards or status. She questioned why qualified professionals should commit themselves to something described by the CSP Education Department as a 'lateral award'.

It was she said, too cumbersome, too time-consuming and too expensive.

25. With the introduction of PACE the CSP should ensure that research by the profession is encouraged by making it mandatory that holders of the advanced diploma have had at least one research article published.

It would not be enough for holders of the Advanced Diploma 'merely to have com- pleted some sort of research' said Frank Martin, representing Devon Branch, because this did not further the profession. Many research projects never saw the light of day and he added, 'Research that is not widely disseminated is of little use.'

26. The object of PACE is to encourage all physiotherapists to continue professional education throughout their career. The CSP should devise a scheme so that Branch meetings or courses of defined standards would carry points towards the Diploma in Advanced Physiotherapy Studies.

Ronnie Paul of East Essex Branch warned of possible elitism. He said there could never be enough validated courses set up to educate all Chartered physiotherapists. The courses therefore would be available only to those with the means and the money, not 'just the motivation. By encouraging Branches to hold better, more professional meetings and courses, all physiotherapists would be able to get a foot on the PACE ladder.

27. Persons who undertake Branch or Board commitments should have their work recognised and be awarded credit points in the PACE system.

Deirdre Robottom of Gloucestershire Branch outlined the responsibilities of Branch and Board members. If credit points were awarded for Branch and Board commitments it would introduce a degree of competition at elections and give those concerned a tangible and meaningful reward for their dedication and hard work.

Debate While supporting the need for more research and increased publication of current research work, Janette Standring of Manchester Branch said some journals had a higher calibre than others. Having research published was not a measure of the standard of the work done.

Gary Hill, Trent, agreed that publication did not ensure quality.

On behalf of the Association of Chartered Physiotherapists in Independent Hospitals, Jane Beard said she wholeheartedly supported access to continuing education but that this should lead to degree level quelification.

Jane Drain, an East Anglian steward, said she had no intention of publishing her research for a top-up degree. She had learned from her mistakes but it would not benefit the profession for the work to be published.

Al?n Walker, director of education at the CSF', explained that through an agreement with Thames Polytechnic, credit points would be given for work leading to the Advanced Dioploma which could potentially count towards honours or master's degrees. He explained that under its charter, the CSP could not award degrees.

Jan Williams of South West stewards suggested that the hard work of all the stewards should also be recognised.

On a personal note, Janette Ryder said people who took on Board or Branch commitments did so because they enjoyed it. They did get credit for their efforts from their colleagues.

Angie Emmott of Trent stewards agreed that stewards did sterling work, but she asked should not everyone at the Represen- tatives' Conference also get credit?

Catherine Burnett, for Scottish stewards,

pointed out the geographical difficulties facing those from the Western Isles. To attend Branch meetings was costly, involving overnight stay.

Sarah Dann, representing South West stewards, asked if in-service training should also be given credit points.

Ann Trigg, Dorset Branch, said she would not like to think of people becoming officers in order to gain a few credit points and then disappearing from the Branch.

The first motion was carried, and the remaining three were lost.

28. The CSP should urge the CPSM to incorporate a minimum level of regular postgraduate training as a condition of re- registration in order to ensure that employers recognise the importance of continued education in raising clinical and professional standards, recruiting and retaining staff and career development, particularly in view of the difficulties currently being experi nced by many in obtaining funding and t i i e off for courses. (Composite motion).

Teresa Fearn, representing the Association of Paediatric Chartered Physiotherapists, said the Group felt it had insufficient support from employers to do the training necessary to keep up-to-date in specialist areas. Patients deserved the best possible treatment and continuing education was one way of ensuring this.

Many physiotherapists came into paediatrics with little or no previous exper- ience; there were usually staff shortages and often supervision was poor. Children were not getting a good enough service, she said, because of the shortfall in knowledge and experience. However willing therapists were to attend appropriate training, underfunding and inadequate study leave prevented this.

In her District, she said, the annual training budget for physiotherapists was approxi- mately f30 each per annum. Having a minimum level of postgraduate training built into contracts would benefit everyone.

'I would think this is wonderful if I were a manager,' said Marian Morrison from Northumberland Branch. Short-term contracts, physiotherapists paying to upgrade themselves. Who would employ them if they did not?

Theresa Ball, chairman of the MACP Northern Branch, said MACP was trying to devise a points system for continuing education, to help maintain standards and encourage people to teachafter completing their advanced studies.

Physiotherapy, November 1991, vol77, no 1 1 780

Patricia Kehl, East Surrey Branch, said that while supporting the need for continuing education, the motion was fraught wi th difficulties.

Sally Adams, Trent stewards, said that in America in 1967 it was recommended that professional education be linked w i th re- licensing. They had felt that this would ensure professional competence and would increase public confidence. By June 1990 less than a quarter of all States had continuing education as a condition of re- licensing. There was no clear-cut evidence that compulsory continuing education resulted in the maintenance or improvement of competence.

For Scottish stewards, Wendy White said: ’I don‘t think that we can assume that because the CPSM says we ought to have postgraduate training that automatically we are going to get easy study leave and funding.’

Jacky Bradley, a Welsh steward, thought that making continuing education man- datory would be very difficult for mothers of young children and the profession could find it had even fewer members.

Hilary Dickie, Stockport Branch, said the motion was a desperate measure. She suggested the Pay Review Body negotiated the training allowance in the pay review.

The UKCC, said Sarah Evans of London Branch, had recommended that nurses undertake some education at least once every three years. She said it would be interesting to read the UKCC recom- mendations before making a decision.

The motion was lost.

29. Employers should provide Chartered physiotherapists with adequate paid time off and expenses t o attend appropriate courses. (Composite motion.)

Valerie Peat, for Oxford Branch, said it was time to get postgraduate education on the map, in the same way that other health professions had. Physiotherapists must be able to prove that increased education would lead to an improved service.

For Mersey stewards, Janet Lamb said a survey had shown that about 8 5 % of courses were undertaken by physio- therapists in their own time. Other pro- fessions were managing to get more study leave.

Patricia Kehl, East Surrey Branch, said that in her area courses were funded through sales within the hospital. She said they had a healthy training budget which funded all their courses.

The motion was carried nem con.

Course Content 31. The CSP Post-registration Education Section should take responsibility for screening all courses for i ts members. Cost and content of courses are extremely variable. A n individual has no method of redress. Course objectives, and whether these are met, are not presently monitored.

Hilary Dickie, for Stockport Branch, said it was necessary to have courses more closely monitored. The trend seemed to be that physiotherapists put on a study day to obtain maximum profit to supplement training budgets. She asked why similar courses varied so much in price. ’Let us be realistic and professional and set our standards now for quality and value for money in post- registration training’.

Susan Jackson, vice-chairman of the Post- registration Education Panel, said it was up to managers t o assess the objectives and outcomes of courses. She said it would be an impossible task for the CSP to undertake, without at least a doubling of the registration fee.

The motion was lost.

32. With GPs becoming budget-holders, physiotherapy out-patient services will be much more in competition w i th chiroprac- tors and osteopaths. We urge the profession t o make specialised manipulative training more readily accessible t o i ts members.

Jan Williams, for South West stewards, said the profession needed to improve mobilisa- t ion and manipulation skills and techniques so that its treatment compared favourably w i th that of osteopaths and chiropractors. There had to be resources and commitment from physiotherapy managers to ensure that specialised training in these techniques was widely available.

Janet Baker, North West London Branch, said the choice of treatment was up to the

patient, and physiotherapists had to educate the public on what physiotherapy could offer them.

Thelma Harvey, CSP continuing education officer, said she hoped that more local courses would become available under the PACE system.

Val Noble of Plymouth Branch said physio- therapists expected a decrease in referrals when working with a budget-holding GP, but the reverse had happened. She believed physiotherapists had enough skills to compete wi th other groups. What was needed was a broad increase in training and education, rather than highlighting one particular area.

Yves Dereix for the AACP said there was a strong movement towards chiropractors and osteopaths. As a physiotherapist and an osteopath, he said there were many more techniques in physiotherapy. All that was needed was more training and skill in manipulation.

Sandra Hicken of West Midlands stewards said physiotherapists should not be so negative about their skills. There were many physiotherapists who were not members of MACP but were perfectly able to treat backs.

Angela Clough, out-patient superintend- ent at Southend, told physiotherapists to get to grips wi th marketing their skills.

Speaking for Mersey stewards, Carol Kelly said the fear was that GPs, without physiotherapy management guidance, would employ more junior physiotherapists, where the benefit would be throughput at the expense of quality.

Hector Walker, from St Helen’s and Knowsley, said he was a skilled physio- therapist in musculoskeletal disorders but was not a member of MACP.

Avril Imison, superintendent at St Thomas‘ Hospital, said i t was time that manipulative training was introduced generally in preregistration training.

The motion was carried with only a few against.

This report will be continued next month.

Books in Brief The NHS Handbook, edited by Barbara Connah and Ruth Pearson. Macmillan, London, in association wi th the National Association of Health Authorities and Trusts, 1991, 7 th edn (ISBN 0 333 53736 X). 267 pages. f 18 .95 .

The changes brought about by the NHS and Community Care Ac t 1990 are incor- porated in this edition, which has expanded sections on family health services and community care. There are new sections on X-ray and imaging, ophthalmology and laboratory medicine services.

A new quick reference section provides useful statistical information and the names and addresses of NHS authorities and the first wave of Trusts.

The original concept of this book was t o provide a readable guide to the NHS for all those interested either inside or outside health care services. Although daunting in its physical (A4) size and extensive in scope, this edition maintains that tradition - each chapter is easy to understand at any level and very pleasant to read.

Holidays and Travel Abroad 1991/92: A guide for disabled people, edited by John Stanford. Royal Association for Disability and Rehabilitation, 2 5 Mortimer Street, London W1N 8AB, 1991. f 3 post free.

This sixth edition of the RADAR guide to international travel and holidays for people wi th disabilities is completely revised and larger than ever. There are entries for 100 countries from Algeria to Zimbabwe, as well as individual sections on transport , insurance and health matters.

There are also lists of international hotel groups and details of voluntary and commercial organisations which provide services of particular interest t o disabled people.

The country entries, which have now been extended to cover much of the Caribbean, Eastern Europe, Latin America and Asia, include useful contact addresses, transport information, specialised services, information on guide books, and listings of accommodation which may be suitable for disabled travellers.

More Pictures of Health: Hospitals and old picture postcards, by Cynthia O’Neill. Meadow Books, 22 Church Meadow, Milton under Wychwood, Chipping Norton, Oxford- shire OX7 6JG, 1991 (ISBN 0 951 5655 1 6). Illus. 104 pages. €7.95.

Mainly but not exclusively devoted to historic pictures of nursing scenes, this book could make an intriguing Christmas present for anyone connected with the hospitals featured.

Photographs of a hot air room at Harrogate Royal Hospital, an elegant salt water pool at the Royal Alexandra Hospital, Rhyl, and the Middlesex Hospital electrical department in 1904 prompt the author to mention that a long extensive training is needed t o become a physiotherapist today.

This is the second collection of such illustrations but just as interesting as the first presentation - it by no means gives the impression of being a set of ‘left-overs’.

physiotherapy, November 1991, vol77, no 7 7 78 1