NHS Change: Implications for Physiotherapists - Essay Example

Running head: NHS Change: Implications for Physiotherapists NHS Change: Implications for Physiotherapists s Critical analysis of statement and the implications for physiotherapists The "NHS Plan (DOH, 2000) requires a fundamental change in thinking, practice and delivery over the next decade (Pattison, 2001, pg7)." Finding Journal articles more specified, up to date and directed towards the specified areas, the reference material is mostly comprised of Journal articles, material provided on Internet and most importantly NHS plan. Physiotherapy is a developing subject area. Not many current and up to date books are available. Journal articles are more helpful providing to the point and current research material. The material used is basically based on material printed in last five or six years. Material related to the Physiotherapy mostly depicts diverse direction of thinking by different practitioners, since there are not specified scientific theories. A gap, which was realised, was that there is an enormous amount of knowledge on the problems related to Physiotherapy as profession but most of the writers fail to describe a course of action to get a result. The second gap was that there is not much material provided about the impact of change in NHS on Physiotherapists. The 'Physiotherapy' journal publishes an up to date and well informing articles. Many terms were tried but those, which helped a lot, were Change management, physiotherapy, NHS plan, NHS escalators, KFS served the purpose. Introduction: The NHS has an important place in the history of medical treatment in the U.K. An organisation noble in conception has two dimensions to put up with. The dual dimension challenges are to cope up with the changing needs of patients with ever increasing costs due to advances in medical knowledge, medicines and technology. From the other side the pressure is to find solutions in the restricted budget and to handle the changing political pressures. From its beginning the NHS gone through many reforms. (Short NHS History) In the last few years NHS has contributed to medical innovations such as Meningitis C vaccine which dramatically reduced cases of the disease, cutting waiting lists through cancer strategy, Rapid access chest pain clinics and NHS Walk In Centres on the high street (Prime Minister's speech on the NHS, 2001) Coote (2005) identifies few challenges facing NHS in order to cater the needs of the patients. They are keeping it clear to engage service users in decisions or engaging the wider public. Secondly to develop a link between the public and the health system. Third, Quick solutions through open discussions. The fourth is to take a long run at this. Finally, achieving above goals and much more from the NHS by engaging users and patients in the decision making process. Requirement of change in NHS: The last few decades have seen a major change in the Primary care requirements, increase in the ageing population, widespread of chronic diseases, increase in the patient's awareness, and greater accountability due to increased exposure (Coote, 2005). This has created a paradigm shift in the requirements of patients. The increasing trend of client centred services has made it important for the NHS to find ways to provide rapid and easy to access primary care to the patients (NHS, 2005). In 1999 it was estimated by the then secretary of state for health Mr Alan Milbun that it will take 10 years to modernise the NHS. He stated the fact that the NHS will have to train and recruit the extra staff needed BMJ, 1999). The vision of the change was to improve the services according to the convenience of the patients. He emphasised the need of 24 hours delivery of services to the patients (BMJ, 1999). The Government in the past has recruited and encouraged professionals to the NHS (Frontline, 2000). Extra budget for training of physiotherapists was provided. There are many physiotherapy graduates who were graduating in 2005 through NHS funded, 3 year BSc or accelerated 2year MSc courses (Gray, 2005). Due to these provisions by the Government NHS physiotherapy workforce increased by 6.8% in 2004 (Gray, 2005). The current Government has also expressed its concern and stated that the NHS reform is one of its top most priorities (NHS, 2005). According to the Department of Health change plan (2005) the vision of change in NHS should be directed towards the needs of the patients rather than the service providers. In order to undertake the change process effectively the professional role of the NHS staff should also be transformed. These steps towards modernisation were indicated: 1) Adoption of change by the NHS staff i.e. doctors nurses, physiotherapists and other healthcare. 2) Government's role in getting rid of barriers in the way to change. 3) The method for education and training should also be restructured. In a study conducted by Hofmamn and Jones (2005) presented a notion of collective personality. In case of physiotherapy profession the NHS plan has to improve its collective personality by introducing the consistency and reliability of performance in the field of education and practise (Gardiner & Wagstaff, 2001). There is a need to change from top to bottom in the Physiotherapy profession (Morris, 2000). A change is required regarding the training, knowledge database, accountability structure and professional duties assigned (Potts, 1997). Key drivers for change: With the changing demographics and the increase in health care service demand the demand for Physiotherapy is also increasing (Gray, 2005). According to an estimate, 1.3 million people receive Physiotherapy for back pain each year in Britain (CSAG, 1994). This increasing and diverse needs of the patients have posed different challenges for the professionals to define their role (Richardson, 1999). Most studies (Holland, 1997; Furness, 1993) and (Gandy and Sauders, 1990) have found that taking students in work force as helpers can fulfil present increasing need of the patients. The growing waiting lists for Physiotherapy patients has been identified as a major problem since last few decades (Christie et al, 1997). According to the NHS plan (2005) there are 19, 000 Physiotherapists working in the NHS. Still the surge is felt to increase the number of staff at NHS in order to fulfil the needs of the patients (NHS, 2005). Changing roles, role redesign, flexible working, skill mix, re-designing professional boundaries: As indicated by Morris (2002) although the first professional physiotherapy society was developed in 1894 but still the major problem facing the profession is the availability of credible scientific research material. He also stated that although some betterment has been done but still a substantial physiotherapy theory is not established (Morris, 2002). Till now the physiotherapists are not able to justify their services which has adversely effected their position in patient care (Morris, 2002). Wagstaff & Gardiner (2001) stated that there is a need felt to address the issues of internal and external accountability in the profession in order to attain a professional standard. The NHS plan is a good opportunity for the physiotherapists and their societies to put forth all their change requirements need references here. In order to improve the profession's condition, an advanced and compatible frame work should be introduced which not only help the practitioners but also the students can also be able to make most of it (CSP, 2001). With the technological advancement the patients have become so much aware that they have to be answered about the treatment (Coombs, 2002). Potts (1996) states the fact that with all the professional challenges faced by the health professionals; they have to justify their professional groupings, for which they need to assign boundaries to the services provided by them. Still the people have confusion regarding the difference between an Extended Scope Practitioner (CSP, 2000) and Clinical Specialist (CSP, 1995). Sparkes (2002) highlights the challenges facing physiotherapy as a profession. According to her physiotherapy until now has not gained the position of a profession. Physiotherapy is still striving/vying to gain the status of professionalism since the introduction of certified clarification of knowledge Need references here. With chalking the core skills and services provided by the Physiotherapists need is felt to steps to be taken for the future of the profession. (Golledge, 1998; Brown and Greenwood, 1999) The part two of the article indicates towards the multidimensional duties of the practitioner physiotherapists of formulating a credible information database for the new comers and developing a see of a standard ethical codes which can be helpful in understanding and serving the needs of patients. In an article (Ellis, et al., 2000) address the problem of absence of reliable literature relating to physiotherapy in the NHS. The library provision of standard material regarding the physiotherapy education and practise has always been severely needed the NHS should take steps in order to fulfil this need by providing an online database and make the clinician's enable to make the most of it Need references here. In a study conducted by (Taylor, Ellis, & Gallagho 2002) the scope of telephonic advice to patients was examined. It was found that the patients were very much satisfied with the advice given to them in case of back pain this not only helped the patients but also helped the management in managing the primary care workload. In the same way the net will also enable the physiotherapists to educate their patients about their treatment, do's and don'ts and their diet schedule in a more effective, consistent and timely manner to consolidate the physiotherapists relationships with other institutions in order to share their ideas about different discoveries and enhancements in the field of physiotherapy. This process is under way in some parts of the world. Williams & Ropert, (2004) under taken a project in the Universities of Australia and Philadelphia in which eighty-four students were brought together, The main purpose of the project was to determine whether Internet is an effective tool in exchanging ideas and discoveries in a useful manner. The result determined that the use of Internet was useful in exchanging the ideas about a topic, it not only enhanced the knowledge but also opened new dimensions for inquiry and research. Team working: Reinertsen (2005) indicates that the transformation in the present healthcare is not possible if healthcare system works isolation from community. He also states that many current problems result from the fragmentation of care as patients move from one provider to another in the course of treatment. Cameron et al (2000) finds out that most of the healthcare provider groups are still unable to create co-ordination between them. It was also stated that the planning and management in the departments are done in isolation from each other. With a lot of work still remain to be done in order to make the profession more organised the professionals still face the feeling of lack of confidence in their profession and their role as generic workers (East, 2000). According to the NHS plan the NHS Agenda for Change is the new NHS revised pay system which provides the employees of NHS to get equally paid for work of equal value. It offers: Redesigning of staff job areas into a dimension of more Greater scope to create patient-centred care Payments regarding the amount of work done by the staff Well being of the NHS staff. Creating a link between career and pay progression. All the NHS staff is covered under the change plan that directly employed at NHS. In order to make the employee learn and develop the skills required on every stage of their jobs, the NHS plan has introduced Personal Development Review (PDR) process. Through this process each and every Physiotherapist will be able to discuss all the shortcomings in complying with the standards of Knowledge and Skills Framework (KSF) and will develop a personal plan in order to gain the skills to overcome these shortcomings. The Skills Escalator structure introduced by the NHS plan is an important step towards opening a way of lifelong learning and progression for the practitioners and NHS staff. It has combined the qualification required, areas of job, pay scales and other benefits provided to the NHS employees. These fringe benefits will be helpful in attracting a large amount of work force and will be helpful in dealing with the problems of unemployment. This in turn will positively effect the poor health. (NHS Plan, 2005) The skill escalator is divided into Levels 1 - 8 according to the education and pay i.e. from Level 1 Education Required: NVQ 1; GCSEs Grades D-G, Pay Scale 11,494 - 12,539 to Level 8 Education Required: Specialist awards; Doctorates, Pay Scale (Range A-D) 34,372 - 71,494 (NHS Plan). Leadership: Doyal and Cameron et al (2000) states the fact that many studies and authors have pointed out the problems before but now it is important to find out the solution of these problems. Laschinger and Shomain (1994) conducted a case study and found that successful management is positively related to the managerial self-efficacy and job related empowerment and is possibly a link between organisational structure and personal levels of confidence. Welling (1985) in his book Behaviour Technology proposed an alternative aspect for leadership vision, which replaced the already available traditional methods of leadership. His work emphasised on improving the organisational performance through understanding the sub-ordinates issues and introducing the problem solving dimensions. He was in favour of understanding the subordinates and achieving the targets through solving their problems. Last few decades have seen the transformation of the notion of management into leadership. This is due to the importance of understanding that most important moot issue is understanding the needs of the subordinates, this belief gave rise to a debate of difference between management & leadership (Ajayi, 2002). The Real Change Leaders team and John Katembach (1999) define change as situations in which the performance of the corporation is highly dependent upon the learning and adoption of new behaviours and skills. These skills help the organisation to successfully compete in the market and add advantages for the enterprises. The medical industry has changed in most of the developed countries of the world (Schneider, 1998). New technologies have implemented and the natural environment of the world has changed which has given rise to new diseases and has changed the need of the patients (National Science Foundation, 2000). So in order to respond to these external changes the NHS has to change internally. (Gray, 2005) states that with the change in the whole NHS plan the physiotherapy department is also underway to change. They are delivering modernise and innovative services to the patients. From top down programs, such as re-engineering, restructuring and transformation should be undertaken in order to keep the pace with the present patient needs and requirement (Mugaseth, 2002). In order to undertake these change leaders are required in the staff who can successfully make the way to undertake change (Ajayi, 2002). Change leadership demands to alter the groups to the need for changes in the way things are done; restructuring and introducing new techniques and tapping them fully into the organisational capacity (Ajayi, 2002; p. 02). The change reader is the champion, who takes the change initiative and efforts, builds support and maintains commitment of rest of the team members towards embracing change. The drastic change required needs to develop Physiotherapists and leaders who can bring the revolution in the profession (Ajayi, 2002; p. 03). Conclusion: The above discussion has made it clear that the Physiotherapy as a profession is facing with the multidimensional challenges as compare to other healthcare professions. The progression should not only do in exploring new theories but also base the work done on scientific evidences. Provision of reliable database is also an important necessity. In practice need is felt to prepare leaders and professionals who can lead the rest towards the right direction. In order to undertake all the important tasks related to the physiotherapy effectively and timely, it is important to introduce the use of e-technology. The technology inclusion will not only make the whole process time- savvy but will also broaden the role of the physiotherapy assistants. On the customer side the introduction of e-dimension will make it easier for the patients to get on-line advice from the physiotherapists in case of emergencies. The exposure to the technological change will serve the needs of the patients and their increased expectation. Now patients expect their physicians to give them support on 24/7 basis; to give them access to treatment information; and hassle free. The introduction of e learning, a revolutionary new approach will bring multifold advantages in training and developing physiotherapists and will drive a quantum change in nature of training. The e learning will provide two types of benefits, internal an external. Internal benefits will include the provision of time-savvy and easy to reach database, reachable by all the trainees and students which will be helpful in improving their expertise. This knowledge providing database about physiotherapy will overcome many hindrances such as hesitation to ask a question from the trainer, visual database about the exercises can make them understand the procedures and methods in most effective manners. The better the quality of the training provided internally, the better the quality of the knowledge the hospital staff will be able to share with the patients, thus building a stronger, more efficient and sustainable relationship. References 1. AJAYI, O., (2002). 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