No-touching Physiotherapy

Just when you began to think that ideas couldn't get any barmier, along comes health commissioners in Rushcliffe. It seems that NHS patients will no longer get hands-on treatment, but will simply be given "advice and guidance". The aim, according to health commissioners is to help patients to "self manage their condition ... and to take control of their condition and get better quicker". 

Let's have a look at the background here. In the Government's Health and Social Care Bill, Clinical Commissioning Groups will take over from all Primary Care Trusts in April 2013.

Nottinghamshire is ahead of the Government's timetable, and has already devolved budgets to new groups. In the Borough of Rushcliffe, which is where I live, the new clinical commissioning group is called Principia, and is responsible for planning and buying healthcare services in the Borough.

This group are responsible for the no-touching rule for physiotherapy. A spokesperson said that the change in service had not been a cost-cutting measure, and that "costs were broadly the same as before". Now call me cynical if you like, but I don't believe it, and what the hell does "broadly the same" mean anyway?

There's no more of this

Today's Nottingham Post says, "For many patients suffering from chronic back, neck or joint pain, physiotherapy is an essential step on the road to recovery". Statistically, 80% of the population suffer from lower back pain at some stage in their lives, which if applied to Rushcliffe gives a figure of over 96,000 patients.

Previously under the NHS in Rushcliffe, if you had problems, you were offered one assessment and up to four treatments for physiotherapy. The clinical commissioning group has reviewed its services, and changed from being a treatment service to an advice and guidance service. As the Post says, "This means the physiotherapists are no longer allowed to touch patients, and instead give advice on what exercises they should be doing and information on how to manage their condition themselves".

Even before you can get a referral to a physiotherapist, you have to visit your GP on two occasions, six weeks apart. If you can navigate that hurdle, all patients in Rushcliffe can expect is a maximum of two physiotherapy appointments a year, and that for advice and guidance.

Following a survey of all Primary Care Trusts in the country, The Chartered Society of Physiotherapy has said that Principia was the only group not to offer a hands-on treatment to physiotherapy patients.  Commenting on the new service, the Society's Chief Executive said, "They seem to have invented a new form of physiotherapy that no one has heard of - do-not-touch physiotherapy". Patient's group are equally concerned about the new service. A spokesperson for the Local Improvement Network in Nottinghamshire said, "I think it is just awful. If you need physiotherapy, you need the treatment, not just advice". 

As someone who suffers from back pain, and has benefited over the years from physiotherapy treatment, I share the concern of many at the withdrawal of hands-on services. Even after getting advice, not everyone is in a position to access online information, and many people need practical demonstrations to ensure that they are doing physiotherapy exercises correctly. My treatment was private as I could afford to pay for it; I can though no longer afford to pay around £40 - £50 for a thirty minute session, and I expect many other people are in the same boat. So, many residents in Rushcliffe who cannot afford to pay for treatment (yes, even in this affluent Borough, there are those struggling with cash flow), knowing that there is no hands-on treatment available on the NHS for them, will probably not do anything, except suffer.

Commenting on the new service of advice and guidance instead of hands-on treatment, The Chartered Society of Physiotherapists said, "It is a completely barmy form of treating people". I agree, and I hope that the day will come when the clinical commissioning group will reverse the decision and allow the residents of Rushcliffe to receive hands-on physiotherapy treatment when they need it.

Obesity - a big problem

The media, and health professionals are in full Armageddon mode following a recent series of articles in the Lancet medical journal on the subject of obesity.

The BBC, and all of the major daily newspapers have extensively covered the subject. For the sake of anyone who has been away from TV, radio, phones and newspapers for the last 20 years, let's remind ourselves of what obesity is, and how it is calculated.

It is basically carrying too much body fat for your height and sex. The system used to calculate it, and which is accepted across the world, is what is termed, your Body Mass Index (BMI). This is your height to weight ratio, which is calculated as a score. Any score of 30 and above means that you are classified as being obese. Now let me put my cards on the table here. In a recent, regular health check, my BMI turned out to be 31.32 which classes me as obese. I should resist the temptation to say that I feel my problem is not being overweight, but under-tall - but that is far too flippant, and unworthy, but I couldn't resist saying it. I need to lose about one stone to take me out of the obese category. The rest of my health check was fine, but statistically I am in the obese camp.

Nobody, walking around any village, town or city in the country could fail to see that too many children, young people and adults have a weight problem. In the Guardian last week, Peter Walker commenting on one of the Lancet studies by Claire Wang, said that "based on around 20 years of historic data, the study says that by 2030 as many as 48% of British men could be obese, as against 26% now, and for women, the figure could rise from 26% up to 43%". The future forecast is an extrapolation of the past, and may not be quite as bad, but if the historic trend continues, the UK could have 26 million obese people, up 11 million on the current figure. Whatever the actual future figures may be, nobody can be in any doubt that obesity is a major health problem in our society - as it is in many other parts of the developed world. Many British people have historically taken great delight in making fun of the size of many Americans, but we now have nothing to laugh at, as we have the same problem on our own doorstep.

An area highlighted by many health professionals is the health consequences of obesity. These cover type 2 diabetes, heart disease and a shorter than average life expectancy. The consequences are serious, but somehow the message is getting lost in all of the rhetoric.

In an on-line Daily Mail article last week by Daniel Martin, the headline read, "Obesity crisis in UK drives up the price of diabetes drugs by 40%". It went on to say that diabetes drugs now account for 8.4% of the NHS medicines bill, costing taxpayers £725 million, which is 41% up on that which was spent in 2005/06. According to Daniel Martin, "most of the rise is down to the treatment of type 2 diabetes, which is linked to obesity and unhealthy lifestyles". Apparently, one in every 25 prescription items now dispensed is for diabetes.

To one of the Lancet's contributors (Professor Boyd Swinburn), there is a clear primary culprit: a powerful global food industry "which is producing more processed, affordable, and effectively-marketed food than ever before". He went on to say that an "increased supply of cheap, palatable, energy-dense foods, coupled with better distribution and marketing has led to passive overconsumption". This was perhaps highlighted in a BBC news report where a Mother was being interviewed. She may well have been talking about a well known frozen food chain when she said, "You can buy a pack of oven chips for £1, and a Pizza for £1.75 - that's a meal for my family for under £3".

We don't have to spend any longer on the problem. The question now under consideration is the more thorny one of what to do about it. Some press for the importance of personal responsibility here, while others are looking for Government intervention. Still others see it as a combination of the two. In a Guardian article last July, Denis Campbell took the Health Secretary, Andrew Lansley to task on two fronts. He pointed out Mr Lansley's oft-repeated pledge in opposition that he would encourage greater personal responsibility as a form of preventative medicine, but that little has been heard of that promise since. He also questioned whether his reliance on partnerships with industry bodies to voluntarily tackle the problem was sufficient. To Denis Campbell, "Changing people's behaviour requires much more than deals with supermarket giants, healthy food vouchers and pleas for more willpower in people's lifestyle choices".

Those that advocate strong Government intervention will take heart from another of the Lancet's studies by Steven Gortmaker from Harvard University's school of public health, when he lists eight cost-effective policies to deal with the problem. Most of them focus on shielding children from TV advertising, or ensuring they exercise more. At the top of the list is a proposed tax on unhealthy food and drink. How you practically 'shield' and 'ensure' is another matter. Advocates for strong Government action point to Wales and Scotland as examples of pursuing adventurous things. Wales may well ban smoking in cars when there are children present, and Scotland ,with the recent SNP landslide, will look to introduce a minimum price per unit for alcohol. I don't have too much of a problem with the Welsh idea, but what next? A smoking ban in homes where there are children? And how will that be monitored? An army of snoopers, or children encouraged to grass up their parents? The current smoking regulations in vehicles, or the use of mobile phones can't be managed, why should we expect anything different from an extension?

I think that too many people are coming up with ideas without thinking them through. One thing though that I am absolutely against is using taxation as a form of social control. There are two reasons for this, one is that it punishes everyone, and two, it doesn't work. Excessive tax on tobacco has not stopped smoking; excessive tax on alcohol has not stopped binge drinking: excessive tax on fuel has not driven cars off the road. What makes people think that excessive tax on unhealthy food and drink will make people stop buying those products?

In my opinion, Government can do something by working together with people. The current NHS bill for dealing with the effects of obesity is enormous, and as we've seen, will rise exponentially over the next two decades. In line with encouraging better food to be more affordable, why not allocate money to regional pilot areas to work with the worst affected individuals and families to address their 'obesity time bomb'? And please, don't tell me it can't be afforded.

I don't agree with everything that Denis Campbell says in his Guardian article, but I agree with this. "Why are there not, for example, Department of Health funded pilots of teams of visitors, dietitians and psychologists working together intensively with individuals or families to help them to start leading the healthier lives many would surely prefer? That would constitute integrated care and preventative health". Social control through taxation is not the answer, but intensive work as above has got to be worth a shot, and as Denis Campbell says, it "might just work".