NHS ten year plan: change makers

NHS England is carrying out the biggest consultation in its history to feed into its 10 Year Plan of reforms, to be published next May.

Four physiotherapists have led panel discussions with thousands of NHS colleagues to shape what the frontline needs to see from reforms.

They tell Frontline how physiotherapy workers are perfectly placed to lead the changes.  

Karen Poole is an AHP rehabilitation consultant for East Sussex Healthcare NHS Trust and strategic clinical lead for rehabilitation and reablement at NHS Sussex. 

A physiotherapist by background, she brought a clinical focus largely around intermediate care and community services and a strategic lens to her panel discussion on a move to more community-based care. 

‘I definitely get a sense that the government is listening – they really, truly want to hear the perspectives and the voices of our members on what needs to change,’ says Karen, whose panel event was attended by a health minister. 

Karen is passionate about physiotherapy workers actively participating in the NHS 10 Year Plan consultation. She highlights the risk that if they don’t engage, their contributions beyond injury recovery – their clinical leadership, and critical role in public health – won’t be recognised, and gaps will be filled by other professions.

We need to show where physiotherapy is leading, shaping and implementing exemplars of community delivery.

Physiotherapy workers’ biopsychosocial approach to treating mental and physical health is exactly the kind of best practice that needs rolling out. 

Minister for secondary care Karin Smyth attended the panel, and heard Karen underscore the importance of leadership and supporting roles to create the headspace and capacity for a transition from acute to community care. 

Karen also drives home the need for better integration of primary care and community services, whose separate funding streams and communication gaps – including inpatient data sharing – make effective collaboration difficult. 

The creation of first contact practitioner roles and the emerging advanced clinical practitioner for community rehabilitation will help, she added, but more work must be done to achieve a ‘parity of esteem’ between roles across sectors.

She raised concerns about the NHS workforce plan being insufficiently needs-led, preventing a true understanding of what gaps there are. In the panel, she quoted a stark example of people ending up in care homes who could have been supported to live independently if given the capacity to offer more proactive than reactive care. ‘Unfortunately, this is a missed opportunity as teams have needed to shrink our resource to live within our means.’

Now, she says, it’s the turn of the physiotherapy workforce to add to these growing calls by completing the consultation survey.

‘We also have the insight in terms of what needs to change, and I would say that the survey gives our members an opportunity to have this say.’

Share your valuable perspective

Alex Wilson, head of record services at Surrey and Borders Partnership NHS Trust and Caldicot Guardian at Oxford University Hospitals NHS Trust, was a panellist on a discussion about digital transformation.

Though hundreds of NHS workers took part, agreement on some of the foundational changes needed was surprisingly easy to achieve, says Alex of his panel discussion.

‘The facilitator asked us about the current challenges and potential enablers, with the audience commenting on [virtual whiteboard] Menti. Then myself and the other panellist gave our perspectives on their suggestions and comments.

‘What it really boiled down to is that we have to do the basics to a very high standard because if you get those right, you can layer all the really interesting stuff on the top of it.’

Digital solutions should not be imposed from afar, but co-created by the workforce, insists Alex, reflecting talk on the most common pitfall for IT change programmes. 

‘Going to the frontline to experience, ask and observe is vital.’

Use our amazing workforce in the NHS because they know what the problems are, and they probably know what the solutions are too.

Having a comprehensive shared care record would be a great start, he argues, saying it could improve healthcare efficiency and patient safety by reducing repetition and enabling data use across multiple settings.

But no change could succeed without trust and leadership. ‘Data sharing is limited by the pace of trust and if you don’t have trust from citizens or staff, you’re not going to make these changes,’ he says. 

‘Leadership must provide a clear narrative to gain trust and cultivate a good culture, ensuring stability through change’.

He encourages all members to join him in having their say on digital transformation through change.nhs.uk 

‘Use the platform to make your voice heard. Physiotherapists have a broad base of experience of NHS problems and bring valuable perspectives on how to improve the effectiveness of healthcare using digital tools.’

Ushering in digital change

Christina Sothinathan is an innovation business partner at CW Innovation, a collaboration between Chelsea and Westminster Hospital NHS Trust and its official charity, CW+, and an advanced practice physiotherapist.

She has also had clinical leadership roles in London, and in digital health initiatives at NHS England and Digital Health, London. Her panel was on digital transformation.  

All agreed that change shouldn’t start with shiny new technologies. ‘It’s not good enough having to wait 15 minutes for your laptop or the computer to start. You need to get the basics right first,’ Christina argued, as poor digital infrastructure and lack of data sharing emerged as key issues.

Reforms depend on NHS workers being able to use any new systems and tech, too. ‘Give the workforce the right training and protected time needed for successful digital adoption,’ Christina added. 

The impact of years of underfunding, and under staffing on the workforce was a key concern in all panels. 

You have to look after your workforce, because they are the ones propping the NHS up.

Christina advocated for better support for physiotherapy workers, including portfolio careers to sustain the workforce, and digital solutions. There should be a focus on allowing digital transformation projects to be led by frontline clinicians who understand the needs of users, she says. This could include relieving the admin burden through appropriate use of AI or robotic process automation or using technology to help manage lower-complexity cases, which could free up physiotherapists to focus on more complex patients.

The government seems to be pitching the NHS app as a way of enhancing patient agency, but a serious upgrade is needed if it is to realise this potential, says Christina. 

She believes the NHS app could develop features that support physiotherapists, such as booking and cancelling physiotherapy appointments, managing care plans, and tracking rehabilitation progress. 

Additionally, integration with other health apps could be a future goal, where different apps (such as those for exercises) could integrate within the NHS app, reducing the need for multiple logins.

But with any national rollout, provision should be made for those in vulnerable communities who may experience digital poverty, or a lack of skills and confidence. The need for training and improved accessibility, as well as attention to cybersecurity concerns, were key.

In terms of tech used by healthcare workers, the audience agreed a priority should be to streamline governance, so once a technology is approved at one hospital trust, it should be easier to implement in others. This would avoid redundant processes like safety reports and assessments. 

All the themes that emerged during the discussion will feed into the 10 Year Plan; a fact Christina welcomes. ‘It’s not just a tick box exercise – they will be used to inform policy.’

She encouraged physiotherapists to contribute to the 10 Year Plan consultation. ‘It’s really important that we’re represented, not only as the third biggest NHS profession but because our training across such a broad range of specialism mean we have an unrivalled range of skills to bring to improving population health.’

The vital role of physiotherapy staff

First contact practitioner and clinical project manager at Homerton University Hospital NHS Trust, Matt Harrison, was on a panel discussing primary and secondary prevention. 

As a physiotherapist who works across hospital and GP practice settings, Matt’s reflections run the gamut of biopsychosocial approaches.

Hot topics in his discussion were how to reduce bureaucracy and red tape, funding challenges, time pressures and staff shortages. 

‘What came up a lot was how to support teams for their overall wellbeing due to increasing levels of burnout due to stresses in their roles, and at a time of an increasing amount of fixed term contracts which adds financial worries on top. 

One part of the answer is looking longer-term, especially when it comes to funding and job security.

This is a particular challenge when it comes to prevention, he argues. ‘It’s very easy to respond or report in a reactive way and that becomes your way of working. It’s more difficult to do, say, the outreach work, and justify the resource for it when there aren’t the metrics outside of acute to support it.’

Despite this, there was enthusiasm for more screening and education. ‘If we have the right leadership to take this forward, and data on outcomes to keep improving.’

Physiotherapy workers were recognised as key players in prevention and rehabilitation, as they have the time and expertise to engage with patients, support early prevention, and provide rehabilitation to prevent hospital readmissions.

The role of physiotherapists in improving patient outcomes and supporting people’s participation in society through work was also highlighted.

‘Physios are well placed because it’s about again that principle of getting it right first time of using skills from working in multiple specialities to help support people,’ Matt explains.

Matt stresses the value of getting involved in the consultation process, noting that it provides an opportunity to shape policies that affect the profession and patient care. 

‘Sometimes we just crack on with the problem right in front of us, we don’t take the time to share our voice wider and tell the NHS – what are the things that are missing. And you can do that at all levels including apprentices, physiotherapy assistants and chartered members.’