#Physio14: Where will the next 100 years take us?

This post has been slightly delayed partly due to me gallivanting in Vietnam for 2 weeks but also due to my change in shift pattern on Trauma and Orthopaedics I have less time in the evenings to sit and write my blog. This post will mainly cover my trip to Physiotherapy UK and will touch on future exciting developments in the pipe line.

Attending Physiotherapy UK was a relatively last minute decision. I had been to the conference for the last 5 or so years as a student and newly qualified, however this year with me going to Vietnam for a couple of weeks I was definitely counting my pennies.

I can tell you the decision not to go did not last long as everyone kept messaging me  asking “Are you going to Physio UK?” and in the end I just didn’t want to miss out! It was a great 2 day event which was credit to the organisers  and council, a truly inspiring event with lots of learning to take away. I have written this blog  in blocks so you can skip to the presentation summary you want,( I have not included all of the presentations as I would be here all night). Each one will be divided by a horizontal line.

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Rob Webster- Meeting the 201 Challenge: Opportunity and Threat. NHS Confederation.

It was great for Rob Webster, Chief Executive of NHS Confederation, to come and deliver a talk at Physio UK. Rob really did set the scene for the challenges faced by the NHS in the near future and where Physiotherapy can play its part.

So the current Challenges:

  • Generational Challenge- A society becoming dependent on the health service.
  • Ageing Population- An increasing demand on the Health service.
  • NHS Reform
  • Funding Cuts
  • A population with multiple issues.

We have a leadership role to be optimistic: 7 Themes the NHS needs to address.

  1. The Need challenge-changing population
  2. The Culture challenge
  3. The Design Challenge
  4. The Finance Challenge
  5. The Leadership Challenge
  6. The Workforce Challenge
  7. The Technology Challenge.

So we need ambition for the future- Where is the NHS going?

The vision and asks: The 2015 Challenge Manifesto a time for action.

  • Start with Prevention
  • Long Term Conditions- supported self care
  • Seven day services- local hospitals
  • Hyper acute trusts to save your life in need.

Things we need to remember as Physiotherapists and other Health Professionals.

  • We are guests in other peoples lives. We need to put ourselves in our patients’ shoes to truly understand what they are going through.
  • Our outcomes should be theirs.
  • We should organise around them and not our professional egos.

The Opportunities.

  • Integration working as one team across community and across organisations
  • Cost effective- using and promoting the work being done by Physio Works.
  • Right Person, Right Care.

Threats

  • Misunderstood Role- we need to learn to shout a bit louder about our profession.
  • The Heft of Status Quo.- “If you always do what you have always done you will always get what you have always got”
  • Visibility- Do commissioners know what we can do?
  • Unintended consequences of safe staffing
  • Plurality.

My take home message: We are facing a challenging environment within NHS whether it be cuts, increasing pressure to meet demands or trying to make Physiotherapy heard. We could easily just sit on our laurels and wait for someone to make a plan for us however we all have a responsibility to push our profession forwards and demonstrate how we can be a major part of the transformation of the NHS.


Centenary Founders Lecture 1912-2014 Karen Middleton.

I think I must have done 3 blog posts including a speech from Karen but each time I take away something different. The lecture was focused on how Physiotherapy has transformed over the last 100 years. How we take for granted our Autonomy and need to look back at how our founders over came the challenges to achieve this. Physiotherapy has a great future if we continue to push the boundaries of our profession.

Karen’s Leadership Lessons.

  1. Take Responsibility for your own development- I have taken this forwards by finding a mentor to guide my development.
  2. Things that Karen reflects on: What are you known for? What do you want to be known for? What challenges you? What have you learnt? What have you recently added to your CV? Why should anyone be lead by you?
  3. We need to be flexible! Learn to live with a bit of mess!
  4. What level of risk can you accept? What can you get away with?
  5. Learn to act quickly but not rashly. Don’t over think.
  6. Leadership takes guts
  7. Speak out when others are silent when integrity is at stake. Would you stand up for Physiotherapy?
  8. Everything in your body will tell you you can’t do it. Imposter syndrome we diminish our own value.
  9. We must be authentic
  10. People need a reason to follow you. People need to feel empowered.

If you want to see the video to Karen’s inspirational lecture please click the link below.

http://www.csp.org.uk/news/2014/10/10/karen-middleton-calls-action-stop-physiotherapy-sleepwalking-obscurity


Supporting People with Long Term Conditions- Prof Ann Ashburn

Patients need:

  • Support, Information, choice- patient preference, self-management, Information about their condition, prevention+ health promotion, psycho-social, point of contact when things go wrong, feedback from patients for service improvement and Training for all.

The Strengths of Physiotherapy

  • Active participants
  • Targets set and agreed
  • Collaboration
  • People views of Physiotherapists.

Challenges

  • Limited Research
  • Psycho-social aspect
  • Leisure activities- health promotion
  • Utilising Technology

Disempowerment and Psycho-social factors in long term conditions

  • Attention
  • Diminished concentration affects learning
  • Not being given enough time to think
  • Too many instructions
  • Background noise
  • Fatigue
  • Day to day variability, medication cycle & sleeping patterns. Affected by dehydration (as a result of slowness to swallow,concern about bladder control) so could have headaches, fatigue, constipation all of which will affect performance.
  •  Answering phone – better face to face

Empowerment

  • Allow patients to achieve
  • Recognition of previous life and the patient as a person
  • Choice
  • Support

The final part of Ann’s presentation looked at some of the health promotion activities that Physiotherapists could be involved in such as a scheme called Life after Parkinson’s. For example they set up a dance group for patients with PD . This was just one example of how we need to be creative to improve patient experience and that there is life after a diagnosis of a long term condition.


Assessment and Treatment Planning for MS- Dr Jenny Freeman

Symptoms of MS

  • Fatigue
  • Weakness
  • Poor Coordination
  • Spasticity
  • Sensory Disturbance
  • Visual Disturbance
  • Poor Swallow
  • Bladder and Bowel etc

Some questions and top tips for people with MS.

What are you currently doing to manage your health? What exercise?

Is there anything putting you off?

Do you ever Fall? Impaired  balance during Transfers, STS, Turning./Delayed motor response/Alteration of 2 sensory inputs/use of walking aids.

Exercise is proven to be beneficial and is not associated with relapse. Transient symptoms should settle down.

Should be aiming to complete Resistance training 2-3/week at mod intensity 60-80% 1rep max 1-3sets for min 8 weeks. Aerobic training 2-3 times a week 30 mins 4x a week.

Some of the balance interventions: Increase sway in quiet stance, delayed anticipatory + autonomic postural adjustments. Evidence suggests the benefits for balance interventions.

Current Outcome Measures Used.

10m Timed Walk, Single leg stance, lateral reach, confidence scale ABC, MS Walking scale, Activities specific MS, Grip strength, 9 hole peg test.

Useful Resources: Rehabilitation Measures Database- Neurology/ MS edge outcome measures database.


Measuring Respiratory Symptoms in Advanced MS? What’s the point? What’s the evidence? What are the options? by Rachel Moses.

This was a regular problem when I was working on an acute respiratory ward, MS patients being picked up too late for respiratory Ax. If these patients are caught early there are many interventions which can be taught to prevent admission to hospital but the new NICE guideline for MS have removed speech/swallow and respiratory management from the guidelines even though anecdotal evidence suggests there is a need.

MS pulmonary dysfunction and function 

  • Marked expiratory dysfunction – poor cough
  • Severe diaphragm weakness ? Indication or higher cervical cord lesion.
  • Limited ability to maximally exhale
  • reduced vital capacity for patients who desaturate over night.
  • MS- abnormalities in breathing control, resp muscle weakness, bulbar dysfunction.

What’s the Point?

So when we are assessing a patient we want to be looking at their peak cough flow. If the patients peak cough flow falls below 270ml then it is likely they will need some support to have an effective cough.

  • Lung Volume recruitment bags would be the first port of call this aids breath stacking to increase lung volume for a more effective cough.
  • If LVR isn’t enough some patients may need a Manual assisted cough as well.
  • The final port of call would be manual Insufflation: Exsufflation. This is a machine which delivers a volume and then switches the pressure release the volume and augment a cough. MI:E has been shown to be a cost effective admission avoidance strategy for patients with advanced NMD.

From this presentation it reiterated the importance of early respiratory assessment to prevent acute admissions. It also highlighted a need to educate commissioners on the benefit of respiratory management for patients with MS.


The Dementia Challenge- Iain Lang

What is Dementia?

  • A set of symptoms, progressive condition.
  • Not easy to differentiate between different types of dementia
  • variable condition day to day.

Why is dementia important?

  • Common
  • It’s frightening- most feared health condition, reliance on others
  • £26 billion cost to UK Economy
  • people with dementia stay an average five days longer in hospital.

How can we respond to the challenge?

  • Diagnosis more than 1/2 of people with dementia are not diagnosed.
  • Treatment- drugs are used to reduce symptoms and deal with psychosis, anxiety or depression. No current drug developments.
  • Understand how to communicate with patients with dementia- now mandatory training.
  1. Prevention- managing other commorbidities  HTN, Diabetes.
  2. Don’t smoke this increases the risk of dementia
  3. Eat a Mediterranean diet
  4. stay engaged prevent social isolation, learn new things
  5. Exercise best evidence to prevent dementia

Implicit memory- how you do things?

  • Evidence suggests the way forwards
  • error less learning
  • positive experience
  • repetition guiding what you want.

Implicit vs Explicit

  • Priming
  • errorless learning
  • repeated constant practice
  •  avoid multitasking

Dual Tasking

  • Capactiy overaload
  • Structural interface- sensory overload- for example during standing use fingers instead of hands to support patient.
  • be patient
  • don’t overload senses
  • one thing at a time
  • may choose to do this as part of rehab.

Communication

  • Dementia questionnaire inpatient- what do they enjoy?
  • Smile
  • Understand where people come from.

Pain

  • Very overlooked
  • most unable to verbalise
  • unable to process pain
  • unable to identify pain
  • unable to understand why they are in pain
  • What were they taking before?
  • Pain scale- Abbey pain scale.

People with dementia should be given the opportunity to maximise their potential.

  • Approach from the front good eye contact
  • think about what they are called
  • short commands and being courteous
  • keep hand movements open
  • use positive tone
  • goal based- lets go and look out the window
  • stand up tall
  • use gesture or tap where
  • avoid jargon
  • use of equipment be aware may not understand how to use.

I have been able to take this learning into practice in the acute setting by adapting my communication and limiting sensory bombardment, in turn I have found my patients with dementia have made good progress. Sometimes you need to be patient and try and build rapport  before asking them to do something but if you can get them on your side you will make your job a lot easier. I have also found that by reducing my handling has encouraged patients to be more active during the treatment session which has limited the manual handling load for me.


So that was just a review of some of the presentations I attended whilst at Physio UK. During the event I was able to catch up and network with many different people who I aim to stay in contact with. Physio UK always offers a great opportunity to speak to new people who share a similar interest to you whether that be Management, Education, MSK, Respiratory, Neurology and more. Whilst at the drinks reception I got talking to Paula Manning, outgoing Vice Chair East Midlands Regional network and Catherine Pope, Vice Chair of council. They asked me whether I would be prepared to stand as Vice Chair for the East Midlands Network. I was ecstatic to have been asked but I suggested that I would need to confirm this with my manager. My manager has now agreed to support me and I have been selected to run as Vice Chair of EMRN. The role will be a challenge but it will give me valuable experience which can be transferable to my professional developent. I have lots of people to support me so I am looking forward to taking the role forwards into 2015.

One final thing in the pipe line, I have been asked by the CSP student reps to speak at the annual rep development weekend.  I am really looking forward to sharing my experience as a new graduate with reps and hopefully inspiring them to do great things and take the future of our profession forwards.

Apologies for the length of this blog, but Thank you for taking an interest. Wishing everyone a Merry Christmas and a Happy 2015! Any comments or questions please leave a message below or tweet me @LCphysio.

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Painting my Future Plan!

It appears I have been absent for a month or so from the blogging scene, so it is nice to finally have chance to sit and write a new post. On my last post I was just starting my new permanent rotational band 5  job in Derby. Taking on a new job is an exciting and scary time and I did wonder whether I had made the right decision….will I slot  into the teams, will I enjoy the rotations, how will I cope with a bigger commute and will I drive myself mad living back at home with my parents? All I can say is so far this post and my current situation has been far from a disappointment. We make our own luck and certainly everything appears to be falling into place.

So where to start…. My first rotation is on elderly medicine which is due to finish at the end of April to move to respiratory medicine and on call training (eeeeek!). I have felt so welcomed within the teams at Derby Hospital and they have really been pushing my personal development and quality of care for patients. I have now begun the Preceptorship process and regularly meet with my supervisor to plan and take action on future aims and objectives. My objectives on this rotation aim to cover 4 tasks set by the preceptorship programme (which a scheme to create a seamless transition from Student to Band 5 physiotherapist minus the 6 month incremental pay!).

Task 1: Working with Patients and Groups. 3,2,1.

Task 2: Working with Colleagues and Other agencies. 2,4.

Task 3: Written Communication 2,3.

Task 4: Using local Clinical Policies relating to working practice. – Identifying risk and creating a follow up plan. Carrying out a notes Audit.

The numbers following each task, cross reference to my objectives which I will use as evidence for each task.

My Objectives 06/01/2014- 22/04/2014.

1. i) To be able to identify appropriate patient’s for humidified Oxygen. ii) To be able to set up a humidified oxygen circuit independently.

2. i) To be able to explain the range of rehab options for any given patient. ii) Identify the most appropriate referral. iii) To be able to complete a timely referral.

3. i) To complete a comprehensive + patient specific new  Ax. i) To create a specific and comprehensive problem list. ii) Treatment Plan. iii) Smart Goals.

4. To lead case load management on ward, delegating to BS/ PTA’s and other qualified members of staff.

5. Present an in-service training session for the therapy team.

NB: How I will evidence this is recorded in my Portfolio.

This just gives you an idea of the sort of things I am looking at as a Band 5 physiotherapist. I plan to update my progress post rotation…. What I would do differently? Are there any other objectives I should be including? What went well? And what am I hoping for in my next rotation?

Since starting at Derby I have been given the  opportunity  to continue my work for the CSP as I been selected to sit on the Industrial Relations Committee as the Newly Qualified Rep.

The Industrial Relations Committee (IRC) have special responsibilities in relation to decisions on Pay, Terms and Conditions. Members of the IRC have Leadership and Governance roles to support CSP members.  This may involve inspiring, engaging and empowering members in relation to the work of the IRC and wider trade union issues and campaigns.

In brief the IRC aims to consider all matters and develop policies and strategies, relating to salaries, employment, labour utilisation and conditions of service for Chartered Physiotherapists, Associates and other persons represented by the Society.

I am trying to find the best way to keep in touch with Newly Qualified physiotherapists to put their view across. I have posted a link on iCSP

http://www.csp.org.uk/icsp/topics/calling-all-newly-qualified-physiotherapists?networkid=226045

to see if this generates some interest. I would like New grads to come forward with any issues affecting them in the work place (NHS or Non NHS), which they feel needs to be taken further than Steward and H&S rep level. Local issues can normally be resolved through Stewards and H&S reps. However, if a problem is of a national scale or you feel other New Grads may be facing a similar situation please get in touch.

KEY COMMUNICATIONS MESSAGES- IRC MEETING 5TH FEBRUARY 2014 

New IRC Chair – Jill Barker elected as new IRC Chair.  IRC paid warm tribute to outgoing chair Alex MacKenzie.

Wider Environment – Important to track what’s happening in the wider economy.  Changes to benefits, public services, living standards etc. All impact on profession and patients.

Lobbying Bill – now passed by Parliament.  Strenuous campaigning secured some improvements, but still a big step backwards in terms of democratic rights. CSP to assess how best to mitigate the impact on our ability to lobby and campaign on behalf of members.

NHS Pay, Pensions & Conditions

  •  Pay Review Body (PRB) recommendations on this year’s pay lift, and the Government response, now expected in March. Also likely to be big challenges ahead, issues such as incremental progression.
  • Changes to Agenda for Change terms and conditions in Wales to go out to member consultation once position re doctors clarified.  While not welcome, they represent a significant shift from those originally proposed.
  • First report of joint employer/union working group on implications of staff working longer due out next week. CSP represented on the group.
  • Discussions taking place on very difficult issues around the future funding of the NHS and other public sector pension schemes.  Widening access to the NHS scheme for non-NHS members delivering NHS services represents a concrete success

NHS Social Partnership Working – CSP now has a seat ‘at the table’ in all 4 countries, giving access to information and key decision makers

Competition – new cross-CSP group to be set up to steer CSP’s future work on competition, including learning lessons from early initiatives.  Outcome of current negotiations on an EU-US trade treaty could have big impact.  TUC lobbying making some headway in ensuring public consultation on treaty takes place.

Safe Staffing Levels – CSP employment and professional functions working together on key issues for profession raised by the Francis report, in particular guidance for members on safe and effective staffing levels and the duty of candour.

TUC ‘For a Future that Works’ campaign – IRC agreed to support next major national demonstration planned for October, and to encourage maximum member participation.  Also to support the new Robin Hood Tax petition and video.  Aim of both initiatives is to present the practical alternatives to austerity. Rally’s are a way of organisations/unions showing solidarity on a campaign.

http://www.tuc.org.uk/about-tuc/britain-needs-pay-rise-%E2%80%93-tuc-mass-demonstration-autumn

http://www.csp.org.uk/professional-union/union-support/future-works

Organising – formal CSP recognition secured at the Percy Hedley Foundation in the North East. Welcome precedent.  New briefing on CSP employment services for members working outside the NHS in preparation.

NB This is only a snapshot of the meeting and the comprehensive range of papers tabled.

The weekend after the meeting I was also fortunate to be invited to the Student Rep Development Weekend (which I attended as a student CSP rep). It was strange being on the other side but this years Student Executive Committee have done a great job ensuring the student voice remains . There were many great speakers from the conference which generated a lot of interest on twitter! The transcript for the event can be found here:

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?hashtag=SRDW14&fdate=02-06-2014&shour=0&smin=0&tdate=02-09-2014&thour=23&tmin=43&ssec=00&tsec=00&img=1&page=2&page=1

And Analytics here:

http://www.symplur.com/healthcare-hashtags/SRDW14/analytics/?hashtag=SRDW14&fdate=02%2F06%2F2014&shour=0&smin=0&tdate=02%2F09%2F2014&thour=23&tmin=43&ssec=00&tsec=00&img=1

If I was to talk about all of the speakers from the weekend you would be here reading all night ! Ella a student physio summarises and reflects on the weekend very well ( a great blog from a student physio)

http://aphysiostudent.wordpress.com/2014/02/09/student-rep-development-weekend-2014/comment-page-1/#comment-4

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The key points I took away from the weekend in bullet form:

  • If you want something go after it! Don’t wait for something to happen, go make it happen. Simon Shepherd brought this to life talking about his life story.
  • Some very interesting links from Simon Shepherds talk: http://www.firstbeat.com/ http://www.firstbeat.com/work-well-being/investing-in-well-being-pays-off#Individual
  • “Take a chance, don’t make a plan”, following Karen Middleton’s interview on her career from Student to Chief Executive, it highlighted that we should be flexible in our career path and grasp opportunities made available to us. She talked about pushing the boundaries of her work by working out of her comfort zone. She demonstrated the ability to develop coping strategies whatever she turned her hand to. (Note this is my interpretation of the interview).
  • Aspire to be the best you can be. Set yourself Goals and write a mission statement.
  • Network, Network, Network a useful place to start in Linked IN or Twitter. Networking can open many opportunities start now.
  • Remember you are upholding your profession on Social Media Platforms. Mitigate the risks and engage!
  • Learn about power poses! http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html how can you implement this into practice?

I always come away from each Student Rep Development weekend feeling truely inspired by leaders of the profession, the speakers and the energy from the student reps. Physiotherapy is such a dynamic profession and the more I put in the more I get out.

My action points following the development weekend are:

  • To learn more about motivational interviewing and power poses.
  • To write a personal development plan for the next 5-10 years (as a guide)
  • To find a mentor to help me to refine my leadership skills.

Below are a few photos from the event.

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And so all I have left to do now is to write my Mission Statement:

“I will always strive to achieve excellence in my work and life. I will continue to help others and guide them to opportunities within Physiotherapy. I will always remain open-minded and will take others opinions into account to inform my decisions in practice. I will continue to promote Physiotherapy to my service users, commissioners, and wider network of colleagues to provide a sustainable future for  the profession as a whole.”

Thanks for taking the time to read my blog if you have any comments please feel free to leave one below or tweet me @LCphysio