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Physiotherapy: Rehabilitation Services

Volume 827: debated on Thursday 23 February 2023


Asked by

To ask His Majesty’s Government what assessment they have made of the survey by the Chartered Society of Physiotherapy, published on 1 December 2022, which found that there was a shortage of rehabilitation services, that rehabilitation spaces had not been returned to use for physiotherapy care following the COVID-19 pandemic, and that stroke survivors were being “imprisoned at home with a bed and commode” while waiting for care.

We welcome the Chartered Society of Physiotherapy survey and the valuable insights it gives us regarding rehabilitation services. Integrated care systems are responsible for commissioning appropriate services for their local populations. Decisions on the use of physical estates are rightly for local organisations. Rehabilitation and physiotherapy are critical to many patients’ care and recovery. For stroke survivors, the NHS aims to deliver personalised, needs-based, goal-oriented rehabilitation to every stroke survivor in their home environment.

My Lords, the CSP survey paints a dismal picture of the state of rehabilitation services: overstretched and underresourced prior to the pandemic and still struggling to re-establish physio rehab services that had their staff, space and facilities diverted to deal with the crisis and with chronic staff shortages. The recent stroke audit showed that only 10% of the UK’s stroke survivors were able to access the recommended amount of rehabilitation they need. What actions are the Government taking to address this unmet demand for the vital services that will help prevent patients deteriorating and becoming more frail and vulnerable?

I thank the noble Baroness for bringing this to our attention; again, I believe that the advantage of these Questions is that they shine the spotlight on particular areas. As the survey pointed out, there are a lot of places which, for very understandable reasons, were swapped over to Covid uses during the pandemic and which now need to be brought back into physio use. That was one of the main recommendations from the society, and we will now write to all the NHS chief executives on the back of that. As the House will be aware, I am doing some work anyway to make more space available as part of the capital programme, so this is very much on my list to make sure that we expand that space and provision.

My Lords, does the Minister agree that physiotherapists do very little of their work in the actual appointment, and that it is the supervised exercise patterns they give patients afterwards that are probably the most important for all forms of rehabilitative structure? Bearing that in mind, what is the Department of Health doing to make sure that local government has facilities such as swimming pools and gyms that remain open under the financial squeeze?

I agree with the noble Lord’s point; our estimate is that over half of all physiotherapy takes place outside the hospital environment. Clearly, all sorts of settings, including swimming pools and gyms, are vital for that. The work we have done with the Energy Bill and the caps has been a vital help to those leisure centres, and, thankfully, we are now starting to see bills come done and so these places are on a better financial footing.

My Lords, I was previously a trustee of the Stroke Association and the chair of Chest Heart & Stroke Scotland. Every five minutes, a person suffers a stroke. Their outcome depends on two crucial factors: first, the so-called golden hour during which they should receive treatment—if they do not, their outcome is poor—and, secondly, the rehabilitation they get over the next three to six months, including training on speech, mobility and dealing with daily life. Sending these patients to care homes or their own homes without that kind of support decreases their outcomes considerably. Currently, 10% of these patients end up in nursing homes for ever; if these services are not available, that number rises to 30% to 40%. So, despite the positive response from the Minister, there is a degree of urgency for integrated care boards to address the issue of rehabilitation for stroke patients.

Absolutely. That is why, as part of my research, I was pleased to read up on the national integrated community stroke service, which is designed to give personalised stroke rehabilitation in every person’s home. Its work is vital in achieving this. The House has heard me talk many times about the 13,000 beds that are blocked in our hospitals, and a lot of the way to free them is by having rehabilitation and getting people back into their home environment. I absolutely agree on the importance of this issue, and that is why noble Lords will see it as an important part of the workforce plan.

My Lords, I welcome the Answer my noble friend the Minister gave, but I will give him a real-life example, and declare my interest in doing so: somebody had two strokes, then had a third while waiting over an hour for an ambulance to arrive, has had no physiotherapy rehabilitation at home, and is still waiting a year on for that. This is a real example of people on the ground. Does the Minister agree that we must connect our policies with very clear outcomes?

Totally. I am sorry to hear that case, and I think that we would all agree that that is not the sort of service we would want to see. As I said, we have put increases in staff in place—there have been 3,300 extra staff since 2017—but, clearly, we need to do more. That is why I was very pleased to read that this area is an important part of the workforce plan, which noble Lords will be happy to hear we are now seeing drafts of.

My Lords, if stroke survivors are imprisoned at home with a bed and a commode, as my noble friend’s Question suggests, does the Minister agree that their unpaid carers are similarly imprisoned? Is the lack of rehabilitation services part of the reason why the numbers of people giving more than 50 hours a week unpaid care is increasing rapidly, as the latest census figures suggest?

As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.

My Lords, I declare my interest as the president of the Chartered Society of Physiotherapy. Do the Government recognise that almost three-quarters of physiotherapists feel that they cannot do their job properly now, and that, as well as a workforce plan, there needs to be a workplace plan for adequate rehabilitation that goes way beyond cancer and stroke services? All orthopaedic operations, and many other interventions, will not be successful without adequate, immediate physiotherapy in the post-op period, so, by failing to provide physiotherapy, we are stacking up problems for the future with long-term physical dependency and not maximising the benefit of interventions provided early.

I start by wishing the noble Baroness a happy birthday. I was pleased to read the three recommendations from the Chartered Society of Physiotherapy: return the rehab space to use; include physios in the long-term workforce plan; and give staff and space to the physio service. As I have said in my earlier responses, we are working on all three: we are working with the NHS trusts to return the rehabilitation space; we are putting physiotherapy in a very important part of the workforce plan; and we are providing the services. So we are making a lot of progress, but I welcome the involvement of the Chartered Society of Physiotherapy in that.

My Lords, it is pleasing to hear that physiotherapists are included in the proposed and long-awaited workforce strategies; there is clearly a shortage in this area. Can the Minister comment on today’s press reports that, while his department is persuaded that there needs to be a dramatic increase in training places across the medical professions, his friends in the Treasury are declining to support that essential expansion?

As we are all aware, the Chancellor was very keen to kick this off in the first place. We have been participating in this by working very closely with the Treasury, and I am heartened by the work we are seeing on it all. There are some early reports, and, while they do not yet know the full picture, I am looking forward to being able to talk to the whole House about it in the not-too-distant future.