DESIGNED TO TACKLE RENAL DISEASE IN WALES: A NATIONAL SERVICE FRAMEWORK
DRAFT RESPONSE FROM THE CHARTERED SOCIETY OF PHYSIOTHERAPY (CSP) IN WALES
1.
Introduction
1.1
The Chartered Society of Physiotherapy (CSP) is pleased to provide a
response to this Welsh Assembly Government consultation document.
1.2
The CSP represents around 1,500 physiotherapists, technical instructors,
assistants and students in Wales. CSP members work primarily in the NHS
but also in the independent sector, education, research, the voluntary sector,
industry and occupational health.
1.3
The CSP is the professional, educational and trade union body for its 47,000
members in the UK, physiotherapy being the third largest health profession
after doctors and nurses. 98-99% of all registered physiotherapists are
members of the CSP.
1.4
Chartered physiotherapists, their technicians and assistants provide
treatment and support for their patients, clients and carers in a variety of
different clinical environments in the course of NHS treatment. These
include intensive care, acute and rehabilitation hospital wards, outpatient
departments, hydrotherapy pools and multidisciplinary clinics.
Physiotherapists also work in community settings, within schools, GP
practices, health centres and in people’s own home.
1.5
‘Physiotherapy is a health care profession concerned with human function
and movement and maximizing potential. It uses physical approaches to
promote, maintain and restore physical, psychological and social well-being,
taking account of variations in health status. It is science-based, committed
to extending, applying, evaluating and reviewing the evidence that underpins
and informs its practice and delivery. The exercise of clinical judgement and
informed interpretation is at its core.’ (Chartered Society of Physiotherapy
(2002) Curriculum Framework for Qualifying Programmes in Physiotherapy.
CSP, London).
1.6
Physiotherapists may work with patients who have renal disease in a range of
different clinical and treatment settings. From post-renal surgery where
respiratory ability and physical capability will be important, to assistance in
managing an independent lifestyle in the home environment whilst living
with a renal condition. The profession is therefore keen that physiotherapists
should be considered as a key profession, involved in the delivery of the NSF
in Wales.
2.
Welsh Assembly led consultation questions
The NSF is based on 5 modules – 1 module applying to the children’s
standards 1 –10, and four modules applying the adult’s standards 1 – 16.
1.
Do you agree with the standards we have chosen?
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Yes
2.
Do you think they will effectively tackle renal disease in Wales and
improve the quality of renal care?
Yes
3.
When writing the key interventions which underpin each standard,
every attempt has been made to ensure each one is clear, specific, and
measurable to enable effective audit. Are there any key interventions
which you do not consider meet the above criteria? If so, how would
you suggest a form of wording that would improve the key action?
The CSP considers the document to be well written and that the key
interventions are clear, specific and measurable. The profession does
however have some comments about some of the interventions. These are
included in the answer to question 5.
4.
Do you consider they could be achieved in your area over time?
The CSP does believe the interventions will be achieved where there is the
will to deliver (by LHBs and NHS Trusts) and the financial viability. The
profession is pleased to note that there is to be a similar approach taken to
the NSF as to Designed for Life. Three year targets and reviews will allow
the Welsh Assembly Government to monitor progress against the standards.
5.
Do you have any other comments that you would like to make about
this document?
The CSP has the following comments on various aspects of the NSF:

(p22) The profession would like to see an additional bullet point relating
to support for people to lives their lives. This may be an overall goal of
the NSF but it is not explicit in the text.

(p15) The document highlights the intention to develop a care pathway
for the care of people at risk of renal disease. This will need to be a
multidisciplinary activity and the CSP suggests that equally, there should
be the development of care pathways for surgery, rehabilitation, dialysis
and conservative management. Physical health and wellbeing will be an
integral part of these pathways and physiotherapy should be involved in
the care pathways development process.

(p45) Under standard 4, key intervention 2 highlights provision of a full
and effective multidisciplinary renal team to address the range of
psychosocial issues. There is a lack of reference to support for physical
ability and maintaining functional capability despite restrictions. The
society is keen to ensure that physiotherapists are part of the
multidisciplinary renal team or, where this is not possible, that the team
has access to physiotherapy when required and the physiotherapy service
links closely with the renal team to ensure an adequate service is
provided.
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The physical abilities of children and young people (and indeed adults as
referred to later in the NSF document) is very important to the goal of
living as high a quality of life as possible, despite having renal disease.
This needs to be reflected in the document.
The points made in relation to standard 4 are also applicable to standards
3, 5 and 6.
6.

(p51) The CSP believes there is an omission here in that there is no
reference to the importance of maintaining physical ability and functional
capability. Physiotherapy will be important and access to palliative care
therapists will also be valuable for managing in the home environment.

(p55) Physiotherapists also play an important role in pain management
and are important members of pain management teams.

(p83) In standard 4, the CSP would like to see physiotherapists named as
members of the multidisciplinary renal teams. Physiotherapists are
involved in delivering services on medical and surgical wards and will
work closely with renal patients, helping them with respiratory and
physical function. Mobility and exercise is crucial to the rehabilitation
process and for maintaining independence.

(p101) In point 1 of standard 7, the CSP would like to see
physiotherapists identified as members of dedicated multidisciplinary
renal teams. (the arguments are the same as for the previous point)

(p103) Reference is needed in standard 9 to access to physiotherapy and
occupational therapy in relation to home visits, adaptations and managing
to live independently at home.

(p104) The same is true for standard 10.

(p136) Reference is needed here for access to physiotherapy and
occupational therapy palliative care services.
How would you like to see the NSF standards document presented? e.g.
loose leaf binder, one complete publication as a bound book, split
publications e.g. each separate module as a booklet, or adult and
children’s sections
The Society suggests that the document will need to be available in a range
of formats. In particular, it will be important for versions to be available
which are accessible and understandable to children and young people. The
CSP supports a loose leaf binder with sections for the different modules
which allows for additional inserts as reviews are undertaken and progress
made.
7.
Which of the key interventions do you think will have the biggest
impact on renal disease and the services to diagnose and treat?
The CSP would like to believe that the interventions concerned with
prevention and early detection of chronic kidney disease will have the biggest
impact. Resources are needed and a drive to continue the ‘healthy living’
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agenda. There will also be a need to integrate the monitoring of ‘at risk’
patient groups with other condition based screening and preventative
programmes.
8.
The key interventions are going to be implemented over time. Which of
the key interventions do you think are the most urgent for
implementation? Please give specific reference.
The Society considers all interventions to be important and does not single
out any for priority.
9.
What ideas do you have to ensure patients and the Multidisciplinary
Renal Team are involved in influencing implementation, the setting up
of renal networks and the work of the Renal Advisory Group?
The CSP has already commented on AHP involvement in Multi-disciplinary
Renal Teams, the renal networks and the Renal Advisory Group.
The profession believes the Multi-disciplinary Renal Teams should link into
the renal networks across Wales and be able to communicate regularly with a
named person on the network.
Multi-disciplinary Teams (MDTs) should have patient involvement
processes in place and both the MDTs and the networks should be able to
link into these patient facilities.
The Community Health Councils will also be important links for patient
groups and in some areas, there may be active voluntary support groups who
will want to develop close links with the networks and the MDTs.
10.
Do you have any ideas about how developments at Welsh Assembly
Government level on renal disease can be communicated to you more
effectively?
Welsh Assembly Government needs to consider all available communication
networks and make best use of public and patient networks set up by Local
Health Boards and NHS Trusts. It will also be important for WAG to make
best use of the National Public Health Service and the Wales Centre for
Health in capturing data and delivering/communicating information. The
voluntary sector will also be an important stakeholder. Full use must also be
made of professional advisory machinery to cascade information. The Wales
Therapy Advisory Committee (WTAC) will provide a key professional
network.
11.
What ideas do you have to ensure patients can be involved to help
organisations to make their service better?
The Welsh Assembly Government has produced two guides on involving
patients and the public (Signposts 1 and Signposts 2). The Expert Patient
Programme is also being developed and will be rolled out across Wales. The
MDTs and the renal networks will need to develop their patient group and
work with the public to encourage engagement and involvement in the
development of renal services.
Can you foresee any barriers to the implementation of these standards?
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Barriers include lack of funding to deliver the NSF and a service completely
absorbed in reconfiguration and financial constraints.
If so, are there any actions, which the Welsh Assembly Government should
take to overcome these barriers?
The Welsh Assembly Government will need to show clear leadership in relation to
delivery on this NSF. Where possible, some financial incentive needs to be provided
and linking key interventions and standards to Service and Financial Framework
(SAFF) targets will be essential if NHS Trusts and LHBs are to be required to meet
them.
Are there aspects of implementation you think these groups should be
addressing that these groups are not currently considering?
LHBs and NHS Trusts will need to look closely at the standards and key
interventions and predict whether they will have the financial ability to deliver on
them. They will also need to consider, from their needs assessments and health,
social care and wellbeing strategies, whether renal services will be a priority for
them and whether they have (or will have) the workforce to deliver renal services in
the future.
LHBs and NHS Trusts will have to address shortfall with the Welsh Assembly
Government and will need to feed in workforce planning requirements into the
National Leadership and Innovations Agency for Healthcare’s (NLIAH)Workforce
Development, Education and Contracting Unit (WDECU). The renal networks will
be well placed to provide detailed evidence to WDECU and services are developed
and the NSF standards audited.
What programmes of action to support implementation do you think are
needed?
Education – (LHBs and NHS Trusts)
Workforce Planning – Renal Networks and WDECU
How useful is the website to you and your organisation?
The web site has been very useful
Could it be improved to meet your and your organisations requirements more
effectively?
The CSP has no comment to make here
What would enable you to share your knowledge and your examples of best
practice with others through the website?
The CSP is in favour of sharing good practice. The Therapy Strategy included a
compendium of good practice models and the intention is for them to be managed by
NLIAH. It would be useful for the renal models to be managed in the same place. A
link would needed from the NSF page on the web site.
Can you think of any important issues we may have missed out?
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As mentioned in answer to question 5, the CSP believes that there needs to be a
focus on physical health and functional ability which is missing from the document.
In several places the profession indicates that there needs to be reference to patients
having access to physiotherapy. Also, for those involved in the conservative
management of established renal disease, there needs to be mention of quality of life
and access to palliative care therapists as appropriate. Physiotherapists and
occupational therapists can be crucial in assisting patients to manage their life whilst
also managing a life challenging condition.
3.
General Comments
3.1
The CSP hopes that the Welsh Assembly government will ensure there is
therapy representation on the Renal Advisory Group. The profession is
unsure if there has been any involvement of therapists in developments to
date. The Wales Therapy Advisory Committee (WTAC) will be able to
advise on a nomination.
3.2
The CSP has some concern that only 2 network groups are being proposed.
Other NSF and clinical specialties have developed 3 clinical networks to
mirror the NHS Regional Office boundaries. It would seem logical to follow
this approach to avoid confusion. The document gives no indication or
rationale for the chosen approach.
3.3
The CSP considers that renal MDTs will need to link with these networks to
provide information and a steer on how services need to develop in the
locality. Professional advice from the clinicians involved in renal medicine
(including therapists) will also need to feed into the networks. A further
consultation on the networks development will be needed.
4.
Concluding Remarks
4.1
The CSP has found this consultation document to be clear, concise and very
well laid out. The evidence section and presentation in modules works well.
4.2
The profession is concerned that there is no reference to physiotherapy or
physical and functional ability but believes that this is due to lack of therapy
involvement in the advisory stages. It is hoped that changes can be made to
reflect the points made in this submission.
4.3
The Society has been very pleased to play an active role in the consultation
process and looks forward to continued involvement. If any further
information is required, do not hesitate to contact the CSP’s Cardiff Office.
Philippa Ford MCSP
CSP Policy Officer for Wales
June 2006
In association with:
The Welsh Board of the Chartered Society of Physiotherapy
The All Wales Physiotherapy Managers
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