A disturbing picture of scarce resources and threadbare physiotherapy provision
I recently read with interest your Sept/Oct 2009 issue [of SEN Magazine] and the pieces by parents on reviews and therapy or inclusion, and the article on statements of SEN.
I hope you will accept my need for anonymity in the interests of being able to speak with complete candour on these topics, as they impinge on my working life every day as a paediatric physiotherapist.
To the parent who posed the question “inclusion or therapy?”, I would say, yes, I am afraid that is the choice. When inclusion came to the fore a few years ago, my experience of it was that it was largely driven by the ideologies of educational psychologists and represented a triumph of hope over experience. The parents I worked with fought tooth and nail to prevent the closure of their special school because they saw that their children would get a worse deal in mainstream school, with worse pupil/teacher ratios, poorer facilities and the worry of bullying ever present. The therapists were not really consulted about it and were just expected to make it work with the same amount of staff they had before, when all the patients were located in one geographical place.
Well, I’m afraid we have not entered nirvana, and inclusion, for us, has been a logistical nightmare; the children have scattered to the four winds and are singletons in schools all over the district; there are vast tracts of the day when we are driving around in cars to reach them and this “dead time” obviously cuts down the amount of treatment time available. The same issues apply to treatment space and equipment, and there are examples of therapists treating children in toilets because no provision has been made for treatment space in the school. The expense of equipment has also become an issue as children can no longer share expensive pieces of equipment, like hoists; now, we need one in each place and there are no economies of scale. Finally, access to hydrotherapy has become hugely problematic.
If it’s any consolation, the situation in the special schools is not greatly better. We are managing ridiculous caseloads on fewer hours; there is a lot of tokenism going on and we are mainly fire-fighting problems, rather than treating children in the way we used to when I first qualified. A lot of the time, the therapist assesses the child, but then, for the ongoing day to day treatment, you are working through the hands of non-medically qualified teaching assistants, not even physiotherapy assistants. So, I would ask: how can that be quality of service? We have ceased to be an assessment, management and treatment service and are only an assessment service now.
My advice would be, if you want a quality service, with quality time for your son with a paediatric physiotherapist, then the only way to obtain it would be to pay for it privately, as NHS therapists are spread far too thinly.
To the parent who talked [in issue 42 of SEN Magazine, Sept/Oct 2009] of person centred reviews, I would say, it sounds great, but, unfortunately, we don’t have enough capacity to even attend the meetings anymore, let alone think about their actual content. Even the reports that are sent through have to be severely truncated to the absolute basics in order to facilitate their speedy submission.
Article first published in SEN Magazine issue 45: March/April 2010.