Guidance f or branches and people wanting to deliver or set up physiotherapy and e xercise groups
Physiotherapy and exercise provision by MS Society branches
Many people with MS want better access to physiotherapy and to suitable exercise. This booklet offers guidance for branch members who are trying to improve these services.
The booklet looks at how to identify the best service for your area, the legal and financial considerations, and ways to monitor the service you set up.
Section D contains essential health and safety forms as well as helpful checklists and example assessment forms.
There’s a lot to consider – but remember, many branches are already improving their exercise and physiotherapy services. Your Area Team are here to help.
Each section is downloadable on its own as are the individual forms
Section A: What you need to consider before setting up a service
Section B: Practical considerations when setting up a service
Section C: Accepted qualifications and standards of practice
Section D: Supplementary information and forms
A. Things to consider before setting up a service
The first step is to consider what type of service you really need. Although one to one physiotherapy can be very helpful, it isn’t always the answer and should be provided by the NHS in times of greater need. Sometimes general exercise is just as beneficial, especially if it is done in an enjoyable way which promotes social interaction at the same time.
It is important that you look at what is already provided & what people with MS want. Your area team should be able to help you with this and you could seek the views of your members using a simple questionnaire to ask about the services they receive and what they would like. See Appendix 1 for an example.
Your area team can also help in other ways such as liaising with local NHS Managers or putting you in touch with other branches who might like to work with you to develop services. They can also contact the Physiotherapy team at National centre for more specific advice.
1. Physiotherapy
If you have already identified that local physiotherapy provision is not meeting demand, the next step is to know more about how these services fall short. Do they fail to meet standards recommended by the Government (see below), or is it just that they cannot be accessed easily or quickly? Knowing this will help you come up with the most efficient plan of action.
Are local services below government standards?
One way to assess this is by comparing the local services to the targets and recommendations set out by the Government in:
· National Institute for Health and Clinical Excellence (NICE) Clinical guideline 8: Multiple Sclerosis 2003
· National Service Framework (NSF) for Long-term Conditions 2005
The free MS Society publication Translating the NICE and NSF guidance into practice: A guide for physiotherapists (Second edition, 2008) makes this assessment easier by detailing the relevant parts of both. Your area team can help you to interpret this.
Improve local NHS services
If you feel that local services do not match up with government recommendations, you should consider working with your area team to try to improve access to physiotherapy. Base your requests on what the Government guidelines say rather than what people with MS would like in an ideal world. Here are some examples of how you might use Government recommendations and targets to improve services:
Example – early rehabilitation
Local NHS commissioners will not have the resources to provide daily physiotherapy on an ongoing basis, so it’s fruitless to demand this. But they should, according to the NICE guidelines (2003), be monitoring patients and providing “early rehabilitation” in time of need, such as following a relapse or after a period of illness. In addition, the National Service Framework for Long-term Conditions (2005) states that early rehabilitation “…reduces the risk of preventable secondary complications and reduces length of stay in hospital and re-admission rates”.
Example – self-management
There is also a lot of emphasis in Government papers on helping patients to self-manage their condition. This creates the opportunity for therapists to develop exercise and education sessions or work to improve access to other resources by liaising with local branches, Therapy Centres or leisure services.
Example – influence and involvement
Almost all recent Department of Health documents have emphasised the need for service providers to consult with, listen to and involve patients when planning and delivering services. Now is a great time to have a say in how your local statutory services are provided, and to influence the long-term development of services. Your area team will be happy to help you to find out how you could become involved in to help make the voice of people with MS heard.
Make contact with your local NHS managers, through your area team to discuss how services might be improved. Many branches have successfully worked in partnership with their local NHS providers to improve access to a physiotherapist with experience in helping people affected by MS (often known as a specialist neuro-physiotherapist Your area team can help you find the best solution for your local situation; if you have a particular issue where you feel you are not getting what you are entitled to, you could seek the assistance of the Policy and Campaigns team at National centre. In relation to Functional Electrical Stimulation, you might find their campaigning pack helpful; this can be found on the MS Society website under Policy and Campaigns ‘Hot topics’ or you can order a copy by phoning the Helpline on 0808 8008000
What other options are there for improving physiotherapy services?
If working with your local NHS providers doesn’t get the results you need, you could look at:
· Working with other charities which might have similar needs – such as the Stroke Association or Parkinson’s disease Association.
· Speaking to your local MS Therapy Centre, which might already offer physiotherapy. Perhaps they could arrange for MS Society branch members to access their services. This is already happening in a number of Therapy Centres.
· Providing an exercise group led by a physiotherapist or additional one-to-one physiotherapy sessions – by paying for physiotherapy.
Providing a physiotherapy service
If you decide to provide an exercise group or other sessions led by a physiotherapist, you’ll need to ensure the standard of the service. The most effective way to do this is to pay the NHS to use their physiotherapists. This relieves the branch of many responsibilities and provides a more comprehensive service. It also costs less to arrange services this way than employing a private physiotherapist. Your area team will be happy to help you to negotiate with your local NHS provider.
If you are unable to obtain the services of an NHS physiotherapist, you might decide to work with a private one. This does, however, place responsibility on you to ensure that the therapist meets all the standards laid out in section C.
Whether you use an NHS or a private physiotherapist, you should set up a service level agreement (SLA) with the provider (see sections B and D)
Whichever route you take, ensure that any physiotherapist you use has appropriate knowledge and experience of MS for the service they are to provide. For example, some physiotherapists may have had limited experience of neurological conditions such as MS so would not be suitable for delivering specific one-to-one treatment; but they might be quite able to run group exercise sessions. The skills and experience of a physiotherapist will affect what they charge, so it’s worth trying t get the best fit for the work they will do.
Your area team will be happy to assist you and can liaise with the Programme lead for physiotherapy at National centre for specific advice.
2. Exercise
If you feel that access to exercise is what is needed, you may not need to engage the services of a physiotherapist. You might consider:
· Making use of existing local services.
· Paying an instructor such as a fitness trainer, Yoga or Pilates teacher to run sessions.
Making best use of local facilities
Local leisure centres might already offer suitable exercise opportunities. For example, they may run special swimming sessions when the pool will be less crowded or organise activities such as Boccia (a form of bowls) which can be played in a seated position. You could contact the leisure services department at your local authority or approach the facilities direct to find out what is available or persuade them to start something new
Attending or organizing sessions in local centres has some major advantages:
· You are not responsible for insurance or the safety of the venue
· People can do different activities suitable for their ability level & interests but still meet up socially as there are usually meeting & refreshment areas
· There may be funding available through the leisure centre to support some activities and in any case it is likely to be cheaper than running classes elsewhere
· Fitness trainers will be vetted & insured by the leisure centre
There are some interesting schemes running in both private and council leisure centres around the country as well as some Department of Health sponsored initiatives aimed at increasing access to exercise; for example in some areas, GPs can prescribe exercise which gives free or subsidised access to leisure facilities and many councils offer free swimming for certain client groups such as the over 60’s.
A scheme called the Inclusive Fitness Initiative aims to make sport and leisure more accessible for all so it is worth trying to find one of their affiliated centres. More information can be obtained from their website www.inclusivefitness.org . Search out what’s available in your area – neighbouring branches, local charities and your area team might all have useful knowledge of this.
Ensuring standards
Whatever form of exercise you want to organise, it’s important to have confidence in the experience and suitability of the practitioner. Many disciplines have national bodies which train and register their practitioners and there is further advice about this in section C. If in doubt about the suitability of instructors or classes, you can always seek advice from a physiotherapist or consult the Physiotherapy programme lead at National Centre
As a starting point, you might find that other similar charities (such as the local Stroke Association or Parkinson’s Disease Society) in the area know of facilities and practitioners they have used.
If you employ an exercise practitioner directly, it is important that they have appropriate experience and meet the minimum standards laid out in section C of this publication.
Providing services for all
It is worth bearing in mind that different types of exercise will suit different people so it may be helpful to find out what the majority would like and what people are already doing. The questionnaire in Section D will provide some of this information & you could produce a factsheet or database giving details and alert others to these facilities. You could also organise ‘taster’ sessions where people have a chance to try different activities
It might be helpful to put members in touch with each other for mutual support; sometimes having a ’buddy’ can make all the difference. For example, walking is good exercise but some people may lack the confidence to go out on their own. Likewise, someone might avoid swimming because they need just a little help to get changed. Even cycling is possible for some who thought they’d never ride a bike again – it might just take a little assistance and the right type of bike or tricycle. You might even be able to set up links with a local cycling, swimming or walking group whose members would be willing to act as ‘buddies’
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B. Practical considerations when setting up a service
This section has more details about vital health and safety issues, financial plans and service monitoring.
Health and safety and r isk assessment
There are a number of risk assessments which should be carried out with the assistance of your area team to ensure that every effort has been made to minimise risks and observe health and safety regulations. The main one is form VFRA 701A ‘Physiotherapy and exercise risk assessment’ but there others which you should complete for specific activities like water-based exercise or use of equipment such as exercise bikes. All of these are available from the fitness section on the branch health and safety site. Form VERA 903A has been developed to help you assess venues and is also available from the Events section on the branch health and safety site.
Risk assessments should be reviewed annually, or when anything has changed. Completed copies should be kept by the branch.
A health and safety audit including a review of risk assessments will be completed annually by your area team. Members of the MS Society Health and Safety Team will also carry out audits on an adhoc basis. It is important that we all have these records and procedures, to be as safe as possible and to protect the work of individuals and the Society should accidents happen.
If there is an accident or near miss, HSV: 722 Accident report form or HSV: 723 Incident report form should be completed and a copy sent to the person who is responsible for health and safety issues at the branch. If the accident is serious and has resulted in severe injury, the branch health and safety representative should immediately contact their area team who will make necessary arrangements.