About a month or so ago we published a blog highlighting the results of an audit (The Hip Sprint Audit) of hip rehabilitation services around the country. The audit was conducted by our professional body the Chartered Society of Physiotherapists (CSP) and the Royal College of Physicians. The audit showed an enormous variation in services across the country and had some very worrying statistics such as the average waiting time to see a physio after a hip replacement was 15days. As a home visit physiotherapy service based in Lichfield and seeing patients in Sutton Coldfield, Tamworth, Walsall and Rugeley to name but a few of the areas we travel to, we see a large number of hip replacement and hip fracture patients and as such we are acutely aware of the importance of a speedy referral to physiotherapy.

Recently the CSP published seven standards that it thinks all services should be aiming for when trying to rehabilitate hip fracture patients and which I have reproduced below:

1. A physiotherapist assesses all patients on the day of, or day following, hip fracture surgery 
2. All patients are mobilised on the day of, or day following, hip fracture surgery. 
3. All patients receive daily physiotherapy that should total at least two hours in the first 7 days post-surgery
4. All patients receive at least two hours of rehabilitation in subsequent weeks post-surgery until they have achieved their goals. 
5. All patients moving from hospital to the next phase of rehabilitation are seen by their new rehabilitation provider within 72 hours. 
6. A physiotherapist is part of every hip fracture programme’s monthly clinical governance meeting. 
7. Physiotherapists share their assessment findings and rehabilitation plans with all rehabilitation providers to enable clear communication with the MDT.

 

Now, I think most physiotherapists would agree that generally the standards above look reasonable and rather than go through each one I just wanted to raise a couple of points about them which might get missed by somebody who is not working as a physio. Firstly these are targets and are unlikely to be met by many services across the country at the moment Secondly I suspect that when reading the standards above many ordinary patients and people would be surprised that these aren’t already the basic standards which patients are already receiving. For example Standard 3 requires that patients receive 2 hours of physiotherapy in the first 7 days post surgery – now this really is not a lot of contact with a physio over 7 days and equates to about 18 minutes per day! It is worth bearing in mind that these are patients who have just undergone major open surgery which has cost the NHS thousands of pounds (just in the surgery alone, never mind the cost of being in hospital as well!) and then they only get 18 minutes with a physio each day (as a target!!). Also many of these patients are confused, elderly, frail and have dementia, it takes time and patience to help them and to make a significant difference to them.

Lastly it is worth thinking about standard 5 that asks that every patient is seen within 72hours after leaving hospital. Now this is a reasonable time frame and should in my opinion be the longest period that we should allow between leaving hospital and seeing a physio in the community. However I am absolutely certain that there are very few areas where this is actually achieved and shows how little priority is given to rehab services in the NHS.

One last point that I want to make clear is that this is not a dig at NHS physiotherapists. My complaint is about how money is spent in the NHS and the lack of priority that rehabilitation and physiotherapy is given.

Okay, rant over…. I hope that you have found this blog post interesting. Just to remind anyone reading we are a home visit physiotherapy service based in Lichfield and serving Tamworth, Sutton Coldfield, Cannock, Rugeley and Walsall. If you or anyone you know needs help with recovering from a hip replacement please get in touch.