Health and Social Care Committee
One-day inquiry into venous thrombo-embolism prevention
VTE 1 – Chartered Society of Physiotherapy
CSP Wales Office
1 Cathedral Road
Cardiff CF11 9SD
029 2038 24289
Committee Clerk
Health and Social Care Committee
National Assembly for Wales
Cardiff Bay
CF99 1NA
April 2012
Dear Chair and Committee Members
Health and Social Care Committee one-day enquiry into Venous Thrombo-embolism (VTE) prevention in hospitalised patients in Wales
The Chartered Society of Physiotherapy (CSP) in Wales is pleased to provide a written submission to this one-day enquiry.
Key points from the Profession
The CSP notes the importance of venous thrombo-embolism risk assessment and fully supports the National Risk Assessment Model (DH 2010).
The mobility part of the assessment is considered by the profession to be very important and concern is raised that lack of mobility is a factor in the development of VTE that can be impacted upon by staffing levels in hospitals and clinical practice.
In the event of a hospital admission, for whatever reason, patients will experience a decrease in their mobility unless they are self motivated to exercise or encouraged and empowered to do so by clinicians.
Post operatively, particularly following major operations, patients will be apprehensive about mobilising and will need reassurance and support to do so. There will be crucial roles for the nursing and physiotherapy professions in ensuring patients can mobilise and exercise safely and effectively as soon as clinically appropriate.
The CSP raises the concern that where patients require large amounts of assistance to mobilise (eg the support of 2 people and a walking frame) it may be perceived as more time efficient to offer them a commode for toileting purposes. While recognising limitations in staffing resources this denies the patient the opportunity to improve their confidence in mobilising by practice in walking to the toilet thereby improving circulation and accelerating the potential for discharge home as soon as possible.
It is also worth noting that risk avoidance due to manual handling considerations leads to staff using equipment rather than utilising the limited mobility people might have thus further restricting mobility and exercise.
The physiotherapy profession has see a cut in services over the last financial year and due to vacancy control processes being operated by the Health Boards services have been required to put in place prioritisation protocols to ensure patients who are most in need of rehabilitation (including mobility practice and exercise) receive treatment from the physiotherapy team.
Whilst the CSP cannot provide direct evidence that cuts in services have an effect on VTE levels in hospitalised patients, the profession fears that continued cuts will spread services even more thinly, further compromising the care afforded to patients.
Concluding comment
The profession hopes the Health and Social Care Committee will ensure that mobility is a key issue explored within the enquiry.
The NHS National Patient Safety Agency ‘How to Guide’ on ‘Venous Thrombo-embolism Risk Assessment’ publication identifies medical staff, nursing staff, midwifery staff, pharmacy staff, general practitioners, information analysts and Trust Board members as key professionals involved in VTE risk assessment.
The CSP considers that, in terms of preventing VTE, professions such as physiotherapy have an important role to play and that mobility and exercise provided by both physiotherapy and nursing professionals is very important in the overall approach to cutting out VTE acquired in hospital.
References
Department of Health (2010) Venous Thrombo-embolism (VTE) Risk Assessment http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088215
NHS National Patient Safety Agency (2011) How to Guide – Venous Thrombo-embolism Risk Assessment http://www.nrls.npsa.nhs.uk/resources/?EntryId45=94727
In association with:
The CSP Welsh Board
The All Wales Physiotherapy Managers Committee
About the CSP and Physiotherapy:
The Chartered Society of Physiotherapy is the professional, educational and trade union body for the UK’s 50,000 chartered physiotherapists, physiotherapy students and support workers. The CSP represents over 2,000 members in Wales.
Physiotherapists use manual therapy, therapeutic exercise and rehabilitative approaches to restore, maintain and improve movement and activity. Physiotherapists and their teams work with a wide range of population groups (including children, those of working age and older people); across sectors; and in hospital, community and workplace settings. Physiotherapists facilitate early intervention, support self management and promote independence, helping to prevent episodes of ill health and disability developing into chronic conditions.
Physiotherapy delivers high quality, innovative services in accessible, responsive and timely ways. It is founded on an increasingly strong evidence base, an evolving scope of practice, clinical leadership and person centred professionalism. As an adaptable, engaged workforce, physiotherapy teams have the skills to address healthcare priorities, meet individual needs and to develop and deliver services in clinically and cost-effective ways. With a focus on quality and productivity, physiotherapy puts meeting patient and population needs, optimising clinical outcomes and the patient experience at the centre of all it does.
Philippa Ford MCSP
CSP Policy Officer for Wales
07990 542436
April 2012