I thank the committee for the invitation to attend today. I am president of the Irish Society of Chartered Physiotherapists. Mr. Ruaidhrí O'Connor is chief executive officer of the society, Ms Fiona McGrath is chairperson and Ms Mary Gorman is vice chairperson.
Chartered physiotherapists play a pivotal role in the delivery of primary care services. We rely on evidence-based treatment and treat a wide range of conditions from the very young prenatal patient right up to the elderly patient. We need to be readily accessible at local level, working as an autonomous profession in conjunction with our GP and other health professional colleagues. The primary care setting is the optimum position for physiotherapy services, the reason being that it is essential for us to have early intervention as this is critical to retain the function and independence of the patients who need our services. The presentation will show there is evidence to justify why we need to be in the front line. This is clearly evident in both the sports arena and in occupational health where many companies will fund physiotherapy services because they are cost effective. It is important to have ready access to patients when they need us within a very short space of time.
The slide on the screen will show we really only have a three-month window during which physiotherapy practice should have been commenced and completed because then there will be a 100% return to work. This relates to low back pain disability. I will describe a case study. This work was done in the UK. If patients are off work for six months their chances of ever working again reduce to 50%. If somebody is a year off work — which is not unusual in Ireland — with something as simple as a musculo-skeletal low back problem, their chances of ever working again, regardless of their age, occupation, qualifications, is as low as 25%.
The next slide shows that the UK situation was one where they prompted an expansion of physiotherapy services in order to try to reduce the level of disability and consequently the number of days lost due to back pain. A total of 22% of UK health care expenditure is expended on chronic pain. This is significant. A better roll-out of physiotherapy services would have a significant societal impact not just for back pain but for all chronic disability such as the arthritic knee or the early onset neck problems, hip problems and problems faced by stroke patients. There is no need to inform the committee of the excessive need for physiotherapy services for children with disabilities and for the elderly who want to stay at home in preference to using health care services in institutions.
The society welcomes the primary care strategy published in 2001 and we advocate that this is necessary. We can reduce acute service uptake both in accident and emergency departments but also in the long-term disability sectors if people can be retained in their own homes which is where they want to be. The problem is there are still significant waiting times for our services. There has been a delay in roll-out of the primary care centres and we advocate that they be expedited.
According to our survey conducted last week, waiting lists ranged from 16 weeks to one year across our acute services which means there is an unmet need for physiotherapy services. Out-patient physiotherapy departments are having to juggle and prioritise. The unmet need is even more critical for us because 59% of our 2008 graduates are unemployed or working outside of physiotherapy. Unfortunately the range of occupations in which they are working include care assistant and Burger King. We need to retain and harness this highly educated, highly motivated group of people, many of whom are trying for work on a pro bono basis. This is very inadequate when we know that people need our services. The increase in places was provided on foot of the Bacon report and it is unacceptable that we are putting so much capital and expertise into educating people but not utilising a group of people who are badly needed in the service.
The society has been very patient with the confusion between the titles of physiotherapist and physical therapist which has been the case over the past 12 to 15 years. We have been looking for State registration since the early 1980s. A Millward Brown survey indicated that one in three people does not know the difference between the two titles. It is unfortunately the case in Ireland that physical therapist is being used as a title by a group who are not a health care profession in the sense of having completed a physiotherapy degree course. We are internationally qualified and are associated with the Wellcome Federation of Physical Therapists. We are allied to and have reporting with the UN and so on. The Good Friday Agreement recognises both titles in the North of this country. It is important that we address this issue now because the confusion for the public represents a public safety issue. People need to get the appropriate treatment and level of expertise holistically in all systems — for respiratory, cardiovascular and neurological conditions, the treatment of children and the treatment of the vulnerable. The very least this country needs is a standard of qualification that reflects the expertise that is required for our patients in all health care settings.
We hope the committee will urge the Minister to recruit more physiotherapists for front line services because that is where we will get cost benefit. It would reduce the cost of long-term disability which results from the present inadequate access. Many physiotherapists become demoralised and de-motivated because they are seeing patients for whom they could have done something six months earlier and certainly a year earlier. That earlier intervention would have reduced their level of human suffering and disability considerably. We have a serious concern about public safety. We need to get the legal protection of both titles. Regarding the Good Friday Agreement we are hoping that reciprocity and common policies can be reflected.