Perhaps one of the greatest challenges facing the physiotherapy profession in the future will not be whether it can secure the necessary economic and political support to remain at the forefront of physical medicine, but whether it wants to take what’s on offer.
Throughout its history, physiotherapy has benefited from world events that have consolidated the profession’s relationship with the State, the public, and the medical profession (think here of the growth in the profession’s size and status as a result of World War I, the polio epidemics, the birth of the welfare state, etc.). But these have all nurtured our image as a caring profession in service of the entire population. Health and social welfare reforms of the last few years suggest that the times are about to change.
There has been much talk about the unaffordable cost of modern healthcare, and a range of solutions are now being offered. Two that are closely linked are the idea of a Universal Basic Income, where the state no longer offers welfare, but gives each of us a ‘salary’ to cover all of our welfare needs (pensions, prescriptions, health care, benefits, etc.), and Fit For Work Assessments.
In a post on the superb New Zealand site Public Address, the ever reliable Emma Hart takes to task those who support these measures, arguing that they cost more than existing welfare provisions, carry an unacceptable level of risk to people’s health, and engender a cynicism and managerialism across the entire health care sector (link).
There will be many physiotherapists reading this who have moved into areas like vocational rehab and ‘Work Hardening’ programmes, or are now involved in Fitness For Work Assessments, who believe strongly that this is good work (haven’t physios always been involved in getting people back to work?) And there will be others who have chosen, or have been forced by economic circumstances, to leave the public sector and go where the money is.
These are the economic realities of healthcare today. But that doesn’t mean that the profession, as a whole, can afford to abandon those people who cannot afford individualised, private healthcare, because they make up the bulk of the burden of disability and illness in the population, and who will care for their physical health needs if we don’t?
The question that physiotherapists have to ask is whether we want to be party to these health and social care ‘reforms,’ or whether we want to exercise moral objections to the slow, unrelenting assault on public services. Because to do so would require us to challenge the hand that has long fed us, and risk losing the generational patronage that has seen the profession rise to being the orthodox provider of physical rehabilitation services.
These are going to be difficult times for the profession and we will be forced to make some hard choices. “Fearless speech,” as Foucault called it, may be the only way to retain our professional identity and dignity in the years to come.