On 25 July 2001, Peter Bacon and Associates presented a report on current and prospective future trends in the supply and demand of qualified personnel in speech and language therapy, occupational therapy and physiotherapy. At the launch of the report, Minister Micheál stated that ‘there is a strong recognition running through the report that strategic, long-term workforce planning must become a core activity of the human resource function of the health services. This will necessitate a further strengthening and deepening of relationships with educational providers.’
Dr Peter Bacon and Associates reported that there are at present almost 200 job vacancies in the three professions. The report recommended 75 additional course places in speech and language therapy (25 places at present), 75 in occupational therapy (35 places at present), and 25 in physiotherapy (120 at present). The ‘structural shortfall’ in the number of training places in the three professions was seen as a major issue to be confronted. Minister Martin promised that the departments of Health and Children and Education and Science will work together to ensure the rapid provision of the additional places. An Inter-Agency Working Group has been established (between the two government departments and the Higher Education Authority). A broader geographical distribution of training provision is to be sought, and a wider range of clinical placement opportunities. The Minister called for ‘flexible and imaginative approached to increased training provision’ and asked the public sector to respond energetically to the provision of additional clinical-training places. A national network of Clinical Placement Co-ordinators is being establishment within the health boards to work closely with the training providers.
The university training programmes leading to professional qualification in the three professions have argued in recent years that the number of course-places available has been restricted largely because of the difficulty in sourcing suitable clinical placements with the necessary supervision and monitoring.
The Minister has asked the three professional associations to examine ways to facilitate a more rapid validation of foreign qualifications, and perhaps to issue temporary validation of qualifications in order to facilitate waiting employers. The Bacon report has recommended a professional registration system for each of the therapy professions, independent of the professional representative bodies.
Following the publication of the Bacon Report, Frontline sought the response of professionals in the field. Three therapists have shared their early reactions to the report.
Speech and language therapy
With regard to speech and language therapy (S<), there have been huge endeavours made by the profession to highlight the snowballing crisis around recruitment and retention. This has been a key concern for the profession for a number of years and so it was with great anticipation that we waited to hear Dr Bacon’s recommendations, when the report was launched. His proposal that the number of speech and language therapists be increased four-fold over the next fifteen years was very much welcomed, as was the Minister’s commitment to follow through on this.
In order to achieve the recommended increases in all three professions, a number of strategies are put forward in the document. A major increase in training places is proposed (75 more per annum for S<). Interim measures suggested for dealing with the shortfall in therapists include fast-tracking qualifications, whereby individuals with a related qualification could be trained-up in two to three years, instead of four years. This particular suggestion has been greeted cautiously by some therapists. It is seen as essential that opportunities are provided for professionals to air concerns around such issues and that their views are heeded.
Clearly it is not just a matter of increasing the number of training places. We have been losing more and more speech and language therapists over recent years, for many reasons—pay and working conditions, limited opportunities for career advancement, stress in managing huge caseloads, and ever-increasing waiting lists. The Bacon Report recommendation for a review of career structures is therefore also very much welcomed. Personally, I feel we have received positive news and I am hopeful about the future. However, it is vital that work begins immediately to address the key issues and concerns of the profession, the clients we serve and their families.
Alison Byrne, Senior Speech & Language Therapist, St Augustine’s School, Blackrock, Co. Dublin
In November 2000 I was approached by Peter Bacon Associates to co-operate with the preparation of the above report. AOTI welcomed the involvement in and the commissioning of the report. Ireland has had a shortage of Occupational Therapists for many years resulting in vacant posts and poorly developed services.
The Republic had only had the capability to offer 30 training places a year (increased to 35 in the year 2000). The report very clearly identifies the major gaps in services and projects demands for future requirements—with which we are very much in agreement. The accuracy of some of the data is questionable, but the current and projected deficits are evident to all.
The most warmly greeted recommendation in the report is the creation of additional training places in the Republic. The Association of Occupational Therapists would recommend that the second school should be outside of Dublin, because demand for student clinical placement facilities in Dublin are already saturated. We also welcome the recommendation for training occupational therapy assistants and developing this role; indeed the Association has already submitted a proposal to the Department of Health and Children in relation to this.
The recommendation to review career structures and increase resources is most important, especially because the Expert Review did not adequately address some of these issues. The report calls for a new look at training the professional groups and certainly the Association will be actively involved in dialogue and accreditation of additional training schools.
Finally, we very much hope that the recommendations are moved on quickly and efficiently to alleviate the current situation and to improve services all over the country in all specialities over the foreseeable future.
Stephanie Manahan, Chairman, Association of Occupational Therapists of Ireland
This is a comprehensive report undertaken to review the current and future needs of physiotherapists, occupational therapists and speech and language therapists. It merits detailed study at managerial and clinical levels and in the training colleges, as changes are recommended in all areas.
The authors conclude that demand for physiotherapy services exceeds current supply and that there is an urgent need to address this. Experience in the area of learning disability shows that they are correct. I would question whether the additional 25 physiotherapists which the Report recommends would be sufficient to meet the increased needs of our ageing population.
The view that methodologies to estimate demand are needed, is welcome. Agreed criteria for community services would help those working in learning disability and provide a means of looking at equity of service in different health board areas, so that location does not dictate service quality.
The Report states that over 70% of ISCP members work in private practice. This seems to include the Dublin teaching hospitals and other organisations, including many service providers for learning disability. However, these are usually regarded as part of the public sector, and only those in private hospitals and self-employed are considered to be in the private sector. The assumption in the report skews the calculations.
The assumption that 80% of physiotherapists work full-time is possibly over-estimated, given a 95% female profession. My experience in learning disability and physiotherapy is that 50–60% of therapists work full-time. The consultants express surprise at the 95% female population in the therapy professions and suggest that this is due to females doing better in areas with high points requirements. The poor career structure and low pay are the more likely reasons, and thus the recommendation of the Report for a review of the career structure is welcome.
The report supports the initiative to employ clinical specialists. It is regrettable that no specialists have been appointed in learning disability.
While the employment of physiotherapy assistants in learning disability needs to be explored, I have concerns about the recommended employment of therapy assistants and physical therapists to fill physiotherapy posts. This is not in our clients’ best interests. Rather than resorting to the employment of non-chartered physiotherapists to fill immediate vacancies, it would be preferable to explore how to retain staff, with flexible working, increased incentives to work in learning disability, and training to encourage therapists back to the workplace.
Finally, while there is a need for more people to enter the profession, graduates of the new RCSI course and the recently increased UCD intake have not yet come on-stream. It would be preferable to review shortfalls in supply in about five years’ time. Although the government has undertaken to increase health-sector funding, there is no guarantee that increases will be sustained over the next five years and, with the economic slowdown, the Report’s recommendations on higher public sector employment numbers may yet be shelved.
Riana Ó Cofaigh, Manager, Physiotherapy Services, St Michael’s House
(The reviewer writes in a personal capacity and the views expressed do not necessarily represent the views of the physiotherapy profession or the organisation for which she works.)