I was sent this email today from a physio, Grace O Malley, working in the USA. I am posting it on her behalf as it is a useful foreign perspective.

Hi,

As an Irish PT now residing in the US I have to urge you all to really make a stand on this issue. It is very clear that here, in the privatized system the autonomy and decision-making of 'free-thinking' physical therapists is far more eroded than in the UK/Ireland/Europe/Australia/Canada. The PMI's seem to treat physio. within a strict medical paradigm, which even though PT has an ever-growing evidence-base, it's effects cannot be simply measured with the same tools as a drug or surgical approach. As physiotherapists we are all aware of the time we spend listening to our patients, helping them cope with depressive symptoms post injury and working tirelessly to instill the self-efficacy and confidence required to really improve function and well-being. We simply cannot accept a system that offers a certain number of sessions to eg. all patients with stroke and if treatment is not effective within that time, well then, either the patient pays for more treatment (at highly inflated costs) or treatment is deemed ineffective.

We all must remember that PMIs are private companies with one basic tenet......to make as much profit as possible. If our primary concern is with providing the most cost effective and clinically effective holistic treatment to our tax-paying patients...we must defend our right to practice autonomously as highly skilled physiotherapists within the multidisciplinary healthcare team.

My vision would be for nationalised healthcare to move toward a more preventative approach where PTs would have a pivotal role in promoting musculoskeletal and cardiorespiratory health throughout the whole population. Prevention is the only method of saving tax-payers money in the long run afterall. We are in a time now economically where companies/corporations will do their very best to work toward a privatized system as the health of a nation when privatized is a cash-cow.

Just a few thoughts. Keep up the good work and I will continue to follow this with great interest.

Grace.