Please fill in this anonymous questionnaire to help save my local hydrotherapy pool:
Don’t let faceless NHS administrators cancel vital hydrotherapy treatment to cut costs
Background to what’s proposed in Thames Valley
For years, NHS accountants have waged a war with Physios over hydro pools. Accountants look at the bottom line; Physios know these pools are of tremendous benefit for a variety of Patients.
Post Covid-19, many pools across Britain are under threat, as hospital accountants look for cost-savings.
Berks West Clinical Commissioning Group (BWCCG) is running a consultation seeking our views on future provision of hydro services at the Royal Berkshire Hospital. Others are bound to follow, unless patients can show hydro pools are beneficial for us.
Why are BWCCG consulting on this service now?
The NHS must ensure the services and care it provides are fit for purpose, and that money is being spent wisely to provide efficient and effective services for the benefit of as many patients as possible.
Hydrotherapy is an effective and well-recognised therapy used in hospitals around the world. Over 2000 years ago Hippocrates was advocating it to speed recovery – and since then millions have benefited.
Royal Berkshire hospital treats up to 1,800 hydrotherapy patients a year. Since March 2020 the hydro pool has been closed for Covid infection control, and remains closed, even though swimming is now allowed in public pools.
What is Hydrotherapy?
Hydrotherapy is the use of water in the treatment of different conditions, including arthritis, muscular-skeletal and neurological conditions, lymphoedema, osteoporosis, neuropathy, polio and post-polio syndrome, fibromyalgia, Axial Spondyloarthritis , many conditions where patients have lost the use of their legs, etc.
Hydrotherapy differs from swimming in that it involves special exercises that you do in a pool with a physiotherapist, with water temperature at 33-36C (warmer than a typical swimming pool).
- The warmth of the water allows muscles to relax and eases pain in joints, helping patients to exercise.
- Water supports your weight, which helps to relieve pain and increase the range of movement of your joints.
Aquatic therapy (hydrotherapy) is beneficial for Patients that are restricted by pain on land; they can often start some exercises in water without pain, partly due to reduced muscle spasm in the water. The buoyancy of the water can assist with movement as well as helping to strengthen muscles.
For paraplegics, post hip surgery, broken or fractured bones that cannot support weight, etc. the buoyancy of the water keeps patients upright enabling them to exercise; something that is impossible on dry land.
Users say it gives them a sense of independence. Even if they rely on walking aids on land, they can move without these in the water, carry out exercises which are impossible without water to support them, and improve their general feeling of well-being.
Is there clinical evidence to support the effectiveness of this type of service?
Now this is where the gloves come off, with BWCCG citing NICE (National Institute for Care Excellence), the national clinical standard-setting body, normally known for adjudicating on use of drugs. However, NICE refer to hydrotherapy in two wishy-washy guidelines : – …………………………………………………………………………
1. NICE CG79 Rheumatoid (2009) arthritis makes no formal recommendations, but an evidence statement states that: “exercise, whether on land or in water is beneficial for most people with RA”.32. NICE CG177 Osteoarthritis (2014) makes no formal recommendations, but states in the evidence to recommendations section that: “there is limited evidence to suggest exercise in water may be beneficial in the short term.
Why do the West Berks CCG cite NICE, when even Lord Darzi, ex-Parliamentary Under-Secretary of State for Health, officially asked the All-Party Parliamentary Group on Cancer (Dec. 2008), “can anyone tell me what use is NICE?”
One does wonder – surely comments from the Aquatic Therapy Association of Chartered Physiotherapists (ATACP) would be more relevant?
Or ask Charing Cross Lymphoedema Clinic. They mentioned the Italian specialist Paolo Zamboni’s research into aqua aerobics: –
“Zamboni and others have produced a paper (extract in the magazine Phlebology (Oct. 18th 2016), on a specifically designed aquatic exercise protocol to reduce chronic lower limb edema, exploring advantages of basic aqua aerobics; this mentions sources including work at University of Ferrara”.
I came across him when I went to Italy to find out what I could do about Osteoporosis, and he knows his stuff! I found his exercises beneficial when successfully eliminating lymphoedema from my limbs.
At Chelsea and Westminster Hospital they offer a new hydrotherapy programme for victims of torture.
The Australian Health System has possibly the world’s best healthcare for those with physical disabilities, and their Ministry of Health says hydrotherapy
- Reduces load bearing on joints:
- Reduces muscle aches and tightness
- Increases muscle strength:
- Improves cardiovascular fitness:
- Stress relief:
The list is endless – so one questions why the BWCCG don’t do better research.
Why am I involved?
When I had Polio I was treated with hydrotherapy at the Royal National Orthopeadic Hospital. I was told I’d never walk again, but after months of treatment in their hydro pool, I walked out. So this worked for me.
How NICE imagines a quadriplegic might exercise, I don’t know., but this therapy has proven benefits for many – see https://www.youtube.com/watch?v=ieJYQiUsJz0
Strange fact – if you Google Hydrotherapy it will come up with multiple hydrotherapy pools for dogs and horses – but very few for humans! However, the Racing industry is a big employer in the area, and the Injured Jockeys Fund obviously considers it worth-while spending funds on hydrotherapy for injured humans. They say they are “fortunate enough to have hydrotherapy pools at three centres. We consider them invaluable in the rehabilitation services we provide for injured jockeys. We have now recommenced use of them following the easing of restrictions imposed relating to the coronavirus”.
Evidence I’ve found
Just to make sure I wasn’t the only one who thinks this therapy beneficial, I asked NHS guru Roy Lilley if he knew of a useful explanatory website. Previously vice-chairman of West Surrey and North East Hampshire Health Authority, Roy is an energetic commentator on the NHS. He came with :
and more – Google these in the address bar :
BWCCC say Land-based physiotherapy appointments normally cost between £22 to £45. Hydrotherapy appointments are in the region of £150 each. However, what isn’t mentioned is how much it costs to keep a pool going when it lies closed and unused – often because staff have been taken away to work elsewhere, which is ‘excused’ as maintenance. ;
So how will the BWCCG make a decision?
Alongside your views, BWCCG say ” we will also use national best practice and clinical guidance to review the service. Our recommendations will align to a number of principles to ensure a consistent and fair approach. These are:
- To offer procedures and treatments consistently and fairly to patients.
- To ensure that services meet the latest national clinical guidance and are supported by robust clinical evidence.
- To review the use of treatments that do not have any benefit, or have a very limited evidence base.
- To prioritise treatments which provide the greatest benefits to patients.
- To ensure best value for NHS money.
- To ensure services are provided in the right place at the right time and care is offered closer to home where feasible.
After years to study this therapy, (it has been around since the time of Hippocrates), you would have thought they would have made up their minds by now.
They want your views
You can comment on https://www.surveymonkey.co.uk/r/hydrotherapy
The survey is anonymous, and BWCCG say it will give them a detailed understanding of your views to help guide decision making process, so please take a little time to fill it in. The closing date is 2 Nov. ’20.
If you would like a hard copy of the review, or need it in a different language or in an easy to read format, email BWCCG at email@example.com or phone 0118 982 2720 (please leave a message and they’ll get back to you).
What happens next?
At the end of the 12 week consultation the survey results will be reviewed and discussed by the Berkshire West CCG Governing Body in December 2020, and full information will be shared with all interested parties.