New: Money

A lot of really interesting attempts to change the way health care is being delivered are foundering because people can't work out how to fund them.

There are certain pockets of money available: seed grants and step-change funds that get projects started, but often these are term-limited and there is rarely any chance of ongoing funding.

One of the unspoken principles underpinning a lot of new models of health care (including primary care, health promotion, inter professional practice, patient-centred care), is that they will cost less, (or at least they will shift the responsibility for payment onto the individual and away from the state.)  But few people have yet worked out ways to make the transition from traditional care in the absence of secure funding.

Physiotherapists are ideally placed to respond to the changing economy of health care.  Name another profession that can boast diagnosticians with a high social standing, who can speak the language of biomedicine but work with the whole person, using techniques that are portable and inexpensive?  Despite this, physiotherapists have been slow to move away from their traditional roles and service responsibilities.

Physiotherapists working in the public health system appear to be reluctant to abandon what is increasingly looking like a sinking ship, having learnt to tolerate more than 30 years of cuts and compromises.  And private practitioners seem to be working towards elite specialisation as their future practice model rather than looking to funding that might provide a 'breadth' of employment opportunities.

So if money from central government is in decline, it is likely that the profession will pass into a period of both insecurity and opportunity.  Today's graduates will likely find public sector jobs harder to come by, and they will need to find work in a range of different sectors.  It is likely that partially funded, relatively short-term projects will become more common, and the ability to be innovative about one's work patterns and service responsibilities will change.

It would be lovely to imagine returning to a time when graduates entered the public health sector and had a job for life, but those days are gone, and the sooner we come to terms with this and look to the possibilities for new funding models, the sooner we will learn what new opportunities lie ahead for us.