The large print giveth, and the small print taketh away

[embed]https://www.youtube.com/watch?time_continue=29&v=XDYdHjBNCS8[/embed]

It's often tempting to think that it's the big changes, the grand gestures, that do the most damage to a profession, but it's really the small acts of violence that really do the damage.  The daily drip, drip, drip, that slowly erodes the foundations until, one day, the house falls down.

'Threats to democracy come one dollar at a time', goes the old American political aphorism, and so it is with professions like physiotherapy, which can suffer death from a thousand cuts if they are too distracted to notice.

Foucault would say that the most powerful and dangerous ideas are those that arrive under the cover of common sense, where it seems almost impossible to dispute the reason and logic being put forward.

"Power" he argued "is tolerable only on condition that it masks a substantial part of itself. Its success is proportional to its ability to hide its own mechanisms."

And so the most dangerous of all ideas perhaps come with tempting incentives and inducements that make it almost impossible to resist.

Take this recent announcement of a £100,000 funding award to innovations that will make a difference to the lives of patients within the NHS.  Surely there can be nothing wrong with that can there?  And any self-respecting professional body would surely be negligent if it didn't promote the opportunity to its members, as the CSP did here recently.

[su_pullquote align="right"]Saving money and improving the efficiency of physiotherapy services never comes with more physiotherapy[/su_pullquote]But one doesn't have to look far beyond the rhetoric of patient-centred care, to see that the primary objective of the SBRI funding is not more physiotherapists doing more work for more people, but return on investment, cost reduction, and a shift of responsibility away from centralised healthcare services to the community and, ideally, to the 'consumers' themselves.

Consider the project won by Advanced Therapeutic Materials Ltd, to improve on the 'treatment of venous ulcers in the UK' which 'costs the NHS approximately £300-400m per year. This project intends to show that using their 3D technology primary care could save in excess of £100m per year', or Xtal Technology Ltd's project which unashamedly states that 'The NHS must deliver £20bn of efficiency savings by 2020. Xytal’s sister company has a unique experience of increasing productivity in the English primary care sector, by utilising lean process improvement techniques.' (Link).

Saving money and improving the efficiency of physiotherapy services never comes with more physiotherapy.  It always results in patients getting less contact and more instruction, less hands-on care and more processing, less time with an expensively trained and irreplaceable clinician and more rough handling from cheaper, less engaged and infinitely more disposable alternative.

So while the lure of £100,000 of investment at a time when money is bleeding out of the public healthcare system seems like too good an offer to refuse, we should remember that a trojan horse isn't only a computer virus.