Austerity on the frontline- a preliminary study of physiotherapists working in the National Health Service in the UK

ABSTRACT

Background

Organizational reform has been commonplace in the response to global socio-economic changes. Rising managerialism, consumerism and marketization has accelerated reforms; providing challenges for the healthcare professions. The latest socio-economic challenge, austerity, and its professional implications have scarcely been researched. This study aims to explore the lived reality of austerity as experienced by physiotherapists working on the frontline of the National Health Service (NHS) in the UK.

Methods

Ethical approval was granted by the University of Nottingham; the study was advertised via the Chartered Society of Physiotherapy online network. Two participants took part; semi-structured interviews were completed, audio recorded, and transcribed. Data was analyzed using thematic analysis.

Findings

Three themes arose from the data: (1) Fulfilling professional responsibilities; (2) Changing organizational landscape; and (3) Professional reality of rationalizing and accommodating austerity. The clinical implications of austerity included increased length of hospital stay, insufficient community services, constrained resources, and understaffing. Participants demonstrated attempts to preserve their professional status and services through restratification throughout the intra-professional hierarchy, changing division of labor, and re-professionalization.

Conclusions

Despite claims that austerity is coming to an end, it remained a reality for these clinicians in the NHS. Physiotherapists in this study used similar methods to preserve practice when faced with exogenous constraints as seen in medicine, such as re-professionalization and restratification. However, this attempt to defend professionalism by a non-medical healthcare profession was met with both successes and losses and has implications for the wider healthcare profession ecology, identifying an area for future research.

KEYWORDS:

• Austerity
• physiotherapy
• National Health Service
• professions
• United Kingdom
• sociology of the professions

Acknowledgments

Many thanks to the University of Nottingham for hosting the study and to the participants who took part. Many thanks go to the Chartered Society of Physiotherapy for their assistance with the advertisement of the study during the recruitment phase. Thank you to Mirko Noordegraaf for feedback on early iterations of this manuscript.

Declaration of interest

The authors declare no conflict of interest.

Notes

1. Zero hour contracts, also referred to as ‘casual’ contracts are based on employment where the employee works when requested; work is not guaranteed (the employer does not have to provide work) and the employee does not have to work when asked (Government UK, 2012).

2. STPs were introduced by NHS England in 2017 across 44 regions in England; aiming to improve health and social care (National Health Service England, 2017), though to some extent have become vehicles for cost reduction (Edwards, 2016; Gulland, 2016).

3. C-diff refers to the bacteria Clostridium difficile. This is a bacterium affecting the bowels, which can cause diarrhea; it is often associated with recent use of antibiotics and hospital admissions (National Health Service Choices, 2016).

Additional information

Funding

This work was supported by the National Institute for Health Research (NIHR) [MRES-2015-03-019-210] awarded to RT. This work was also supported by the Economic and Social Research Council (ESRC) [ES/P000711/1] awarded to RT for the duration of their PhD studentship.