2010 revisited from the perspective of 2020

Looking back on the last decade, one would have to conclude that it has been one of the most turbulent, yet exciting, periods in the profession’s history.

The centrepiece was, of course, our centenary celebrations in 2013, but by then much had already changed.  Public funding for physiotherapy from DHBs and ACC was diminishing, and the plethora of local, community-based fund-holders that we see today were beginning to emerge.  Fortunately, we had taken steps to broaden our traditional approach to treatment, and it was this as much as anything that kept physiotherapy afloat when the new Rehabilitation Services Reform legislation came onto the books in the middle of the decade. 

New legislation has made it much easier for physiotherapists to spread their wings and develop services that would once have been considered beyond us. The legislation, which involved a major reworking of the Health Practitioners Competence Assurance Act, made possible the creation of an entirely new structure for the rehabilitation professions: one that directly challenged traditional professional silos.  The debate continues about what this means for physiotherapists, but clearly the economic problems of the first half of the decade have only made the discussions about how to fund rehabilitation services in the future more urgent.

The government has clearly signalled that the ‘old’ model of disjointed health care services – designed around the “elite” professions (and here we are clearly being tarred by the same brush as the medical profession), is long overdue for reform.  The precarious state of the nation’s economy has only hastened the project to dismantle the welfare state – a project that was begun in earnest more than 20 years ago.  Surely, the days of publicly funded hip replacements have gone, as all the government’s health budget is now being spent on genetic therapies and dialysis machines. 

But technological innovation has been a boon to physiotherapy as well.  One of the most interesting areas of research and innovation has been in robotics with physiotherapists leading the way in some of its possible uses; from keeping our frail elderly safe at home, to robot-assisted devices in neurological rehabilitation.  Likewise, the use of virtual reality and patient simulations have radically transformed undergraduate and postgraduate education.  No doubt none of this would have been possible without the support of some prestigious technology companies.  And who knows how long it will be before the Lockheed Martin physiotherapy  programme in the United States establishes a virtual school here. 

Closer to home, one of the most gratifying changes has been far more modest, but in some ways more profound.  Opening up the profession to greater scopes of practice, and recognising that physiotherapy had existed in something of a vacuum in the 20^th century, has resulted in a much more diverse, inclusive profession.  Maori and Pasifika physiotherapists now make up nearly 15% of the profession, and we have elected our first Maori president.  We also have a strong and growing Asian contingent serving the needs of people from Cape Reinga to Bluff.  Of course, this was necessary because New Zealand itself became a much more cosmopolitan country in the last decade; and not just in the large urban centres, but in the rural heartlands too, and physiotherapy needed to reflect that change.

So what of the future?  Physiotherapy will no doubt continue to expand, and some time in the next decade we may well graduate our 10,000^th member.  Physiotherapy New Zealand will continue to represent the profession, even if the Physiotherapy Board becomes part of the new Rehabilitation Professional’s Registration Council.  The trend that has seen physiotherapists forming alliances with massage therapists, acupuncturists and others may well see closer working ties between our profession, osteopathy and chiropractic; something that could not have been imagined even 10 years ago.  Any day now we expect to see a proposal from the government’s Rehab Taskforce for closer working ties between physiotherapists, occupational therapists, podiatrists and rehabilitation nurses, and it is rumoured that they will recommend the creation of one rehabilitation professional.  Surely the success of the Rehabilitation Assistants only makes this more likely. 

These are exciting times for physiotherapy to be sure, and as always, nothing stands still for long.  It all begs the question: what will someone write about us in 2030?

By David Nicholls