Licensed by the state Physiotherapists in the United Kingdom have to be registered with the Health Professions Council (HPC) in order to work in the National Health Service (NHS). In the near future this will be a requirement in order to use the title physiotherapist, and therefore work in any setting in the UK. This is a government measure to protect patients from unqualified or inadequately skilled healthcare providers. Within the next few years, the HPC will put in place a system requiring re-registration at intervals of, perhaps, five years, based on a demonstration of an individual's continued competence to practise, probably through the submission of evidence of the outcomes of continuing professional development (CPD). Re-registration is in response to a decrease in public confidence in the NHS following, for example, the report into children's heart surgery in Bristol (Bristol Royal Infirmary Inquiry 2001). Equally disturbing were the revelations about the murders of so many patients by Harold Shipman, a man who had been a previously trusted general practitioner, where health systems failed to detect an unusually high number of deaths. This has led the government to take a number of measures, including the requirement for all health professionals to re-register at specified intervals, to be seen to be protecting the public through a more explicit and independent process. It will aim to identify poor performers who may be putting the public at risk, as well as providing an incentive for professionals to keep up to date, maintaining and further developing their scope of, and competence to, practise. Disciplinary processes are in place to, ultimately, An aspiration to achieve consistency of services across the NHS This is founded on two principles: • If one trust can provide excellence in a service, why can't all trusts? • Local services should, where possible, be based on national standards, for example National Service Frameworks, or nationally developed clinical guidelines. There is some evidence to suggest that nationally developed standards or clinical guidelines are likely to be more robustly developed (Sudlow and Thomson 1997) and that their universal implementation locally will ensure consistency and effectiveness.

Mead 1998, with permission.) Figure 1.2Whatdowemeanby'evidence'?(AdaptedfromBuryandMead1998,withpermission.) Making a commitment to assist those in need As stated earlier, one of the characteristics of a professional is to want to 'do good'. This is reflected in the ethical principles of the physiotherapy profession, where there is a 'duty of care' incumbent on the individual towards the patient, to ensure that the therapeutic intervention is intended to be of benefit, as set out in Rule 1 (CSP 2002a). This is a common-law duty, a breach of which (negligence) could lead to a civil claim for damages. More generally, professionals are perceived to have moral authority, or trustworthiness, if they (Koehn 1994): • use their skills in the context of the client's best interests, and 'doing good' • are willing to act as long as it takes for assistance to achieve what it set out to achieve, or for a decision to be made that nothing more can be done to help the client • have a highly developed internalised sense of responsibility to monitor personal behaviour, for example by not taking advantage of vulnerable patients • demand from the client the responsibility to provide, for example, sufficient information to allow decisions to be made (compliance) • are allowed to exercise discretion (judgement) to do the best for the client, within limits. Koehn argues that trustworthiness is what stands out as a particularly unique characteristic of being a professional - to do good, to have the patient's best interests at heart and to have high ethical standards. Physiotherapists not prepared to maintain such ethics, even in difficult and stressful situations, run the risk of losing the respect as well as the trust of their patients and the public.Definition Clinical governance is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (Secretary of State for Health 1998). While this definition has been used in England, similar interpretations of the term have been made in Scotland, Wales and Northern Ireland.

This is an exciting time to become a physiotherapist. If you are training or if you are about to commence training as an undergraduate, you are entering one of the most stimulating, varied and rewarding careers possible. The new millennium holds endless possibilities for physiotherapists. The first edition of Tidy's Physiotherapy was published in the 1930s, and the fact that it endures as a bestseller amongst student physiotherapists confirms that students want a clear reference guide to help them through their studies. This thirteenth edition has been extensively redesigned. Experts from a wide range of clinical and academic backgrounds have rewritten each chapter, to reflect current clinical practice and theory. Previously existing chapters have been updated, and there are new chapters covering a diverse cross-section of the topics to which student physiotherapists need to be introduced. Physiotherapy as a profession underwent spectacular changes in the second half of the twentieth century. Tidy's Physiotherapy now reflects those changes and will evolve as our profession evolves. This new edition covers some key areas and developments in the field of physiotherapy in the early twenty-first century, and the book will look as different in ten years as this edition differs from its predecessor. More information about evidence-based practice can be found in Bury and Mead (1998), or at http: //www.nettingtheevidence.org.uk/, a catalogue of useful electronic learning resources and links to organisations, which facilitate evidence-based healthcare. See also the section 'Sources of Critical Appraisal Tools' towards the end of this chapter. CLINICAL EFFECTIVENESS Clinical effectiveness as defined by the Department of Health sounds very much like evidence-based practice • doing things you know will be effective for a particular patient or group of patients. But the fact that an intervention has been proved to work in research studies, in a relatively controlled environment, does not necessarily mean that it will work for a particular patient. Both patients and practitioners are unique beings, and there are many additional factors, practical and behavioural, that need to be considered to ensure the patient gets the maximum benefit from an intervention. Is clinical governance something new? Yes and no. Its component parts are all familiar activities, but there is also an underpinning philosophy in clinical governance, to reduce risks for patients, a new and more focused emphasis that was not previously articulated. It can be argued that clinical governance is, at least in part, a response to a loss of public confidence in the NHS discussed earlier, which has undermined public perceptions of the NHS as an organisation they can rely on to 'do CLINICAL GOVERNANCE So far, this chapter has explored the responsibilities of being a physiotherapist from a professional perspective. The focus has been on the individual's personal responsibility as a professional. This section will put all that in the context of a professional's responsibilities to their employer organisation, whether it be in the public or independent sector. In the NHS, responsibility for the clinical safety of patients and the quality and effectiveness of services is through a system of clinical governance. It seems probable this will apply equally to the independent sector in the near future. But even though clinical governance is the responsibility of NHS trusts, its foundation is based on 'the principle that health professionals must be responsible and accountable for their own practice' (Secretary of State for Health 1998). So the individual's professional responsibility is still paramount. When I was asked to act as Editor, it soon became clear to me that to accomplish a successful project would involve a team effort involving a diverse group of people who already had extremely busy lives. I have been moved by the willingness and dedication of the contributing authors to devote the time to their chapters, and the grace with which they have accepted my periodic nagging. It is greatly appreciated. I would also like to thank Heidi Allen, Robert Edwards and Judy Elias at Butterworth-Heinemann for their support and faith in me in entrusting me with the task of editing this book. I would like to thank Richard Cook at Keyword Publishing Services also. The following people have been an invaluable source of opinions and comments: Marc Hudson, Joanne Fawcett, Hannah Cushion, Laura McLeod, Eleanor Ford, Robert Hodgkiss, Kezia Purdie, David Wilkes, James Baldwin, Vicky Platt, Jamie Murphy, Paul Sparrow, Mark Eales, Steve Morris, Candice Olliver, Amy Glasgow, Chris Hodson, Laura Hay, Natalie Price, Elaine Byrne, undergraduate physiotherapy students who formed the focus group; Patricia Lambert-Zazulak DCR(T) BA PhD, research associate at the Mummy Tissue Bank, Egyptology Department, Manchester Museum for her advice on ancient diseases and trauma; my great friend of 35 years Mark Hothersall for some of the digital image manipulation; PaulaJayne McDowell, Guidelines Initiative Officer at the Royal College of General Practitioners; Nick Goudge, Kate Slingsby, Kay Hack, Simon Crozier, David DeanThe components of clinical governance Although clinical governance should be seen as a package of measures that together ensure excellence and a reduction in risk, it can also be viewed as a number of component parts, some of which have been in place for a number of years and are already familiar (Figure 1.1). They include: • • • •