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TX: 13.05.05 - Hydrotherapy Pools

PRESENTER: PETER WHITE
Downloaded from www.bbc.co.uk/radio4

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

WHITE
Patients are angry that two new state of the art super hospitals being built in the Midlands will not have hydrotherapy pools. Selly Oak Hospital in Birmingham currently has a pool but it's due to merge and form a new Queen Elizabeth Hospital by 2010 which will not have a hydrotherapy pool. Peterborough finds itself in a similar situation. Sue Arnott from Birmingham is a patient with arthritis who's used the Selly Oak pool both as an inpatient and as an outpatient.

ARNOTT
It has enabled me to learn to walk again. It has given me pain relief. It has made me feel a hundred percent better, even as an inpatient, when I was very, very immobile. And as a result of that I'm now back to full mobility or almost full mobility, I can't quite sit down in an ordinary chair but I'm getting very close to it and without that I don't think I would probably have got to where I am now.

ATKINSON
Now the fact that there is now no way that a new patient can use the existing pool and the fact that when the new sort of super hospital is built there is no plan at all to build a hydrotherapy pool what is your reaction to that?

ARNOTT
My reaction is it's a disaster. We have here apparently the biggest new hospital build in 70 years in Europe, every other health authority in Birmingham has a pool and this is going to deny those patients at this hospital - that is patients who are neuro-patients, trauma patients, orthopaedic patients, dermatology patients and rheumatology patients, the ability to regain their flexibility. And without the hydrotherapy pool those patients are going to spend longer in hospital and the cost to society will be enormous.

WHITE
Sue Arnott talking with our disability issues reporter Carolyn Atkinson, who's with me in the studio. Carolyn, what is the state then of hydrotherapy provision?

ATKINSON
Well thousands of people with all sorts of conditions use hydrotherapy pools. That's everyone from people with stroke, with spinal injury, people with MS, surgical patients perhaps have a hip replaced or an elbow replaced, children and of course rheumatology patients there like Sue Arnott. Now let me give you an idea of what these pools are like. Generally there's about six metres by four, they're no more than five or six foot deep so that people can touch the bottom, they can walk along and they can be supported. And they're set at a temperature between 33 and 35 degrees. Now if you compare that with a swimming pool, which is about 29 degrees, you can say they are a lot hotter. Now as for the numbers in the UK no one has exact figures, although lots of people have made attempts but as we've heard the people who use them say they are life changing.

WHITE
So what's the feeling of some of the organisations who support and represent people who use the pools?

ATKINSON
Well the overriding message from the groups that I've been talking to, and that's groups like Arthritis Care, ARMA - which is the Arthritis and Muscular Skeletal Alliance - and the chartered society for physiotherapy is that firstly there are not enough pools, full stop. But secondly, of the pools that do exist there's just not enough capacity. So they say the net result of that is very long waiting lists and they point out that if someone's having a flare up then they need relief straightaway not in, say, six weeks times. Now to illustrate this apparent lack of capacity I came across one large teaching hospital in the Midlands which does have a hydrotherapy pool, now to give you an example of the sort of situation that's arising, they have 25,000 rheumatology patients a year going through the books, as it were, 10% of those or 2,500 they say would benefit from using their hydrotherapy pool but they say they can only accommodate 1,500. So do the maths - a thousand people in that example are missing out and would benefit from hydrotherapy.

Now the two future hospitals, that we've identified as not having plans to build hydrotherapy pools, are all very happy with their decisions. Selly Oak Hospital tell us that the pool there at the moment is very difficult to get into, either by hoist or by steps, they say it's very small - only eight patients are using the service at any one time - and they say that the evidence so far on whether it works or not is not proven and in fact they are actually carrying out a trial, as we speak, at the moment, comparing hydrotherapy with what people call land based treatments - so physio in the gym. They're awaiting the results of that but they do that they've reviewed their facility already, they've decided that they will close their current pool to new patients and they say all those new patients can go to other hydrotherapy pools in the area, which they say are bigger and better, if you like, they've got level access, they've got better changing facilities.

Now in Peterborough the officials there confirm that there's also no plan to build a pool at that new super hospital there but they say they do want to provide hydrotherapy in a community setting, rather than at an acute hospital, they think it's better for people to go into the community rather than to a hospital. And they say they're still looking at the options.

Just one other point to make is that many hospitals are now being funded under the government's private finance initiative. Now of course lots of PFI hospitals do have pools but critics would argue that funding is being squeezed at the moment, that hydrotherapy pools are seen by some as a bit of a luxury, a bit of a hot bath, and therefore they are dispensable, in fact this was actually a worry flagged up to the Commons health committee inquiry way back in 2001, it was looking at the private funding of the NHS then and physios told that committee - they spoke of their worries about funding and about allocating enough space for pools.

WHITE
Carolyn, thank you very much indeed. Well in support of the idea of having a pool in the Selly Oak Hospital we can now hear from Paul Bacon, who's emeritus professor of rheumatology at Birmingham University. Now he recently retired from Selly Oak Hospital and he chairs the Birmingham arthritis appeals trust, which raised 250,000 to buy the existing pool before it was handed over to the NHS. He's very unhappy with the decision not to build a new pool and the running down of the current one.

BACON
We paid for it, thinking this would be a long term facility and I'm sad as an ex-rheumatologist because this is something that patients want. We hear a lot about choice, it's the current buzz word, Blair talked yesterday of putting patients in the driving seat of the new NHS, patients want this pool, they wanted it at the beginning and the current patients' advisory group wants it now.

WHITE
But what evidence is there that hydrotherapy actually does any good? I mean we've heard anecdotal evidence but of course medicine now has to be very evidence based, can we actually prove that this succeeds?

BACON
The evidence base for old therapies is not as strong as it is for new ones because it was introduced before there was these rules. So the evidence base for hydrotherapy is a bit thin at present but that doesn't mean to say it doesn't work, it just means that not enough work has been done on it. My personal view is that for patients who are really severely disabled, as Sue Arnott was, that this can be a very important starting point in their rehabilitation.

WHITE
But what do you say to those who say these pools were fine in the past but now there are more options, there's better drugs, more knowledge about disease?

BACON
But we still don't have a cure for disease and therefore we need a broad package of measures which will include new drugs, new drugs are directed at particular sorts of arthritis and not necessarily at all sorts of arthritis. And we also need old measures. In fact the realisation of the importance of exercise is something that's coming across very strongly in current research. And it's all very well telling someone with bad arthritis to exercise, it's harder for them - they have weak muscles and painful joints - so you can't just tell them to go jogging, they need a careful programme of exercise and the pool can often be the beginning - the starter for that.

WHITE
Now just looking at the whole issue of effectiveness and cost effectiveness, I mean the tank at Selly Oak is very small, can only accommodate two or three patients at a time, aren't they right perhaps to restrict its use, it's not cost effective in terms of physio time - you could be land based with 10 patients and one physio?

BACON
Well I'll say two things about that. The first is that I think the trust is making a very good case for having a full size pool that will treat a lot of people and I entirely agree with them, that that would be better than the small pool that's there at the moment. But you have also to remember that the physiotherapists who are the experts in treating people and getting them going again they want to use the pool, they feel that it is an effective way of getting people back to work. So maybe we need to talk about quality of care, rather than just quantity - we're not talking about how many arthritics you can pack on to a bus, we're talking about providing top quality care.

WHITE
But there are other pools aren't there in South Birmingham, what's wrong with going down the road to use another pool nearby?

BACON
The current pool is an integral part of a comprehensive inpatient and outpatient service. If you're an inpatient and severely ill, like Sue Arnott was, then if you have to go into an ambulance to another hospital, have a treatment which is quite tiring, because they work in a pool, they don't just like around in it, and then they have to wait for an ambulance to come back again, that really isn't the same quality of care.

WHITE
So what would your solution be to this problem?

BACON
My solution would be to build a full size pool in the new hospital as an integral part of high quality comprehensive rheumatology service.

WHITE
That's Paul Bacon, emeritus professor of rheumatology at Birmingham University.

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