The rising number of people waiting for physiotherapy treatment is causing problems in other parts of the NHS and harming the UK’s economy, leading clinicians have warned.
Waiting lists for treatment for musculoskeletal (MSK) problems such as back, neck and knee pain have grown by 27% since January last year. The Chartered Society of Physiotherapy (CSP) said the number of physiotherapy posts in the NHS was not keeping pace with demand from Britain’s ageing and increasingly obese population.
The CSP said the UK needed a 7% increase in NHS physiotherapy positions every year to meet rising demand. Musculoskeletal conditions that are left untreated can become more complex and lead to mental health problems or the need for surgery, as well as time off work.
The latest NHS community health service figures show 323,965 people were waiting for musculoskeletal treatment in March, a year-on-year rise of 33,257 or 11%, and 27% higher than the 254,521 people waiting in January 2023.
Rishi Sunak last month accused Britain of having a “sicknote culture”, with 2.8 million working-age people classed as economically inactive. Ministers have focused on rising mental ill health, claiming that doctors are “overmedicalising” conditions while also floating a plan to cut benefits for 420,000 sick and disabled people.
However, more people are living with chronic pain, according to the Health Foundation. Google searches about pain reached their highest ever levels in the UK earlier this year, with searches for lower back pain at their highest ever level in March.
Sara Hazzard, the assistant director of the CSP and co-chair of the Community Rehabilitation Alliance, said that there were plenty of people who wanted to become physiotherapists, but a shortage of NHS positions.
“We haven’t got posts being created where people need them, so people are not able to get appointments,” she said.
“And by not being able to get that treatment, people ‘snowball’ – their mental health suffers because they’re in pain, and then it snowballs into other problems.
“So rather than people getting what they need to get back to work, they end up being off work. Once people are off work for a year, it’s very difficult for them to get back into the workforce.”
There were knock-on effects to other NHS services as well, Hazzard said. Untreated aches and pains can turn into conditions that require surgery, adding to other waiting lists for knee or hip replacements. “We’re at a point where we need to recognise that rehab is as important as medicine and surgery, because that is the answer for a large group of people.”
Freedom of information requests by the CSP indicate that the unmet needs for physiotherapy may be having broader effects. In the North East and North Cumbria integrated care service, the number of 111 calls received about back pain was 52,431 in 2019. That rose to 73,660 in 2020, when people spent long periods of time inactive at home in lockdown. Calls fell in 2021 and 2022 but then rose sharply to 71,427 last year.
The picture was similar in Sussex, where the South East Coast ambulance service fielded 45,677 back pain calls in 2019 but more than 97,000 in 2021 and 70,595 last year. The Sussex MSK Partnership held a two-day special event last year where people on the waiting list could see physios in a leisure centre.
Some patients have gone to extreme lengths to get treatment. Vic Paterson was a frontline police officer in Cambridgeshire eight years ago and slowly developed excruciating back pain, possibly from wearing heavy body armour.
She realised she had a problem when she went out into her garden one evening to look at the International Space Station overhead. “I realised I couldn’t look up,” she said. “I tried to put my head up and it really, really hurt. I just came inside and cried because of how much it hurt, and the realisation that it was an issue.”
Paterson was lucky enough to get access to a police rehabilitation centre, and after two weeks was able to move her neck. She was sent away with advice to have fortnightly massages, but couldn’t afford the £40 cost.
“Me and my husband worked out it would be cheaper for us to do a training course,” she said. “Seven years later, neither of us are police officers.” Instead they run State 11, a soft tissue therapy clinic in Spalding, Lincolnshire.
Esther Fox is a clinical specialist physiotherapist with a PhD in the subject. She started her career in the NHS in 2003, but then moved to private practice and is now the clinical lead at Mount Kelly Physiotherapy Centre in Devon.
“When I first started working in physiotherapy in 2003, we had a great provision of physiotherapy and the services were really good,” she said. “I used to be able to see people once a week. You could see people often. You could do a lot of manual therapy. That had gone when I left the NHS in 2010, 14 years ago, and then, as time has gone on, that significantly decreased again.”
• The picture caption on this article was amended on 26 May 2024 because an earlier version said that Vic Paterson retrained as a physiotherapist. In fact she became a soft tissue therapist.
