Whither the BS(P)RM?

The British Society of Rehabilitation Medicine, the BSRM, is changing. The proposal to change its name to the British Society of Physical and Rehabilitation Medicine (BSPRM) was one factor precipitating this change, but the changes already underway were probably due anyway. New people are joining the Executive committee. The new curriculum has led to a discussion about our Society’s nature. The pandemic has unsettled many long-standing habits and organisations, and there has not been any significant debate for some years. The last matter to cause quite a vigorous discussion was allowing other professions to join the Society.

In this blog post, I review the situation after the first month of debate and discussion. My main finding is that the proposal to change the name suggests many benefits, such as increasing our membership. However, the proposers have not developed any plans to connect the name change to these benefits, nor do they consider other, more straightforward, quicker ways to achieve the same goals. Our Society has embarked on a substantial set of changes and developments already. Some planned changes may well gain some of the goals wanted. In the absence of any plans, voting to change the name will not lead to any benefits. Until these other changes are complete and we know what future we envision for our Society over the next 20 years, we should postpone changing the name. Members should vote no, not now.

Context

I have reviewed the history of our Society here, from the first glimmering of rehabilitation as a healthcare activity in the UK in 1935 through the foundation of the British Association of Physical Medicine in 1943, becoming the British Association of Physical Medicine and Rheumatology in 1970. This Association changed its name to the British Association for Rheumatology and Rehabilitation and then disbanded itself in 1983. One half merged with the Heberden Society to become the British Society of Rheumatology. One half became the Medical Disability Society which later changed its name to the British Society of Rehabilitation Medicine.

I have also reviewed the other medical specialities and organisations interested in and providing rehabilitation. (here) There are many. Almost all medical specialities will include some doctors who undertake rehabilitation. The following specialities have significant numbers of consultants who routinely undertake rehabilitation as a part of their work:

  • Geriatrics. Rehabilitation training forms a significant part of their curriculum. (here)
  • Stroke medicine. Rehabilitation is one third of their speciality training in the 2022 curriculum. (here)
  • Paediatrics. Training in paediatrics includes an option to study childhood disability management, and there is a specialist society. (here and a 2021 curriculum here)
  • Psychiatry. There is a Faculty for psychiatric rehabilitation. (here and a curriculum here)
  • Neurology. Two of their eight speciality capabilities in practice in the 2022 curriculum concern rehabilitation with a third including management of people with a prolonged disorder of consciousness. (here)

Other specialities will e interested in rehabilitation, such as ophthalmology and audiology, rheumatology, sports and exercise medicine, palliative medicine, learning disability etc

Last, in 1968 the British Association of Physical Medicine held a meeting at King’s College Hospital, London. The talks show the broad, inclusive nature of the Society and the scope of rehabilitation. They included (see here):

  • report on a double-blind controlled trial of physiotherapy exercises for people with backache (Dr P Hume Kendall)
  • an estimate of the prevalence of disability, from Dr George Cochrane
  • a discussion on rehabilitation for people with severe mental health problems by Dr Bennet
  • a talk from Dr J C Brocklehurst, a well-known geriatrician on rehabilitation in the elderly
  • a talk from Dame Cicely Saunders who made two notable statements. Terminal care is care of “the state that commences when somebody else said that there was nothing further to be done.” and that “patients should die peacefully but, until that time, they should live fully.”

Current changes

Many changes are happening. These changes demand considerable work from the management structures and personnel of our Society. Except for our Administrator, Marlene Worrell, every one undertaking the work has a job, usually working full-time. Many activities require attention, such as consultations on matters appertaining to rehabilitation, commenting on official documents, planning next year’s conference, working on standards documents, etc. It is primarily a hardcore of 5-10 people who do most of the work.

The additional changes that have already started or are about to start include:

  • an indepth review of the constitution and our charitable status
    • this will demand much work, and is no small task
  • a continuing review of the strategy of our Society
    • this also demands much work, and has stalled for lack of time
  • a recent change, not fully worked out, in the way that people become members of committees
    • this requires attention, to ensure a workable system
  • a new communication subcommittee, desparately needed to overhaul all aspects of communication
    • this will also demand much time and effort
  • continuing disruption by and adaptation to the consequences on COVID
  • development and delivery of a training programme for all trainees, suited for distant learning and tailored to the new curriculum

There are not enough people able and willing to undertake this work. For example, I suggested ways of increasing membership at the beginning of 2021. Still, no action has followed despite the high priority given to increasing membership by those wishing to change the name, a focus that I agree with.

The proposal to change the name of our Society may have started these changes. It is more likely part of a general move towards changing and improving the way our Society runs. In either event, given the large amount of work already underway, much of it vital, it seems unnecessary and unwise to add another body of work.

Comments on proposal to change name

I welcome the increased engagement of members of our Society with Society business. However, I am not sure how widespread the engagement is and how committed some people who talk about name change are. For example, there was much concern within the PRM WhatsApp group about the curriculum. I was not a part of that group, and no one thought to tell me as chair of the Specialist Advisory Committee even though everyone knew that I was chair. At least one of the complainants was a member of the Education Subcommittee of the BSRM throughout the curriculum development.

Once I knew, after joining the WhatsApp group, I sought volunteers for a group to write the syllabus. Of the 14 volunteers, about only six did most of the actual work of writing competencies. I wrote almost half of all of them, including musculoskeletal competency, which was one of the areas of greatest concern. Equally, a call for volunteers to help with the website and communications strategy attracted no volunteers; I recruited four people and two more were recruited by another person.

Therefore, I have a great concern that the keenness for change, at least by a few people, may not translate into a body of people willing and able to put in the work needed. People need to attend committee meetings. People need to take on tasks required and then undertake and complete the job on time. It is my experience that a few people do most of the work. I have been to many meetings where less than half of the committee members turn up (virtually now) and remain in the discussion for the whole session.

One significant concern I have about the proposal is that people may vote for it and expect everything to happen – new members, more consultants, more commissioning of musculoskeletal rehabilitation from services provided by consultants in Rehabilitation Medicine etc. Nothing will happen because of a vote to change the name of the Society.

The proponents of the change of name have not put forward any plan whatsoever for how any of the outcomes will occur. Without a plan, nothing will happen. The document suggesting a name change does not:

  • say how our Society might take matters forward:
    • who will take responsibility for organising the change
    • how the views of those who did not want change will be respected and taken into account
    • what processes are needed to change the name
    • what resources will be needed
  • give any plan of action after the vote to increase
    • the membership
    • the number of trainees, given that Health Education England is not being given any more money for training training doctors, and all specialities need more trainees
    • the number of consultants, given that the NHS has no more money to spend on doctors
    • the commissioning of services with consultants in rehabilitation in them
  • explain what practical advantages arise from having the new name
    • they give no evidence that our services are disrespected in other countries because of a different name
    • verbally at least, one proponent suggests that changing the name will enable UK consultants to work anywhere in the world, including the US, without explaining how this is true (it is not)
  • state openly that they wish to change the name of the speciality and the give no plan or information to suggest
    • how this might occur, and how long it would take
    • what it might cost
    • how they will manage all the obstacles, not least the General Medical Council
    • what the balance of risks are and benefits is

In summary, the proponents write and act as if the name change is all that is needed to achieve the stated benefits. Changing the name of our Society will not accomplish any other change, a fact admitted publicly by the proposer of this change. Although the proposers have been requesting a change in name for over four years, they have not produced any action plan to achieve their goals. They have not shown that changing the name is the only way or a better way to achieve their stated goals.

The alternative plan

I think it is premature to change our name now. Some reasons have been alluded to earlier, but I will summarise them here:

  • The current body of work already underway in our Society will stretch our resources, and taking on yet more change risks delaying or stopping more urgent work
  • Some of the changes already planned or started may lead to some of the goals put forward by the proposers for a change in name
  • There is no plan to use the change in name to achieve the goals, and no explanation as to how the change might be the easiest way to achieve the aims.

I, therefore, suggest that members should vote against the proposal. I recommend that our Society carry out the actions given below, some of which have already started. When these actions are complete, members can reconsider the matter.

The actions we can undertake now include:

  • an active recruitment drive. Some specific ideas set out last year and presented to the Executive Committee, can be found here.
  • review and simplify membership and the categories. Various possibilities need consideration, and a few are:
    • reduced fee for members of other selected organisation interested in rehabilitation, such as the British Geriatrics Society (here)
    • full membership for anyone in a senior career post (not just for consultants in Rehabilitation Medicine or other consultants)
    • a membership fee set in proportion to the midpoint full-time salary of a member’s post
  • develop close specific links with more organisations with a major interest in rehabilitation, to share educational and political resources. We have a link with the Society for Research in Rehabilitation. An initial list of other organisations can be found here but there are many more.
    • we should develop with other organisations a common strategy to improve rehabilitation in the UK.
    • we are already in the Community Rehabilitation Alliance (here) but (a) I am not sure what this is achieving and (b) it is restricted to community rehabilitation.
  • improve the sharing of information within the Society, and encourage more involvement in working parties and committees
    • the communication subcommittee will be taking this forward
    • vacancies for posts in committees, working parties etc should be placed on the website
    • anyone should be able to put themselves forward at any time on a list of volunteers also using the website
  • emphasise that our purpose is to improve rehabilitation. Our published standards already do this.
  • continue our involvement in European and other international organisations who are already aware of what we have to offer.

Our Society can and will improve many other ways, but many are peripheral to the discussion on changing the name.

Summary

I conclude that the proposal to change the name does not have any follow-on plan on what should happen after the vote to lead to the benefits proposed. Most of the goals are reasonable, but there is no explanation of how they will arise following a vote for change. I recommend the reader vote against the proposal. Rejecting the proposal would not necessarily be saying that a name change should never the considered. It would be recognising that our Society is changing already and that these changes coupled with some other actions may well achieve the goals more quickly and effectively, with less stress. For background information and other posts and pages on this topic, click here.

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