In the previous issue (sportEX dynamics 2015;43:8–11), Brad Hiskins wrote about the situation concerning professional standards in the soft tissue industry in Australia. In a response to his article, Paul Medlicott voices his thoughts about the situation in the UK – how is it similar or different and what can we learn from Australia?
By Paul Medlicott MBA, MSMA
Reading Brad Hiskins’ article in the previous issue of sportEX dynamics left me with mixed emotions. So much of what he said resonated, loudly, with me and many of my colleagues. The first thought was, “How could you snatch defeat from the jaws of victory?” Insurance companies paying (in part) a patient’s costs for massage therapy? We in the UK would give our collective right arms to be in a similar situation – and yet the professional associations (PA) and training providers somehow conspired in their own downfall. Once the slightly unworthy feeling of Schadenfreude had passed my next question was, ”Are we doing any better in the UK?” Well, yes … and no. The Australian massage industry was where we aspire to be, but appears to have shot itself in the foot. We need to look to their experience and ensure that we learn. Let’s start with the issue that acted as a catalyst for Brad’s article.
Private health insurance and Cash Plans
We are in a very different situation to Australia. Private health insurers do not as a general rule cover massage. There are policies that have a complementary therapy ‘allowance’ for named therapies, which may include massage, and there are Cash Plans that may include massage. There is anecdotal evidence that some Insurance companies will pay for massage treatments if linked to physiotherapy treatment, and there are examples of entrepreneurial individuals negotiating the payment of client’s treatments directly with insurance companies. The overall picture is one of chaos.
The situation is further complicated by a lack of meaningful communication (we are trying) between the industry and the insurance companies. If you visit the websites of any major Cash Plan provider and look for a list of ‘approved providers’ you will see that it will include, amongst others, an eclectic mix of PAs, awarding organisations (AOs), regulators and training providers. There is no clear understanding by the insurance companies of the roles played by these individual organisations, or indeed what constitutes a minimum level of competence in massage education. From a client’s perspective they will be playing a variation of ‘Russian Roulette’ unaware if their massage therapist has had a year of training or ‘qualified’ in a weekend. In Australia it was more straightforward ‘in order for private insurance companies to pay a patient’s costs for massage therapy, the patient has to go to a therapist who is an approved provider for that insurance company. Hence the need for massage therapists to be members of accredited associations (whose members had achieved agreed minimum standards of educational competence)’. Not only was massage therapy paid for but therapists had a compelling reason to join a professional association!
It must also be recognised that the private health insurers are commercial organisations. They rely on regular premiums and infrequent claims to make a profit – regular massage treatments do not sit comfortably within this financial model. Cash Plans where the financial burden is more skewed towards the plan holder, and are designed to pay for frequent treatments may be where the best opportunities lie for our profession.
Soft tissue therapist? Sports massage practitioner?
One of the issues Brad referred to was ‘Title’. There is no protection of title in the UK for our profession, we are not regulated by statute and within reason therapists can call themselves whatever they want. So we have a range of titles including Sports Massage Practitioner, Sports Massage Therapist, Sports and Remedial Massage Therapist, Clinical Sports and Remedial Massage Therapist, Remedial Massage Therapist, Remedial Therapist, Massage Therapist – I’m sure you can come up with others. This situation has arisen for a number of reasons including ‘advice’ from other bodies on what we can call ourselves – the inclusion of the word ‘therapy’ is in certain situations considered misleading, implying that we are acting beyond our brief. Confusingly the use of the word therapy does not appear to be contentious in other countries. There has also been a desire to remove the words ‘sports’ and ‘massage’ from titles. ‘Sports’ because it is clear that most of us do not deal exclusively with sports people and ‘massage’ because of the continuing association with the sex industry. The term ‘remedial’ is favoured by some and discouraged by others primarily because remedial implies, to some, a curative treatment, and in these days of advertising standards and professional sceptics we all have to be careful about what we claim unless backed by robust research evidence.
So where does that leave us? My good friend and colleague at the Sports Massage Association (SMA) Paula Clayton mentioned some years ago that the term used in elite sport was ‘Soft Tissue Therapist’ and that perhaps we should consider giving this title greater exposure. This was to some extent a ‘light bulb’ moment … a title that was already in use, no mention of massage, no mention of sports, no mention of remedial. Still the dreaded use of the word Therapist, but hey you can’t have everything, and perhaps the concerns about the use of the term should be tested in the public domain. The title is also inclusive providing an umbrella terminology for all of us involved in hands on soft tissue work. So for the last 2 years my own professional association has been the SMA, ‘the association for soft tissue therapists’ and the General Council for Massage Therapies (GCMT) is ‘the Council for soft tissue therapies’. This is a ‘soft sell’, it is a term we can all get behind but does not demand that therapists have to change the title they prefer to use for commercial or personal reasons. Of course we hope that in time we will all use the same title, but without legislation the choice remains in the hands of the therapists.
The industry is over-represented. When individuals graduate from their courses they are faced with a multitude of choices (if they decide to join a PA at all). Some will simply join the association recommended, and sometimes run, by their training provider. For others cost will be an issue or they may feel that their needs are better suited by a multi-disciplinary association. Whatever the decision making process is we have been left with a multitude of small associations run on a largely voluntary basis. This is not a criticism of these associations or the individuals that run them, but the lack of financial and human resources available to them mean that their influence and credibility on the national stage is very limited. It is also clear that there is an element of competition between PAs that can prove unhelpful. Competition is fine in some instances and can lead to lower subscription, insurance and supplier costs, but it can also lead to division.
It is clear that Australia has experienced similar problems with associations unwilling to cooperate with each other for the greater good – and let’s not mince words here it is some of the individuals who run these associations, both in Australia and in the UK, who are at the root of the problem. For many, the concepts of cooperation and collaboration are alien ones – where they may have invested many years in the development of an association they are unwilling to give up control without a fight. But what does this achieve? If you are not in this business for the development of your members and the broader profession then why are you here in the first place?
So what have we done to address this issue? For many years there has been an organisation called the General Council for Massage Therapies (GCMT), it has in recent years had a chequered history with all the schisms and confrontation far too familiar to many of us in the soft tissue industry, but now we have managed to pull together many of the associations along with the AOs and training providers. It provides a forum for the soft tissue industry to discuss the issues that affect us all. We currently focus on education issues with an objective of achieving standardised content at the core of every qualification. We work with the AOs and training providers to achieve this. We also debate a variety of issues including codes of ethics, policies on informed consent, regulation, etc. but more importantly we are developing working relationships and an appreciation of what each of us can bring to the debate. With changes in education the role and influence of the GCMT will only increase, particularly with AOs and others looking to us for support on the development and approval of qualifications.
This is a good start, but is it enough? I don’t think so. I believe there is a need for radical thinking including the merger of small associations into a larger representative body. The combining of financial and human resources will provide members and the profession with infinitely better representation and credibility. Will it happen? I think it will – it won’t happen in a hurry, but I would expect to see the first mergers happening in the next couple of years
We are, slowly, moving in the right direction in the UK, but as we are currently structured ‘slowly’ will continue to be the operative word. There needs to be, in my opinion, radical change in the way the industry is represented and this will require bold thinking rather than parochialism and self interest. We need committed, skilled individuals who can represent their members eloquently and effectively. We need financial and human resources to achieve this. However, above all we must remember, this isn’t about us – it’s about the members.