A rota on a community rehabilitation unit can reveal a trust’s priorities more honestly than a strategy document. When a physiotherapist begins maternity leave, her post may remain on the establishment but nobody is authorised to fill it. Her caseload is divided among colleagues already carrying their own, while patients are offered fewer sessions. Pregnancy gives an employer months of notice, making maternity leave one of the most foreseeable workforce absences. Yet analysis from the Chartered Society of Physiotherapy (CSP) suggests that almost half of English trusts have made no financial provision for it.
The society submitted freedom of information requests to trusts and found that 49 per cent had neither a dedicated maternity-cover budget nor a policy allowing overspend to pay for it. Physiotherapy fares worse than nursing: in 22 per cent of trusts, cover arrangements did not extend to physiotherapy posts, against 9 per cent for nursing. About 79 per cent of the NHS physiotherapy workforce is female, so the weakness falls particularly heavily on a predominantly female profession. The figures describe funding arrangements, not actual uncovered posts; some trusts may have used vacancy savings.
Ash James, the CSP’s Director of Practice and Development, has stressed the practical consequence, patients do not stop needing treatment when a physiotherapist goes on leave. The workload is transferred to colleagues, or care is delayed. His clinical and NHS experience informs the CSP’s wider staffing campaign.
The gap between professions deserves more attention than the headline. Nursing has safer-staffing frameworks, established bank pools and a political profile that makes rota gaps visible to boards and ministers. Physiotherapy has less of that apparatus. The CSP has pressed for safe-staffing guidance for allied health professionals. James has warned that, without the national benchmarks available to nursing, it is harder to demonstrate when physiotherapy staffing becomes critical. A service unable to evidence its minimum requirements can be treated as elastic; unfunded maternity cover is one way that elasticity is put to use. Cover follows visibility.
The financial setting explains the gap. Trusts have been told to balance their books, and a recruitment freeze is among the quickest tools available to a finance director. A CSP member survey at the end of last year found about two-thirds of NHS respondents working under some form of freeze. James has warned of the effects of recruitment restrictions and unfilled physiotherapy posts. Under those rules, a replacement hire can be treated as growth, while a planned absence becomes a vacancy nobody may fill. A predictable event becomes a service reduction without a board vote. The saving appears in the local ledger; the cost emerges in a waiting list, months later and far from the finance committee.
Patients bear the cost. Rehabilitation after stroke or hip fracture depends on timing and intensity; a missed fortnight of early therapy cannot simply be recovered later. Smaller teams also work in tighter conditions. Earlier CSP research found four in ten NHS physiotherapy staff had lost, or expected to lose, dedicated premises. A smaller team in less space, facing rising caseloads and no replacement, is not operating normally.
The policy context raises the stakes. The 10 Year Health Plan aims to move care from hospital to community and from treatment towards prevention, with rehabilitation and falls prevention central to that ambition. Musculoskeletal pathways account for much orthopaedic demand, and physiotherapists increasingly act as first-contact practitioners. James has called for investment in physiotherapy, warning that recruitment barriers can leave qualified staff unable to meet patient need. A workforce plan that counts heads but fails to fund predictable leave will overstate capacity, with the shortfall appearing in operational data long after publication. Ministers who want the community shift to succeed have a direct interest in the unglamorous question of who covers the rota when someone goes on leave.
There is also a governance question that boards should not leave to professional representatives. A pattern in which a workforce that is 79 per cent female is more likely than nursing to go without maternity cover invites scrutiny under the public sector equality duty. The figures do not establish unlawful discrimination, that is for lawyers and tribunals. But boards should examine their own arrangements. A trust unable to explain its position has a problem.
The remedy is modest and administrative. Trusts can hold a central maternity-cover allowance at establishment level, applied evenly across professions, so that cover is a funded line rather than a local negotiation. National planners can require reporting by profession, turning an FOI exercise into routine management information. Rostering software can model predictable absence, but no tool can supply a missing budget. A band 6 maternity-cover post advertised in 2024 carried a salary of a little over £35,000. For an acute trust, that is modest, the leave is known months in advance.
The test of any workforce plan is whether it can pay for the rota in the spring. A system that cannot budget for an absence it has known about for nine months has little ground to ask for trust in its ten-year ambitions.
