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Commissioning of hydrotherapy services in Berkshire West

Future provision of Hydrotherapy services

Berkshire West Clinical Commissioning Group (BWCCG) ran a 12-week public consultation, from the 10 August - 2 November 2020, to seek views on the future provision of hydrotherapy services in Berkshire West. Berkshire West CCG commissions hydrotherapy services which are currently provided at the Royal Berkshire Hospital in Reading.

The NHS has a duty to ensure the services and care it provides are fit for purpose and that money is being spent wisely to provide modern, efficient and effective services for the benefit of as many people as possible.

Why are we consulting on this service now?

The CCG commissions the Royal Berkshire NHS Foundation Trust to provide a hydrotherapy service. This service treats around 1,800 patients a year. From March 2020 the hydrotherapy pool at the Royal Berkshire Hospital has been closed in line with Covid infection control policy and is likely to remain this way for a considerable period of time to minimise the number of patients accessing services in acute settings. Even before this, it has had to be closed frequently over the years for essential maintenance.

The ongoing challenges and potentially open-ended nature of this pandemic has prompted the CCG to examine the future options for this service.

What is Hydrotherapy?

Hydrotherapy is the use of water in the treatment of different conditions, including arthritis, muscular skeletal and neurological conditions. Hydrotherapy differs from swimming because it involves special exercises that you do in a pool with a physiotherapist, with water temperature at 33-36C, which is warmer than a typical swimming pool.

Is there clinical evidence to support the effectiveness of this type of service?

NICE (National Institute for Care Excellence), the national clinical standard-setting body, refers to the use of hydrotherapy in two guidelines. However, it does not recommend the use of hydrotherapy over conventional physiotherapy for any condition.
1. NICE CG79 Rheumatoid (2009) arthritis makes no formal recommendations, but an evidence statement states that: “exercise, whether on land or in water is beneficial for most people with RA”.3
2. NICE CG177 Osteoarthritis (2014) makes no formal recommendations, but states in the evidence to recommendations section that: “there is limited evidence to suggest exercise in water may be beneficial in the short term”.

However, despite this lack of definitive clinical evidence, it is recognised that some clinicians and patients believe there is a therapeutic benefit for certain patients. It’s shown to improve mobility, strengthen muscles, increase circulation and help movement in some painful joints.

How many appointments does the service provide each year?

Out of the 107,000 physiotherapy appointments Berkshire West commissions each year, around 1,800 (1.7%) are for NHS Hydrotherapy.

From January to December 2019, 247 people used NHS hydrotherapy in Berkshire West. These numbers have been slowly falling over the last few years from 292 NHS patients in 2017. Most complete treatment within a six-week period.

What does the service cost the NHS?

Land based physiotherapy appointments normally cost between £22 to £45. Hydrotherapy appointments are in the region of £150 each. Therefore, the cost for the number of appointments each year is between £35,000 and £72,000 for land based appointments and around £240,000 for hydrotherapy.

How will we make a decision?

Alongside your views we will also use national best practice and clinical guidance to review the service. Our recommendations will align to a number of principles to ensure a consistent and fair approach. These are:

  • To offer procedures and treatments consistently and fairly to patients.
  • To ensure that services meet the latest national clinical guidance and are supported by robust clinical evidence.
  • To review the use of treatments that do not have any benefit, or have a very limited evidence base.
  • To prioritise treatments which provide the greatest benefits to patients.
  • To ensure best value for NHS money.
  • To ensure services are provided in the right place at the right time and care is offered closer to home where feasible.

Give us your views

The survey has now closed.

If you have any questions, please email us at or phone 0118 982 2720 (please leave a message and we’ll get back to you).

What happens next?

The survey results are now being reviewed and discussed by the Berkshire West CCG Governing Body in December 2020, and full information will be shared with all interested parties.