Mani Neelamegan

Can you describe a single incident at work which sticks in your memory?

I have a few that I can think of, but I’ll mention this one. I was working as a community reablement Physio in Powys and I visited an elderly gentleman. He was in a difficult state and the referral was for providing a frame to get him to transfer from chair to bed. I found him to have more potential, but felt he had more needs associated with social and care aspects. I spent about six weeks with him and was able to coordinate with various teams of social services, health services and his family. 

At the end of the treatment, he was so independent that he started using public transport to get to day centres and leisure centres with all the support systems in place. He wrote to the local MP about the service he had from me, and team and the family was so happy with the complete transformation he had had. Looking back at it, all it needed was to identify his needs, locate the appropriate services and coordinate. It needed little more than a physiotherapy assessment, but the outcome was amazing. 

The gentleman had a domino effect that he did not feel motivated to do anything as he did not have anything to look forward to, and he stayed in bed over a long period. It affected his mobility, particularly with his pre-existing medical conditions, and he was confined to bed. At this point, carers were struggling to transfer him and hence there was a referral for an assessment and delivery of a frame as appropriate. In fact, there was a discussion about care home placement for him. 

The assessment just gave a clue as to how strong his quads were and it initiated the goal from being able to transfer on to a few steps within the room and changed the goal posts. It progressed by coordinating with the social worker, in making changes to the care packages and medication times, and joint sessions with an occupational therapist led to the gentleman being able to be independently use public transport along with significant improvement in quality of life.  
I feel my work is a work in progress and parts of the progress make me feel proud. It may be because I feel it's natural and expected for it to happen. 

How and why did you get into physio? 

I was born in Vellore, a rural south Indian town. My family does not have a medical background, but I wanted to work in medicine as a child since my school days. Due to the high scores in my higher secondary schooling, I was able to choose the university that was quite highly ranked with government stipulated fees, which usually is a privilege available for high scorers.

But the first year at the university drove me entirely into neurosciences. I started my degree in 1995 for a Bachelor of Physiotherapy, which was still very new for a university degree in Physiotherapy those days and graduated in 1998.

Travelling from a rural part of India to university in a huge city was a cultural shock and to get used to the university campus and course aspects was very challenging, but the university itself had wonderful facilities and faculties, which facilitated and helped me settle. Also, because the university had multiple medical courses, it gave me an opportunity to develop passive knowledge and skills in different areas. 

I enjoyed and was very fascinated by the human brain and neurological aspects that controlled every aspect of the body. Neuro physiotherapy was my area of interest during study and post study. I faced challenges, due to the difficult prognosis and irreversible damages and progressive neurological aspects, and it was enjoyable and challenging. 

I did not specialise in any specific area, but my interests and my focus was on neuro physiotherapy. I thoroughly enjoyed the versatility of the university, where the exposure and hands on experience and access to various departments was readily available. The importance of multidisciplinary working and the significance of team working is something that drew me in during my study. I gained insights into the limitations, boundaries, overlaps and merging of the different professional areas in handling different conditions and patients. 

As a student I don’t think I was mature enough to feel this is what I wanted to do, nor accept that this is what I would do for the rest of the life. It was a very academic approach to complete and get the degree. As a working physio, with more challenges and opportunities, came the short-term rewards of satisfaction and feedback and the long-term rewards of progression with roles, pay and the ability to learn more and do more - seeped in the feeling that I like what I do and I wanted to do more. 

Just after graduation, with the lack of awareness amongst the general public about physiotherapy and with the resistance of including physiotherapy within the healthcare setting by private and public sector health authorities, it was a challenge beyond my ability to face. 

I managed to build my own freelance client base, and threw myself into the deep end just after graduation. There was no structured career path beginning with a rotational mentored role, allowing me to spiral up towards a speciality and skill development. 

This scattered beginning pushed me to optionally choose an area to specialise in, and of course to choose to work in a different country with the view of learning and eventually earning more. New Zealand and Australia were the best names at the time for Manual Therapy and naturally I leaned towards New Zealand, at which time I concurrently applied for UK registration with dreams of completing the course and hoping to have employers queuing for me. 

I did not get a chance to work as a physio in New Zealand, but I interacted with many different physios during my time there and in a way I felt it was very monopolised with manual therapy. I used to work for the NHS as a community physio and now I am running care homes, as there is a good synergy between the NHS and care homes. My care home job was basically working as a 'carer' - however, the residents were elderly people with multiple problems, needing assistance with personal care, mobility and transfers. So, my physio background and interest in neuro physio drove me to handle and manage and care with the therapeutic element. 

My application to gain registration in the UK, was responded to with a recommendation to complete 22 weeks of clinical adaptation. During this period, my course and part-time jobs as a carer, call centre staff and income tax officer helped with my patient handling skills, communication skills, administration and management skills. 

With my newfound confidence, I approached the HCPC in two years’ time, since I had the letter of rejection/recommendation for adaptation and I decided to appeal against the decision with the relevant rationale and reason for my appeal with the right documentation. My appeal was accepted and I managed to get a junior physio role in Wales. 

When you arrived in the UK – what made you choose Wales? 

I felt very welcome in Wales, very settled. It is a close community and I felt at home. At first I thought I wanted to go back to New Zealand, but now I’ve been here for 20 years! To be explicit, I saw farms, lambs, rugby and music an that was so very relative to New Zealand and Wales. It’s laid-back, all-embracing and has welcoming close communities, which made me feel so very comfortable from the start. 

At first I wanted to live in London but I was so geographically ignorant when I landed at Heathrow, I called for a taxi to take me to Pontypridd (I must have said to my family I've had a job offered in London). Having said that, within six months, I felt I was comfortable and I never felt I wanted to move or apply for a job closer to London. I still fancy London for the buzz and energy. But Wales has spoilt me so much that I do not fancy living elsewhere. 

I am overseeing the business development aspect of Ann Physiocare. I work in compliance and recruitment on a daily basis with updating existing policies, implementing new policies, procedures and developing training programs for staff and managers. 

Being based in Llansamlet near Swansea, I feel demographics have a vital role in the profession and the profession has a vital role in supporting the people of the community. I feel and witness this happening organically in Swansea. This is vital; it is imperative that this balance, understanding and mutualism is dynamic and progressive, as communities are made of people and professions are primarily to help and support people and communities with their changes and needs. 

We had 70 patients during our first month,  and we have1800 patients a month now, and 9000 appointments a month across all areas, as there is a constant and growing need. From here, I want to build the network wider. I think physiotherapy in the UK has evolved and developed leaps and bounds, building autonomy within the profession at various levels in various specialities. It has grown remarkably over the last 10 years especially.  

How did the pandemic affect your working life and professional life?

The pandemic was very challenging from a professional aspect. The design of business had to be redone in a short period of time, to design, implement, train and execute a new system of working and translating hands on and face to face in to virtual and educational mode of practice. It was very interesting and challenging. 

How would you say you approach your work and what is your work philosophy?

Empowerment is a lot to do with the understanding and handling the condition/situation based on the understanding.

Understanding patient expectations and giving them clarity and possibility naturally gives the empowerment and confidence to achieve a realistic goal, as a therapist-patient team. 

I have always liked changing and progressive challenges and believe they are the opportunities to prove one’s efficiency and worthiness and to keep us dynamic. I’m influenced by various literature of Tamil culture where I come from, which has instilled many of my beliefs. I am the owner and I am responsible for every action and outcome that relates to my job. 

What is your impression of CSP as an organisation? 

I knew little about the CSP when I first started, but with time I came to know more about it and gained some first hand experience, after which I explored and was very impressed about the whole package that it provides. It just gives the comfort, support, protection wherever needed. I've experienced this as an employee, as a colleague who was supporting a colleague who needed support, and as an employer.

I feel CSP resources are under-used as I feel that every member can benefit. The sense of empowerment and a ‘go to’ place for anything is CSP. That’s my inference after my first few years of working in UK.

The CSP’s current working pattern is very impressive from my viewpoint. The support starts from the start of the career in terms of resources, updates and gradually grows with the professional in specialising, diversifying and developing management skills and making everyone feel they are an integral part of the organisation but also feel the organisation is a support system and structure when needed. 

The support and contribution by CSP for the profession and professionals has been fantastic and that support is evolving to suit the changes and needs with the progress of the profession. 

How would you describe your personal working style? 

My personal working style most of the time is, that I put myself into the shoes of the person who I work with, be it a patient, colleague, or employee. That gives me insight into the level of expectation they have and I am then able to work based on that…or to work on their expectation to be changed!

I tend to shift my position as a team leader to a follower based on the strengths and weaknesses of my other team members. 

I would like to think at work I’m a friend on the other end of the phone, who will listen, who you can ask for advice or support. I am proud of building a pleasant and amicable friendliness, despite the differences and difficulties. My professional strength I feel is my accessibility, approachability and relativity. 

I have always felt my managers, colleagues and patients to be supporting me and encouraging me. Criticisms and feedback have always been my mentor.  

I lead the team with my strengths and follow the leader for my weaknesses. The switch between leader and follower makes it easy to be a part of the team as a team player or a team leader. Treat others the way you like to be treated. I apply this almost to all situations. I fail sometimes and work on keeping that number very low. It just helps the rationale and justification from the other side and helps me improve or change my approach to suit and become acceptable. 

As a physiotherapist, I wanted to advance working with different healthcare specialities and the use of advanced technologies, such as ultrasound guided injections for diagnostic and treatment purposes working orthopaedic surgeons, radiologist and advanced technology. I unfortunately could not get a point where I could do it, but I am pursuing it by having my team do it. 

What about your personal life?

I am married with two daughters. My wife supports me in business, and they all support me with managing business and having a balance with work, social and family life. I follow cricket and enjoy music and Tamil literature. My lovely friends help me keep my mind young and stress free!

Of course, they share the happiness and success which multiplies when it is felt by loved ones, and they support and understand me when I'm going through challenging times. Giving the space, time and accepting and tolerating the unexpected response and unpleasant expressions, if it happens to be when the focus is in a different direction, is a gift, and something that should be appreciated without which the work life balance is unachievable. 

How do you feel about the profession’s ability to help the community and how do you feel it benefits people’s health?

I personally feel the profession has evolved and developed to the needs of the community and I feel CSP has a phenomenal role in making the transformation. The change in the autonomy and associated working with different specialities and disciplines and professional empowerment has helped the profession to deliver more and more over the last two decades that I have lived and worked here.

The rate of the changes over the recent years with physiotherapy has been really good and the level of autonomy and scope of collaborative working. The approach towards physiotherapy is changing with awareness, accessibility and direct access services. 

Tell us about your personal development and how that has progressed?

Personally, I have become more patient and developed perseverance. Always try to understand the expectations of the other person, either to work towards it or to not. I request and advocate therapists to own their job as opposed to hold their job. Ownership gives a different dimensional responsibility, accountability, handling of workload, patients, etc.