Suzanne Rastrick: How do we give AHPs more powers to unlock new models of care?

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Suzanne Rastrick

Suzanne Rastrick, Chief Allied Health Professions Officer at NHS England, talks about the ways in which allied health professionals can become leaders in the delivery of individual and population-based care.

This presentation was given at The King's Fund event Enabling allied health professionals to lead and shape new models of care on 8 December.

Transcript

Good morning, I’m Suzanne Rastrick, I’m the Chief Allied Health Professions Officer for England and welcome to colleagues who are also joining us who are not AHPs. In terms of the presentation today, I think my title could suggest it’s about changing regulation or policy and telling you what to do.  Clearly I’m actually going to be telling you something slightly more of a story which is aligned to the five year forward view in the sense it’s the first document in my career, I’ve been qualified almost 30 years and most documents in the service historically have told us what to do.  It’s been about the top down.  And as Sam described earlier, actually the five year forward view is very much about setting out the issues for us and what the responses are and I think for me, because of exactly what was described earlier, this is perfect for allied health professionals and indeed those who are interested in solving population problems.

I’ve had a career similar but parallel to Sam’s in some ways. I’ve also been a chief exec and I’ve also been a director of nursing although many of you know I’m not a registered nurse.  I think in the context of this and thinking about how teams work, that’s quite important.  Before I come to anything else, in terms of the five year forward view, I have a bit of a joke with my director of nursing colleagues and forgive me for those of you who’ve heard this before.  Last year at the CNO summit I sat down with a group of my former nurse director colleagues and said right, you’re accountable at board level, write down on your napkins the 12 allied health professionals you’re accountable for at board level.  Can you all do that?  Before you leave here, can you actually write down your colleagues of the other 11 allied health professionals if you are an allied health professional and if you’re responsible for allied health professionals can you list them all out?  Because I think if you can’t, that actually begins to describe something of our challenge here.

My theme for today is almost … it’s a bit of a northern phrase, it’s either six or two threes and I want you to remember six or two threes and I’ll tell you for why and it’s a little mnemonic in terms of the themes I’m going to cover. There are six of them divided into two threes, so remember that.  How many of you have read the five year forward view?  I didn’t turn round quickly enough.  If you haven’t read the five year forward view or the exec summary and if you think you don’t work in the NHS and think, nothing to do with me, you’re wrong.  In terms of CPD I would urge you to go home and read it this evening because actually it is really important, regardless of whether you work … and for me as chief of service, I represent practitioners in England, wherever they practise as allied health practitioners, whether that’s private practice, local authority and housing, education or social care, or in the third or voluntary sector, as well as the NHS.

So for me, the five year forward view is about all of those as allied health practitioners. As Samantha said, there are the three key areas, the health and wellbeing gap, the care and quality gap and indeed clearly the funding and efficiency gap.  So I think for me in terms of these areas, if you will, these are two of the key areas and I’m not leaving finance to one side, that really epitomise the attributes of allied health professionals and I’ll tell you for why.  Because we work already across those historical boundaries that the five year forward view talks about needing to cut across and that Sam’s alluded to in terms of what patients and their carers want from us.  We already work across and demonstrate that we act in each of those areas, which is quite different to some of our other colleagues.  We work in an enabling way, we support self-care, we keep people out of hospital.  We offer rehabilitation and we keep people safe and independent.

Those really for me are the collective attributes of allied health professionals and that is why we are fundamental in terms of making the five year forward view a success. I want to focus particularly on the care aspects.  There are a number of those in terms of what do we do individually, at a personal level for the individual patient?  Then Linda Hendle, my colleague from Public Health England will be talking slightly later this morning about really what we do for the population and that’s at that population prevention public health level, so those again are the two key areas.  So I would suggest to you in terms of our collective key attributes as allied health professionals, it’s about what we deliver for my health on an individual level and our health on a collective population level.  And really what I want us to think about is how can AHPs be the engine that delivers those two key planks of the five year forward view.

What is it about our individual health and our population level my health. It’s really where those two areas overlap that efficiencies … when it works well, when we bring together the population level health and the individual aspects, that we can achieve efficiencies.  I’m concentrating obviously here on the my health, the individual patient aspect and the new care models and Linda will touch later on that at a prevention and public health and population level.  So, remember the next of my two threes.  So I talked about the first three priorities are those which are within the five year forward view and the next, bringing my lens down a level if you will, to allied health professionals particularly and for those of you who have leadership responsibilities for AHPs or indeed commissioning responsibilities, these are three things which I think are really important that I will be focusing on with my team at NHS England as well as working with you across England.  The first of which is around workforce.  For me, integration is a given for allied health professionals.

We work in a very integrated way across teams and as I say, across historic boundaries. But MDT working will not be enough in the future and that was set out in the NHS England multidisciplinary development guide which was published back in January 2015.  For those of you who are worried that I’m beginning to talk about generic roles here, I’m not, I’m actually wanting us to enable a state of readiness to think about how we work differently in the future.  These four dimensions if you will are something I’ve begun to talk to some of the professional bodies about and it’s really about thinking for yourselves as individually registered allied health professionals.  What is your unique selling point that absolutely, in your registration that you alone must do, then what are the things that … across teams, that we actually share competencies, they’re things that we actually do collectively together.

We talked about, as I say, taking blood, but that’s not necessarily a good analogy, but things that we do collectively that are shared within our training with others. There are also things about how do we delegate effectively, things that perhaps historically we have done to colleagues, say an agenda for change between bands one to four.  Then in terms of the extended skill mix, things that again we could take on from medical colleagues for example and we’ll be hearing later on this afternoon in some of the seminar sessions about where that is already happening.  My colleague Helen Marriott who leads the non-medical prescribing and mechanisms of prescribing work in NHS England is here and will be talking along with one of my former colleagues, who’s a consultant podiatrist who’s using independent prescribing as a particular mechanism.  So I think there are things that we can do to change our thought about the workforce.  That’s about a state of readiness.

Evidence is one that’s a real bee in my bonnet and I don’t … is Claire Holditch here? Marvellous.  Claire’s a director of the NHS benchmarking network of whom I’m a great fan I have to say and as indeed I now David is.  I was asked by Claire to attend the event they had recently at the ICC in Birmingham for acute therapies where … was anybody there?  Marvellous.  So you know what I’m going to say then.  I think one of the interesting things for me, these paradigms were set out by Lord Darcy in terms of describing quality and if you’re thinking about any service improvement changes or solutions that you want to take to your organisation or indeed to commissioners, those are some of the key factors that you must begin to think about in terms of how you set out your offer and structure that.  Obviously within that, cost is clearly important too.  But one of the things is about outcomes,

I’ve been a commissioner now for two-thirds of my career, including my job in NHS England, is still in a commissioning context and as Sam said, aspects of that as we know contractually are not perfect. But one of the things I’m interested in both as a commissioner and somebody who uses services is actually about what works on a population level.  What I saw at the event in Birmingham was actually that quite a goodly number of my colleagues and it was for dietetics, speech and language therapy, physiotherapy and occupational therapy, that a goodly number of colleagues were keeping outcome measures.  There were a goodly number that weren’t too and that was of concern.  But of those that were keeping outcome measures there were just a complete random mix, though none of it was wrong, they were all validated, researched methods, outcome measures that were being used.

But if I was even the most sophisticated service user, looking at say NHS choices, and say I lived between the borders of Nottinghamshire and Derbyshire, and wanted to make a decision about whether I drove down the road for 20 minutes into Derbyshire or up the road for half an hour into Nottinghamshire, say to choose between an MSK physiotherapy services, I wouldn’t have been able to do it. I wouldn’t have known which was giving me the best outcomes.  I think that’s a real challenge for us in the coming period.  Could I just ask Doctor Joanne Fillingham, who’s my clinical fellow to make herself known to you?  Joanne and I are doing a piece of work again via … partly via Twitter, but we’re also kicking this off, looking at outcome measures across the service.

It isn’t about again the top down telling the service what to do or professions what to do, it’s about seeking a consensus for how we might develop a suite of outcome measures across particular activities and particular professions, simply because we need to understand on a population level, what is providing the best outcome and in the context of the five year forward view so that we can actually help services understand which aspects of allied health professions really deliver for them. I think that’s really important.  We talked about … briefly about leadership and there’s something about, for me, for those of you who are allied health professionals in the audience, from the time you qualify you are autonomous practitioners.  That is very different and interesting to medicine where my medical colleagues, forgive me David, are described as trainees for the subsequent 15 years or so of their medical development.

So for me I am looking to you as your chief of service, to say, from the time you qualify you are autonomous practitioners and I would suggest therefore leaders in the service in your own right. So it’s part of this five year forward view, it isn’t about me, it isn’t about Samantha or colleagues such as CCG accountable officers or chief executives, it’s actually about all of us actually collectivising together.  One of the key things I think in terms of leadership is … I’m not going to deal with the issue today of board leadership for allied health professionals, but what I would say for those of you who are working with the nominated … and it generally is the director of nursing at board level, it’s about how you can actually take support to that person, you can influence them, and importantly take solutions.  It’s about the influencing that you can do to support that person who has the accountability for allied health at the board.

We have a duty to inform, that for me is really, really important. In terms of strategic workforce planning, again workforce planning can happen around us.  My role covers the Department of Health and HEE, and quite often we will see things coming in from the local education and training boards that I actually wonder how many of you had input to.  Do any of you work with services that have orthotics and prosthetics in them?  Good.  I’m going to ask you … I won’t ask you a pub quiz question but my question to nurse directors, who are responsible for orthotics and prosthetic services in England, is how many orthoptists and prosthetists graduate in England each year?  Does anybody know?  Not in my team.  It’s 30.  We just published a report which we’ve been tweeting about, two weeks ago, from NHS England, describing the state of orthotic services in England, which is woeful.

Partly the reason is because as a family of allied health professionals we can support each other so in terms of contributing to workforce planning it isn’t just about we ourselves in our unique professions, it is about supporting others and acting in … and adding a voice for those … for allied health professions that are smaller too. I did ask for a cross to be put through this and Sam very kindly as a nurse didn’t mention nursing.  But for me there is a narrative and a rhetoric and pinned to the top of my twitter account is actually a video that Simon Stephens did for my first conference in June, where he does say, after a bit of a preamble, it is not just about doctors and nurses.  I think for me, particularly whether it’s in supporting CCGs in their thinking or within your own provider organisations, the interesting thing for me is we don’t know what we don’t know.

So actually it is your duty to support and help your organisations whether they be vanguards or not, in knowing something about what you’re doing, the solutions that you can offer for patients. That’s really, really important.  So although there is that rhetoric it is for us to constantly push against it.  One of the things that … when I talk to nurse executive directors about engagement, the reason quite often allied health professionals they tell me struggle to succeed in associate director or board level appointments, is the fact that we don’t actively engage in governance, either clinical governance or corporate governance processes in quite the same way sometimes that our nursing and other colleagues do.  I just offer this one to you as a heads up because during the last year when I’ve been in post, it’s something that I’ve picked up from them.  Again, if those opportunities arise either as part of this work or part of work that you’re doing within your organisations please grasp it because actually talking to my nurse executive colleagues they really want you to engage with that.

Then finally, the thing we’re really good at is quite often talking to ourselves. So a bit like here today really, we’re good at talking to each other and saying what good we do but one of the things that Joanne and I are trying to do with the new care models team that Samantha leads in NHS England, is actually begin to work out how we can gather together some of this good practice that she’s talked and how we can share that and disseminate it.  I don’t underestimate it in somewhere the size of England, it is difficult, but it is something again that we want you to help us with and Joanne and I will both be here all day.  If you have any thoughts or ideas about that sort of virtual network that we can create we’d be very happy to hear it.  I have given Samantha an undertaking that I am going to visit all of the vanguard sites in England and her director of communications Anthony Tirnan is actually emailing out to sites today to say is there any good practice that you want Suzanne to come and see or anything you’re really struggling with.

I’ve done three visits so far and I have to say there’s been a sort of consistent theme there in the sense that colleagues are saying to me, Suzanne I really want you to help us with an allied health professionals strategy and whilst we could put some sort of framework together from an NHS England perspective and we are beginning to think about that in terms of some pointers, it is again for me about yourselves in terms of how you help your organisations with some of that thinking and actually put your head above the parapet. Because nobody’s going to come to you, you’re going to have to go and knock on other people’s doors and that’s the really important thing.  Some of these people are in the audience, you can smile at me those of you who are in this cloud.  This was a group of individuals who were my first set of innovators.  I did a series of talking head videos for my first conference in June and we’re going to be using these and moving forward with this as a development and Andrew’s right on the front row here.

So there are actually … I can spot three people in the audience. They’re individuals who’ve done things which in terms of their own practise are really innovative and entrepreneurial.  For me it really demonstrates … this was across the range of all 12 of the allied health professions, ranging from a guy who’s a helicopter paramedic in the south-west to a drama therapist in Brighton, a really brilliant and inspirational group.  For me that is the real value that you bring to the five year forward view.  You know there’s some really brilliant, brilliant stuff out there and it’s actually how we garner that together and share it, but also about how you raise that profile within your own organisations.  So what I would say is that providers are saying to me, they are really open to possibilities as indeed are commissioners and CCGs and the way in which you work in terms of across the life course is just so important and across all those disease and demographic areas.  There is so much that you have to offer.  But it is about going to both providers and commissioners and engaging with them in the processes that they have, looking at new care models.  Thank you very much indeed.

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