Allied health professionals are critical to new models of care

Allied health professionals (AHPs) make up 6 per cent of the NHS workforce – the third largest professional group – and still more work in social care, housing, local government, and the voluntary and private sectors. They are highly trained and professionally autonomous practitioners, yet too often their vital contribution is marginalised in a public discourse that tends to refer only to ‘doctors and nurses’. This needs to change.

Twelve diverse professions are listed under the AHP umbrella. I want to name them all: podiatrists; occupational therapists; physiotherapists; speech and language therapists; orthoptists; dieticians; paramedics; diagnostic and therapeutic radiographers; prosthetists and orthotists; drama therapists; music therapists; and art therapists. Pharmacists also play a key role in the NHS but are not historically grouped with AHPs.

Each has its own professional body. There is also an Allied Health Professions Federation, which – it is fair to say – does not have as strong a public voice as similar bodies for doctors and nurses.

Yet at a policy-making level, this large workforce has just one chief professional officer, supported by a small team, to advocate for all the allied health professions in England. Compare this to the plethora of doctors and nurses who work within the Department of Health and NHS England. That chief professional officer is currently Suzanne Rastrick, who will be speaking at the conference that The King’s Fund is running next week on enabling AHPs to lead and shape new models of care.

The AHP workforce will be expected to play a critical role in meeting the challenges facing our health and social care systems. But how well placed are AHPs to play that role?

Despite a steady increase in AHP numbers over the past decade, a report last year by the Nuffield Trust showed that there is still major geographical variation in numbers per 1,000 population, difficulty in recruiting to some posts and inconsistency in matching provision to need.

NHS Benchmarking’s National Audit of Intermediate Care 2015 showed that access to all kinds of short-burst rehabilitation services outside hospital has worsened since last year. This is bound to impact on transfers of care and on hospitals’ ability to discharge patients, to prevent re-admissions or to help patients regain functional independence – an issue particularly for older patients. AHPs – especially physiotherapists and occupational therapists – play a key role in all these areas. 

AHPs will also have a crucial role in government policy priorities for service transformation, such as those included in the consultation on the new NHS Mandate, which focuses on preventing ill health and supporting healthier lives; on a safe, high-quality, seven-day health service; on transforming out-of-hospital care and ensuring that services outside hospital are more integrated and accessible; and on supporting improvements in efficiency and productivity.

NHS England’s new models of care – especially primary and acute care systems, emergency care networks and improving health care for care home residents – all require input and leadership from skilled AHPs. At the conference next week, Samantha Jones, the national lead for the New Care Models programme, will be discussing the key role that AHPs will play in delivering the NHS five year forward view.

More widely, the push from the Royal College of General Practitioners, the British Geriatrics Society and others to focus more on care planning, care co-ordination and self-management, and on anticipatory care for older people living with frailty, relies heavily on the role of AHPs. As does the focus on transforming urgent and emergency care services, on improving patient flow and on maintaining performance on the four-hour A&E waiting times target.

There are excellent examples of how AHPs can transform care, some of which will be on show at the conference. Speakers will cover the contribution that AHPs can make to the prevention and public health agendas and to transforming primary care models.

I very much hope you can join us on the day. If you can’t, we will post some of the material online and there is always a lively Twitter following on the day (#kfahps). So one way or another, do come and join the discussion.

Keep up to date

Subscribe to our email newsletters and follow @TheKingsFund on Twitter to see our latest news and content.

Comments

#545182 Nicola Low
OT
Social care county council

Lots of accolades and talk about AHPs .... so why have gov removed funding for their training?? College of OTs have released statement expressing concern ... why the silence from wider media including KF?

#545184 Steve Tolan

AHPs have vital offer around decreasing dependance, increasing resilience and expediting care. AHPs are a vital part of the pathway 'supply chain' which is too often poorly planned...or even worryingly forgotten. Services and systems are unlikely to achieve their financial goals in the long term without consideration of AHP (and social care) contributions. Too consistently this is a productivity, cost, safety, clinical effectiveness and patient experience failure.

Its great to see opportunities within the new models of care, to see increasing consideration by healthcare think tanks and more discussion about diversifying the workforce in primary care.

#545185 Rosalie Boyce
Research Academic and Consultant, Brisbane, Australia

David, thank you for another thoughtful commentary on the 'hidden' contribution of allied health and its potential to transform models of care and the quality of life of those patients that allied health work with in every sector of the health & social care economy.

The issues that you highlight are shared in many countries, including Australia. It can be useful to look at how others are approaching the imperative of increasing the investment in allied health. In Australia’s case much has been accomplished by recognising and supporting the importance of developing allied health leaders to drive change at system and organisational levels.

At the health service organisational level it is the crucial role of the (Executive) Director of Allied Health on the Top Management Team – the place where strategic and resourcing decisions are made – that are driving change by working collaboratively with medical and nursing leaders. There is recognition that allied health needs to be active at Board-member level as well, including on the new Primary Health Networks who are adopting a commissioning model.

At systems level, each jurisdiction (federal, state and territory) has the equivalent of a Chief Allied Health Advisor position (resourced with staff and development budget), who work with their organisational level Directors of Allied Health, and nationally across borders through a National Allied Health Advisors Committee to share innovations and drive developments. They are linked into the International Chief (Allied) Health Professions Officers network (www.ichpo.org) – of which the driving organising force has been Scotland.

Your question of ‘how well placed’ are allied health to play a role in transforming health care is the key. The 2014 Nuffield report (Focus on: Allied Health Professions) is welcomed as it demonstrates the activity and potential for allied health but it also exposes the Achilles Heel of allied health that few are investing systematically (on the scale needed) in data collection that will rigorously prove the positive impact of allied health services. You are correct to identify that health care will increasingly rely on allied health but how do we tell high-value from low-value care without rigorous data?

One month ago we had the 11th (biennial) National Allied Health Conference (http://www.nahc.com.au) in Melbourne attended by 760 delegates over 4 days where some 350 keynotes, workshops, platform papers and posters were presented. We had your very own Professor Mary Lovegrove as one of our keynotes to share and discuss challenging problems. Earlier in the year the Australian Health Review had a special issue on Allied Health contributions (http://www.publish.csiro.au/nid/271/issue/7469.htm). In February 2015 South Australia’s Allied Health Office published ‘Demonstrating the Value of Allied Health Care in SA Health. Quantifying the inputs and outcomes of Allied Health interventions to determine overall value to the healthcare System’. These developments point to the vigour in the allied health sector and the appetite for change and collaboration.

We know things are heading in the right direction in Australia, England and other countries but without the investment in leaders, data and innovative thinking it will be a slow road for allied health to contribute at the level that is needed to transform care.

On a somewhat provocative finishing note it would be very encouraging to see the resourcing level of England’s Chief Allied Health Office returned to at least the levels of around 2011-12 (?) before the cuts took effect. Thank you David for alerting us to the need to address these important issues.

#545191 Kate nicol
Site lead OT
United Lincolnshire hospitals NHS Trust

Real need to consider effects of comprehensive spending reviw on ahp recruitment. Loss of bursaries a major concern here.
We struggle to recruit staff in this part of the world and have taken steps to ' grow our own, through encouraging support staff in health and social care to gain qualification as OT or physio. These mature learners are often dependent on bursaries.
There is a need for commissioners to recognise the net value of rehabilitation, its key effects on reducing spending on benefits and scarce social care resources and to servicevusets themselves. If we were properly resourced we could achieve real economic outcomes as well as improved health and webeing for individuals. We need to be empowered to prov ide more than a minimum 'patch up and discharge' service.

#545193 Donna Smith
Operating Department Practitioner
Ramsay Healthcare

Great feed nice to see someone is rooting for AHP's. However, you firgot an integral part of the Theatre team, Operating Department Practitioners are also allied health professionals, registered with the HCPC.

#545195 Tim Chearman
Mobile programme manager
HSCIC

I agree with this sentiment. I am working to look at how to best utilise mobile devices as part of community based working. There are some excellent examples where given the right tools the AHP's are innovating e.g. Speech therapists utilising apps to work with patients and utilising the cameras on tablets to record interaction/speech and coach parents

#545196 Rob Finch
Chief Executive
Royal College of Chiropractors

In England alone, some 6000 regulated health professionals, highly skilled in the management of low back pain, are potentially available to the NHS in the form of registered chiropractors and osteopaths, but their services are almost completely unused. Note that, like AHPs, these practitioners are regulated, plus they routinely function as primary contact practitioners albeit in the private sector, but they are not AHPs.

The ‘Pathfinder’ Pathway for Low Back & Radicular Pain defines the skills and competencies required for managing each part of the pathway and it is clearly apparent that many of these are met equally by physiotherapists, chiropractors and osteopaths. A move towards innovative, competency-based commissioning, utlising the chiropractic and osteopathic services available, would release a significant, pre-existing, community-based manpower resource and so dramatically improve the NHS’s ability to deliver the pathway cost-effectively.

#545200 Graeme Wilkes
Medical Director
Connect Health

AHPs have been extending their role and like nurses are able to take on tasks previously performed by doctors. As Rosalie points out there is a need to collect outcome data and prove the value of all of this. It is also worth stating that in the MSK pathway, the only consistent output of outcome data has been for surgery. Non-surgical orthopaedics and the massive amount of MSK care provided by GPs is largely un-assessed and anecdotally may often not be acheiving best outcome. The opportunity is therefore there and needs to be grasped by whoever can prove their worth whether AHPs, Chiropractors, Sports Therapists, GPs or others. AHPs are well placed at the current time.

#545201 John
Retired
Retired

Phamacists and Chemists are pushing and are being suported in seeing themselves as AHAs -not a good idea letting in Big Pharma into access to medical health records to be sold to to markets. Chemists run by Hedge Fund Managers, Branson - the attempt so far has been delayed by the Health and Social Care Information Centre so far- campaigns are increasing to stop such chances of deep mining information for comercial gains- and extending priviatisation of NHS. No wonder the Royal Pharmacutical Society or desperate to be seen as included in the NHA definintion. They are not !

#545213 Umesh Prabhu
MD
Wrightington Wigan and Leigh FT

Great article David. One of the reasons why in Wigan 7 days has been successful is great leadership by our AHPs and their wonderful leader and anyone can see huge benefit to patients.

We focused on values, culture, appointed values based leaders and put robust governance not simply for clinical staff but all leaders and managers and excellent staff and patient engagement. Now anyone can see the result.

Of course, David, as you remind me Wigan is not the only Trust with excellent practice and I am glad that there are many. But what is important is for all of us is to learn from each other and make all Trusts good so that all patients get the best care and all staff feel proud to work in our wonderful NHS.

#545225 Sue
SLT

Thank you for speaking up for AHPs. I feel however as a group we are becoming less well placed with cuts to budgets meaning loss of posts and downgrading and in particular loss of a lead AHP role in many Trusts.Management tends to be via a nurse at exec level. There are few Trusts that have an AHP at exec level yet there is a whole plethora of nurses at all levells. AHPs do have some commonality of purpose such as rehabilitation however the roles and training of the individual professions are quite different. Grouping us as AHPs often means one individual in an organisation is meant to represent all. AHPs are often marginalised when decisions are being made and then considered as an afterthought. The smaller professions like speech therapy remain poorly understood and lack investment. Francis has returned the focus to nursing and AHPs have lost out on the back of this. This of course means ultimately that patients miss out. We perhaps need some national guidance or staff acuity work around AHPs as a group but also as individual professions to show the value they add to patient care in all areas of health and social care. We need something that has teeth for the situation to change

#545229 Rosalie Boyce
Research Academic and Consultant, Brisbane, Australia

Sue. you raise some important points about the position of Allied Health in health care organisations and the health system.

There is an old saying along the lines "If you're not at the table you are likely to be on the menu". This is why the most strategic approach for Allied Health to get positions at the 'table' where resource decisions are made is to prove their worth through their ability to value-add to Top Management Teams (TMTs) and Boards in the context of transforming services and improving health care outcomes for people.

We don't see' Allied Health' as a model of one individual representing all the professions. Rather, think of 'Allied Health' as the synergy that is released from the cooperation and joint efforts of those that identify as allied health. Our research shows that leaders in Allied Health come from all the different professions which gives great strength from pooled intellectual capital and masses of ideas and innovation. Just this week we finished a national study of all public sector health service organisations and their Boards to quantify the number of people with allied health and other clinical qualifications. We also identified the number of CEOs with allied health backgrounds (~8%). Encourage your colleagues to get Board-ready qualifications and some leadership experience outside their comfort zone. Allied Health is an under-exploited talent pool in the health sector and credible leaders are making a difference working with their medical, nursing and management colleagues and engaging with the community.

Other professions may seem to be more numerous or powerful but the main game is about what you can do for patient care - it's about impact rather than numbers. As someone reminded me recently, 'It's no longer the big that eat the small, it's the fast that eats the slow'!

#545260 Leah Carey
Physiotherapist

Great articles, AHPs are great problem solvers and solution providers. Sadly management level jobs often have the pre-requisite of a nursing or medical degree. Challenge the norms, contact the recruiter- say why the job could be done by an AHP instead. As AHPs we have to put our hands up and say 'I can do this, here is my idea....'

#545279 Tim Atkin
chair elect, CYP&Families, Division of Clinical Psychology
British Psychological Society

Why are psychologists completely absent from this conversation? Psychologists are marginalised in all these discourses, yet with parity of esteem being so high on the NHS agenda, and "leadership is all about self awareness" (quote from the opening sentence of the leadership fellowship, 2011-12, led by the King's Fund), this doesn't make sense? We are not the biggest profession, and indeed are smaller than 2 or 3 of the 12 listed at the start of this piece, but not even to have a funded part of the remit of a chief professional officer such as Suzanne Rastrick (who can't support professions for which she is not given a remit to support) means we are on the outside looking in.

#545836 Amy Lucas
Fulk Chiropractic

I agree with you, Rob. Many are beginning to consider chiropractors their primary care physician. This trend could reduce routine medical costs, prescription medicine and unnecessary testing.
www.fulkchiropractic.com

#546127 Pearl Baker
Independent Mental Health Advocate and Advisor/Carer/Trust Governor
Independent

Having joined the NHS Discussion group re AHPs, and reading this article 'Allied health professionals are critical to new models of care' it soon became clear that 'Mental Health' is NOT even listed within the 12 diverse professions listed under the AHP umbrella.

There is absolutely no way services to Mental Health can improve if we are on the 'outside' looking in.

I am surprised the KingsFund have NOT done more to highlight the 'inequality' and 'invisible' Mental Health within AHPs.

Add new comment