Let’s hear it for allied health professionals

Reflecting on our recent paper on the NHS and social care workforce, modern health care is a team venture. It is impossible to deliver effective care without the crucial contribution of highly trained allied health professionals (or AHPs).

I look after older people with complex needs for a living. Alongside multiple co-morbidities, many have social vulnerability, functional impairment or communication difficulties which complicate the acute problem they presented with. This is the reality of modern hospital case-mix. Both Francis Inquiries recognised that it was the care of such frail older patients that had caused most concern.

I know I can’t do a ward round or be on call without drawing on the knowledge of AHPs constantly. In my clinical care of older people, I find that the comprehensive geriatric assessment – an interdisciplinary bio-psychosocial diagnostic tool that AHPs use with older patients when they present to hospital – means that they are more likely to be alive, independent and in their own home up to a year later. The AHPs are critical in getting patients back to their own home quickly from the front door of the hospital and ensuring good inpatient rehabilitation and discharge planning. They also play a vital role in stroke units, intermediate care, re-ablement and virtual wards.

AHPs, pharmacists and specialist nurses are highly skilled, autonomous professionals. I am always impressed by the way that even newly qualified therapists take full professional ownership and accountability for patient care. Unlike many overseas health systems, the NHS doesnt require doctors to 'prescribe' input from other members of the multidisciplinary team. These other specialists are rightly able to challenge doctors, often flagging problems that we have failed to recognise, and to advocate for patients. They add great value to teams – often leading them and acting as a safety net.

Yet, whenever the quality of health care is debated – whether in the media, in parliament, or even in the Francis Report and the Department of Health response, these vital staff are written out of the conversation. Everything is reduced to ‘doctors and nurses’, generally with falsely polarised praise for the technical medical advances and ‘medical’ care (despite many doctors’ failure to adjust their practice to care adequately for frail older people) and poor ‘basic’ nursing care, accompanied by half-truths about ‘matrons’, an imagined ‘golden age’ of nursing and the terrible consequences of introducing degrees as a requirement for nursing.

In the recent Health Service Journal list of influential NHS clinicians there was only one AHP – Karen Middleton, the professions officer for NHS England – who has responsibility for 12 different professions, while NHS England is stuffed full of doctors and nurses. This needs to change.

Despite my admiration for the work of AHPs, I do have some small criticisms.

First, they could be better self-advocates. I realise that there are a large number of nurses and that doctors are a powerful group, but I think that AHPs could be more visible in promoting their roles and skills. In repeated scandals around poor care, AHPs could keep their heads down amid the nurse-bashing, but they are best placed to claim a stake in accepting responsibility for deficiencies in care and be seen to be part of the solution.

Second, I do think there are times when graduate practitioners (for instance in occupational therapy and physiotherapy) are doing work that could be delivered by generic rehabilitation assistants and supervised by them. For some aspects of rehabilitation, boundaries could be flexible.

Third, we need to move towards one common set of clinical records and trusted assessments, avoiding duplication of assessments, which bewilder patients and introduce delays. Sometimes it is therapists who maintain this territorialism.

Finally, they suffer the same issue as nursing – that once people move into senior leadership roles they generally stop hands-on clinical practice – and possibly therefore lose clinical credibility – in a way that doctor-leaders do not.

Despite these quibbles, it’s high time we gave AHPs overdue recognition as key players in services that are now team ventures. Population demographics mean that increasingly the business of health care will be the business of caring for older people who require a genuinely multidisciplinary approach. We can’t do it without them.

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#40723 george coxon
independent healthcare advisor / care home owner
classic care homes devon

As well as the above roles I am also a MHN and CPN during the 80s and 90s (currently am still chair of the MHNA - mental health nurse association) - I was a senior commissioner during the noughties too for many years and have a wide and varied continuing role working across primary, community secondary and specialist care areas as well as a pluralist working with pharma organisations - enough of me setting the scene for my comment !! my comment is about what we are all doing to address the plight of older people not just AHPs. I am leading some work on dementia kite marking across Devon with a growing group of likeminded care providers - mostly independent sector colleagues where we are trying hard to contribute to better integration of health and social care for older people with a disconnected system seeing too many people with dementia especially going to hospital too easily, staying too long, not doing well there and many dying there - only very exceptional circumstances should have a person dying in hospital with dementia. the word I used earlier was plural - this for me is the key to addressing the inevitable challenge ahead re A&E, hospital activity explosions and NHS bankruptcy - true integration must become a reality for us all AHPs, care home providers, CCGs and most critically frail older people inc those with BPSD. I hope my thoughts add some value in a debate we must all continue to have many thanks

#40725 Michael Dimov
Interim Assistant Director - Clinical Services (Bedfordshire)

Excellent article and perfectly valid points! Can AHPs respond with a single voice? The "doctors and nurses" stereotype leaves many excluded. It would be very difficutl to integrate pathways and services without achieving a shared identity for those involved in delivering various aspects of care.

#40726 Liz Mowbray
Head of Therapies and Rehabilitation
Oxford University Hospitals NHS Trust

Thank you for your support David and recognition of the crucial and vital role AHPs can play. Locally, I'm advocating the same, creating and gaining some support for the appointment of band 8a, AHP clinical leadership posts; physiotherapists and occupational therapists who are experienced enough to make complex decisions that may be considered too greater risk by those who are less experienced. These posts also have an impact on patient goal setting, the development of rehabilitation plans for elderly patients in the acute sector; too many have been left immobile and dependent during a hospital admission.

Commonly, there is a lack of inter- professional working, professional silos with in organisations and across boundaries. Each profession should trust and respect each other whilst working together to develop a safe patient environment. True MDT working and the creation of “great teams” takes cultural transformation and leadership development to achieve. Look at the amazing work at the UCLP Staff NHS Leadership College and the impact made clinically to MDT working at UCLH. This all impacts on the delivery of high quality patient care.

I do support what you say about the strong nurse and doctor representation; AHPs are often represented by nurses and are not considered to be able to represent themselves. We need to gain more AHP representation at Board and Director Level, to influence what should be important multi-professional decisions which will then filter down to the clinical coal face. Once this works well within a single organisation then it will filter out across boundaries and help to bring to integration gap ever closer and more patients remaining safely within their own homes.

#40727 Helen Whiteside
Clinical Care Home Pharmacist and Independant Prescriber
Leeds West CCG

Brilliant article
Great to see pharmacists mentioned. As an ex hospital pharmacist, I loved working alongside other AHPs on acute admission, long term elderly care and stroke wards over 20 years. AHP were extremely helpful in prioritising patients who needed my support.

In this time I am please to have witnessed a gradual change to patient care to a less medical management model to reflect the need for and impact of all the teams' skills. Sadly, in particular discharge decisions remain too often within the "medically fit" model but more and more acute wards now regulary have pharmaceutical care team represented at decision making ward rounds and meetings.

Our willingness to undertake patient assessment, counselling and overseeing medicines element of rehab e.g. self medication of medicines schemes is rarely in doubt - but it is still hugely hindered by our time input still required by the other elements of a pharmacists and pharmacy staff jobs.

This patient support element of our role in hospitals requires review and extension or teams built up in community settings primed to support patients, especially those unable to get to GPs, community pharmacists and others who are fixed in specific sites in primary care.

Medicines safety and risk management in many hospitals is still underpinned on a daily basis by pharmacists role in prescription/ chart review and supply authorisation. Our roles within Trusts have expanded in recent years to include essential medication reconcilliation and clinical medication review to meet the challenge of the safety agenda when dealing with highly complex, elderly and frail patients, their medicines and the risks of information mistransfer across the interface.

The current position of (in my experience) insufficient pharmacy input into practical medicines support and rehab will remain until electronic prescribing and changes to pharmacy department supply procedures, policies and staffing structures are wholesale across the NHS.

Our voice on the subject of MDT integration is often quiet as our pharmaceutical professional body is not a cohesive animal given the diversity of the profession and the miriad of different 'types' and specialities of pharmacists - across hospital, primary care and industry.

As for patient notes, most hospital pharmacists I know gave up using their own notes several years ago and simply use handover sheets/ computer tracking to ensure essential tasks are completed for each patient, using the medical notes to record all other information but I am aware that all the therapy teams I worked with had not made that move.

Now, as a medication review pharmacist and IP in primary care I use either the GP record and / or the care home patient record for all my notes. I do not keep anything seperate.

We are a relatively new arrival to the primary care scene but one which is very much welcomed by GPs when they see what we can do to help them and their patients.

#40728 Iain Cockley-Adams
Business Manager
Gloucestershire Care Services

I wholeheartedly endorse your message. I’d like to take it a small step further too. You say that “increasingly the business of health care will be the business of caring for older people who require a genuinely multidisciplinary approach”, whilst this is true, the need to shift the focus away from admission into acute hospitals goes beyond how we meet the needs of any one age group – and greater emphasis on the AHPs in many pathways will ensure that the cash savings are made with improved outcomes.
In areas such as the management of the diabetic foot and the diagnosis and treatment of MSK conditions, multidisciplinary teams with a primary/community care mindset supported by the relevant AHP services are the way forward. Of course, they must work well with the consultant-led services (and ideally have consultant engagement) but I contend that patient needs and financial imperatives can be better met be a conscious move away from the consultant led model.
I work with a multidisciplinary team of AHPs (Podiatrists and Physios) and GPSI providing a MSK Clinical Assessment & Treatment service. We have built up a body of Patient Reported Outcome Measure scores from more than 2,800 patients evidencing that we not only reduce secondary care admissions but we deliver significant and long term improvements in patients’ conditions. Saving £millions in avoidable secondary care treatment and repeat attendance at GP surgery.
And yet some still say that our model should be consultant led – in the interests of patient safety and clinical outcomes, despite the lack of evidence to support this view. In other parts of the country CCGs continue to tender for MSK interface services specified as consultant led. Perhaps there is a danger that one consequence of the NHS reforms will be that greater clinical leadership will come to mean even more focus on “doctors and nurses”.

#40730 Emma J
Senior OT

As I have read the recent reports on the healthcare system I have become more and more disillusioned being an AHP in the NHS. With no mention of therapy in particularly the Keogh report and even my trusts aim do not mention us I end up feeling a little bit of a spare part in a very big wheel. I do what I can at my level but as you mention promotion comes with less clinical time, and I don't want to loose this limiting me to a band 6, seemingly for the rest of my career.

#40732 David Oliver
consultant physician/Visiting fellow
Royal Berks/Kings Fund

Thanks for all the posts so far. I can only endorse Helen's point about the vital role pharmacists have to play and i think we could make more use of their skills and knowledge - including those in the high street pharmacies. I agree with Liz from Oxford that we need far more joined up care and fewer silos and that sadly, silos exist even between groups of therapists in many parts of the country with community rehab teams or community hospitals or single points of access insisting on referrals, documentation of rehab goals etc etc from colleagues who have already done all this. We need to do a good comprehensive asssessment once, add to it where we need to, share it and trust one another rather than creating a whole load of extra steps and "death by assessment". For Ian, i completely agree that musculoskeletal conditions are also an important test bed for interdisciplinary and interagency working. My focus happens to be old people because thats been my career but integration and continuity can benefit other groups to as clearly can AHPs. For Michael, and the "single voice" i guess my point was that if we look at some of the big issues that patients and carers complain about then they include big-time nutrition (dietetics), safe discharge from hospital (OT), people losing function and independence whilst in hospital [PT], communication around changes in drugs and side effects to look out for [Pharmacy] etc etc I could go on but you get the point. In all of those common complaints i would like to see the various AHP organisations saying loud and proud "we have a key stake in getting this right and we can help deliver many of the solutions" [but doing so also means that you cop the flack that nurses and doctors have taken over the numerous scandals aorund poor or unsafe car]. For Emma J, i completely sympathise with your predicament and it isnt easily in your gift to solve. But ultimately nurses and therapists have some control over their own national pay scales and career structures. I was able to be the national clinical director in the DH and still do 2-3 days hands on clinical work [as do most divisional directors in hospitals who are doctors and many CCG leads and as did other NCDs]. I dont see why careers couldnt be restructured so that even a director of nursing or a manager of a big hospital OT service couldnt do a day or two a week clinical work to keep their hand in and remain grounded in frontline reality. As for George, of course i agree with all you say about the need for integrated and preventative care closer to home for those with Dementia, but it just didnt happen to be the subject of my blog which was very much focussed on greater recognition for allied health professionals.

David Oliver

#40734 Rosalie Boyce
Principal Research Fellow (Allied Health)
Australian University

David thank you for an inspiring blog.

I’d like to respond to the point you and Michael raise about allied health ‘speaking with one voice’ and offer a view from Down Under.

Since the late 1980’s the Australian health system has invested in developing the Director of Allied Health (or equiv) role as a crucial leadership and structural/governance approach to bringing together all the creative intelligence and clinical skills of the various health professions into the managerial and policy domain of health services and the health system more broadly. I’m going to propose that if you want allied health ‘speaking with one voice’ then you have to have the leadership and infrastructure there to support and nourish it.

An important part of our pathway to that outcome has been through leadership positions such as the Director of Allied Health (similar but bigger than your Director of Therapy or equivalent but I’m not sure you have many of them left in England at least?). Not more costly managers I hear some say. No, these positions pay for themselves through driving change at clinical and corporate level and saving money by doing such things as ensuring clinical programs have the right skill mix of professional services (aka Ian's comments) or closing down ineffective services and directing resources elsewhere. They wouldn’t prosper here if they weren’t effective. Yes, it is a ‘cop the flack’ role equivalent to that of the most senior medical and nursing position in the organisation and one of the many roles is to support the development of, and be accountable for, quality, performance improvement and safety issues for patient care.

These roles didn’t come about in Australia because the professional associations or the health service organisations wanted them. No! They came about because individual allied health professionals saw that there could be a better way and they clubbed together (often in the face of strong barriers) to form interprofessional leadership groups and organisations under the identity of ‘allied health’ and fight for these positions (and to keep them).

The guiding vision for these developments was “Allied Health: Allied to Each Other and the Communities we Serve”. Across Australia today we have more than a hundred people with the responsibility of Director of Allied Health type positions (all with an allied health background) working together with medical, nursing and management colleagues to create better care for patients and stronger health care policy. The majority of our hospitals and health services have these roles, as well as Chief Allied Health Advisors in the Government. In addition to these leadership positions we have fantastic organisations such as ‘SARRAH (Services for Rural and Remote Allied Heath); IAHA (Indigenous Allied Health Australia), both member-based associations created by the drive, passion and commitment of individual allied health professionals joining together to create change.

Health Workforce Australia and the federal, state and territory governments have supported the development of ‘allied health’ as they know you can’t progress patient care or workforce planning etc. if you don’t have all the ‘shareholders’ at the table. For allied health it is essential that they speak with one voice to be heard.

Our latest innovation is the formation of an individual member association called AHLANZ: Allied Health Leaders of Australia and New Zealand. Allied Health is taking the fledgling step to internationalise across borders and there is a lot of sharing between Australia, New Zealand and the UK in particular. The creation of ICHPO: International Chief Health Professions Officers group is another example of that vision. However, there is more work to do, much more to do. Next international meeting is the 2nd International AHP Conference Edinburgh on 3/10/13 if you’d like to get on board with allied health ‘speaking with one voice’. See you there??

Note 1: Allied Health is broader than a ‘therapy’ concept in Australia. In any hospital or health service, allied health would typically consist of at least 10-12 professions and perhaps up to 20 or 30 depending on how it is constituted.

#40735 David Oliver
consultant geriatrician/visiting fellow
royal berks/kings fund

Dear Rosalie

I am sure everything you have said will be of immense interest to the readers. Just to be clear, when we discuss AHPS in the UK, although i have a particular interest in OT/PT/SALT/Dietetics/Pharmacy because they are the professions i deal with day in day out in the care of my patients, we do define it more widely - so for instance Podiatry, Audiovestibular clinical scientists etc would also be in my thinking. I don't have the right expertise to comment in detail on career progression to senior leadership roles among AHPS in the UK and other readers will have views. What i can say is that when i have been to Australia and New Zealand to speak at conferences it has always struck me how PT and OT are very prominent researchers (for instance several of the world's leading falls/exercise researchers are from PT/OT in Australasia) often presenting as many papers and posters as the medics and seemingly on a level playing field. In terms of career progression, and as i say i am not an expert so speak just anecdotally from experience, there appears to be a long tradition over here of nurses progressing from clinical roles, becoming operational/general managers no longer practicing clinically and often going all the way to CEO posts. I have seen several OTs and PTs go down the same route, or moving into consultancy. And of course, nurses and therapists can progress to senior hands on clinical roles such as nurse consultants/advanced practitioners/highly specialised senior therapists. What i have not seen is the equivalent of what doctors commonly do which is to be a senior medical manager running a large section of a hospital or a clinical commissioning group, or a royal college or being a senior government official, whilst continuing to practice clinically on the wards, on call, in clinic etc. It was a disconnect from the coalface and operational matters that was behind many of the problems at Mid Staffs and my view is that to keep registration, continuing clinical practice should be a requirement, Its also good for morale among the troops to see that their leaders can still do what they do
But maybe thats just me


#40738 Fiona Jenkins
Executive Director Therapies and Health Science
Cardiff and vale University Health Board

Thanks David for being such an advocate for AHPs, this is welcomed., as you say we dont often make ourselves as visible as we should - but Exec Director roles for AHPsin Walesis a step in the right direction. Career paths for AHPs have not often enabled the maintenance of clinical practice while moving into more senior roles, as Agenda for Change banding for AHPs as with Nurses rewards different element that the medical consultant contract., and the relatively few consultant AHP posts we have tend to focus on expert pracrice and R&D. However I agree we must maintain clinical credibility and ensure that those leading the professins maintain their clinical expertise and patient focus. You will be pleased to know that research I am currently undertaking identifies that the majority of most senior physiotherapy leaders in England and Wales do undertake some element of clinical practice.

#40739 David Oliver
consultant physician/visiting fellow
royal berks/kings fund


That sounds like a really positive development you are describing and i can only commend it. The interesting thing regarding agenda for change or the renegotiation of the GP or Consultant Contract is to what extent clinicians were involved in negotiating what they wanted out of the deal. Clearly, doctors, and in particular the BMA have been quite successful in negotiating favourable terms and conditions. What I don't know and am interested in is whether when nurses or therapists via their own colleges/societies were influencing agenda for change whether they lobbied hard for career structures that enabled people to work in clinical practice alongside management roles. It strikes me as unfair that a doctor is able to progress his or her career into senior leadership roles while continuing to be a hands on doctor, but that for others they are often effectively forced to stop clinical work - which is the reason most of use came into the caring professions. I wonder how many senior nurses and therapists would really like to continue in clinical practice alongside divisional or board level roles but find that their career structure doesnt allow it. Anyway, i can only say keep up the good work


#40741 C
Research Speech and Language Therapist

Thank you for this blog, championing the role of AHP’s and the important discussion that has followed. The mention of cultural innovation is very interesting, but equally complex to achieve. For a protracted period of time, AHP’s have worked hard to ensure their specialist clinical skills are recognised, their voices are heard, and their expertise are reflected in pay scales and within hospital hierarchy. Clinical posts are frequently frozen for cost saving measures, or downgraded, and much effort is spent by professional leads, protecting small specialisms, such as my own, speech and language therapy. I believe the inherent awareness of being a vulnerable underfunded, small service which managers don’t really ‘understand’, has resulted in a reluctance to blur the boundaries of our clinical expertise, and rather, actively retain our skills and identity. It is in my opinion that we are hesitant to become part of the monolithic ‘doctors and nurses’ group due to our perceived vulnerability. In reality, our independent position on the health care spectrum actually exacerbates the issues we are most concerned about, as we are less likely to have representation via influential positions within health care trusts, people have less exposure to our skills due to limited integration etc etc. The shift in culture required to change this situation undoubtedly needs to come from within our professional groups, however, I think this will be a difficult task in such challenging economic times. Do you have any suggestions for tacking this complex cultural situation? Camilla

#40742 vi nu

In areas such as the management of the diabetic foot and the diagnosis and treatment of MSK conditions, multidisciplinary teams with a primary/community care mindset supported by the relevant AHP services are the way forward. Of course, they must work well with the consultant-led services (and ideally have consultant engagement) but I contend that patient needs and financial imperatives can be better met be a conscious move away from the consultant led model.
I work with a multidisciplinary team of AHPs (Podiatrists and Physios) and GPSI providing a MSK Clinical Assessment & Treatment service. We have built up a body of Patient Reported Outcome Measure scores from more than 2,800 patients evidencing that we not only reduce secondary care admissions but we deliver significant and long term improvements in patients’ conditions. Saving £millions in avoidable secondary care treatment and repeat attendance at GP surgery.
And yet some still say that our model should be consultant led – in the interests of patient safety and clinical outcomes, despite the lack of evidence to support this view. In other parts of the country CCGs continue to tender for MSK interface services specified as consultant led. Perhaps there is a danger that one consequence of the NHS reforms will be that greater clinical leadership will come to mean even more focus on “doctors and nurses”.

#40748 David Oliver
consultant physician/visiting fellow
royal berks/Kings fund

Hello Again

To Vi Nu, I am a consultant myself and spend most of my time in secondary care, but i do have consultant colleagues who work almost full time in the community. My personal view (and it is a personal view) is that there is no need for people to get hung up on an MSK service being "consultant-led". The majority of MSK are already dealt with in primary care in any case and the last thing most consultants want is to be spending lots of time seeing patients who could be dealt with perfectly well in primary and community care. What IS important is to ensure that patients have full access as part of any programme or pathway to the full diagnostic and acute care facilities of secondary care when this is required and that there is adequate access to specialised diagnosis for more complex cases. I dont ever for instance want to see older people denied access to secondary or acute care expertise on the grounds of age alone. But if secondary care/the consultant is at the top of the apex of demand - with many people being dealt with lower down the pyramid, i can see no need for a consultant to lead the entire MSK programme. What is crucial though is for secondary care experts to be part of designing the pathway so their expertise is used from the outsed and for there to be clear mechanisms for accessing specialist expertise.

With regard to Camilla's point, its one i recognise. Speech and Language therapists are highly skilled and provide an invaluable service (on my ward now they have been very helpful in assessing and following up 5 of my current inpatinets for instance) and you are right, even compared to other AHPs such as PT/OT/Radiography they are small in number. I dont think i ever advocated in my own comments that there should be some kind of "one voice" coalition between AHPs and each discipline does have distinct skills and messages. And inevitably, you arent going to see many Speech and Language therapists ascending the corporate ladder and moving away from the bedside when they ar already busy enough trying to maintain a core clinical service. But what would have been refreshing in the wake of Francis, Ombudsman's Report, Patients Association Reports, Keogh Reviews, Dementia Strategy, Government Push on integration, etc etc is a really strong set of messages coming from each of the disciplines about their crucial role in getting some of the care right and really pushing themselves into the "public conversation" armed with solutions but also saying (as nurses have done) that they might not have the numbers and support in many places to do their job as well as they would like


#40749 Christine Whittaker
Assistant Director for Service improvement
Bridgewater Community Healthcare NHS Trust

What a refreshing blog and about time the issue of the "invisibility" of AHP's was raised. As a physiotherapist who went into management in the mid Nineties and general management in the mid Noughties I also held a clinical caseload for 6 years. It became impossible to maintain, as I took on additional work, as AHP services simply do not have the flexibility of approach that medical colleagues have maintained. Perhaps adopting a “job plan” approach to structuring the delivery of AHP services might make this easier for younger AHP colleagues to do in the future.
In managing medical and nursing services after managing AHP’s I was struck by the difference in cultures between professions, once I stepped away from my own. The characteristics of many AHP's of a problem solving approach and a willingness to take properly assessed and mitigated "risks" is what the NHS should be encouraging, in the current circumstances. Too often the concentration is on problem identification with little resulting action. More AHP's at Board or sub-Board level would bring a proactive approach to the changes we need to make to our services to ensure we continue to deliver high quality patient care whilst improving efficiency and effectiveness.
Time to harness the enthusiasm and energy of the AHP professions. Doctors and nurses may save lives but it is AHPs who can make that life worth living again.

#40750 Camilla

I absolutely agree, and the reports that you mention are such an important platform for public conversation, with patient care at the centre of discussion. I also think your point about being armed with solutions is a subtle but valuable suggestion in the context of innovating culture.
Many thanks for your response,

#40751 Lynne Douglas
Director Allied Health Professionals
NHS Lothian

David, thank you for your sharing your thoughts and insightful view on AHPs in our modern healthcare system. As a clinical leader and one of 14 directors of AHPs in NHS Scotland I come from a perspective that we can speak with one voice certainly in a political and strategic sense. We probably don't market the 'brand ' enough and the public on a 1:1 interface with an AHP rightly think of us as a OT, PT, Dietitian..etc
In part the defensiveness I think can come from a distinct lack of clinical respect afforded at times within the 'system'. We are small in number and often investment has not kept up with the shifting needs of a different case mix as you point out.
I feel privileged to to lead this highly professional group of staff, and recognize that we are fortunate and well developed at attaining board level leadership in Scotland. I agree we have some modernizing to do with regard to workforce and models of care but most importantly we will continue to deliver person centered, outcome focussed quality care to the patients we serve.
We have many advocates who promote innovation, enhancing the evidence base and happy to fly the AHP leadership flag. With the onset of personalization, integration and a rapidly changing population demography I am confident the skills of AHPs will be required for a very long time to come.

#40752 David Oliver
Consultant Physician/Visiting Fellow
Royal Berks/Kings Fund

Dear Lynne

All i can do is reiterate that AHPS have nothing but major clinical respect from me as they are integral to the multidisciplinary care we offer to older, frailer patients with complex needs. And i feel sure that other medics working in areas where rehabilitation and interdisciplinary approaches are required such as stroke medicine, care of patients with hip fracture, neuro-rehabilitation or integrated community rehab/intermediate care teams/virtual wards/community hospitals share the same regard for what you do. The low profile is more to do with the dominance of doctors in terms of professional power and status, of nurses in terms of sheer numbers and the fact that so many of them leave clinical practice to go into organisational management/leadership including board and regional level roles and so have a strong voice and just the way our media and politicians are completely reductionist in the way they represent health care as either being about heroic high tech cutting edge medical interventionalism/or slagging off GPs for not being available enough and being "overpaid" or nurses being either "caring angels" or neglectful and not up the standards of "matron with her beady eye who would spot dust under a bed at 100 yards". Its completely unhelpful. But i do think that AHP organisations could be more proactive in their messaging. If we take two simple examples. One is the constant concern from the public and regulators/ombudsman/campaigning groups about discharge of older people from hospital - in which OTs and PTs and AHPs in community teams have an absolutely vital role. A second is the even greater concern about poor nutrition and nutritional support for older people in hospital. We get celebrity chefs trotting out their ideas for menus. And yes indeed both BAPEN and a coalition hosted by AGe UK of several players in the dietetics and nutrition field are trying to highlight solutions, but in the lay media, you would hardly know that OTs or dieticians existed or what they did. I think thats a real shame. They are completely undervalued. Hence my writing the blog - which does seem to have struck a chord as i have never had one of my blogs get so many comments, likes or re-tweets

#40757 Ann Green
Allied Health Federation

It is great to see all the contributions to this blog about the role of AHPs in delivering high quality patient care through our unique role as integrators of care within clinical pathways in a range of settings and across health and social care.

David very clearly sums up the role of AHPs and the positive impact that they have upon patient care. He highlights many of the best practice examples that underpin the need for AHPs to be a prominent voice in the development of integrated patient pathways and clearly signposts the biggest problem in the system.

The phrase ‘doctors and nurses’ describe the overarching issue. Where are AHPs in the decision making about the whole system and in the redesign of care pathways? It is a truism that you don’t know what you don’t know. Therefore without a truly multi-professional approach to decision making there is a risk that the patient benefits provided by increased use of AHPs may be overlooked.
For example we still see services where the therapy component of the patient care is a bolt on after thought rather than the key component of the pathway.

Liz Mowbray in her response states a solution in the need for more AHPs in board level roles. The Allied Health Professions Federation (AHPF) also strongly endorses this opinion and we believe that there is a need for guidance if not specific instruction to both CCGs and service providers to this effect.

With our ageing population and a continuing restrained fiscal climate we need to radically rethink our approach to health and care to truly put the patient and the public in charge of their own health with the most appropriate sustainable support. AHPs will be key to that change therefore we not only need to build AHP presence to deliver services in the way that we know and that David has described but to put AHPs centre stage in the reshaped future model of care.

Ann Green
Chair of Allied Health Professions Federation

The Allied Health Professions Federation (AHPF) provides collective leadership and representation on common issues that impact on its member professions. The overall purpose of the AHPF is to promote inter-professional working enabling Allied Health Professionals (AHPs) to provide high quality care for patients and their carers across the whole of the health and social care sectors.

#40764 Bryony Simpson
Chair of Council
Royal College of Speech and Language Therapists

Hi David,

Thanks very much for writing this blog and starting such an interesting conversation. The Royal College of Speech and Language Therapists (RCSLT) and I are delighted to hear someone giving a cheer for AHPs! Your points about some of the hugely important work done by AHPs, including speech and language therapists, are very well made, as are your suggestions for the work that needs to be done in the future.

As you well know, there is a real challenge involved in making sure the voice of ‘smaller’ health professions are heard within the health and social care system – but it is a challenge that the RCSLT and others are resolutely focused on. As a member of the Allied Health Professions Federation (AHPF), we fully support Anne’s remarks above on behalf of the AHPF.

We are also working hard to make sure that the critical link between clinical practice and leadership is strengthened. I know from my own clinical practice just how valuable the ‘frontline’ perspective is and will remain to be for those in leadership roles, and you are absolutely right that there are particular challenges for speech and language therapists who want to balance leadership and clinical practice.

Again, thank you for starting this conversation and highlighting the critical work that AHPs do throughout the health and social care system.

Bryony Simpson

#42361 Ethan

Making career in health field is really difficult and a person should be talented and be aware about this. As human being have been facing several health diseases, our health specialists are trying invent new techniques or medicines. It changes with respect to time, so a person in this career should keep his/her self updated to do his/her responsible in an effective way. For better performance one like to go for training or coaching.

#505604 Moris Ledaea

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#544949 Maria Jones
Bramingham Dental Clinic

The BMA supports shared decision-making between patients and doctors and believes that some of the best healthcare outcomes can be achieved when patients have an understanding of their care, and are able to actively participate in the decision-making process. However, it is important that this does not lead to burgeoning bureaucracy. Even the Bramingham Dental Centre takes the proper care of all these things. http://www.braminghamdental.com/tooth-whitening.html

#545224 Pearll Baker
Independent Mental Health Advocate & Advisor/Carer

I did in fact put a 'Paper' together on the concept of replacing the Social Worker & CPN with another Innovative way of providing health and social to those suffering from Mental Illness, but unless I have missed something MH is not mentioned.

As an Independent Mental Health Advocate and Advisor you are obliged to keep up to date with new Laws Legislation, Welfare Benefits are just a few items to mention.

I would receive monthly drug bulletins from the Head of Pharmacy at the Maudley Hospital, these were past on to the Psychiatrist I worked with. GPS Solicitors, Psychiatrist referred many of their patients to me, where the families were suffering hardship, due to Welfare Problems be it money or emotional.

The starting point was visit, the next usual step was they usually had no welfare benefits, or a child was having to care for a mother and father.

The third step apply for Welfare Benefits,and set up a Crisis Contact with Me.

The family I refer consisted of a father who suffered with onset Schizophrena, his wife was blind, they had three boys and one girl of school age. The daughter cared for the entire family. A bus pass was arranged by me, eventually after discussions with the Psychiatrist it was agreed the girl now of working age, should have the opportunity to work.

This young woman was found a very good work placement, after I contacted the appropriate person in a position to offer her employment.

The medication was arranged on a daily basis in a simple way, that would allow easy self administering. The young woman gas a life, and now married.

I will give you another example a Bipolar sufferer, lived in a DYSO accommodation scheme, part rent, part mortgage. The mortgage became to high due to interest rates, a visit to the Mortgage Company agreed a lower repayment.

To be a successful Independent Mental Health Advocate you really need direct access to the patient's Psychiatrist and their GP.

I contacted the Psychiatrist on a daily, who was willing to take referrals directly from me, it was often never necessary to place them into the system, direct access saved time, and lives.

Mental Health is the most difficult to manage, and only experienced individuals like me can offer the real package, of course there are others but few and far between.

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