Let’s hear it for allied health professionals

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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.

Comments

John Smith

Position
Head of Department for Pharmacy & Pre-Operative Assessment Manager,
Organisation
Acute Private Hospital
Comment date
11 June 2020

Skip forward 7 years from original article:
What do you do when you have been informally told that even though the Director of Clinical Services job specification states RGN or AHP but the hiring managers have informed recruitment they are actively only considering/hiring nurses for these roles?

order lab tests

Position
manager,
Organisation
healthonelabs
Comment date
17 April 2019

This is a great post. Thank you

Paul Gowens

Position
Vice Chair College of Paramedics,
Organisation
College of Paramedics
Comment date
15 January 2018

Paramedic- quickest growing AHP Profession. Much to offer.

Pearll Baker

Position
Independent Mental Health Advocate & Advisor/Carer,
Organisation
Independent
Comment date
08 December 2015
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.










Maria Jones

Position
Dentist,
Organisation
Bramingham Dental Clinic
Comment date
05 October 2015
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

Moris Ledaea

Comment date
26 January 2015
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Ethan

Comment date
11 August 2014
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.
http://www.reginafasold.com/performance-coaching.php

Bryony Simpson

Position
Chair of Council,
Organisation
Royal College of Speech and Language Therapists
Comment date
16 August 2013
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

Ann Green

Position
Chair,
Organisation
Allied Health Federation
Comment date
15 August 2013
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.



David Oliver

Position
Consultant Physician/Visiting Fellow,
Organisation
Royal Berks/Kings Fund
Comment date
13 August 2013
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
David

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