Allied health professionals are critical to new models of care

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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.

Comments

Sue

Position
SLT,
Comment date
08 December 2015
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

Rosalie Boyce

Position
Research Academic and Consultant, Brisbane, Australia,
Comment date
09 December 2015
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'!

Leah Carey

Position
Physiotherapist,
Comment date
16 December 2015
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....'

Tim Atkin

Position
chair elect, CYP&Families, Division of Clinical Psychology,
Organisation
British Psychological Society
Comment date
22 December 2015
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.

Amy Lucas

Organisation
Fulk Chiropractic
Comment date
25 February 2016
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

Pearl Baker

Position
Independent Mental Health Advocate and Advisor/Carer/Trust Governor,
Organisation
Independent
Comment date
25 April 2016
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.

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