Realising the potential of allied health professions

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Last week I read a blog posted on Facebook by a friend. The blog was written by a father, five weeks after his daughter and her friend went to watch the Ariana Grande in concert in Manchester. That tragic night many people were seriously injured or killed: this father’s daughter was seriously injured and her friend lost her life.

The blog talks of his daughter’s homecoming from hospital, another step along a journey of recovery and rehabilitation. Her father tells the story beautifully, bravely and painfully. Reading the blog, you get a real sense of the journey that this father, his daughter and family have been on and the anticipation of what is to come: with his daughter at the centre, a team of individuals – family and friends, an array of health and care professionals, the community in which she lives – is working together to support her on her journey.

What stood out for me were the following sentences:

With the help of the occupational therapist, we have plenty of things in place, for as long as we need them, to make it work. I didn’t even know what an ‘OT’ did a few weeks ago.

Overall, she has done fantastically this morning and is settled watching TV. Won’t be long though, the physios are on their way.

These statements made me think about how allied health professionals – or AHPs – have been supporting individuals, families and communities following the tragedies we have witnessed across England this year.

An AHP is someone trained to perform services in the care of patients other than a physician or registered nurse – including occupational therapists and physiotherapists, but also many other professionals1. These wider professional groups, and the multidisciplinary teams they are part of, are crucial to care delivery. Data from the National audit of intermediate care 2014 demonstrates that the greater the number of professions in a care team – skill mix, not head count – the better the outcome for the person receiving care. I’m not one for jumping on a soapbox about this, but I do think that there continues to be a fundamental challenge across the system about what prevents the effective use of AHPs.

My view is that it is just not possible for everyone to know the range of skills these wider professions can offer across the health, care and wider system and the impact they can make. But every organisation should have someone who does. In NHS England the Chief Allied Health Professional Officer, Suzanne Rastrick, holds this position. At a trust level, the AHP lead is responsible for ensuring effective professional governance, management and leadership for AHPs. The role involves maintaining and developing high-quality, innovative practice and services across the trust and supporting the organisation to recognise the positive, wide-ranging and added value that AHPs can bring to services and how to use this to best effect.

However, despite growing evidence of the transformative potential of AHPs, not all NHS organisations have AHP representation on their boards or at senior management levels. Forward-thinking organisations – for example, South Staffordshire and Shropshire Healthcare NHS Foundation Trust – see AHP leadership as crucial as they move towards delivering more care in the community with a focus on recovery, rehabilitation and re-ablement. And with that in mind, the trust recently advertised and appointed to the role of Director of AHPs on its board. This is in contrast to other organisations in which AHPs lead individual services without significant collective representation at more senior levels. The result of this is that there is no single reporting mechanism to the board. This feels like an ‘access gap’ in senior management structures rather than an ‘engagement gap’, as described by Rosalie Boyce when discussing AHP leadership in Australian public sector health boards and top management teams; which carries risks with regard to ensuring standards of clinical responsibility and accountability in order to improve safety and quality, and the ability to not only optimise but transform care.

There are many brilliant AHP leaders across the system who are quietly and confidently carrying out their role to ensure that those who require care see the right person, at the right time, in the right place. But these leaders need to be at the right table, at the right time and in the right place to ensure the skills of AHPs are known about and used, so that they have the greatest impact for the people in the communities they are privileged to serve.

So, when I visit sustainability and transformation plan (STP) footprints and converse with individual trusts to offer my support, my standard question is, ‘Where is the AHP leadership?’.

How would you answer this in your organisation?

  • 1. Allied health professionals include: art therapists, drama therapists, music therapists, chiropodists/podiatrists, dietitians, occupational therapists, operating department practitioners, orthoptists, osteopaths, prosthetists and orthotists, paramedics, physiotherapists, diagnostic radiographers, therapeutic radiographers, speech and language therapists.

Comments

Pearl Baker

Position
Independent Mental Health Advocate & Advisor/Carer/DWP Appointee/Deputy to COP,
Organisation
Independent
Comment date
26 July 2017
It is unclear how the AMHPs co-ordinate with a AHPs? or indeed if they do at all.

'Integration' is exactly that, but my experience has shown the Mentally are ignored.

'Safeguarding' abuse and neglect are common place for those suffering from Mental Illness, they have become 'invisible' to the system.

A GP instructed their STAFF NOT to speak to an Individual who provides significant Health and Social Care to their Patient. The GMC new Guidelines have been ignored 'if there is evidence of an Individual involved in the Health and Social Care' of their patient, they should SHARE. 'Safeguarding' 'duty of care' issues have been raised with the CQC. The current CQC GP Inspection Methodology is NOT 'fit for purpose' as it fails to 'pick up' on Safeguarding issues that would lead to NEGLECT if the Individual they are ignoring stops their Deliver of Health and Social Care.

I am sure AHPs are delivering a 'wonderful' service to many, but NOT those suffering from 'severe mentally illness'.

There are a number of Mental Health TRUSTS: so why are we still seeing the victimization of this group by the Welfare Benefit System? 'fit for work' no longer ill? get a 'job'? Benefits STOPPED even for those subject to Section 117 of the 1983 MHA

Mental Health Trusts and LA have got to be more involved 'Proactive' not allow their Patients to live on the Streets, brought about by their Health and Social Care Providers not taking responsibility for their Patients, and NOT having sufficiently trained Individuals withing the system to ACTUALLY carry out their RESPONSIBILITIES to the clients/patients.

Thirty years working in the Community for Mental Health, the above is a correct Summary of what is wrong, and what is needed to fix it.

Sheila Munro

Position
AHP Manager,
Organisation
NHS Forth Valley
Comment date
26 July 2017
Here in NHS Forth Valley we have AHP's embedded in the community MH teams that support people who have severe and enduring illnesses. There is also access to more generalist AHP services as needed. We are also core to a lot of other teams and support a wide population - both in acute inpatients, rehab places and most importantly in the community. We are looking at how and where we are working in order to ensure we are meeting the needs of the people in Forth Valley and will be looking at linking work streams and services with the new national AHP AILP (Active and Independent Living Programme) in Scotland. There are always ways to improve services and listening to our clients/patients is at the heart of it all.

I am a physiotherapist and now in a management position and do agree that we can be such a positive group of staff that are fundamental to the well being of our population and this kind of information needs to be more widely shared, many thanks for this blog.

Mr DJ King

Position
In Reach Nurse,
Organisation
WH&CT
Comment date
10 August 2017
The solution is hidden in plain sight and delightfully simple: a Health Team that works together with Patients + / - (informal) Carers and relevant Partners and all contribute in a(n inter-disciplinary) way as (equal) Partners (all valuing all); recognising the assets and strengths of all, enlisting advice / support / specialism as indicated. The lead is the most appropriate Person.
The aim always being therapeutic supported self-care, where possible, and assets are assessed and support + / - care is titrated accordingly.
There is so much opportunity

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