Sustainable Healthcare: Allied Health Professionals, Realising the Potential HENWL AHP SHARP project June Davis Professor Mary Lovegrove OBE Co-Directors Allied Health Solutions 6th July 2015 Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre Background to SHARP Health Education North West London (HENWL) commissioned the Allied Health Enterprise Development Centre (AHEDC), a joint venture between Allied Health Solutions and Buckinghamshire New University Project timeline: Part A - March 2014 and October 2014. Part B - November 2014 – May 2015. Focusses on the contribution that the AHP workforce currently makes, and on the potential enhanced contribution AHPs can make to future services. Supports the vision of HENWL (HENWL Workforce Skills and Development Strategy 2013-2018) and the ‘Shaping a Healthier Future’ programme. Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre HENWL area Allied Health Enterprise Development Centre

Allied Health Professions included in project scope Art Therapists Dietitians Diagnostic radiographers Occupational Therapists Physiotherapists Speech and Language Therapists Paramedics Osteopaths Podiatrists Orthoptists Prosthetists and Orthotists Music Therapists Drama Therapists Therapeutic Radiographers Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre Project aim Identify and provide evidence to support and strengthen the contribution that AHPs can and do make to effective patient outcomes in a number of areas Allied Health Enterprise Development Centre

Scope Part A Part B Dementia care through to end of life Transfer of care across integrated care services Dementia care through to end of life Adult reablement and rehabilitation Neurological conditions Chronic Obstructive Pulmonary Disease (COPD) Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre Project objectives Undertake an analysis of AHP involvement and leadership models in the areas in scope within the study Critically analyse the impact AHP clinical leadership has had to patient care in the areas of focus across NWL. Identify the gaps in AHP clinical leadership, support available to AHP staff, and what they would require in new future clinical leadership roles areas of good practice Identify the nature of new roles in the areas of focus. Demonstrate productivity improvements in care, and reductions in costs, as a result of the involvement of AHPs utilising QIPP as a framework. Allied Health Enterprise Development Centre

168 AHP and associated staff All AHP disciplines in scope included Data sources 15 provider organisations in NWL (2 local authorities, 12 NHS providers, 2 independent sector provider) 168 AHP and associated staff (128 part A, 40 part B) All AHP disciplines in scope included

Data sources Data collection Part A Part B Focus groups 14 7 (3 COPD, 4 Neurology) Semi structured interviews 4 1 (Neurology) Telephone interviews 2 2 (1 COPD, I neurology) QIPP examples 15 3 (1 COPD, 2 neurology) Local best practice examples National and local policy

Findings and themes from focus groups and semi-structured interviews Allied Health Enterprise Development Centre

Part A: AHP involvement in rehabilitation and reablement Mental and physical health expertise Holistic approach Improve the quality of life of people Lead decision making with the patient at the centre Facilitate hospital discharge Prevent hospital admission Respond to changes in a patients needs throughout their journey Reduce length of stay Sign post to other services and agencies Proactive approach and early intervention Coordinate and lead rehabilitation

Part A: Dementia through to end of life Maintain clients even if outside service criteria/flexible to patients needs Focus on the needs of the patient and their family and not the diagnosis Encourage patient engagement Embrace a team approach Consider the ‘bigger picture’ Promote activity and ‘socialisation’

Part A, Transfer of care across integrated services ‘Often AHPs start the conversation of what the next steps are for the patient’ Promote and foster seamless care Cross service and cross organisational boundary working is the norm Key workers Lead transfer of care in many cases Comprehensive and bespoke written and verbal information Triage patients

Part B: AHP involvement in COPD Support Discharge Pulmonary Rehabilitation and other exercise classes Oxygen clinics Holistic Manage anxiety and depression Motivational interviewing Mindfulness Promoting self advocacy

Part B: AHP involvement in neurology Manage cognition, memory, emotional wellbeing Complex positioning and postural needs Communication needs Splinting, casting, spasticity management Family and carer support Key working and case management Strong MDT working Vocational rehabilitation in some areas Graded discharges Maximise independence Work closely across agencies Large variety of clinics Triage

Best practice across AHP services Part A Joint working and co-location AHP research and development strategy AHP colleagues in physical and mental health undertaking joint sessions Arts in health team – rehabilitation Orthoptists engaged in falls work AHPs leading the communication between professionals and patients Sensory work with dementia patients Allied Health Enterprise Development Centre

Best practice across AHP services – Part A Programmes for patients with a range of long term conditions Pre-assessment screening and support in oncology, orthopaedics and pre-amputation Multiprofessional falls services Allied Health Enterprise Development Centre

Best practice across AHP services Part B Maximisation of medication (COPD) Variety of outcome tool used Mood integrated care pathway Integrated care pathways for patients in a prolonged disorder of consciousness for assistive technology iPad visual field app and eye tracking therapy programmes Orthoptist pathway for pituitary tumours Rehabilitation assistant pathway Sensory modality assessment and rehabilitation technique AHP led clinics i.e. Motor Neurone Disease Occupational therapy working with COPD patients Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre Skill sharing ‘It makes no sense for a therapist to find someone on the floor and then not be able to take a blood pressure and feedback to the geriatrician.’ ‘We do more and more physical work, more than we have done previously. We are not just mental health OTs. We can’t function just dealing with mental health issues as most of our clients have complex physical health needs also’. ‘There are lots of up-skilling opportunities’. ‘As an AHP you need to know almost everything that the doctors know’. ‘I do step over the line and become a social worker which is really not my role’. Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre Skill sharing ‘I (orthoptist) have been on the ward with the occupational therapists, yes. The way I started to get quite a lot of patients referred to me was there was an occupational therapist at Hillingdon who had had a lecture about eyes, and so she particularly was keen to find out a bit more about it. She said, “Could we do it together?” and so we did do a few together.’ Neuro navigator role Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre AHP leadership models ‘AHP leadership promotes integrated working, governance and horizon scanning.’ Significant variation across providers Leadership model varies by AHP discipline in different organisations Where there is senior AHP leadership in the organisation, there is good evidence that this has had a very positive effect on the profile of AHPs in the Trust. Not having an AHP lead was seen as a major gap by several respondents. ‘Therapies and AHPs’ Professional leadership for each of the disciplines also varies considerably with the majority of organisations not having designated professional leadership for the individual AHP disciplines. Mixed responses to the provision of formal and informal leadership support. Healthcare Leadership Model Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre AHP leadership models ‘I think the theme of the leadership with AHPs is there isn’t enough of a stepwise plan. ‘actually it's frustrating when you come into somewhere like this to some extent, where you think, "No one's asked me what I think." Because they don't, you know, they don't need to because they're making the decisions higher up than you.’ ‘Don’t have leadership as such. I have a manager who’s an outpatient manager, so I don’t have AHP leadership.’ Allied Health Enterprise Development Centre

Support identified for those in AHP leadership roles Development right across the grades required Enhance clinical skills along with clinical leadership Support career progression Development programmes specifically for AHPs ‘Demonstrate how learning leadership skills and gaining such experience can be of benefit to the individuals future career potential and to appeal to their inherent belief in the importance of helping their patients.’ Allied Health Enterprise Development Centre

AHP leadership at the point of care Many examples of AHP leadership at the point of care e.g. clinics, board rounds, leading MDT discussions Often the only professional seeing the patient Cross skilling Triage Clinical knowledge and expertise promotes clinical decision making Research and strong evidence base for interventions ‘You do end up spending a lot of time with patients just because of … How it’s affected their whole body and trying to just position them and everything.’ Allied Health Enterprise Development Centre

Allied Health Enterprise Development Centre QIPP examples Part A Falls assisted discharge Utilising therapy services differently on an acute hospital setting The role of the occupational therapist in the assessment and management of compulsive hoarding Therapy In-Reach at Charing Cross Hospital at weekends Delayed Transfers of Care Part B Respiratory outreach team Effective goal planning on the acute stroke unit Patient Guideline Boards Allied Health Enterprise Development Centre

New roles and extensions to current roles Neuro navigator Psychiatric liaison Peer support workers Associate practitioner roles Dementia – more potential Extended assessment skills Non medical prescribing – physiotherapy and podiatry Nutrition Long term follow up of intensive care patients – AHP led Allied Health Enterprise Development Centre

Opportunities for AHPs to make a greater impact AHPs could influence across the board is that if we had more involvement in HCA training Acute macular degeneration injections Self management and health and wellbeing programmes Vocational rehabilitation where not already provided Health behaviour change experts Allied Health Enterprise Development Centre

Themes where AHPs can have a greater impact Opportunities for AHPs 7 day services Urgent and emergency care Public Health Supported self management New technologies and service models Leading MDT teams in primary care and community provision Integrated care Allied Health Enterprise Development Centre

Other outputs from the AHP SHARP project AHP SHARP Part A article Development of a bespoke multiprofessional development programme for Allied Health Professionals Allied Health Enterprise Development Centre Allied Health Enterprise Development Centre

How to develop and present your business case as AHPs Multiprofessional development programme for Allied Health Professionals C The relevance and importance of the shape of caring, shape of training and talent for care to AHPs D Clinical commissioning and AHPs demonstrating economic benefit and quality outcomes E How to develop and present your business case as AHPs F Workforce planning A The Five Year Forward View and the changing landscape of health and care for AHPs B Clinical leadership and personal effectiveness for AHPs Allied Health Enterprise Development Centre