1. 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

2. 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 ) and the ‘Shaping a Healthier Future’ programme.
Allied Health Enterprise Development Centre

3. Allied Health Enterprise Development Centre
HENWL area
Allied Health Enterprise Development Centre

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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’

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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