Sustainable Healthcare: Allied Health Professionals, Realising the Potential

HENWL AHP SHARP projectJune Davis

DirectorAllied Health Solutions12th November 2014

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: March 2014 and October 2014.• 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

HENWL area

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Allied Health Professions included in project scope

Allied Health Enterprise Development Centre

NHS AHP workforce across North West London (as at 31.3.14)

Allied Health Enterprise Development Centre

AHP workforce across North West London(as at 31.3.14)

Nationally: 172,686 registered AHPs & 64, 377 FTEs in the NHS (Nuffield Trust 2014)

Qualified total FTE Band 5 - Band 9

% of total qualified staff

Assistant staff FTE Band 2-band 4

% of total assistant staff

Art, Music and Drama therapists 40.51 <1 1 <1Dietitians 259.78 5 21.54 5Occupational Therapists 640.12 12 132.15 32Physiotherapists 955.7 18 110.19 27Diagnostic Radiographers 597.72 11 71.77 17Therapeutic Radiographers 126.63 2 18.94 4Speech and language therapists 427.41 8 31.56 7Podiatrists 129.65 2 18.1 4Orthoptists 17.8 <1 0.8 <1Paramedics 1909.6 34 0 0

Total

5104.92 (7% of total

AHP FTEs nationally) 406.05

Project aim

Identify and provide evidence to support and strengthen the contribution that AHPs can and

do make to effective patient outcomes in:

Dementia care through to end of life

Dementia care through to end of life

Transfer of care across

integrated care services

Transfer of care across

integrated care services

Adult reablement and

rehabilitation

Adult reablement and

rehabilitation

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Project objectives• Scope general background information available across NWL in the

areas of dementia, discharge management, and reablement and rehabilitation.

• Undertake an analysis of AHP involvement and leadership models in the areas in scope.

• Critically analyse the impact AHP clinical leadership has had to patient care in the areas of focus across NWL.

• Identify the support, AHP staff currently receive, and what they would require in new future clinical leadership roles.

• Identify the gaps in AHP clinical leadership, and 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.

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Methodology – Data sources

• Local and national policy

• 14 focus groups • 4 face to face semi

structured interviews• 2 telephone interviews• 15 QIPP examples• Local best practice

examples

15 provider organisations in NWL (2 local authorities, 12 NHS

providers, 1 independent sector provider)

128 AHP and associated staff

All AHP disciplines in scope included

15 provider organisations in NWL (2 local authorities, 12 NHS

providers, 1 independent sector provider)

128 AHP and associated staff

All AHP disciplines in scope included

Findings and themes from focus groups and semi-structured interviews

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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

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’

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

Best practice across AHP services• 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

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Best practice across AHP services

• Programmes for patients with a range of long term conditions

• Pre-assessment screening and support in oncology, orthopaedics and pre-amputation

• Multiprofessional falls services

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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’.• ‘The AHPs in OASIS and critical care have embraced the cross skilling

and skill sharing’.

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AHP leadership models

‘AHP leadership promotes integrated working, governance and horizon scanning.’

•Significant variation

•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

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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.’

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AHP leadership at different levels

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AHP leadership at the point of care‘When you are the first person in you are often the person who is helping them untangle who they go to about what and referring them on to the right services.’

•Strong AHP leadership at the point of care•Often the only professional seeing the patient•Triage•Clinical knowledge and expertise promotes clinical decision making•Research and strong evidence base for interventions

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New roles and extensions to current roles

• 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

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Falls assisted dischargeQIPP dimension Description

Quality • Quality of care improved by seamless transition of care from acute hospital to primary care

• Patients completed satisfaction questionnaire on discharge and the results were either good or excellent.

Innovation • Partnership working between acute hospital and primary care resulted in new way of delivering service to patients

Productivity • Assisted discharge contributed to reduction in length of stay and intensive therapy for up to five days reduced readmission with cost savings in reducing excess bed days and reduced readmission.

Prevention • Partnership working with intensive therapy for up to five days post discharge had led to reduced anxiety and reduced readmissions.

OASIS (older adults specialist intervention service team)

QIPP dimension Description

Quality • Patients seen by most appropriate specialist team from point of admission to discharge.

• Prevention of institutionalisation and deterioration in function whilst in hospital as patients have therapy plans from the point of admission

• Reduction in duplication of assessments• Therapy discharge is planned from the point of admission rather

than on referral

Innovation • Good cross professional working relationships• Development of competencies between nursing and therapies

Productivity • Reduction in length of stay following the service redesign of 9 days

• Based on the cost of an overnight stay of £225, the saving per admission was £2025 = total saving of £1,764,180.

Prevention • Reduction in the need for residential and nursing placements following a period of hospitalisation.

Opportunities for AHPs to make a greater impact

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