This post is from The King's Fund Blog
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 professionals*. 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?
*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.