AHPs as agents of change in health and social care - The National Delivery Plan for the Allied Health Professions in Scotland, 2012 - 2015

Introduction by the Chief Health Professions Officer

"The demands for health care and the circumstances in which it will be delivered will be radically different in future years. We must be bold enough to visualise the NHS that will best meet the needs of the future in a way that is sustainable and make the changes necessary to turn that vision into reality."
Scottish Government (2011a)

Visibility, accountability and impact

In November 2011, the Scottish Parliament debated the importance of rehabilitation and enablement to the health and social well-being of the population of Scotland. MSPs acknowledged rehabilitation and enablement as core elements in ensuring individuals can live meaningful and productive lives and paid tribute to the crucial roles allied health professionals (AHPs) play in their promotion. They recognised the importance of rehabilitation and "enabling" approaches in underpinning safe, effective, affordable and sustainable health and social care services and declared strong support for the development of a National Delivery Plan for the Allied Health Professions in Scotland.

The National Delivery Plan was subsequently commissioned by the Minister for Public Health with the support of the Cabinet Secretary for Health, Wellbeing and Cities Strategy. It is the first of its kind in Scotland and, indeed, the UK and provides a unique opportunity to align the contribution of AHPs to the nationally agreed outcomes for integration of health and social care currently in development, the Healthcare Quality Strategy for NHSScotland (Scottish Government, 2010) and Achieving Sustainable Quality in Scotland's Healthcare: a "20:20" Vision (Scottish Government, 2011a).

Scotland's AHPs serve a population of 5.2 million people through partnerships across health, social care, education, voluntary and independent sectors. Demographic changes mean that the number of people over 60 will increase by 50% by 2033 and the rise in the over-85 population will be 144%: this is especially significant given the increased prevalence of dementia among this age group.

Almost a third of total annual spend on older people's services is accounted for by unplanned admissions to hospital: that is more than is spent on social care for older people. Delayed discharges of less than six weeks account for around £54 million per annum in bed days lost, to say nothing of the cost to individuals and their carers of remaining in an environment not appropriately reflecting their needs.

The vision for delivering high quality health and social care services in Scotland is focused on a joint commissioning strategy to enable integrated care. The delivery of more "enabling" services, shifting the focus away from professional dependency and towards supported self-management and resilience, will be central to achieving better outcomes for people who use services, their families and carers. Key elements of shared commitments across health and social care will require professional leadership from AHPs and others to deliver our vision of effective, sustainable and affordable service provision for the future that is built around the individuals and communities who use those services.

AHP role, leadership and strategic vision

AHPs are a distinct group of practitioners who apply their expertise to diagnose, treat and rehabilitate people of all ages across health, education and social care. They work with a range of technical and support staff to deliver direct care and provide rehabilitation, self-management, "enabling" and health improvement interventions. In Scotland, the AHP group includes arts therapists, dietitians, occupational therapists (OTs), orthoptists, podiatrists, prosthetists and orthotists, physiotherapists, radiographers (diagnostic and therapeutic) and speech and language therapists.

AHPs are the only professions expert in rehabilitation and enablement at the point of registration:^[2] their expertise in rehabilitation and enablement will be key to supporting the "20:20" Vision of everyone being able to live longer, healthier lives at home or in a homely setting and delivering on the NHS quality outcomes and the nationally agreed outcomes for integration of health and social care services.

Reablement is a key deliverable for local authorities, with the focus on maintaining independence and reducing reliance on home care support. A shift towards a more "enabling" ethos across a whole range of services can release capacity and facilitate provision of a more flexible, personalised service. This kind of shift needs to be replicated and integrated across sectors to reduce unnecessary duplication of assessments. AHPs, particularly local authority-based OTs, are core to defining, developing and reviewing person-centred goals for delivery by homecare teams: there is strong evidence that a partnership-based approach can reduce homecare hours by around 30% with true integration of community rehabilitation teams. We published examples of these kinds of innovative initiatives in the From Strength to Strength: Celebrating 10 Years of the Allied Health Professions in Scotland report (Scottish Government, 2011b).

AHP leadership at strategic and practice levels will play an essential role in transforming services to ensure they are fit for the future. Leaders' distinctive expertise in supporting an "enabling" ethos will need to be effectively positioned and strengthened to maximise the added value of the AHP workforce within an integrated health and social care system.

This National Delivery Plan calls for AHP leadership to be more visible and accountable at the highest levels within NHS boards and local authorities. Robust leadership from AHP directors and AHP service leaders will be required to bring about and sustain transformational service-level change. I will work with the Association of Directors of Social Work (ADSW) and the Chief Social Work Adviser to explore how the particular contribution and leadership of AHP services in local authorities can be strengthened to enable their contribution to be fully realised within their organisations.

AHP leadership and expertise are needed now more than ever to underpin strategic planning and innovative practice. Elevating AHP leadership influence and impact will be vital to the successful delivery of the quality ambitions for the NHS and the nationally agreed outcomes for integration of health and social care services, and to initiatives focused on reshaping care for older people and those with long-term conditions.

The strategic vision for the AHPs that has driven the development of this Delivery Plan is shown in the box below.

AHP strategic vision

AHPs will work increasingly to transform well-being and recovery, promoting prevention, earlier diagnosis and reducing unnecessary referrals and admissions to hospital and care by working "upstream" and supporting early years development to strengthen user and carer capabilities and assets in the communities they serve.

The National Delivery Plan for the Allied Health Professions in Scotland

This National Delivery Plan will help to maximise AHPs' contribution and effectiveness by:

• empowering strong professional leadership
• enabling the development of integrated teams across health and social care services to support continuous improvement
• developing innovative new models of care and fully utilising innovation in health technology
• creating added value beyond health and delivering excellent outcomes for people who use services, their families and carers
• providing effective, efficient solutions to the challenges of delivering national policies within a reducing financial envelope
• strengthening partnerships with the third and independent sectors and other agencies.

The Delivery Plan applies to all AHPs in Scotland, which will be particularly important as the new health and social care partnerships (HSCPs) emerge. It has evolved following a process of national consultation which provided strong support for the vision and direction of travel of the National Delivery Plan from a wide range of stakeholders. It was particularly encouraging to see the active engagement of the third sector in the consultation process, signalling their wish to develop strategic alliances with AHPs, working in partnership with us in common purpose.

The Delivery Plan focuses on the period 2012−2015 and provides a strategic platform for future AHP activity. We recognise that further support will be required to support implementation, and I will be working with AHP leads and others to develop appropriate resources for this purpose.

The Plan demonstrates the contribution AHPs can make and the impact they can have on the delivery of national policy, on the experiences of people who use services, their families and carers, and on outcomes across health and social care sectors. It makes explicit the alignment of AHP leadership and practice towards the delivery of the nationally agreed outcomes for integration of health and social care services and shows how better value can be extracted from AHP expertise from strategic to frontline levels, demonstrating the added value of preventative, upstream approaches in enabling people to live well and for as long as possible in their own homes and communities.

Fundamentally, the Delivery Plan defines the future vision for AHPs and the services they deliver. In doing this, it focuses specifically on a number of high-level outcomes that AHP services will effect, with key actions defined.

Moving forward together

AHPs strongly support the ADSW position statement on integration, which states that "a better outcome for individuals should become a common ethos". We recognise that early intervention, personalised care, power, choice and control for individuals, supporting and empowering communities and carers, seamless pathways of care, equitable access and an evidence-based approach to best value and preventative spend should be our priorities.

AHP directors and leaders will want to work closely with their social care colleagues and other professional leaders to ensure that these principles underpin local joint commissioning and planning of services, and that we strive to tackle inequalities and promote equality. In doing so, we will make significant progress towards building services around the needs of individuals and the communities we serve.

Jacqui Lunday, Chief Health Professions Officer, Scottish Government

ACTIONS

No.	Action by	Delivery by end of
1	NHS boards and local authorities will develop local implementation plans identifying how they intend to deliver and evidence the outcomes of the National Delivery Plan for the Allied Health Professions in Scotland.	2012
2	The Chief Health Professions Officer will lead annual reviews of progress against local implementation plans.	Ongoing, annually