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

5. Maximising workforce engagement and development

"The current context presents us with many practical and resource challenges, but with the right support and encouragement, health and social care professionals can work together to transform services and drive better outcomes for people who use services, their families and carers."
Peter Macleod, President of the Association of Directors of Social Work

Recent years have witnessed a slowing of growth in numbers of AHPs seen over the first decade of the 21^st century. As of March 2012, there were approximately 10 000 AHPs working in acute and primary care settings across NHSScotland. There were also around 500 AHP practitioners in social care, predominantly OTs who, despite comprising only 1% of the total social care workforce, addressed 35% of all adult referrals.

The AHP workforce has a significant role to play in the delivery of quality services that meet people's needs within modern health and social care services. In the context of health and social care integration, the issues facing the collective workforce have changed significantly since the publication of A Force for Improvement: the workforce response to Better Health, Better Care (Scottish Government, 2009).

The Cabinet Secretary for Health and Wellbeing and Cities Strategy has agreed to the development of an NHS workforce initiative in the summer of 2012. Work is currently underway to support the development of this 20:20 workforce vision and AHP directors need to engage fully with this initiative, as the AHP workforce can provide the solution to many of the challenges being faced by the NHS workforce and services as a whole. AHP directors will therefore wish to be involved with the three emerging work streams of the 20:20 workforce vision: leadership and capability; modernisation and capacity; and staff governance and engagement.

There are many instances in which AHPs have been pivotal to service redesign and the achievement of performance targets. This is particularly evident where AHP advanced practice has become integral to the development of sustainable and affordable multidisciplinary teams, with tasks shifting between professions and non-medical leadership of pathways of care emerging. Examples include AHP-led musculoskeletal services, radiographer reporting of diagnostic imaging, and podiatric surgery being undertaken by consultant podiatrists as part of an integrated orthopaedic team.

The AHP Workforce Planning Project was commissioned by the Chief Health Professions Officer to scope the AHP workforce in the community and primary care, to identify current workforce issues and to make recommendations about future workforce development needs. The key recommendations of the report include:

• the need to define appropriate AHP national waiting time targets
• AHPs should develop more partnership working with general practitioners to ensure early and direct access
• AHPs need to continue to develop capacity to match future service demands, including flexible working and the shift from acute to community
• the need to review and update Scottish Workforce Information Standard System (SWISS) AHP workforce data to increase the validity of workforce location of service delivery data.

The AHP workforce planning report will be published in late 2012.

It is now important to develop the AHP workforce at all levels to underpin sustainable and affordable services by strengthening advanced and consultant-level practice and introducing assistant and assistant practitioner roles to enhance the skill mix and ensure best use of AHP resources and expertise.

The Scottish Government will continue to work in partnership with NHS Education for Scotland (NES) to maximise educational opportunities for the AHP workforce. This will ensure that the skills of AHP staff working at all levels of the career framework are fully utilised through educational support that connects practice to policy. NES has produced a wide range of tools and supporting educational resources to enable AHPs to transform their leadership capabilities, skills base, skill mix and services.

All services need to be safe, effective and person centred and service redesign needs to involve both people who use services and, where possible, a health economic analysis as part of its evaluation. At the very least we must commit to demonstrating the impact that our improvement work delivers for both the individual user and the organisation before we begin to implement the changes. Such approaches will support evidence-based workforce planning for the future.

Work with NES to develop an AHP data platform to provide ongoing intelligence and analysis on the AHP workforce will continue. This will assist AHP directors to undertake annual workforce modelling, enabling the projection of AHP workforce requirements to meet service needs. This should be carried out with key stakeholders from higher education institutions, health and social care.

AHPs in Scotland have experienced significant review and restructuring of their services. AHP directors have worked in partnership with staff side and professional leaders to plan and deliver sustainable and affordable services for the future. This work needs to continue and develop further to identify AHPs' contribution to greater efficiency and productivity and explore how AHPs can ensure appropriate and flexible delivery of services beyond traditional patterns of working. This is particularly relevant to "key" or essential AHP services supporting diagnostics, treatment of at-risk individuals, preventing admission to hospital/rapid response, supporting patient flow and enabling timely and safe discharge from hospital.

The Releasing Time to Care Stocktake Report (Health Improvement Scotland, 2012) showed that AHPs are starting to implement and benefit from this improvement programme. Implementation of the recommendations in the report will support AHPs to further reduce waste, increase productivity and release time to improve the quality of services and meet increased demands.

In many parts of Scotland the shift of focus towards "upstream" community AHP service provision has progressed quickly and some NHS boards now report that over 50% of their staff are primarily providing interventions in a community setting. This is a tremendous achievement, but more needs to be done if AHPs are to make the desired impact in delivering better outcomes for people across health and social care.

For that reason, this National Delivery Plan seeks to move closer to a 70% community/30% acute care split and accelerate the pace of change towards the sustainable delivery of community AHP services. It has been recognised that this community focused approach needs to be balanced with the continued delivery of "key" and essential AHP services within the acute setting, which are essential to existing pathways of care, patient flow and also to overall efficiency and productivity.

AHP directors and AHP professional leaders will therefore need to explore and challenge models of practice that are at odds with this approach and develop supporting evidence around service impact.
They will also need to work closely with directors of strategic planning to develop a robust plan that will enable this shift towards "upstream" service delivery to take place in a measured way, appropriate to local need and context.

The Scottish Government will also work in partnership with AHP directors and the AHP Federation Scotland to develop a consensus statement on AHP quality standards in Scotland in 2013.

The robust evaluation of such initiatives, together with good financial data, will be key to demonstrating the impact of change and to supporting the roll out of best practice and best-value approaches at scale, where this is considered to be desirable.

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