Driving Improvement: Implementing Realising Potential

Introduction by the Chief Health Professions Officer

It is people who make the real difference in delivering change, and implementing policy to transform services relies on people who are engaged, motivated and informed.

Realising Potential has undoubtedly delivered positive impacts - as you will see from the accounts set out in this report - through the people who have embraced the agenda and led the work with energy and passion.

We've seen so many examples from all over Scotland of how Realising Potential is driving change, changing attitudes and creating improvements for users of services and AHPs. But I don't think any of that would have happened without the stake in the ground of integrated AHP leadership in mental health.

While the individual disciplines were ploughing their own furrow, we were no more than the sum of the parts. Now, the synergy of common purpose provides support and reinforcement that creates comprehensive, person-centred services.

The national Strategic Mental Health AHP Leads Group and AHP mental health leads in NHS boards have grown from strength to strength, validating the importance of leadership and the structures that create governance and accountability frameworks, shaping expectations of how things should be done and defining the responsibilities of each of the AHP disciplines in playing their part. This has been vital in sustaining the momentum around Realising Potential: it set a vision and direction of travel, but backed it up with the infrastructure that allowed the vision to be realised.

I see Realising Potential not only as a driver of improvement in mental health services, but also as a contributor to Scotland's wider policy agenda. Demographic, health, social and policy changes in Scotland require us to rethink our models of care. AHPs as Agents of Change in Health and Social Care - our national delivery plan for AHPs - embodies this. It takes some of the learning from Realising Potential and shows that what has worked well in mental health can be made to work in other sectors of health and social care.

The national delivery plan is helping leaders in Scotland understand AHPs' potential contribution to addressing existing health and social care pressures and challenges, showcasing their added value in preventative spend, cost-avoidance and improved outcomes and quality of life through asset-based approaches, partnership-development and new ways of working. Exciting developments in areas such as direct and self-referral to AHP services, a facility that has particular resonance in mental health, are now happening across Scotland as a result.

AHPs are now engaged in conversations that matter about how they can adopt these ways of working with confidence within complex health and social care systems. Essentially, it calls for a paradigm shift, from a position of "we need to do it all" to one in which we see ourselves as enablers and empowerers of others across a wide range of sectors. Brokering the alliances, partnerships and relationships that allow us to explore shared and common purpose with other groups and moving towards enabling and empowering have been big shifts since Realising Potential began.

AHPs are central to this paradigmatic shift. We support users of services to move away from dependency on professional inputs towards self-determination and empowerment. But the rising expectation of what AHPs can deliver makes it vital that we produce evidence of our impacts to ensure we remain core to future mental health services.

Credit: Care Inspectorate

AHPs in mental health are naturally comfortable with personal narrative and have shared service users' stories very effectively to demonstrate the impacts of their inputs. As Realising Potential has evolved, the Strategic Mental Health AHP Leads Group has begun to look more closely at how they can robustly evidence the outcomes.

That's very important. Otherwise, how will we know that change has led to improvement? How will we know that the work we are doing is having a positive impact on the health, well-being and quality of life of the people who use our services?

Data are being gathered through tools like MOHOST (the Model of Human Occupation Screening Tool) and individuals are reflecting how they attain the goals they set for themselves, but these data are not yet being aggregated. We have many stories and anecdotes of how Realising Potential has driven improvements, but we now need wider evidence of its impact.

In building on the achievements of Realising Potential, the next phase for AHPs in mental health should be about moving "upstream". AHPs have done a lot for people with pre-existing mental health conditions by improving the quality of their interventions and ways of working. Now we need to look at how we can utilise our expertise to support prevention and early interventions, working closer with general practice and primary care to enable people to remain in work and self-manage their stress and distress.

It's about realising our own assets across populations and communities. By increasing our efforts on upstream interventions and prevention, we'll reduce the energy we have to spend downstream.

Realising Potential has given us a really solid platform. It has enabled us to build the leadership structure, common purpose, will and skills to let us extend our influence across sectors and present a wider range of opportunities to people with existing mental health problems than has been possible previously. Now we have an opportunity to extend our reach even further to support people whose mental health challenges are just emerging.

Jacqui Lunday Johnstone
Chief Health Professions Officer
Scottish Government