Ready to Act: interim report on implementation and recommendations

1. Introduction

“We are arriving at a place that doesn’t exist yet!’’
AHP CYP Lead

Ready to Act (Scottish Government, 2016a) is the national transformational framework supporting the development of an allied health professions' (AHP) children and young people's (CYP) community across Scotland. Its focus is on promoting early intervention and prevention and enhancing accessibility of services for stakeholders, CYP, their parents and carers, and it is responsive to the wellbeing needs of CYP.

Two years on from the launch of Ready to Act, Scotland's AHP CYP services have embraced its ethos, committing to local implementation of the five ambitions for transformational change, embedding the principles of improvement methodology into practice to deliver effective and efficient services, and placing CYP's wellbeing at the heart of practice.

This whole-systems transformational change project tells the story of change from populations, across provision, to practice and evidencing impact, strongly linked to key policy and legislation in Scotland.

“We have had freedom to act and think outside the box, to show initiative, make connections and influence.”
AHP CYP Lead

We have established an effective communication network that engages practitioners in change across health, social care, education and the third sector, recognising the critical place of Getting it Right for Every Child (GIRFEC), the Health and Social Care Delivery Plan (Scottish Government, 2016b) and Primary Care Transformation (Scottish Government, 2017a), and embedding Ready to Act in local children's services planning where possible.

We have collaborated at strategic and practice levels to embed the critical role of AHPs in CYP services in supporting delivery to the literacy and numeracy challenge in Scotland and, through a commitment to a public health programme, are working to interrupt the intergenerational cycle of poverty and deprivation (see: Annex A. Collaborative CYP Framework) with significant shifts in the culture of practice towards early intervention and prevention through a tiered model of service delivery (see: Annex B. Tiered Model of Service Delivery).

Recognition of the critical place of data and its analysis has been central to the improvement activity in AHP CYP services, with an emphasis on leads' understanding of local needs driving best use of resources and ensuring CYP-centred outcomes that are linked to wellbeing. We have piloted the Balanced System® Better Communication outcomes-based framework for the commissioning and delivery of therapy and other services for CYP (Better Communication CIC, 2018) in four NHS boards across speech and language therapy, occupational therapy, physiotherapy and dietetics, with the evaluation of this whole-systems approach published in 2018.

AHP CYP communities in all of Scotland's NHS boards have co-created shared drivers for implementation of Ready to Act ambitions (see: Annex C. Example Driver: National CYP Occupational Therapy Professional Leads Group Driver), with clear deliverables supporting transformational change to improve accessibility to expertise at the most appropriate time and place to meet needs (see Box 1).

Box 1. Examples of impact from transformational change – NHS Fife

Wellbeing questionnaires

Wellbeing questionnaires were co-produced with service users as a vehicle for facilitating wider wellbeing conversations and assessments. The process includes a wellbeing website for further self-assessment. Feedback to date from service users and clinicians has been good.

Access: occupational therapy

CYP, their families and others who are concerned can access the occupational therapy service directly. Within two weeks of an initial request for assistance being made, their concerns and what matters to them are discussed and listened to. The response is appropriate to the help required to address wellbeing concerns and enable self-management and empowerment.

Access: podiatry

The introduction of request for assistance removes all access criteria, thereby enabling any person who is concerned about a child's or young person's foot health to have a telephone conversation with a podiatrist and, if necessary, a face-to-face appointment as follow up. This has been piloted in one clinic and will be rolled out over central Fife prior to becoming pan-Fife. All those who have contacted the service have evaluated it well, both in terms of advice given and convenience.

With thanks to the CYP, parents and families, and AHP CYP leads and practitioners of Fife for sharing their stories of implementation of Ready to Act.

The adoption of a national approach to requests for help/assistance represents a critical change process within AHP CYP services, with seven boards undertaking effective conversations training in 2016/2017 (supported in part by AHP Fellowship funding) and another two providing training in 2017/2018 through board funding. This change in thinking at the point of request is already having a significant impact on the positive destinations of CYP in Scotland (see: Annex D. Request for Assistance Improvement Project, Occupational Therapy, NHS Lothian; Annex E. NHS Fife CYP Service Journey, 2007–2017; and Box 1).

The Scottish Government and the Royal College of Speech & Language Therapists (RCSLT) are taking forward the outcomes of the two communication summits held in Scotland in 2016 and 2017, with the emergent cross-agency and cross-profession recommendations relating to speech, language and communication due for publication in spring 2018.

Ready to Act sits within the Starting Well programme for the Active and Independent Living Programme (AILP) (Scottish Government, 2017b), with key commitments to delivery of the Eat Well and Move More programmes for CYP in Scotland. In collaboration with key stakeholders at strategic and practice levels, we are building on the excellent activity already underway to address the obesity epidemic in Scotland's CYP and increase their physicality.

As we progress into the next phase of the transformational CYP programme to 2020, we will focus on the national workstreams, addressing the emerging policy agenda with key deliverables for all AHPs working with CYP in Scotland to ensure effective partnerships and collaborative practice focused on health and wellbeing outcomes is CYP's right, and not just "a nice thing for AHPs to do". This will require a commitment to true partnership-working built on a solid foundation of collaboration and positive relationships, with a focus on the voice of CYP at the centre of every decision we make, every action we take and every outcome we set.

“The shared flexible ambitions of Ready to Act, with the child at the centre, have given space to co-create and innovate.”
AHP CYP Lead

The Starting Well AILP programme is the beginning of a journey in taking a whole-life approach to the health and wellbeing of the people of Scotland. By putting in place creative, innovative and evidence-informed approaches, AHPs in CYP services will demonstrate the critical place they have in achieving real change for the CYP of Scotland.