Ready to Act: interim report on implementation and recommendations

2. What did we achieve?

“Does that mean we can use the advice you have given us for [X] with other children before we contact you? That is great!”
Teacher

The creation of an AHP community is one of the most significant outcomes of the transformational CYP programme so far. This community has a dynamic, creative and intuitive view of the world and a commitment to challenge complexity in CYP service development and delivery (Plsek and Greenhalgh, 2001).

“There is power in feeling part of an AHP CYP community.”
AHP CYP Lead

We have adopted a complexity theory approach based on the understanding that health and social care systems are interconnected and form a landscape that is continuously changing (Best et al., 2012).

Following the launch event in 2016, each NHS board area held an AHP CYP Ready to Act event with stakeholders and parents to discuss how best to translate the ambitions of Ready to Act to the local context to meet the needs of local populations. Since January 2016, the AHP CYP AILP Reference Group (Appendix 1) has been working to develop a realistic and effective approach to implementing the National Framework in response to the emerging CYP policy and legislative landscape (Craig, 2017 (unpublished)).

“We are doing realistic medicine. We have lots of synergy with other policy areas across CYP and adults.”
AHP CYP Lead

AHP CYP board leads have been integral to the success of our transformational change, and we recognise the need to commit to supporting their role at board level.

“The AHP CYP Leads have become a strong team and we can often take more informed risks whilst doing no harm.’’
AHP CYP Lead

The focus of improvement planning and delivery of impact outcomes has focused on a number of key areas.

• Shifting the practice culture to a focus on early intervention and prevention, with a demonstrable increase in the availability of targeted interventions supported by AHP expertise across Scotland, including Eat Well, Play Well, Learn Well (NHS Tayside in 2017), Inclusive Gym (NHS Tayside in 2017), Nursery Narrative (NHS Forth Valley in 2017) and drop-in clinics (NHS Lanarkshire), to name but a few. This commitment to the value and upstream benefits of AHP CYP targeted activity has resulted in some initial evidence of changes in patterns of access to assessment and intervention (see: Annex E. NHS Fife CYP Service Journey, 2007–2017).
• Changing the conversation at the point of request (see Box 2) will be an ongoing workstream across the CYP programme (in collaboration with NHS Education for Scotland (NES)), with pilots proposed in adult services in 2018.This is a major culture shift in practice at the point of request for help (referral), impacting on the nature of conversation with the person making the request and, critically, changing the focus of activity from the CYP to the person requesting help on their behalf. A key performance indicator (KPI) for the CYP programme will be evidence of a shift in positive outcomes from the point of request for CYP and those seeking support from AHPs across four outcomes (see: Annex F. Request for Assistance /Help Decision-making).
• This commitment requires recognition of the place of data collection and analysis, the recognition of improvement methodology to underpin change activity and the need for the movement of resources from specialist individual caseload activity to targeted and universal. This is further evidenced by the need to address the impact of adverse childhood experiences on long-term health, and social and educational outcomes for CYP in Scotland through a robust public health programme of activity in collaboration with partners in CYP services and communities.

Box 2. Changing the conversation

What matters to you – service users:

• for my daughter to be happy, safe and supported in school (parent)
• she just wants to be accepted (parent)
• I want to be able to understand what's going on for him (parent)
• I want to find the best tools to help him with his future life (parent)
• I want to be able to run faster (child).

Clinicians' thoughts on impact of changing the conversation

• It helped me decide where to go from here and what would best help the family move forward.
• It gave me the child's perspective on "what matters", which was very different to what matters to mum at the moment.
• It contributed to the picture that we are not the right service for this family right now.
• I definitely think it helps the parents to feel listened to – even if the most important thing to them is nothing to do with our role, it is important for them to know that is what we care about most too and we can signpost them to the best help.

The emphasis on the need to support all change through local improvement projects and data has resulted in emerging impact improvement data evidencing contributions to attainment projects locally.

The benefit of improved access, with reassurance, signposting and alignment of our learning and targeted interventions to the universal health visiting pathway, has the potential to result in increases in self-referrals, self-reliance and resilience, with reductions in the need for specialist services referral for GPs; an example is the Fluctuating Growth Pathway of the dietetic services of the Royal Hospital for Children in NHS Greater Glasgow & Clyde.

“All I wanted was to speak to a therapist and have strategies to use. This time I've not needed to wait 12+ weeks for it!”
Parent

The impact of reassurance as an outcome of initial conversations plus our commitment to self-referral should impact on attendance at GP surgeries. Evaluation of these outcomes will be a critical part of our work going forward.

We have worked to ensure that the crucial place of effective compassionate relationships in teams is central to effective change through funding and piloting the Important to Me resource, supported by AHP Fellowship funding from NES.

There has been significant partnership-working and collaboration across AHP CYP services and education in closing the attainment gap. The importance of speech, language and communication, fine motor skills, physicality and nutrition in supporting learning outcomes has been recognised, with data to evidence this impact emerging.

To support the sharing of best practice and information across Scotland's AHP CYP community, we have worked with Knowledge Services to establish a separate AHP CYP Community of Practice (COP),^[1] with each board and AHP CYP Professional Network having access to an individual page. The COP will act as a hub for all activity, resource-sharing, information and discussion relating to AHP CYP in Scotland.