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Leading edge: influencing NHS service design

Everyone can play their part in influencing the design of NHS services in their area, prominent physiotherapists tell Daniel Allen.

Leading edge: inflencing NHS service design

How can you influence service design in your area?

UK health care is battling challenges that just keep coming: hospital-centric services that don’t join up; rising demand; an ageing population; a focus on illness above prevention.
 
The Five Year Forward View, a vision for the future published in 2014, was NHS England’s attempt to steer a way through the tangle. Then in December came planning guidance laying out national priorities and goals for local services http://bit.ly/1S6GcWV. This calls on those services to create their own ‘ambitious blueprints’ for implementing the Forward View. Success, it says, will depend on ‘open, engaging and iterative’ processes that harness the energies of clinicians, patients, carers and community partners.
 
But what does that actually mean for physiotherapy staff? How can they engage with service transformation – and what are the risks if they don’t?
 
CSP head of practice Steve Tolan says if clinicians spurn opportunities to shape the changes going on around them the consequences for the profession could be far-reaching. ‘Where physiotherapists don’t take part, the best decisions about how physiotherapy can be designed and delivered will be made by others,’ he says. ‘But they may need to put themselves in a position where they can inform change and not necessarily wait to be asked.’
 
And the best way to do that, he suggests, is to start asking questions.
 
All round the UK, the buzzword is transformation. Integrated models of care are emerging and in some areas are well advanced. In Wales, for example, Together for Health, which put forward plans for an integrated 24/7 system, was published in 2011. In Northern Ireland, Transforming Your Care made 99 proposals for change across health and social care. And in England 50 vanguards, born out of the Forward View, are now out of the blocks. 
 
Their aim is to bring together local partners to develop co-ordinated service models. Physios are actively involved in some, less so in others, but crucially the profession is well represented in NHS England’s new models of care team. 
 

‘Genius’ ideas

Physiotherapist Beverley Harden is associate director of education and quality at Health Education England and, since December, a clinical associate in the care models team. ‘Our role is to work alongside clinicians to support them to deliver the transformation necessary to ensure services keep pace with demand,’ Ms Harden says. 
 
It’s early days but she already has a sense of what lies ahead. ‘A huge part of our work will be helping the whole system move forward as one rather than a chosen few moving faster than the rest.’
 
Much of the role will be coaching people to overcome barriers to better care, she says. Building networks will also be key. ‘A lot of this is getting good practice rolled out.’ She does, however, sound a note of caution. ‘We’re a vocal group normally but the allied health profession (AHP) voice is very quiet. 
 
I would like to hear more around what we can offer.’ 
 
Helen Baxter, another clinical associate in the new models of care team and a physiotherapist by background, agrees that physio staff must get involved. A measure of success in the drive to develop more effective ways of delivering services will be physiotherapists becoming key partners in all the vanguards. ‘We have so much to offer,’ she says. 
 
But is ‘getting involved’ a role reserved for managers? Not at all, Ms Baxter says. 
 
‘It applies wherever you are in the hierarchy.’ Ms Harden agrees. ‘Everyone, from the therapy assistant upwards, sees life through a different lens. Anybody could have the genius idea that unlocks a care model and turns it into something that really delivers.’
 

Fighting  corners

CSP vice-president Sue Rees, deputy head of physiotherapy services with Cardiff and Vale University Health Board, says routes and channels are in place in Wales for frontline staff to play a part in service transformation. ‘It’s part of their job to contribute on a national level but sometimes that gets scuppered by having to meet operational targets or challenges. The potential is there, but it remains potential if you don’t deliver.’
 
Sharing good practice is one way in which frontline staff can take a lead. ‘That’s something in Wales we really have to do,’ Ms Rees says. ‘The pressures are tough but we still need to share what we do and make sure everybody hears about it.’
 
Similarly in Scotland, which is driving towards integrated care, the means are there to engage with service change and lead the way by sharing good practice, says Ann Ross, chief AHP at NHS Greater Glasgow and Clyde and chair of the CSP’s Leaders and Managers of Physiotherapy Services (LaMPS) CSP professional  network.
 
‘But we need to tell staff who are trying to make changes that they have to develop resilience and be prepared to get knocked back but not give up.’
 
She adds: ‘It’s not just managers who need to be fighting corners, it’s every one of us. You may be the one best placed to lead because you can see things that can be changed without a lot of investment.’ fl
 

Leading the way

CSP head of practice Steve Tolan says understanding the way your service works is key to engaging with and influencing change.
 
He says
 
  • talk to your manager about how you can be involved
  • consider the context and structure of your service
  • find time to learn about key policy drivers
  • suggest ideas appropriate to the proposed models of care
  • consider who you need to influence. ‘Depending on your profile and fit within the service, that can either be you influencing directly, or it could be you feeding into your manager, your team or your team lead,’ Mr Tolan adds.
 

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