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You’re in the right place, says AHP chief

We report from the chief health professions officer’s conference held in London earlier this month

Pressure on the healthcare system will result in a shortfall of around £15-20 billion over the next five or so years, NHS chief executive David Nicholson told delegates.

Drivers such as demographics, new technologies and National Institute for Health and Clinical Excellence recommendations were responsible for the situation, he said.

Despite making ‘the strongest case possible’ to government for more money, he said, it was clear that the cash was not there.

One option for dealing with the challenge was ‘slash and burn’, or arbitrary freezes, David Nicholson said but added: ‘We know that this does not work and affects different parts of the service in an unplanned and unmanaged way’.

A greater focus on quality, innovation, productivity and prevention – known as QIPP - would shape the way that allied health professionals restructured how care was delivered to patients, he concluded. ‘Look at the evidence for productivity gains, they are all at the interfaces between services. This is where AHPs are at their best.’

‘Transforming services in those areas are key to unlocking quality of services and reducing costs,’ David Nicholson added.

Emphasising that this could not be done from the top down, he said the critical issue was clinical leadership. ‘It requires people like you to accept the challenge’.

Karen Middleton, chief health professions officer at the Department of Health, reiterated the key conference message that AHPs were ‘the right people, in the right place, at the right time’.

‘My first year as CHPO was full of frustration,’ she told delegates. ‘AHPs lacked visibility and a strategic voice, were not organised and were ready to blame others for the predicament. My concern has always been that your service would be decommissioned due to its lack of visibility.’

However, she believed that over the last year, the spotlight had begun to shine on AHP services.

‘I am optimistic, despite David Nicholson’s scenarios,’ she said. ‘We have two options: bury our heads in the sand, and keep our fingers crossed, which would take us back to the victim mentality of two years ago, or we can take control now and start preparing.’

Both speakers referred to the prevention agenda as critical in saving money further down the care pathway. ‘Prevention is where the biggest gains can be had in terms of public health and the public purse,’ Karen Middleton said.

‘In the next few years you need to talk more and more about being first contact practitioners. We are going to use the “c” word – we are cheaper than some others as first contact practitioners.’

Karen Middleton further underlined her message of ‘the right people, in the right place, at the right time’ by highlighting the competency-based approach to AHP career development and the flexibility and responsiveness this brought.

Newly-appointed NHS national director for improvement and efficiency Jim Easton also urged delegates to look at quality and productivity. ‘We treat lots of people at the highest, most expensive end of care because we fail to treat people early enough,’ he said. ‘We have examples of excellence, but this is not evenly distributed, and we allow local variation to trump what

is right for patients.’

Delegates told to do it differently

Service improvement is not about trying harder to do more of the same, according to associate AHP service improvement project manager (children’s services) Dawn Smith. ‘It is not about improving productivity at the expense of quality,’ she said.

‘You, your partners and your service users are the experts in what improvement will look like locally,’ Dawn Smith added. ‘There is a lot of effort but it needs reorganising, supporting and harnessing.’

As part of the AHP improvement programme, AHPs could be looking at using self referral to offer more timely interventions, developing universal interventions and co-ordinating care planning with other disciplines, she told delegates. ‘This project

is ultimately for everyone.’

In a master class on the AHP Improvement Programme, Shelagh Morris, Department of Health allied health professions officer, and Sally Fowler Davies, AHP service improvement project manager, looked at the challenge of improving services for patients in the current economic climate.

Sally Fowler Davies ran through the new ‘Spotlight on AHP waiting times’ project. Ten strategic health authorities have been invited to work with their provider organisations and the DH in improving waiting times for AHP services.

Benita Powrie, head of children’s occupational therapy services in Leeds, explained how a waiting list ‘blitz’ followed by a move from individual assessment to an assessment clinic model, had slashed waiting lists.

The service had moved from 170 children waiting 18 weeks or more in June 2006, to eight children waiting no more than four weeks in June 2009.

Ditch the focus on hospitals,conference hears 

The healthcare model in the developed world is not sustainable in the face of the rising tide of chronic disease, delegates to the workshop ‘AHPs in a cold climate’ heard.

Financial health columnist Noel Plumridge, who was quoting chief medical officer Liam Donaldson, went on to ask: ‘So why do we keep focusing on the 20th century model of keeping making acute hospitals more efficient?’

He followed NHS chief executive David Nicholson’s lead in an earlier session in focusing on the AHP’s role in improving quality, innovation, productivity and prevention, or QIPP, looking at the example of extended hours for occupational therapy, radiography and physiotherapy as something many organisations are now considering or adopting.

However, he conceded that most examples so far were in acute hospital settings. ‘Without a match in community, primary and social care settings the impact will always be limited,’ he said.

Facilitating a round table discussion, workshop leaders Noel Plumridge and Karen Tanner, strategic health authority AHP lead for the South West, teased some key messages from the audience. They were: AHPs needed to work with partners; the rising number of joint appointments between health and social care at a high level was encouraging and  a major role for AHPs was to collect evidence. ‘Every contact is an opportunity’, was the buzz phrase.

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