Having physiotherapists in senior roles can have a ‘transformational’ effect on NHS reform according to a new report– but how to get into positions of influence? Louise Hunt reports.
A progressive report commissioned by some of England’s most senior nurses and Allied Health Professionals (AHPs), published by NHS Improvement last month, highlights a need for investment in senior AHP leadership to achieve transformational change in health and social care.
‘Leadership of allied health professionals: What exists and what matters’ was commissioned by NHS Improvement. It aims to provide a better understanding of the current leadership arrangements of AHPs in trusts in England and makes recommendations for change. It concludes that ‘now is the time to harness the potential of AHP leadership, but opportunities to do so are often being missed’.
This quote from the evaluation report encapsulates the issues: ‘Leadership for AHPs across the organisation is patchy and relies heavily on senior positions which are all part-time. It also relies on having a director of nursing who has an understanding of AHPs, as there is no direct route to the board. The need for AHP leadership generally is not well understood nor is the need for representation of AHPs in operational matters.’
‘The report was a very welcome piece of work,’ said physiotherapist Rosalind Campbell, NHS Improvement AHP professional lead, workforce and productivity. ‘I am in a national role leading on AHP workforce productivity and I was very interested to see whether there was any link between trusts that had strong strategic AHP leadership and the productivity, efficiency and quality of their services.’
‘AHPs into action’ a previous NHS Improvement report published in January 2017, outlined the specific transformative potential of AHPs in health, care and wellbeing in England, recognising that ‘AHPs can lead change’. Their diversity of skills covering 14 professions and breadth of practice experience, often bridging acute, community, and mental health made them ‘vital at a senior decision-making level’.
However, Ms Campbell told Frontline this transformational potential is not being fully realised.
‘Anecdotally, it feels difficult to implement national strategies and recommendations at scale and pace, perhaps because of the inconsistent AHP leadership that we see across NHS trusts. I’m hoping this report provides an opportunity for trusts to review their own arrangements against the findings of this report.’
There are currently no direct career paths to a strategic AHP leadership role.
Physiotherapist Rachel McKeown, who contributed to the report’s steering committee, last year became one of the country’s first directors of AHPs and her own career path into this post exemplifies the issues.
Ms McKeown says she got as far as she could in senior AHP roles in community and mental health but found that she had to step outside AHPs into senior operational and transformational roles, before a non-executive director of AHP post came up at Midlands Partnership NHS trust.
‘I never thought this would happen for me. It was a career ambition, so I was delighted to be selected,’ she said.
The latest report highlights that the key to AHPs realising their transformational potential is to have more senior AHP leadership at strategic level. The report does not contain targets for achieving this, but Ms KcKeown said it should be seen as the start of a ‘conversation within organisations’.
She explained that because there are no roles for AHPs at executive board level their ability to influence is most often through a director of nursing.
‘That has created professional frustration at times. However, the joint work on this report shows how AHPs are valued by directors of nursing.
‘We can show it’s really time now to approach directors of nursing to say ‘we can provide a solution and we are looking at leadership as a group and we can help you by working together,’ she said.
There is AHP leadership in most organisations now, she added, but the posts with most ability to influence quality and improvement were on bandings on similar lines to a deputy director of nursing.
‘In less strategic roles, they might be the most senior AHP in the organisation, but they might have an element of clinical caseload or they have operational management as well. There will be more layers between them and the board. So, therefore, the report stated their voices are less likely to be heard than a higher banded post that often reports to an executive director.’
Asked whether the readiness exists among AHPs to step into these roles, she replied: ‘I think there’s a lot of passion among senior AHPs for leadership, but we need to make sure we grasp opportunities and put ourselves out there.
‘In my experience, I had to move out of AHPs to broaden my experience, so it’s not just about lobbying for more posts. We have to make sure we are continuing to learn.’
Priya Dasoju, CSP’s leadership development project lead, agreed, saying the report ‘completely supported the work of our AHP leadership programme’.
The CSP launched the first AHP leadership course aimed at physios two years ago and is now seeking to get it accredited and opened out to other AHPs.
She added: ‘This is an initial report and NHS Improvement will build on this work with trusts and we hope this will encourage more AHP leaders.
‘Physios need to recognise that they have transferable skills and developing their leadership skills puts them in an amazing position.’
For more information on the CSP’s AHP leadership programme, visit our website here.
Trusts looking to strengthen AHP leadership should consider:
- Appointing a senior AHP with a strategic focus: Consider constructing the postholder’s portfolio to align AHP skills with the trusts’ priorities
- Harnessing the AHP workforce’s potential for system redesign: identify the AHP workforce’s transformative potential in implementing new care pathways
- Demonstrating AHPs’ value: These roles can enable talent management and succession planning, with AHPs actively engaged in trust and system-wide initiatives
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