Onwards and upwards

Scotland’s cabinet secretary for health and wellbeing Nicola Sturgeon tells Frontline how she sees the future role of the allied health professional

What do you think of the contribution that allied health professionals make to the health service and how do you see their role developing? Better Health, Better Care (the Scottish government’s action plan) highlights the need to shift the balance of care into community settings to support those with long-term conditions. Physiotherapists, alongside other AHPs, will have a key role in contributing to this change. A range of policies, initiatives and targets are in place that will provide opportunities for AHPs to help shape the delivery of services. I am looking forward to seeing professional leadership in identifying solutions to reduce hospital admissions and manage waiting times, promoting anticipatory care and better patient self management. What aspects of the Darzi review in England do you value? Are there any recommendations you fundamentally oppose? In several respects, the Darzi proposals reflect what is already happening in Scotland. For example, the role of the proposed non-departmental public body, Medical Education England, very closely resembles that of NHS Education for Scotland, which was established in 2002. Since you took up your post, has your view of the role of AHPs and their contribution to the health service changed? I don’t think there have been any surprises but I am always encouraged when I hear of new developments driven forward by the professions. The NHS 24 physiotherapy triage project is a good example, aiming to improve waiting times for physiotherapy and the patient journey, and make the best use of technology. Innovative projects like this demonstrate how the professions are responding to new opportunities and looking for ways to make their services more accessible. The Scottish government has identified areas of public health, such as fitness and combating obesity, as key priorities. Specifically, what part do physiotherapists have to play in delivering this? Physiotherapy expertise in physical fitness and exercise is well recognised, not only in supporting individual patients, but also in training and supporting other staff promoting healthy lifestyles. Physiotherapists’ encounters with patients offer them an ideal opportunity to take action to improve patients’ health beyond simply administering the immediate treatment.  The CSP has welcomed the Scottish government’s commitment to implement the adult rehabilitation framework in every health board. How important is it to shift the balance of care and how does physiotherapy feature in that agenda?  The adult rehabilitation framework describes changes at different levels across health and social care, all of which are intended to provide care that is quicker, more personal and closer to home. Physiotherapists have a key part to play in delivering primary care services and are already doing significant work to provide advice and guidance to patients as quickly as possible, for example, the NHS Lothian physiotherapy knee website and NHS 24 triage. Better Health, Better Care mentions the role of the rehabilitation co-ordinator to support self care. How this will work and what background would be ideal for this role? The role of the rehabilitation co-ordinators is to lead multi-agency collaborations on the local implementation of the Delivery Framework for Adult Rehabilitation. They will be responsible for helping to draw up long-term strategic plans across social work and health services, as well as ensuring that service users are central to services. This will require high-level leadership and influencing skills, as well as a detailed knowledge of health and social care services. I have no doubt that there are many AHPs with these skills. Why did the Scottish government decide against an 18-week wait target for physiotherapy? Are there any plans to collect figures on physiotherapy waiting times? Let me be clear that the Scottish government has not decided against an 18-week target for physiotherapy. The 18 weeks referral to treatment standard will take effect across Scotland from December 2011. AHPs are already included in delivering patient care and treatment, which has cut waiting times for patients across Scotland, and this will continue through our 18 weeks RTT programme. The RTT standard will apply to all referrals to consultant-led services, through the patient’s pathway to the appropriate treatment. In many specialties treatment will include triage, assessment and therapeutic interventions by AHPs in both hospital and community settings. What progress has been made on workforce planning for AHPs? AHP workforce planning is embedded within the arrangements for workforce planning across NHS Scotland. The Scottish government has also provided funding for three regional AHP advisers who will work closely with NHS boards on planning and developing skills and workforce levels. We have also focused on creating more opportunities for junior staff, and a range of national and local initiatives are in place. These include:
  • an NHS Scotland physiotherapy solutions group, led by NHS Education for Scotland, which has been tasked with developing and supporting the implementation of short-, medium- and long-term solutions.
  • a development programme, Flying Start, to enable newly qualified practitioners to work in primary care and community settings
  • a bank to support flexible employment and mechanisms to enable graduates not yet in employment to maintain their skills and readiness for work.
There is concern that much of the improvement in employment for newly qualified physios is as a result of new temporary posts, particularly in Scotland. What more needs to be done? Encouragingly there has been an improvement in timescales for physiotherapy graduates gaining posts in NHS Scotland. It is important that graduates are aware of local and national initiatives and how to access recruitment resources. A Ready4Work website is being launched to provide information and advice. The importance of maintaining graduates’ confidence and skills while they seek employment is well recognised and the success of a clinical skills education session in NHS Tayside is being followed up with more sessions. We also need to build on the success of the recent Flying Start in primary care pilot and the move for graduate staff to contribute to service delivery in community healthcare settings.

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