At September 2011, there were approximately 10,000 AHPs working across Scotland in health and social care settings: 95% were in health care and the 546 practitioners in social care were occupational therapists (OTs) who, despite comprising only 1% of the total social care workforce, addressed 35% of all adult referrals.
Scotland's AHPs are already working at the leading edge of a paradigmatic shift towards enablement, promoting an asset-based approach, self-management, resilience and independent living and preventing over-reliance on hospitals and professional intervention.
AHPs are the only professions expert in rehabilitation at the point of registration. Their expertise in rehabilitation and enablement will be key to supporting the vision of health and social care integration and delivering on the National Outcome Framework.
Reducing inappropriate admissions and unnecessary care costs are key to affordable and sustainable services in the future. AHP interventions can significantly reduce unnecessary admissions to hospital and reduce dependency on care services, resulting in significant savings in health and social care.
As first-point-of-contact practitioners, AHPs also make a vital contribution to faster diagnostics and earlier interventions in primary care. They work closely with GPs and community teams to provide alternative pathways to secondary care referral and prevent admissions in areas such as falls prevention and musculoskeletal services.
AHP directors and leaders, working across health and social care, will be key to enhancing the AHP contribution to the joint planning and delivery of services, particularly for those with complex needs, long-term conditions, dementia and for children and young people.
The National AHP Delivery Plan will call for AHPs to be more visible, accountable and impact orientated. It will align the AHP focus on activity with the National Outcome Framework currently in development and will reflect the context of health and social care integration.
Better measurement and data collection will be required to support AHPs in contributing to the delivery of these national outcomes, to underpin improvement and to strengthen efficiency and productivity.
Modern and flexible working practices (including exploiting technology) and implementation of Releasing Time to Care will be key to efficient and effective service delivery built around the needs of people who use services and to realising capacity within existing resources.
COMMENTS
Scottish Government
AHP National Delivery Plan - A Consultation
The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Scottish Government’s call for comments on the AHP National Delivery Plan.
The College has the following general comments:
The College recognises that changing demographics and the resulting shift in pressures on health and social care services, combined with an extended period of financial restraint, mean that it is necessary to raise awareness of the challenges being faced.
The AHP National Delivery Plan outlines a vision for the development of allied health professionals such that they deliver a radically different role in future years. The document is very general in its approach dealing largely with issues such as leadership and impact of AHP services and lacks detail about specific resources; however it provides a useful starting point for discussion.
Section One
The first section deals with leadership of AHP services. It is clear that if the strategy outlined in the document is to succeed, AHP services need to be more visible and accessible to front line services. In the acute sector this could be achieved to some extent through enhanced inclusion within hospital management structures as well as at the level of individual departments. However, on a wider scale, primary and community care service infrastructure will need to develop substantially in order for the aims of this document to be realised.
Section Two
This section considers avoidable hospital admissions. Dedicated access to emergency admission services including both Accident and Emergency (A&E) and the Acute Medical Unit with joined up access to a team within the community (whether this is outreach from A&E or based within the community) will be essential in delivering the plan’s objectives in the future.
New infrastructure and substantial resources will need to be put in place in order to be able to rapidly respond to patient need and support a successful re-establishment of the patient within the community. For this to be of genuine value it would need to be available in the out of hours period (particularly weekends). The document makes no mention of out of hours provision.
The College is concerned that a damaging misperception is emerging in Scotland regarding the level of inappropriate admissions to hospital, and that two unproven principles are now generally accepted: that care of patients outwith acute hospitals will be at least as safe and effective as hospital care, and that it will be better value for money.
Large scale, widespread pilot programmes are needed to examine the potential of all strategies, including the AHP National Delivery Plan, to move acute care services into the community in Scotland: this is especially important given the remote and rural nature of many of our communities.
Although the role of AHPs in helping to prevent admission to hospital could be developed, it is often the case that inpatient medical care is required in the initial stages of patient assessment. Early AHP intervention may be more important in facilitating early discharge or in maximising the use of the community bed base.
Section Three
The document considers a number of aspects of interaction with primary care. It would be beneficial for a strategy to be developed across primary care to widen access to simple aids and modifications to professions across the health and social care system.
Section Four
Section four considers the balance of staffing resource across the social care section. The document indicates that AHPs in the social care workforce in particular have been operating under challenging financial circumstances. In order for the objectives within this document to be achieved, there are significant resource implications as primary and community care service infrastructure will need to develop substantially.
Section Five
Section five considers quality of care. The expansion of the role of AHPs may have much to offer here if sufficient progress is made in primary and community care service infrastructure. For example, consistent access to physiotherapy can greatly enhance quality of care within the emergency services as well as critical care and chest medicine.