Equity and Excellence: Liberating the NHS Overview response to the White Paper 5 th October 2010 Introduction The Allied Health Professions Federation (AHPF) is a federation of 12 Allied Health professional bodies representing over 130,000 professional members across the UK, of whom 84,000 work in the NHS in England. (See Appendix for full list of member organisations) The purpose of the AHPF is to promote the value of AHPs and integrated professional working. The AHPF believes that AHPs are an essential part of the health and care workforce who are well placed to deliver high quality care to patients, clients and service users across the whole of the health and social care sectors. The AHPF is uniquely placed to draw on the expertise and experience within the professional bodies in order to inform and engage with consultations, issues and opportunities impacting upon Allied Health Professionals across the health and social care sectors. This document provides comment where the White Paper Equity and Excellence: Liberating the NHS impacts upon or has the potential to impact upon Allied Health Professionals (AHPs) and the service and care that they offer to patients, clients, carers and the public. It provides an overview to the White Paper as a whole, with detailed referenced comments to follow from the Allied Health Professions Federation (AHPF) in the specific consultation documents. The overview comment is made against the White Paper Executive Summary section headings. The document also poses some questions that we believe need to be considered further. Specific uni-professional comment, where appropriate, will also be provided in separate documents by the individual professional bodies within the AHPF. Principles and intent The AHPF is very pleased to see that the White Paper: Equity and Excellence, Liberating the NHS, upholds the guiding principles of the NHS; free at the point of use and available to everyone based on need not ability to pay. Allied Health Professions Federation, 2 White Hart Yard, London, SE1 1NX
The AHPF is also pleased to see that the intent is to drive up quality in a financially sustainable way. Patient focused services, working to clear clinical outcomes and delivered by empowered specialist clinicians, such as doctors, nurses and AHPs, have to be at the heart of a healthy society, where the public take responsibility for their own well being. Comment against the executive summary in Equity and Excellence: Liberating the NHS We will put patients at the heart of the NHS, through an information revolution and greater choice and control. The commitment that patients will be involved in clinical decision making, together with their specialist clinicians, may or may not result in a financially sustainable approach to care, even though it will clearly improve quality from a patient experience perspective. This is because of the level of patient knowledge required to ensure that respect and recognition is given where due is often missing and there is the risk that patients do not understand the expertise on offer from AHPs as the most appropriate clinician to deliver their care. Therefore the very real savings that AHPs offer under the framework of a QIPP based approach to service delivery risk being lost or underutilised. How will patients and GPs gain sufficient knowledge fast enough about the whole spectrum of care opportunities, including the range of support, care and treatment provided by AHPs in order to benefit from these changes? In order to enhance choice, performance data needs to be available to reflect the impact upon clinical outcomes achieved by AHPs working in the community and across departmental boundaries in education and social care. How will information be gathered to reflect the value of AHPs across whole care pathways and in the community? To achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and the quality standards that deliver them. The Government s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all Outcome measurements and standards need to apply across the whole of care pathways in order to reflect the positive impact that AHPs deliver in long term care, patients with multiple conditions and those who have conditions that do not require GP intervention. The Government s reforms will empower professionals and providers, giving them more autonomy and, in return, making them more accountable for the results they 2 of 6
achieve, accountable to patients through choice and accountable to the public at local level Commissioning based on GP Consortia needs to take a multi-disciplinary approach with AHP input to ensure that local commissioning is intelligent and reflects total patient and carer needs. Many AHPs already work in local authorities and can provide an invaluable link as local health and social care becomes more integrated. This reinforces the benefit to be obtained by including AHPs in the commissioning process, both at a local level and with the national NHS Commissioning Board. How will AHP services that currently sit completely or partly within local authorities be incorporated into the health based commissioning model in a way that maximises the expertise that they bring into the system? The AHPF believes that the move to creating the largest social enterprise sector in the world and increasing the freedoms of foundation trusts has inherent concerns, as well as opportunities. Like all organisations that represent staff, there is a concern that the new employer framework might erode, rather than maintain and enhance staff rights and well being. The AHPF also has major concerns as to how a more pluralistic view of provision supports the development and sustainability of the future workforce, especially recognising the relatively low overall numbers of some AHP specialist clinicians. The AHPF recognises that this creates an opportunity for AHP led social enterprises or employee led services that provide a wider range of quality enhancing services. How will new social enterprises be expected to demonstrate social value? How will social enterprises and foundation trusts be held to the NHS Constitution in order to support the rights and well being of staff? How will workforce planning and development be maintained? We recognise that there will be a separate White Paper published on healthcare education. Many AHPs provide a service that crosses between the arbitrary boundary between providing a health service and a public health service. With a separate ring fenced public health budget, this has the potential to lead to confusion for both funders and the public. The AHPF applauds the intent to create local health and wellbeing boards. However, once again, this raises the concern that those appointed to such a board will not understand or appreciate the full potential of AHP led services to deliver the most appropriate local health outcomes. How will health and wellbeing boards be developed and supplied with information to optimise their impact upon local health needs? 3 of 6
The NHS will need to achieve unprecedented efficiency gains, with savings reinvested in front-line services, to meet the current financial challenge and the future costs of demographic and technological change While recognising the need to become financially sustainable, there are a number of concerns in how efficiency gains, often interpreted too simply as cost cutting, might be implemented. Changes in management structures should not become an exercise in reducing higher level professional grades that actually form part of the integral front line service. While supporting AHP leadership of multi-disciplinary teams, it is important to maintain the breadth of higher grade professional capability across the range of AHP specialist clinical areas in order to offer the optimum patient care. AHPs can be at the heart of a QIPP based approach to delivering patient services and this needs to be sufficiently embedded to allow AHP led efficiencies to continue in the GP Consortia commissioning model. There is a risk that for some services a doctor or nurse focused service will be commissioned because it is the most understood and not because it provides the best quality or cost effectiveness. It will be important to ensure that the wider health care economy is considered such as the role of AHPs in reablement and the return to work agenda with the attendant overall impact upon public sector finance. Major structural change, such as the abolition of the SHAs, has the potential to reduce the sharing of best practice and make it harder to realise the economies of scale that are important with some of the smaller AHP specialities, such as Orthoptics. How will commissioning and development be co-ordinated across GP Consortia to enable optimum use of some of the more specialist AHP services? In conclusion the AHPF fully endorses the following taken from The White Paper supplementary management bulletin, 19 th July 2010, Gateway reference number 14577: The White Paper outlines plans to put Allied Health Professionals at the heart of an integrated and responsive NHS, which is more focused on what really matters better outcomes for patients and their families. AHPs will receive more freedom to innovate they are often the best source of new ideas to improve productivity and deliver better outcomes for patients and their families. AHPs will get a bigger stake in our respective organisations, and a greater chance to influence how they are run. AHPs will play a leading role whether they are based in primary or secondary care settings to cut avoidable readmissions, by working with colleagues across the system to make sure patients get the right support before, during and after discharge. 4 of 6
GP-led consortia will be required to work closely with AHPs, as they take a lead in deciding how money is spent to create a more joined-up NHS. Success shouldn t be measured purely by speedy access to services, but by the true outcome whether the person gets back to optimal function, whether they are pain free and back at work. This means placing greater trust in the judgment of AHPs and empowering them as professionals. 5 of 6
Appendix The Allied Health Professions Federation (AHPF) member organisations are: The Society of Chiropodists and Podiatrists (SCP) The Society and College of Radiographers (SCoR) The Royal College of Speech and Language Therapists (RCSLT) The College of Paramedics (COP) The Chartered Society of Physiotherapy (CSP) The British Association of Occupational Therapists/ College of Occupational Therapists (BAOT, COT) The British and Irish Orthoptic Society (BIOS) The British Association of Prosthetists and Orthotists (BAPO) The British Dietetic Association (BDA) The British Association of Drama Therapists (BADT) The British Association of Art Therapists (BAAT) The Association of Professional Music Therapists (APMT) Contact details For further information contact Vicky Rosser: vicky.rosser@ahpf.org.uk Telephone 020 7378 3022 Or visit the website www.ahpf@org.uk 6 of 6