6. Driving improvement: delivering sustainable quality
"Scotland's ambition to become an acknowledged leader in health care quality will be underpinned every day by the consistently person centred, effective and safe clinical encounters delivered by AHPs and their multi-disciplinary colleagues. Partnerships with patients is an acknowledged strength in the way AHPs work and it will be important to build on this in shaping services for the future."
Scottish Government (2011b)
AHPs have a significant contribution to make to quality improvement and to preventative spending as part of the delivery of safe, effective and person-centred services across health and social care and are committed to the delivery of the quality ambitions as set out in the Healthcare Quality Strategy for NHSScotland (Scottish Government, 2010). They have particular skills in person-centred approaches which are integral to "enabling" practice and is evidenced in the consistently positive experiences of users and families.
AHPs are integral to delivering rehabilitation and "enabling" services to support the reshaping of care for older people. They should therefore lead on developing and testing new models of rehabilitation, which may radically change the way AHP services are delivered. Our work to redesign musculoskeletal services and pulmonary rehabilitation using NHS 24 technology offers excellent examples of this, with potential to be rolled out throughout Scotland across a broad range of care groups and clinical areas. Work has also been commissioned to explore the health economic benefits of the falls prevention work being led by AHPs in communities and in care home settings and the use of telecare in dementia.
The vision for Scotland is to ensure that telecare, telehealth and the use of technology are integral parts of providing equitable access to high quality, safe and effective services, including the provision of advice and information to support self-management through a range of care options remotely via telephone, mobile phone, digital TV and broadband. Deployed effectively, telehealth improves access to high quality and effective care and enhances the user experience.
Recent research identified that using telehealth at scale resulted in a 20% reduction in emergency hospital admissions, 14% reduction in bed days and elective admissions and 45% reduction in mortality rates. It does this by establishing new productive working practices in parallel with enhanced methods of accessing health care for the public. AHPs now need to escalate their use of technology. To avoid duplication and unnecessary effort, AHPs should use existing advice and information resources developed to support people living with a range of conditions and problems that are provided through NHS 24's technology platform.
In 2010, with support from the Scottish Government, NHS 24 appointed an AHP director to lead and develop the AHP technology agenda and an AHP strategic framework was subsequently published (NHS 24, 2010). It sets out a clear direction of travel that aims to transform services and working practices through use of technology, aligned to national priorities, and focuses on improving access and efficiency, supporting self-management and improving outcomes.
People who use services, their families and carers consistently say that AHP services make a real difference to their health and well-being and, importantly, to their quality of life. This enables individuals and families coping with the challenges of caring for a loved one with increasing complexity, frailty, illness or confusion to stay resilient and access support when they need it most. Improving access to AHP services is a long-standing priority for service users. We need to address the responsiveness of our services and take steps to reduce unnecessary variation in AHP waiting times, in line with Action 6.2
This approach is fully aligned with the "personalisation" philosophy promoted in social care. A personalisation approach seeks to promote a focus on personal outcomes so that services can be designed around a person and their family. This individualised approach to service provision will be key to the wider delivery of self-directed support (SDS) for people who use services, their families and carers.
Self-directed Support: a National Strategy for Scotland (Scottish Government, 2010c) sets out an ambitious vision for the transformation of the social care landscape in Scotland in which the quality of life of people who use services, their families and carers is improved through increased choice and control over the services and care they receive. Self-directed support (SDS) is a means to achieving better and more sustainable outcomes for people who use services, their families and carers and was cited in the Christie Commission (Scottish Government, 2011c) as a key way in which public sector services can become more responsive and accountable to citizens.
The implementation of the SDS strategy will be underpinned by primary and secondary legislation. The Social Care (Self-directed Support) (Scotland) Bill is passing through the Scottish Parliament and will enshrine in law, for the first time, the principle of the "right to choose" for everyone eligible for social care. The Bill sets out the full range of options from which people can choose, including taking a direct payment and having a high level of control, or asking the local authority to arrange a package of care and support on their behalf. Critically, the Bill will impose a duty on local authorities to ensure that the choices people make are actioned and that they fully understand the options before making their choice.
There is no policy to introduce personal budgets for clinical care, but NHSScotland has a significant role in facilitating jointly funded health and social care packages and in supporting the very large group of people who are recipients of both health and social care services. The integration of health and social care will also drive increased cross-fertilisation of ideas and approaches, including learning from the principles and approach of SDS in supporting people to live independently for as long as possible in their own homes and communities. AHPs can play a key role in this through, for example, promoting self-management through appropriate advice and training for carers/personal assistants where they are employed to provide someone's support.
Better Together, Scotland's patient experience programme, collects annual data on the experiences of people who use services, their families and carers in hospitals and in communities to underpin a better understanding of the health care experience. AHPs are gathering local information on user and carer experiences using Emotional Touch Points or Talking Points and have also begun using the Consultation and Relational Empathy (CARE) measure: this has been validated for AHP use and reflects the presence of empathy and engagement for the user in their consultation/clinical encounter.
Enhancing carer support is a key strand of the commitment to use the Change Fund effectively across health and social care services. AHPs are already doing much in this area, but they will be able to evidence their effectiveness and impact and support ongoing service improvement by using tools to measure user and carer experience and engagement.
AHP leaders of health and social care teams will drive improvement locally, strengthening the connection between quality improvement for people who use services, their families and carers and the collection of data to demonstrate outcomes and service impact. AHPs now need to strengthen their contribution to quality improvement, understanding how whole systems work from the perspective of people who use services, their families and carers and testing and measuring improvements.
AHPs must embrace the opportunity to learn and use skills and techniques around improvement science to identify areas for greater efficiencies to ensure high quality, effective services are delivered. This will include a reduction in unnecessary variation, improved services and a consistent approach to waiting times.
| No. || Action by || Delivery by end of |
| 6.1 || AHPs across health and social care services will monitor the quality of AHP service delivery, including user experience, by implementing the national data set and using quality measures/dashboard agreed for national and local reporting, particularly in relation to the nationally agreed outcomes for integration of health and social care services. || 2013 |
| 6.2 || AHP directors will drive the delivery of AHP waiting times within 18 weeks from referral to treatment, inclusive of all AHP professions and specialties (except diagnostic and therapy radiographers) with a target of 90% by December 2014. NHS boards will be expected to deliver a maximum wait of no more than 4 weeks for AHP musculoskeletal treatment within the same period. || 2014 |
| 6.3 || AHP directors will drive the expansion of self referral to all therapeutic AHP services (not diagnostic) as the primary route of access. || 2015 |
| 6.4 || AHP directors and leaders in social care should work collaboratively to significantly increase the utilisation of telecare and telerehabilitation as an integral approach to "enabling" services development, implementing pulmonary rehabilitation roll out as an exemplar model. || 2014 |