In November 2011, the Scottish Parliament debated the importance of rehabilitation and enablement to the health and social well-being of the population of Scotland. MSPs acknowledged rehabilitation and enablement as core elements in ensuring individuals can live meaningful and productive lives and paid tribute to the crucial roles allied health professionals ( AHPs) play in their promotion. They recognised the importance of rehabilitation and enabling approaches in underpinning safe, effective, affordable and sustainable health and social care services and declared universal support for the development of a National AHP Delivery Plan.
The National AHP Delivery Plan was subsequently commissioned by the Minister for Public Health with the support of the Cabinet Secretary. It is the first of its kind in Scotland and, indeed, the UK and provides a unique opportunity to align the contribution of AHPs to a National Outcome Framework for Health and Social Care currently in development, the Healthcare Quality Strategy for NHSScotland (Scottish Government, 2010) and the 20:20 Vision for Sustainable Quality in Scotland's Healthcare(Scottish Government, September 2011).
Scotland's AHPs serve a population of 5.2 million people through partnerships across health, local authority, voluntary and independent sectors. Demographic changes mean that the number of people over 60 will increase by 50% by 2033 and the rise in the over-85 population will be an incredible 144%: this is especially significant given the high prevalence of dementia among this age group.
Almost a third of total annual spend on older people's services is accounted for by unplanned admissions; this is more than is spent on social care for older people. Delayed discharges of less than six weeks account for around £54m per annum in bed days lost, to say nothing of the cost to individuals, and their carers, of remaining in an environment not appropriately reflecting their needs.
The Scottish Government established the Change Fund in 2011 to enable health and social care partners to make better use of their combined resources in implementing local plans for older people. It provides bridging finance to facilitate shifts in the balance of care from institutional environments to primary and community settings and enable a refocus on anticipatory care and prevention of unplanned admissions to hospital or long-term care.
The role of AHPs
"The demands for heath care and the circumstances in which it will be delivered will be radically different in future years. We must be bold enough to visualise the NHS that will best meet the needs of the future in a way that is sustainable and make the changes necessary to turn that vision into reality."
(A 20:20 Vision, Scottish Government 2011)
AHPs are a distinct group of practitioners who apply their expertise to diagnose, treat and rehabilitate people across health, education and social care. They work with a range of technical and support staff to deliver direct patient care and provide rehabilitation, self-management, enabling and health improvement interventions. In Scotland, the AHP group includes physiotherapists, occupational therapists (OTs), dietitians, speech and language therapists, radiographers, podiatrists, prosthetists and orthotists, orthoptists and arts therapists.
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 20:20 Vision of everyone being able to live longer, healthier lives at home or in a homely setting and delivering on the NHS quality outcomes and the National Outcome Framework across health and social care.
AHP leadership at strategic and practice levels will play an essential role in transforming services to ensure they are fit for the future. Leaders' distinctive expertise in supporting an enabling ethos will need to be effectively positioned and strengthened to maximise the added value of the AHP workforce within an integrated health and social care system. The National AHP Delivery Plan will call for AHP leadership to be more visible and accountable at the highest levels within NHS boards and local authorities. Robust leadership from AHP directors and AHP service leaders will be required to bring about and sustain transformational service-level change.
The National AHP Delivery Plan
AHPs work across health, education and social care settings. The National AHP Delivery Plan will therefore apply to all AHPs in Scotland, which will be particularly important as the new health and social care partnerships emerge.
The Delivery Plan will focus on the period 2012−2015 and is intended to provide a strategic platform for future AHP activity. It will demonstrate the contribution AHPs can make and the impact they can have on the delivery of national policy, patient experience and outcomes across health and social care sectors.
The Delivery Plan will fundamentally be about making explicit the alignment of AHP leadership and practice to the delivery of integration and the National Outcome Framework. It will show how better value can be extracted from AHP expertise from strategic to frontline levels and demonstrate the impact for service users and their families.
It will define the future vision for AHPs and the services they deliver. To do this, it will focus specifically on a number of high-level outcomes that AHP services will affect, with key recommendations for change.
NHS boards and local authorities will develop local plans identifying how they intend to implement and evidence the outcomes of the Delivery Plan by a proposed target of Autumn 2012. Annual reviews of progress against local delivery plans will be led by the Chief Health Professions Officer (CHPO) for Scotland.
This consultation document has been developed in partnership with AHPs from across health and social care settings. The process of engagement will continue and extend to a broad range of key stakeholders and groups during the consultation period which will run until 30 April 2012.
There has been general consensus among key professional leaders that the broad direction of the plan is right, but we want to consult further on:
- the overall structure and approach of the National AHP Delivery Plan
- the key proposals − are they sufficiently ambitious, are they achievable, and are there any significant gaps that need to be addressed?
- prioritisation to support local implementation.
Responding to this Consultation
We are inviting written responses to this consultation by 30 April 2012. Please send your response with the completed Respondent Information Form (see "Handling your Response" below) to:
Or by post to:Angela Worth
Scottish Government Health Directorate
Directorate for Chief Nursing Officer, Patients, Public and Health Professions
GE19, St Andrew's House
If you have any queries please contact Angela Worth on 0131 244 3739. This consultation, and all other Scottish Government consultation exercises, can be viewed online on the consultation web pages of the Scottish Government website at
Handling your response
We need to know how you wish your response to be handled, and, in particular, whether you are happy for your response to be made public. Please complete and return the Respondent Information Form which is attached as an annex to this paper as this will ensure that we treat your response appropriately. If you ask for your response not to be published we will regard it as confidential, and we will treat it accordingly.
All respondents should be aware that the Scottish Government is subject to the provisions of the Freedom of Information (Scotland) Act 2002 and would have to consider any request made to it under the Act for information relating to responses made to this consultation.
Where respondents have given permission for their responses to be made public and after we have checked that they contain no potentially defamatory material, responses will be made available to the public in the Scottish Government Library (see attached Respondent Information Form). These will be made available to the public in the Scottish Government Library by 31 May 2012. You can make arrangements to view responses by contacting the library on 0131 244 4556. Responses can be copied and sent to you, but a charge may be made for this service.
What happens next?
Following the closing date, all responses will be analysed and considered along with any other available evidence to help us to reach a decision on the content of the final Delivery Plan which will be published in Spring 2012.
AHP strategic vision
The vision for delivering high quality health and social care in Scotland is focused on a joint commissioning strategy to enable integrated care. The delivery of more enabling services, shifting the focus away from professional dependency and towards supported self-management and resilience, will also be central to achieving key elements of shared commitments across health and social care towards effective, sustainable and affordable service provision for the future.
Re-ablement is a key deliverable for local authorities, with the focus on maintaining independence and reducing reliance on home care support. A shift towards a more enabling ethos can release capacity and facilitate provision of a more flexible, personalised service. This kind of shift needs to be replicated and integrated across sectors to reduce unnecessary duplication of assessments. AHPs, particularly local authority-based OTs, are core to defining, developing and reviewing person-centred goals for delivery by homecare teams: there is strong evidence that a partnership-based approach can reduce homecare hours by around 30%, with true integration of community rehabilitation teams.
AHP leadership and expertise in strategic planning and practice are needed now more than ever. Elevating AHP leadership influence and impact will be vital to the successful delivery of the quality outcomes for the NHS and the National Outcome Framework and to initiatives focused on reshaping care for older people and those with long-term conditions.
AHPs will maximise their contribution and effectiveness by:
- empowering the delivery of strong professional leadership
- working in integrated teams across health and social care to support continuous improvement
- developing innovative new models of care and fully utilising innovation in health technology
- creating added value beyond health and deliver excellent outcomes for users and carers
- providing effective, efficient solutions to the challenges of delivering national policies within a reducing financial envelope.
Email: Susan Malcolm