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Driving Improvement: Implementing Realising Potential

This document reflect on the progress that has been made through implementation of the Realising Potential policy and considers how the future should be shaped. It captures the reflections of some key players who have been instrumental in visioning, developing and implementing the policy.


Realising Potential - then to now

Realising Potential,[1] the action plan for allied health professionals (AHPs) in mental health, was launched in June 2010, bringing together for the first time the work of AHPs in mental health in partnership with service users and carers, professional organisations and NHS boards.

The three-year Realising Potential action plan set out a blueprint for maximising the AHP contribution to supporting people with mental health problems of all ages, both within mental health services and in mainstream settings. It provided strategic direction for AHPs in mental health and promoted their contribution to the modernisation of mental health services in Scotland.

Twelve recommendations were presented (Table 1) covering actions in five broad areas:

  • early intervention and timely access for service users and carers
  • supported self-management
  • designing and delivering psychological interventions
  • integrating vocational rehabilitation
  • support for change - making it happen.

The underpinning principles also reflected these broad areas:

  • enhance timely access to AHP services for service users and carers
  • explore and develop the concept of supported self-management for service users and carers
  • promote recovery and strengths-based approaches
  • develop partnerships with service users and carers, other disciplines and agencies
  • provide leadership for change
  • develop the evidence base for practice
  • promote mental health and well-being among the population.

The action plan was accompanied by a DVD that linked policy to practice through demonstrating service users' lived experience of mental illness and how their stories shaped - and continue to shape - AHPs' practice.

Realising Potential recognised that AHPs in mental health offer an enabling service that isn't about a person's diagnosis, but is about the person. The essence running through Realising Potential is about individual and community assets. Those assets include AHPs' potential as social entrepreneurs and catalysts of, and agents for, change.

A report from the National Allied Health Professional Mental Health Clinical Leads' Group (now the Strategic Mental Health AHP Leads Group) on the first year of implementation of the action plan was published in 2012. This report, Realising Potential: our own and others, showed that while it was still early days and significant challenges had to be faced, much had been achieved in year 1 through strong and committed leadership, partnership-working and AHPs' enthusiasm to take advantage of the opportunities Realising Potential presented to improve services. Tangible examples of progress against the action plan's five broad areas of focus were presented from NHS boards across the country.

Examples of asset-building work being taken forward by AHPs in mental health in Scotland - there are many - will be summarised in two forthcoming publications that will evidence our work in co-production and self-management. In the meantime, one of the most encouraging elements to arise from Realising Potential is the realisation that good practice developed in one area is being replicated in others.

Table 1. The 12 recommendations from Realising Potential

Number Who What
1. NHS boards Should fully engage AHPs in leading the rehabilitation of people with mental health problems, developing new models, systems and ways of working to facilitate early intervention and timely access for service users and carers.
2. AHP mental health leads, working with AHP leads in community health partnerships (CHPs) Should promote an integrated approach to service delivery by encouraging collaborative working between primary care services and AHPs in mental health and by linking specialist, community and social care AHP teams to ensure integrated services and smooth transitions between services for service users and carers.
3. AHP services in mental health Will use the Scottish Recovery Indicators tool as part of team approaches to service delivery to promote recovery-orientated services by June 2011.
4. AHP mental health leads Should ensure the provision of evidence-based, socially inclusive and accessible physical activity rehabilitation programmes for service users and carers.
5. AHP mental health leads Should ensure regular nutritional screening is available to service users at each stage of their care journey, with nutritional services working closely with specialist AHPs.
6. AHP mental health leads Should work with partners to promote and enhance the provision of evidence-based, socially inclusive and accessible therapeutic activity provision in a range of settings.
7. NHS boards Should ensure the delivery of evidence-based psychological interventions by appropriately trained AHPs to support rehabilitation, self-management and recovery approaches as part of local delivery strategies.
8. AHP mental health leads Should ensure that AHPs in mental health who deliver psychological interventions as a primary role have access to clinical supervision within protected time.
9. AHPs in mental health, working from a recognition of the importance of work in promoting recovery Should explore work issues at all initial service user assessments and provide ongoing signposting or support to increase service users' potential for work.
10. AHP mental health leads, working with key stakeholders Should ensure the provision of alternative occupational, leisure and educational activities for service users whose vocational goals are not employment-focused.
11. NHS boards and AHP directors Should identify an AHP mental health lead, developing a sustainable clinical leadership function that reflects proposed service delivery changes.
12. AHPs Should use information gathered while providing AHP interventions to evaluate the service user experience, enhance the evidence base and improve services using patient-reported outcome measures and standardised assessments.

The driving forces behind this are many, but central is Realising Potential's impact on defining and refining the leadership role in the allied health professions. Thanks to Realising Potential, each territorial NHS board now has a defined AHP mental health clinical lead in place to provide coordination and direction to the AHP contribution to mental health services, supported nationally by the Strategic Mental Health AHP Leads Group.

Now the initial three-year Realising Potential action plan has been completed, an opportunity exists to reflect on the progress that has been made through implementation of the policy and consider how the future should be shaped.

This report attempts to do that. The informatic starting on page 13 sets out facts and figures highlighting areas of achievement, and our picture gallery (starting on page 27) illustrates some activities that have been progressed in NHS board areas. But the report does not set out to be a formal and comprehensive evaluation of implementation - you should contact the AHP mental health lead in your NHS board area for this information - nor does it provide a recommendation-by-recommendation audit of impact. Instead, it captures the reflections of some key players - AHP mental health leads, a service user, an executive nurse director and an improvement specialist from Healthcare Improvement Scotland - who have been instrumental in visioning, developing and implementing the policy.

Each of these individuals' stories represents an important element of the overall Realising Potential story. AHP mental health lead Lisa Greer speaks of the emerging field of vocational rehabilitation and her colleague Samantha Flower of the crucial importance of leadership in developing and implementing the action plan. Graham Morgan and Sarah Muir share a service user/AHP perspective on its impacts, while Derek Barron provides a view from nursing, focusing very much on the development of a shared psychological therapies skills base across the professions. And June Wylie focuses on how improvement methodology can help AHPs in mental health to keep progressing.

Their stories describe the lived experience of Realising Potential - the impact it has had not just on the implementation of recommendations, but also on the way people (and services) think and behave, and the successes and challenges that Realising Potential has brought. Importantly, they also describe the optimism and hope Realising Potential has created for ongoing improvements in services for people with mental health problems and their carers.

Realising Potential aspired to identify how AHPs can do things differently, moving them from where they were to where they, service users and carers want them to be. Progress has been speedy because of the structures and support that have been put in place and the peer support that comes from people sharing learning and experience. The receptivity of AHPs in mental health to co-production, empowerment and enablement has allowed them to lead the way for AHPs in other sectors, who now have the potential to replicate their success.

Elaine Hunter, AHP Consultant, Alzheimer Scotland, and

Christine Breslin, AHP Officer, Mental Health, Scottish Government

Contact

Email: Susan Malcolm

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