Scottish allied health professions public health strategic framework implementation plan: 2022 to 2027 midway report

Appendices

Appendix 1 Strategic Goals Specific Board Examples

Strategic Goal 1: Developing the AHP Workforce

NHS Ayrshire and Arran has established an Implementation Group and has worked collaboratively with their Health Improvement Practitioner on a resource 'Creating a Fairer, Healthier Ayrshire' to use with students while on placement. A “train-the-trainers” session was organised for October/November 2024, allowing AHPs to use as a resource for all staff and students.

NHS Highland and NHS Shetland Practice Education teams have produced a Sway digital newsletter which is circulated to all their AHPs. Topics have included one-off signposting to events, new training materials, relevant learning opportunities, promotion of opportunities for Fellowship applications, and funding available to support learning as needed.

The State Hospital raise awareness via a standing agenda item at their AHP monthly business meetings. They also offer online learning opportunities with external stakeholders, for example South Lanarkshire College, W2Go, with staff supported by AHP support workers.

NHS Tayside in 2024 held an AHP Public Health day, at which Professor Carolyn McDonald (Chief AHP Officer for Scotland), Nicola Richardson, AHP Director and Dr Emma Fletcher, NHS Tayside Director of Public Health all attended.

In NHS Grampian, the AHP services in Angus Health and Social Care Partnership hosted a "Ageing well in Angus" Conference in September to relaunch the LifeCurve™ with Professor Peter Gore and rebranded their website.

NHS Greater Glasgow and Clyde mapped existing mandatory training onto the AHP public health ambitions and noted that "Equality and Human Rights" supports the achievement of this strategic goal, as do the HCPC Standards of Conduct, Performance and Ethics.

The Golden Jubilee University National Hospital referenced its commitment to the Public Health agenda within their current AHP workforce strategy, acknowledging their professional responsibility to understand their role in health promotion, education and prevention of ill health, as outlined within the HCPC Standards of Proficiency (2023) and established a local AHP Public Health Implementation Plan short life working group.

Work based Learning

NHS Dumfries and Galloway podiatry service has created a health inequality action plan and toolkit with leadership capacity building and wellbeing as a key area of focus. This model will be rolled out to other specialities. The Practice Educator Lead has worked with workforce development and learning to develop a learning needs analysis for staff.

All AHP teams in NHS Forth Valley have an improvement measurement plan in place to deliver to the ambitions of ASPIRE 2 (NHS Forth Valley AHP Workforce Strategy) which includes the strategic goals of the AHP Public Health Strategy.

Strategic Goal 2: Demonstrating Impact

AHP Career Fellows

In NHS Borders, a Fellow was supported to begin “Drop in Physiotherapy walking aid clinics” at established HSCP ‘What Matters’ Hubs which take place in various cafés across the Borders. These hubs enable people to drop in without an appointment, have assessments and discussions with Physiotherapists, Occupational Therapists, Social Workers and Third Sector colleagues, Alzheimer’s Scotland and the Red Cross.

AHPs in Greater Glasgow and Clyde formed an AHP Education Strategic Oversight board to support AHP staff development. An AHP Education Fund was created which offers AHPs the opportunity to undertake Master’s modules at Glasgow Caledonian University. Numerous AHPs have now completed Master’s Qualifications, including the MSc module in Social Action Approaches in Public Health.

The Golden Jubilee University National Hospital current focus in supporting this ambition lies with the implementation of pre-habilitation across all key services and increasing access to universal, targeted or specialist pre-habilitation for all major surgery patients. This is described in their local pre-habilitation Strategy. Success of their first pre-habilitation service for elective cardiac and major thoracic patients has been shared at a number of local and national conferences and now that the service has been fully funded the intention is to write up their experience for publication.

Radiographers in NHS Fife support students and senior school pupils via foundation apprenticeships and school visits, attending school career events and the celebration of World Radiography Day and MRI Safety Awareness week. They are working across the career framework to both develop the roles of their health care support workers, extend the role of Reporting Radiographers into MRI reporting and develop the Consultant Radiographer role within their mammography service.

Strategic Goal 3: Increasing the Profile of the AHP Public Health Role

Showcasing AHP Contributions to Public Health

The Scottish Ambulance Service has worked collaboratively with Education & Learning to develop the TRUST educational campaign around drug harm reduction which was launched in Fife schools with national roll out planned for 2025.

In NHS Borders, Children’s AHP services are focussing on providing ease of access to enable people to make a request for assistance. Occupational therapy and physiotherapy teams are also offering regular input into local early years centres to provide universal and targeted advice to staff, parents and carers, people who would tend not to access health services otherwise. Occupational therapy teams have also offered summer bike sessions for primary aged children to support independent cycling.

The work of AHPs in NHS Ayrshire, Dumfries & Galloway, Grampian, Highland and Lanarkshire providing innovative care to target those with MSK issues, chronic pain, dementia and continence through the use of Community Appointment Days has also featured in the Chief Medical Officer’s Realistic Medicine casebook Realistic Medicine – Shared decision making, reducing harm, waste and tackling unwarranted variation

Strategic Goal 4: Strategic Connections and Leadership

In NHS Highland, the AHP Lead and Public Health Lead jointly chair the Preventative Programme Board, exemplifying integrated leadership in public health. This collaborative approach ensures that AHPs are central to strategic planning and delivery of preventative initiatives, aligning clinical expertise with population health priorities to drive early intervention, reduce inequalities, and improve outcomes across the region.

In NHS Forth Valley the APP (Advanced Practice Physiotherapy in Primary Care) service have, in partnership with the Public Health Scotland LIST analysts, created a data dashboard, which has been implemented nationally by other Health Boards. The dashboard is being further developed to include socioeconomic factors and inequalities in consultation types, locations and outcomes to further support work to reduce inequalities and improve population health.

In NHS Greater Glasgow and Clyde, dietitians have taken a leading role within the weight management service, demonstrating the value of AHP expertise in tackling obesity and promoting healthier lifestyles. Their involvement highlights how AHPs can drive forward public health priorities through targeted interventions and service innovation.

In NHS Dumfries and Galloway, an AHP leads the implementation of the Active Lives Pathway, a programme designed to increase physical activity and improve wellbeing across the population. This leadership role reflects the strategic contribution AHPs make to preventative health and their capacity to influence system-wide change.

Across NHS Ayrshire and Arran, NHS Tayside, NHS Lothian, and NHS Dumfries and Galloway, Boards have established joint leadership meetings between AHP and Public Health teams. These whole-system forums enable collaborative planning and decision-making, with a strong focus on preventative and proactive care. They also support shared leadership and integration of public health principles into service design.

In NHS Fife, children’s AHPs in physiotherapy and occupational therapy are working closely with a Public Health Consultant to implement the local strategy Living Well, Working Well and Flourishing in Fife. This partnership demonstrates how AHPs can contribute to strategic planning and delivery, ensuring that public health goals are embedded in children’s services and aligned with broader wellbeing objectives.

Strategic Goal 5: Health and Wellbeing of the Workforce

In NHS Lothian, AHPs are actively promoting resources such as the NES Wellbeing Planning Tool and Coaching resources. They are also raising awareness of peer support networks, Mental Health First Aiders, and Buddying schemes. These efforts aim to support staff wellbeing and resilience, while also enabling AHPs to guide patients in navigating work-related challenges as part of their recovery and rehabilitation.

NHS Grampian has established a dedicated Vocational Rehabilitation post, reinforcing its commitment to supporting people back into employment. The Board is also strengthening links with its Healthy Working Lives workstream and positioning itself as an anchor institution. This approach reflects a broader strategic aim to embed health and employment support within public services and community infrastructure.

In NHS Greater Glasgow and Clyde, a local guidance document NHS GGC AHP Return to Practice Guidance: Arranging Supervised Practices has been developed, based on the NES Return to Practice framework. This resource supports both AHPs returning to the workforce and the professions facilitating their re-entry, offering structured pathways for supervised practice and study. Several AHP professions have successfully used this guidance, resulting in positive outcomes for HCPC re-registration and employment.

NHS Tayside is applying high-quality evidence to support physiotherapy-led conservative management of urinary and faecal incontinence, which affects millions across the UK. Research shows that surgery for vaginal prolapse, which affects 40% of women over 50 can often be avoided through pelvic floor exercises and lifestyle advice. NHS Tayside is integrating this evidence into practice by working alongside its established Urogynaecology Pathway to develop accessible digital resources. These include patient information videos, leaflets, and links to services such as NHS Inform, Bladder and Bowel UK, and Promoting Continence with Physiotherapy. The resources are available throughout the care pathway, and the Board is currently monitoring their impact on reducing referrals into specialist services.

In NHS Highland, work planning tools are used with students during their placements to help them manage their workload, reflect on their learning, and maintain a balanced approach to their development. This proactive support contributes to a positive placement experience and encourages self-care and resilience.

In NHS Dumfries and Galloway, a well-established Student Coordinator Group, led by the AHP Practice Education Lead, ensures that student wellbeing is embedded into the placement experience. The group oversees induction processes and core documentation, making wellbeing a visible and integral part of the student journey.

NHS Lanarkshire has developed a dedicated Microsoft Teams channel for physiotherapy students, providing a space for peer support, networking, and access to learning resources. The channel includes a wellbeing section that promotes the Queen Margaret University Placement Wellbeing Toolkit. In addition, the Podiatry team facilitates weekly debrief sessions via Teams, where students can share highlights and challenges in a safe, supportive environment. These sessions are led by someone independent of their practice educator to encourage open dialogue and reflection.

Across Higher Education Institutions, AHP student wellbeing is supported through a variety of initiatives, including specific learning objectives, personal tutoring and pastoral care, and extracurricular opportunities such as student associations, mentorship programmes, and buddying schemes. These efforts ensure that students are supported both academically and personally throughout their training.

Appendix 2: AHPs in Action – Examples of Good Practice

AHPs in Scotland are involved in many innovative projects, which demonstrate their passion for their public health work. Some of these have been featured in our webinar series and will feature in the AHPFS Compendium and RSPH case studies. We are grateful to all our AHPs who presented and submitted work and would encourage the wide accessing of these inspirational stories.

This section includes some which were of particular interest and worthy of note. In addition, it provides two in depth case studies which have been selected to demonstrate a breadth of work across the professions and Boards, collaborative working and the redesign of services by frontline AHPs using quality improvement tools to provide a universal and public health approach.

All case studies have been reproduced with permission.

Brief Highlights

NHS Tayside: Youth knee injuries have increased significantly over the past 20 years. Many of these injuries are related to sport. These injuries can have a devastating impact on the child, keeping them off sport for long periods of time as well as having long term health consequences. Research has shown that simple injury prevention protocols incorporated into warm ups for sport can reduce knee injuries by around 50%. In NHS Tayside, AHPs are promoting and encouraging engagement with these injury prevention protocols to local sports clubs and schools. They have already visited one school and engaged with hundreds of children and in the longer term our goal is to deliver this widely across the region. This should have obvious benefits to the children’s well-being as well as reducing the number of patients presenting with significant knee injuries requiring orthopaedic intervention.

Occupational Therapy: In 2024, a group of Occupational Therapists across Scotland, together with representatives from voluntary, third sector and Scottish Government wrote and published guidance to support individuals with criminal convictions and mental health conditions / learning disabilities into work, volunteering or education. Allied Health Professions: disclosure guidance

Case Study 1: Podiatry – The production and dissemination of universal public health resources by NHS Grampian

Working in partnership with service users and the wider multi-professional team, Aberdeen City, Aberdeenshire and Moray Health and Social Care Partnership Podiatry Services have taken an innovative approach to empowering service users by promoting education and their understanding of foot health. Amongst the key drivers for change was the need to provide information which was person centred and answered frequently asked questions about common clinical conditions and treatment options; ensuring that service users and the public are better informed about their foot health. Encompassing views of service users on the care they have experienced and seeking thoughts from the wider multi-disciplinary team, a series of patient information booklets was developed.

As shown in Figure.1 these ranged from providing general personal foot care advice ‘Looking after your feet’, enabling self-management and self-care through early intervention footcare-advice-pil.pdf to providing clinical advice on a specific clinical condition or treatment options for example ‘Toenail surgery’. your-toenail-surgery.pdf.

Based on the principles of Realistic Medicine, a primary aim of providing this information was to support ‘service users and their families to feel empowered to discuss their treatment fully with the Podiatrist, including the possibility that a suggested treatment might come with side effects – or even negative outcomes, a clear message. Reiterating the importance that everyone should feel able to ask their healthcare professional why they’ve suggested a test, treatment or procedure, and all decisions about a person’s care should be made jointly between the individual and their healthcare team’. Realistic Medicine, 2025.

Available in both paper and electronic format, the information booklets were further ‘personalised’ to NHS Grampian by including images which were of team members and public (Figure 2).

A further step in the right direction, has seen the development of a video, based on the information booklets which details what is personal footcare Looking after your feet | NHS inform. A true reflection of the positive outcome and impact from the video and booklets has been the wider engagement from NHS Inform and other NHS Scotland board areas, whereby these booklets have been used to support the public, services and teams, indeed a true local and national collaboration!

Working in partnership, next steps include but not limited to the development of more patient information booklets which include a wider range of clinical conditions, the creation of patient education videos and development of an interactive public facing webpage.

Case study 2: Dietetics - Forth Valley Adult Weight Management (AWM) Service - A Transformational Approach to Reducing Waiting Times and Enhancing Access by NHS Forth Valley Dietetic Services

In April 2024, the NHS Forth Valley Nutrition and Dietetic Adult Weight Management (AWM) Service undertook a transformation to achieve their ambition of delivering an accessible and responsive service. Effective in supporting the population of Forth Valley to achieve improved health and wellbeing outcomes.

The team’s small staffing resource was under significant pressure, with over 850 individuals on the waiting list and some patients waiting more than a year for an initial assessment. This posed considerable risk to patient outcomes, experience, and equity, limiting the team’s ability to deliver targeted initiatives to address health inequalities.

With support from an Improvement Advisor, the team launched a focused initiative to tackle urgent capacity issues, whilst keeping sight of their long-term vision for a more sustainable and inclusive service model.

A key innovation was the introduction of group information sessions, designed to provide early, meaningful contact with patients currently on the waiting list and for future individuals seeking support

These sessions aimed to:

• Set realistic expectations about weight change and what the AWM service can offer.
• Provide reassurance and signposting to both local and national resources including physical activity, wellbeing and supportive self-management for diet and lifestyle changes.
• Support informed decision making on treatment options, helping patients choose the most appropriate intervention for their needs.

Initial feedback and data indicate the sessions are making a measurable difference:

• Timely engagement: Patients are now being offered a session within 6 weeks and following this, depending on chosen option, intervention is available to begin within 2 weeks
• Improved patient experience: feedback and patient stories tell the improved experience of the patient journey
• Empowered choice: Individuals feel better informed, more confident when accessing their chosen treatment option and staff report increased readiness to change
• Improved Self-management: around 40% of individuals choose to self-manage following the session.
• Better programme retention: Early evidence indicates that shorter wait times correlate with better retention rates with our key measure at 12 weeks showing improved retention from ~60% to ~80% in groups.
• Weight Loss Outcomes: It is currently too early to assess weight loss results; however, we plan to investigate this further. While there is potential for improvement, targeting those with the greatest need may mean managing more complex cases than previously encountered.

Implementing this initiative reduced demand on 1:1 appointments and the team regained capacity to focus on longer-term transformation goals, including:

• Scoping and delivering targeted community-based initiatives to tackle health inequalities.
• Reviewing core service delivery to ensure delivery of a model that is high quality, valuable and sustainable.
• Continuing to improve processes, administrative efficiency, and team productivity.

This early engagement model is now a core element of the service as an approach that balances immediate demand with long-term sustainability, person centred care and improved opportunity for early intervention, prevention and equity of access. We will build on our NHS Forth Valley Type 2 diabetes Early Intervention team's experience of navigating complex networks of services using current staffing and resource, as described as a case study in Chapter 1 of Realistic Medicine - Taking Care: Chief Medical Officer for Scotland annual report 2023 to 2024 - gov.scot