Transcript S - Health Education North West London

Sustainable Healthcare: Allied Health
Professionals, Realising the Potential
HENWL AHP SHARP project
June Davis
Director
Allied Health Solutions
12th November 2014
Allied Health Enterprise Development Centre
Background to SHARP
• Health Education North West London (HENWL)
commissioned the Allied Health Enterprise
Development Centre (AHEDC), a joint venture between
Allied Health Solutions and Buckinghamshire New
University
• Project timeline: March 2014 and October 2014.
• Focusses on the contribution that the AHP workforce
currently makes, and on the potential enhanced
contribution AHPs can make to future services.
• Supports the vision of HENWL (HENWL Workforce Skills
and Development Strategy 2013-2018) and the
‘Shaping a Healthier Future’ programme.
Allied Health Enterprise Development Centre
HENWL area
Allied Health Enterprise Development Centre
Allied Health Professions included in
project scope
Art Therapists
Dietitians
Diagnostic
radiographers
Drama
Therapists
Occupational
Therapists
Orthoptists
Osteopaths
Music
Therapists
Paramedics
Physiotherapists
Speech and
Language
Therapists
Podiatrists
Therapeutic
Radiographers
Allied Health Enterprise Development Centre
Prosthetists and
Orthotists
NHS AHP workforce across North West
London
(as at 31.3.14)
Total FTE
2500.00
1909.60
2000.00
1500.00
1065.89
1000.00
772.27
669.49
Total FTE
458.97
500.00
281.32
41.51
145.57
147.75
18.60
0.00
Allied Health Enterprise Development Centre
AHP workforce across North West
London
(as at 31.3.14)
Nationally: 172,686 registered AHPs & 64, 377 FTEs in the NHS (Nuffield Trust 2014)
Qualified total FTE
Band 5 - Band 9
Art, Music and Drama therapists
% of total
Assistant staff FTE
qualified staff Band 2-band 4
% of total
assistant staff
40.51
<1
1
<1
Dietitians
259.78
5
21.54
5
Occupational Therapists
640.12
12
132.15
32
955.7
18
110.19
27
Diagnostic Radiographers
597.72
11
71.77
17
Therapeutic Radiographers
126.63
2
18.94
4
Speech and language therapists
427.41
8
31.56
7
Podiatrists
129.65
2
18.1
4
Orthoptists
17.8
<1
0.8
<1
Paramedics
1909.6
34
0
0
Physiotherapists
Total
5104.92
(7% of total
AHP FTEs
nationally)
406.05
Project aim
Identify and provide evidence to support and
strengthen the contribution that AHPs can and
do make to effective patient outcomes in:
Dementia
care
through to
end of life
Transfer of care
across
integrated care
services
Allied Health Enterprise Development Centre
Adult
reablement and
rehabilitation
Project objectives
• Scope general background information available across NWL in the
areas of dementia, discharge management, and reablement and
rehabilitation.
• Undertake an analysis of AHP involvement and leadership models in
the areas in scope.
• Critically analyse the impact AHP clinical leadership has had to
patient care in the areas of focus across NWL.
• Identify the support, AHP staff currently receive, and what they
would require in new future clinical leadership roles.
• Identify the gaps in AHP clinical leadership, and areas of good
practice
• Identify the nature of new roles in the areas of focus.
• Demonstrate productivity improvements in care, and reductions in
costs, as a result of the involvement of AHPs utilising QIPP as a
framework.
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Methodology – Data sources
• Local and national
policy
• 14 focus groups
• 4 face to face semi
structured interviews
• 2 telephone interviews
• 15 QIPP examples
• Local best practice
examples
15 provider organisations in NWL
(2 local authorities, 12 NHS
providers, 1 independent sector
provider)
128 AHP and associated staff
All AHP disciplines in scope
included
Findings and themes from focus
groups and semi-structured interviews
Allied Health Enterprise Development Centre
AHP involvement in rehabilitation and reablement
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Mental and physical health expertise
Holistic approach
Improve the quality of life of people
Lead decision making with the patient at the centre
Facilitate hospital discharge
Prevent hospital admission
Respond to changes in a patients needs throughout their journey
Reduce length of stay
Sign post to other services and agencies
Proactive approach and early intervention
Coordinate and lead rehabilitation
Dementia through to end of life
• Maintain clients even if outside service criteria/flexible to
patients needs
• Focus on the needs of the patient and their family and not the
diagnosis
• Encourage patient engagement
• Embrace a team approach
• Consider the ‘bigger picture’
• Promote activity and ‘socialisation’
Transfer of care across integrated services
‘Often AHPs start the conversation of what the next steps are
for the patient’
• Promote and foster seamless care
• Cross service and cross organisational
boundary working is the norm
• Key workers
• Lead transfer of care in many cases
• Comprehensive and bespoke written and verbal information
• Triage patients
Best practice across AHP services
• Joint working and co-location
• AHP research and
development strategy
• AHP colleagues in physical and
mental health undertaking
joint sessions
• Arts in health team –
rehabilitation
• Orthoptists engaged in falls
work
• AHPs leading the
communication between
professionals and patients
• Sensory work with dementia
patients
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Best practice across AHP services
• Programmes for
patients with a range of
long term conditions
• Pre-assessment
screening and support
in oncology,
orthopaedics and preamputation
• Multiprofessional falls
services
Allied Health Enterprise Development Centre
Skill sharing
• ‘It makes no sense for a therapist to find someone on the floor and
then not be able to take a blood pressure and feedback to the
geriatrician.’
• ‘We do more and more physical work, more than we have done
previously. We are not just mental health OTs. We can’t function just
dealing with mental health issues as most of our clients have
complex physical health needs also’.
• ‘There are lots of up-skilling opportunities’.
• ‘As an AHP you need to know almost everything that the doctors
know’.
• ‘I do step over the line and become a social worker which is really
not my role’.
• ‘The AHPs in OASIS and critical care have embraced the cross
skilling and skill sharing’.
Allied Health Enterprise Development Centre
AHP leadership
models
Healthcare Leadership Model
‘AHP leadership promotes integrated working,
governance and horizon scanning.’
•
Significant variation
•
Where there is senior AHP leadership in the
organisation, there is good evidence that this
has had a very positive effect on the profile of
AHPs in the Trust.
•
Not having an AHP lead was seen as a major gap
by several respondents.
•
‘Therapies and AHPs’
•
Professional leadership for each of the
disciplines also varies considerably with the
majority of organisations not having designated
professional leadership for the individual AHP
disciplines.
•
Mixed responses to the provision of formal and
informal leadership support.
Allied Health Enterprise Development Centre
Support identified for those in AHP
leadership roles
• Development right across the grades required
• Enhance clinical skills along with clinical
leadership
• Support career progression
• Development programmes specifically for AHPs
‘Demonstrate how learning leadership skills and
gaining such experience can be of benefit to the
individuals future career potential and to appeal
to their inherent belief in the importance of
helping their patients.’
Allied Health Enterprise Development Centre
AHP leadership at different levels
Organisation
Service
Team
Patient
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AHP leadership at the point of care
‘When you are the first person in
you are often the person who is
helping them untangle who they go
to about what and referring them
on to the right services.’
• Strong AHP leadership at the
point of care
• Often the only professional
seeing the patient
• Triage
• Clinical knowledge and expertise
promotes clinical decision making
• Research and strong evidence
base for interventions
Allied Health Enterprise Development Centre
New roles and extensions to current
roles
•
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Psychiatric liaison
Peer support workers
Associate practitioner roles
Dementia – more potential
Extended assessment skills
Non medical prescribing –
physiotherapy and podiatry
• Nutrition
• Long term follow up of
intensive care patients –
AHP led
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Falls assisted discharge
QIPP dimension
Quality
Description
• Quality of care improved by seamless transition of care from
acute hospital to primary care
• Patients completed satisfaction questionnaire on discharge
and the results were either good or excellent.
Innovation
• Partnership working between acute hospital and primary care
resulted in new way of delivering service to patients
Productivity
• Assisted discharge contributed to reduction in length of stay
and intensive therapy for up to five days reduced readmission
with cost savings in reducing excess bed days and reduced
readmission.
Prevention
• Partnership working with intensive therapy for up to five days
post discharge had led to reduced anxiety and reduced
readmissions.
OASIS (older adults specialist intervention service team)
QIPP dimension
Description
Quality
• Patients seen by most appropriate specialist team from point of
admission to discharge.
• Prevention of institutionalisation and deterioration in function
whilst in hospital as patients have therapy plans from the point
of admission
• Reduction in duplication of assessments
• Therapy discharge is planned from the point of admission rather
than on referral
Innovation
• Good cross professional working relationships
• Development of competencies between nursing and therapies
Productivity
• Reduction in length of stay following the service redesign of 9
days
• Based on the cost of an overnight stay of £225, the saving per
admission was £2025 = total saving of £1,764,180.
Prevention
• Reduction in the need for residential and nursing placements
following a period of hospitalisation.
Opportunities for AHPs to make a
greater impact
7 day
services
Urgent and
emergency
care
Integrated
care
Leading
MDT
teams in
primary
care
Opportunities
for AHPs
New
technologies
and service
models
Supported self
management
Allied Health Enterprise Development Centre
Public
Health