Suzanne Rastrick

Chief Allied Health Professions Officer

NHS England

www.england.nhs.uk

Suzanne Rastrick Chief Allied Health Professions Officer

Allied Health Professionals

Resilience in the

Face of

Opportunity

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Patient Choice….

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The Policy Case for Commissioning AHP

Services in England…...

• The NHS Mandate

• The NHS Outcomes Framework

• Patient Choice

• The Five Year Forward View (October 2014)

• The Forward View Into Action: Planning For 2015/16 (Dec. 2014) & Supplementary Information For Commissioner Planning 2015/16 (Dec. 2014)

• ‘Intelligence’ Based Commissioning Models & Approaches

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NHS Outcomes Framework – 5 Domains

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• Quality¹

• Safety

• Patient Experience

• Effectiveness

- Cost

- Clinical

- At a population level

• Data

• Workforce

• Outcomes 1Department of Health. High quality care for all: NHS Next Stage Review final report. Department of Health. 2008. P.47.

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085828.pdf

AHPs can deliver what

commissioners want, but is there

evidence to support this?

AHPs: data capture is crucial 1 DECEMBER 2014

Suzanne Rastrick Chief Allied Health Professions Officer

NHS England

I was appointed by NHS England in September 2014 as Chief Allied Health

Professions Officer. Throughout my career in the NHS I have welcomed independent

scrutiny of health services, so was pleased to be invited by the Nuffield Trust and the

Health Foundation to chair a QualityWatch roundtable discussion focused on how we

can measure the quality of care delivered by allied health professionals (AHPs).

While the report is retrospective, it suggests that AHPs are not adequately

represented in or by many of the national quality measures which systematically

capture data relating to the activities of medical or nursing colleagues. This results in

an inappropriate impression of the activities of AHPs.

Care spanning many sectors

Most striking for me is the fact that, given the nature and scope of their work, AHPs

are ideally placed to address some of the key challenges facing the health and care

sectors. As we see in the report, their publicly funded employment already spans the

NHS, local government (social care and education), housing, third sector and

independent practice. There is now a real opportunity to develop and build measures

across sectors that reflect both the pattern of actual service delivery for patients and

the outcomes AHPs achieve for them.

Let’s talk about data...

www.qualitywatch.org.uk/blog/ahps-data-capture-crucial

www.england.nhs.uk

NHS Commissioning Assembly… • “….as clinical commissioners we need to understand the

outcomes that matter most to people in our communities – these “citizen outcomes” should guide our decisions….”

Gateway ref 01801

www.england.nhs.uk

Commissioners are sighted on

what “citizens” want.

Adapted from: Legatum Institute (2014) Wellbeing and Policy

www.england.nhs.uk

Stakeholder workshop, NHS Southend CCG, May 2014

“We need to move away from a medical view that primarily sees people as patients (passive recipients of care), to one that sees people as citizens (active participants in driving outcomes)’’

Opportunities

www.england.nhs.uk

NHS Five Year Forward View

• The NHS Five Year Forward View

was published on 23 October 2014

• One of its great successes was that it

is a shared vision for the future of the

NHS across six national NHS bodies

• The challenge is now

implementation; we know:

• It will not be easy

• We need to learn from the past

• We’re going to need a different

approach

• AHPs are up for it!

The future NHS

The core argument made in the Forward View centres around three ‘gaps’:

Radical

upgrade in

prevention

• Back national action on major health risks

• Targeted prevention initiatives e.g. diabetes

• Much greater patient control

• Harnessing the ‘renewable energy’ of communities

Health &

wellbeing

gap

1

New

models of

care

• Neither ‘one size fits all’, nor ‘thousand flowers’

• A menu of care models for local areas to consider

• Investment and flexibilities to support implementation

of new care models

Care &

quality gap 2

Efficiency &

investment

• Implementation of these care models and other

actions could deliver significant efficiency gains

• However, there remains an additional funding

requirement for the next government

• And the need for upfront, pump-priming investment

Funding

gap 3

Principles of the New Care Models programme

Clinical Engagement

Patient Involvement

Local Ownership

National Support

• The programme will be developed with a co-design approach –

built with patients and the health and care system

• It will seek to identify replicable standards, tool and methods so

that scale can be reached;

• It will use the transformation fund to maximise progress and pace

through centralised support, especially in technical areas as well

as leadership support and development for those local health and

social care systems;

• The national package of support to prototype sites will be offered

with an agreed Memorandum of Understanding and mutual

commitment to delivery on the ground, and a commitment to value

for local people

• It will establish an evaluation process to support testing and rapid

learning

• It will share early and continuous learning with the whole national

health and care system through a wider community of support.

New Models of Care Initially the new models of care programme will focus on:

• Multi-agency support for people in care homes and to help people stay at home

• Using new technologies and telemedicine for specialist input

• Support for patients to die in their place of choice

Enhanced health in care homes

• Coordinated care for patients with long-term conditions

• Targeting specific areas of interest, such as elective surgery

• Considering new organisational forms and joint ventures

New approaches to smaller viable

hospitals

• Integrated primary, hospital and mental health services working as a single integrated network or organisation

• Sharing the risk for the health of a defined population

• Flexible use of workforce and wider community assets

Integrated primary and acute care

systems

• Blending primary care and specialist services in one organisation

• Multidisciplinary teams providing services in the community

• Identifying the patients who will benefit most, across a population of at least 30,000

Multispecialty Community Providers

First cohort Vanguard sites

Care model Applicant

PACS Wirral University Teaching Hospital NHS Foundation Trust

PACS Mansfield and Ashfield and Newark and Sherwood CCGs

PACS Yeovil Hospital

PACS Northumbria Healthcare NHS Trust

PACS Salford Royal Foundation Trust

PACS Lancashire North

PACs Hampshire & Farnham CCG

PACS Harrogate & Rural District CCG

PACS Isle of Wight

Care model Applicant

MCP Calderdale Health & Social Care Economy

MCP Derbyshire Community Health Services NHS Foundation Trust

MCP Fylde Coast Local Health Economy

MCP Vitality

MCP West Wakefield Health and Wellbeing Ltd (new GP Federation)

MCP NHS Sunderland CCG and Sunderland City Council

MCP NHS Dudley Clinical Commissioning Group

MCP Whitstable Medical Practice

MCP Stockport Together

MCP Tower Hamlets Integrated Provider Partnership

MCP Southern Hampshire

MCP Primary Care Cheshire

MCP Lakeside Surgeries

MCP Principia Partners in Health

Care model Applicant

Care Homes NHS Wakefield CCG

Care Homes Newcastle Gateshead Alliance

Care Homes East and North Hertfordshire CCG

Care Homes Nottingham City CCG

Care Homes Sutton CCG

Care Homes Airedale NHS FT

www.england.nhs.uk

Advanced practice

AHP Medicines Project

• Phase1 (Implementation)

o Independent prescribing by physiotherapists

o Independent prescribing by podiatrists

• Phase 2

o Independent prescribing by paramedics • Service redesign – Urgent & Emergency Care Review

o Independent prescribing by radiographers • Improving patient experience and increasing capacity

o Supplementary prescribing by dietitians • Leading clinical pathways

o Use of exemptions by orthoptists • Workforce – skill mix

Supporting work (1)

www.england.nhs.uk

Advanced practice (cont’d)

• Self-referral (Pilot study completed 2008, confirmed findings of research undertaken in Scotland that self-referral improves accessibility and outcomes while increasing capacity)

o AHP-led care pathways/clinics such as:

• Physiotherapy - musculoskeletal

• Speech & language therapy – dysphasia, early years development

• Podiatry – diabetes, rheumatoid disease

• Occupational therapy – integrated rehabilitation

• Improving career progression to develop flexible workforce

o via AHP HEE Advisory Group

Supporting work (2)

www.england.nhs.uk

• 2012 CAHPO asked by Sir Bruce Keogh to establish if there was a case of need to improve adult rehabilitation services in England

• Examples of good innovative practice and service design, but poor adoption and dissemination

• Clinicians and service users - unsure of services available and how to access them

• More recent stakeholder engagement told us:

• service not always focused on patient need

• lack of focus on outcomes

• commissioning structures an obstacle to care

Rehabilitation Programme

www.england.nhs.uk

Rehabilitation Innovation Challenge Prizes • “Open Mind Partnership”

Leicestershire Partnership NHS Trust

Leicester Open Mind in partnership with Fit for Work

- GP referral or Open Mind therapists

- Long-term MSK pain

- Cognitive Therapy and Mindfulness techniques

- Addressing physical, social and mental barriers such as depression and anxiety

• “Fitness for Work Service”

Derbyshire Community Health Services NHS FT

- Self referral or by managers

- Assessment – physical activity, design of the workplace

- Phased return to work and duties where appropriate

- Service also offers MSK pain education and management, advice on equipment and

educational resources

- ROI - £5 for every £1spent

www.england.nhs.uk

• Publish the economic arguments for rehabilitation

• Take forward recommendations from C&YP scoping project report

• Publish commissioning frameworks:

• Self referral and early intervention

• Supported self management

• Urgent and emergency care review

• Older people’s programme

• Living with and beyond cancer

• Elective care

• Return to work programme

• Support development of regional networks

Plans for Rehab Programme 2015/16

www.england.nhs.uk

Proposals being taken forward across the United Kingdom

• Independent prescribing by advanced radiographers

• Independent prescribing by advanced paramedics

• Supplementary prescribing by advanced dietitians

• Exemptions from Human Medicines Regulations by orthoptists

Work to date

• A case of need for each the above proposals was approved by NHS England and the DH Non-Medical Prescribing Board

(June/July 2014)

• Ministerial approval to prepare for four separate public consultations (August 2014)

• AHP medicines project board established (September 2014)

• Development of consultations and supporting documents including:

• Draft practice guidance for each profession

• Draft outline curricular frameworks for training programmes

• Impact assessments for each proposal

• The four consultations went live on 26th February 2015

• Accessed at: http://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/

• The proposals relating to orthoptists and dietitians closed on 24th April

• The proposals relating to radiographers and paramedics closed on 22nd May

AHP Medicines Project

www.england.nhs.uk

AHP Medicines Project - continued Benefits of proposed changes

• Provision of best care, first time, in the right place through timely access to medicines • Reduced need for additional appointments, onward referral and hospital admissions to

access medicines required • Reducing risks and costs associated with delays in care • Supports new roles and service re-design that is patient-centred and cost-effective • More flexible, responsive and empowered workforce

Next steps

• Consultation responses received are being collated and analysed. The report on the responses to the consultation will inform a paper by the Medicines and Healthcare Products Regulatory Agency (MHRA) to the Commission on Human Medicines (CHM), asking them to consider the proposals in light of comments received

• Each proposal will be considered separately and the CHM will advise Ministers of their recommendations in relation to each of the proposals

• Support implementation through collaborative working with key stakeholders including commissioners.

www.england.nhs.uk

Effectiveness & influencing, from a

different perspective.

Connect… Be Active… Take Notice… Keep Learning… Give…

www.england.nhs.uk

Connect…

www.england.nhs.uk

Apply for national awards

Talk to ‘audiences’ other than AHPs

Be Active… Rock the boat and stay in it!

www.england.nhs.uk

Take Notice… • Innovation Connect is a free assessment and signposting service for innovations

presented to NHS England. Innovators can submit their ideas and receive rapid advice and referrals to appropriate support. High Impact Innovations are quickly recognised, and have their implementation supported with NHS organisations

• Innovation Exchange is an online collaborative web portal designed to support and develop a growing innovation community. The portal is designed for anyone who wants to develop, implement and spread innovations in health and care

• Both can be accessed via http://www.england.nhs.uk/ourwork/innovation/innovation-connect/

• Rachel Burnett, Innovation Manager, NHS England has a blog at http://www.commissioningassembly.nhs.uk/pg/cv_blog/content/view/157834

Last link may require registration on the Commissioning Assembly website

www.england.nhs.uk

• Traditional narrative from policy makers and the media of “doctors and nurses”

• In the NHS Foundation Trust & Trust Boards often not well sighted on the impact / outcomes of non medical or nursing workforce

• Guidance documents for commissioners and providers often silent on suggestions of workforce mix to ensure delivery

• Commissioning an AHP workforce that will support the aspirations of the Five Year Forward View

Challenges….

www.england.nhs.uk

Not Just Doctors and Nurses…

• Safe Staffing

• AHP Clinical Fellowships

• Raising profile with

commissioners

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“…as NHS Leaders we’re in the business of change” Simon Stevens, King’s Fund, May 2014

• Accessing and applying for senior leadership roles; recognising AHP leadership at every level

• Constantly act as advocates for and communicate about the AHP ‘brand’

• Talk strategically to wider non – AHP audiences, not just ‘we ourselves’

And challenges for us as AHPs

www.england.nhs.uk

AHPs are ideally placed to

deliver many of the ambitions in

the 5YFV

• Two fundamentals AHP’s deliver on:

Innovation

Entrepreneurship

• Some areas to strengthen: Economic evaluation

Consistent outcome data

Developing networks to spread excellent practice

www.england.nhs.uk

Over to you…..

Suzanne Rastrick

Chief Allied Health Professions Officer

NHS England

@SuzanneRastrick

Allied Health Professions are: art therapists, dramatherapists, music therapists, chiropodists/podiatrists, dietitians, occupational therapists, ort hoptists, prosthetists and orthotists, paramedics, physiotherapists, diagnostic radiographers, therapeutic radiographers, speech and language therapists.