AHP NATIONAL DELIVERY PLAN

REFELECTIONS ON OUR JOURNEY

“AHPs: Driving Quality and Transforming Care Across Scotland

– Our Achievements and Future Opportunities

Dr Sarah L Mitchell

Programme Manager AHP National Delivery Plan

Purpose of the DayLet’s have the conversation about……..

…….what matters to you?

…….what should we

focus on?

…….what are the

priorities?

The AHP JourneyOutline of Presentation

� Collaboration with Creating a Healthier Scotland

� The Context of the NDP in relation to Health and Social care

� Who are the AHPs in Scotland?

� The AHP National Delivery Plan

� Some examples of National AHP Innovative Programmes

The

Creating a Healthier Scotland: What Matters to

You?

conversation will help shape

Purpose

conversation will help shape

the improvements we make

to our health and social care

services now and over the

next 10 – 15 years.

The Christie Commission Report

“Public service providers must be required to work

much more closely in partnership, to integrate service

provision and thus improve the outcomes they

achieve. . .

Experience tells us that all institutions and structuresExperience tells us that all institutions and structures

resist change, especially radical change. However, the

scale of the challenge ahead is such that a

comprehensive public service reform process must

now be initiated, involving all stakeholders.”

The Christie Commission Report

Commission on the future delivery of public services, June 2011

The Vision for NHS Scotland

Social Care (Self Directed Support)(Scotland ) – Act 2013

� Major culture shift in health and social care

� More than a mechanism – is about an individual making an

informed choice and having informed control

� Personal Outcomes Approach underpins and supports the

culture shift:

� Evidence based, person centred

� Evaluation/review crucialRef: “Measureable and Meaningful”

(Miller and Barrie 2015)

1. People are able to look after and improve their own health and wellbeing and live in

good health for longer

2. People, including those with disabilities or long term conditions or who are frail are

able to live, as far as reasonably practicable, independently and at home or in a homely

setting in their community.

3. People who use health and social care services have positive experiences of those services,

The Vision for Health & Social Care Integration

Health & Wellbeing Outcomes

3. People who use health and social care services have positive experiences of those services,

and have their dignity respected.

4. Public services, particularly Health and Social Care services are centred on helping to

maintain or improve the quality of life of people who use them

5. Public services contribute to reducing health inequalities

6. People who provide unpaid care are supported to look after their own health and

wellbeing, including to reduce any negative impact of their caring role on their own

health and wellbeing

7. People using services are safe from harm

8. People who work in Public Service feel engaged with the work they do and are supported to

continuously improve the information, support, care and treatment they provide

9. Resources are used effectively and efficiently

Allied Health Professionals In Scotland

• Allied Health Professions are the 3rd largest

group 12,000 in health 500 in social care (1%

total social care workforce but responsible for

35% of adult referrals)

• 1st point of contact practitioners (diagnostic,

therapeutic and rehabilitation) – In excess of 2

Million new patients and 5 million attendances Million new patients and 5 million attendances

in health alone

• Only professions skilled in rehabilitation and

enablement on point of registration – closely

linked to the outcomes of integration

• Only professional group directly employed by

BOTH health and social care

• Most likely professional group not to have a

seat at the table - CURRENTLY

Multiple Paradigm Shifts

‘People who use services’ as equals/ even

experts their own body and care requirements!

Specialist care can be delivered in community

settings/ patient’s own home.

Professional leadership (and team) can be from

professions other than medicine.

Rehabilitation, enablement and self management

approaches delivering more sustainable and cost

effective care.

From Deficit to Asset and Beyond !

Affordable, sustainable health and

social care will depend on us driving

these paradigmatic shifts through

sustainable services

AHPs can accelerate the pace of that

shift towards better outcomes for

people who use services their families

and carers

We need to fully realise this untapped

potential and measure the impact

The AHP Journey2007 - 2012

Allied Health Professionals – National Delivery Plan2012-2015

� First of its kind in UK

� Provided a unique opportunity to align

contribution of AHPs to:contribution of AHPs to:

• the nationally agreed outcomes for

integration

• The Healthcare Quality Strategy

• 20:20 Vision

� Made AHPs more visible, more accountable

and necessitated the need to measure our

contribution

Mental Podiatric

Unscheduled Care

Children &

CHPO / AHP DIRECTORS / LEADS

Chair: Jacqui Lunday Johnstone

AHP NDPCo-ordination Group

Sarah L Mitchell

Current National AHP Structure and Work Programmes

Mental Health and Dementia

MSKPodiatric

SurgeryRadiography

Unscheduled

Care /

Flexible

Working

Care

PathwaysIntegrated

Approaches

Children &

Young

People

Falls

AHPD:

Hazel Dykes

National Lead:

Ann Murray

AHPD

Ann

Galbraith

National Lead:

Jane Reid

AHPD:

Elaine

Hunter

National

Lead:

Elaine

Hunter

AHPD:

Billy McLean

National

Lead:

Senga Cree

AHPD:

Lynne

Douglas

Sonya Lam

National Lead:

Sharon

Viener-Ogilvie

AHPD:

Katherine

Sutton

National Lead:

Helen

Robertson

AHPD:

Carolyn

McDonald /

Lynn Douglas

National Lead:

Claire

Ritchie

AHPD:

Susan Carr

National Lead:

Jan Beattie/

Susan Kelso

AHPD:

Karen

McNicoll

National Lead:

Edith

McIntosh/

Heather Hall

“AHPs will work increasingly to transform wellbeing and recovery, promoting prevention, earlier diagnosis and reducing unnecessary referrals and admissions to hospital and care by working

upstream to strengthen user and carer capabilities and assets in the communities they serve.”

�Older Peoples Service

Today’s Focus Areas on the AHP Contribution

�Older Peoples Service

�Unscheduled Care

�MSK Services

�Children and Young

People

�Mental healthhttp://www.scotland.gov.uk/Publications/2012/06/9095

Older Peoples Services

FALLSFALLS

DEMENTIA

The National Falls Programme in Scotland (2010 – present)

What are we trying to accomplish?

To reduce the personal, system and

societal costs associated with falls in

Scotland.

For every health and social care

partnership area in Scotland (32partnership area in Scotland (32

partnerships) to have a local integrated

falls prevention and management and

fracture prevention pathway for older

people in operation by the end of 2016.

People have the opportunity to receive

the right care and support, at the right

time, in the right place to prevent harm

from falls, every time.

The Up and About Pathway (2010)http://www.scotland.gov.uk/Resource/0045/00459959.pdf

Community Alarm Pathways

Falkirk

� Reduction in rate of falls amongst Community

Alarm Clients.

Community Falls Bundles

FALLS

Fife

� Increase in percentage of people

receiving strength and balance training.

Up and About in Care Homes

Three partnership areas

� Reduction in number of falls.

� Reduction in rate of ED attendances.

The story so far : #AHPDementiaEveryone AHP Business

• Good quality care at home can reduce admissions to acute hospital care (Alzheimer Society 2011) – AHP contribution essential

• Post diagnostic support – requires AHPs to work alongside link workers to AHPs to work alongside link workers to ensure equitable access to services –AHP improvement programme underway

• People live for many years after the onset

of symptoms of dementia and remain

engaged within their communities (WHO

2012)

The story so far : #AHPDementiaScotland's Dementia Strategy

Commitment 4:

We will commission

Alzheimer Scotland to

produce an evidence-

based policy document

The outcome of this work will help ensure that people with dementia, carers and families are provided with AHP information appropriate to their needs and that AHPs are in a position to provide advice, education and information to people with dementia, their families and carers when then need it

based policy document

outlining the contributions

of AHPs to ensuring

implementation of the 8-

Pillar model

then need it

By end of 2015 we will have:

� Defined a vision for future AHP practice for people with dementia

� Outlined AHP priorities & the expected roles for all 12,000 AHP’s in Scotland

� Developed recommendations to measure the impact

Unscheduled Care

Hospital @ Home

Scottish Ambulance Service

Minor Injuries

Hospital @ Home

DELIVERABLE•Acute multidisciplinary care in the patients home.

•AHPs in advanced practice roles as first assessors .

•Response time from GP referral is 1 hour

OUTCOMES• Over 75% of patients seen are able to be kept at home.

• Avoidance of admission is currently running at 86%

• Equivalent quality – length of stay 50% less

• Readmissions to date are reduced and are comparable with acute care

• The impact on acute care demonstrates a reduced demand on speciality beds

• Experiences of patients and carers is very positive

Patient Satisfaction High

Scottish Ambulance ServicesPathways

DELIVERABLE•Reduce unnecessary transfer of people who have fallen

and are uninjured to A&E

•SAS assessment with decision support

•Onward referral to integrated multi-disciplinary services•Onward referral to integrated multi-disciplinary services

•Urgent or planned response

OUTCOMES•Reduction in conveyance from 84% down to 66% (2010-

2015)

•Reduction in A&E pressures

•Reduction in re-presentations

•Supporting recovery, restoring independence and

preventing further falls

“……any fall including a slip

or trip in which you lost your

balance and landed on the

floor or ground level”

(Lamb et al 2005)

Minor Injuries

DELIVERABLE• See and treat up to 20% of total demand into ED

(MSK/Soft tissue)

• Appropriate referral onto MSK Pathways

OUTCOMES• 80% (MSK/Soft tissue) discharged from front door• 80% (MSK/Soft tissue) discharged from front door

• Physiotherapy expertise improving outcomes and

reducing re-attendances

• 96% patient satisfaction with assessment and

treatment

• Reduced pressures for other ED staff

• Treatment within 39 minutes compared to 57

MSK Services

AHP MSK RedesignAHP MSK Redesign

People have the opportunity to receive the right care and

support, at the right time, in the right place every time.

Self Management

Advice

AHP Services

ESP Services

NHS Scotland MSK National ProgrammeKey Components

Self Referral

Single Point

of Entry

Protocoled

Clinical

Telephone

Triage

Admin Hub

Orthopaedic

Consultation SurgeryCare

Allocation

GP

of Entry

Web based

Clinical

Algorithm

AHP MSK

Standards

MSK Change

Package

Robust IT Systems

Data for Improvement

Electronic referral, tracking and

appointingLeadership and Quality Improvement Development

Exit routes /

Third sector

partnerships

The National MSK Programme in ScotlandHow do we know a change is an improvement?

Musculoskeletal Assessment and Triage Service

Single Point of MSK Self- Referral Contact for Scotland

�Reduction in referrals to AHP services

�Self-management mean = 13%

�All patients provided with advice on day they call

MSK Administration Hubs

Early Implementer Boards30.00%

Lanarkshire Physiotherapy DNA

MSK what we have achieved

Early Implementer Boards

� Did Not Attend Rates reduced from 18% to 6%

� Slot fill productivity increased from 82% to 93%

� Increased efficiency through shared admin

Improvement in Whole System Flow

All Health Boards

� Shift in flow from Orthopaedic to AHP services

by 25%, with significant reduction in orthopaedic waits

� Conversion to surgery rates went from 35% to 70%

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10.00%

20.00%

30.00%

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Lanarkshire Physiotherapy DNA

NP …

Children and Young People (CYP)

Ready To ActReady To Act

CYP Plan 2015-2020

Children and Young Persons (CYP) Plan

� 1st CYP services plan in Scotland to focus on the support provided by AHP’s

� Sets out the direction of travel for the design and delivery of AHP services to meet the well being needs of CYP.

� Underpinned by :� Underpinned by :

� The Children and Young People (Scotland) Act 2014 and designed to support AHP services in delivering to their duties under the Act.

� Girfec

� United Nations Rights of the Child

� Informed by the views of practitioners, CYP and their parents families,carers and stakeholders

� Builds on good practice and innovation at universal,targetedand specialist levels of service access

AHPs in Mental Health

AHPs in Mental health

AHP’s in Mental Health:

The Strategic Mental Health AHP Leads and Consultants are currently leading on:

• Implementation of the Commitments set out in the Mental Health Strategy 2012 – 2015.

This includes work in relation to This includes work in relation to

• Psychological Therapies

• Employment and Vocational Rehabilitation

• Outcome Measures

• Benchmarking / Data gathering

• Physical Health

• Forensic Services

Lessons Learned

Problem Action Output

Too Many Actions - 27 Not so many next time! FOCUS

No clear measurement of

success for actions

Create clear SMART goals GOALSsuccess for actions

Limited engagement Ensure all stakeholders are

involved from the start

ENGAGEMENT

Unable to Measure

Impact

Get baseline data IMPACT MEASUREMENT

Confusion on

Accountability

Have clear Roles and

Responsibilities from the start

ACCOUNTABILITY

Starting with big national

redesign

Do small tests of change SUSTAINABLE SPREAD

Limited Capability Ensure you have right skillset CAP TRAINING / QI Leadership

The on-going challenges

• Demographic changes and the impact that will have

on how we deliver our services

• Financial challenges

• Providing truly integrated services

• Workforce

• Access to AHP services providing timely interventions

• IT infrastructure to support measurement and impact

The AHP StoryOperational Measures

If you don’t count, you don’t count!

� Existing national data collection was incomplete, inconsistent and inaccurate. We didn’t count so we didn’t count!

� Operational Measures (OMs) group was set up including SG, AHP Directors, AHP Managers, clinicians, local authority representatives and ISD. KPIs were developed for referral, activity, waiting times, workforce and episode of care.developed for referral, activity, waiting times, workforce and episode of care.

� OMs will lay the foundations for AHPs to define who we are, what we do, where we do it and why we do it. It will also increase the profile of AHPs and our increasing role in health and social care delivery.

� Proof of concept to begin in October within 2 boards then rollout nationally from April 2016

Any enquiries to euan.mccomiskie@nhs.net

The NDP Journey – Next steps

• Identify over next couple of months what we need to take forward to new programme

• Complete final report and disseminate widely

• Build on what has been successful and ensure spread and sustainability

• Celebrate our Successes

• Develop the Active and Independent Living Improvement Programme 2016