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Building on Success - Future Directions for the Allied Health Professions in Scotland
Setting the Scene
2. AHPs Making a Difference to the Health of the People of Scotland
While the number of AHPs is continuing to grow, understandings of their functions are often vague and incomplete. This chapter explains the constituents of the AHP workforce and offers an insight into their varied - and developing - contributions to health and health care.
2. AHPs Making a Difference to the Health of the People of Scotland
There have been significant increases in the overall number of allied health professionals in NHSScotland over the last 20 years, and a growing recognition of their expertise and further potential to enhance modern seamless service provision. A further 80% growth in the numbers of 'scientific, technical and therapy workers' over the next 20 years has been predicted in the Wanless Report (2002).
Table 1 Staff in Post at 30 September 2001
| Number | WTE | Ratio |
Total | Qualified | Unqualified | Total | Qualified | Unqualified | Qualified:Unqualified |
|
Art/Music Therapists | 33 | 33 | - | 24.6 | 24.6 | - | n/a |
Podiatrists | 791 | 754 | 37 | 670.5 | 639.8 | 30.7 | 21:1 |
Dietitians | 507 | 501 | 6 | 412.1 | 407.8 | 4.3 | 95:1 |
Orthoptists | 98 | 98 | - | 70 | 70 | - | n/a |
Physiotherapists | 2,523 | 2,243 | 280 | 1,997.8 | 1808.1 | 189.7 | 10:1 |
Radiographers | 1,678 | 1,1466 | 212 | 1,400.7 | 1225 | 175.7 | 7:1 |
Speech and Language Therapists | 984 | 882 | 102 | 813.5 | 739.6 | 73.9 | 10:1 |
Occupational Therapists | 1,699 | 1378 | 321 | 1,424.9 | 1194.1 | 230.8 | 5:1 |
Table 1 shows the number and whole time equivalent (WTE) of qualified and unqualified staff in the eight selected professions who were employed at 30 September 2001.
AHP Staff - Qualified and Unqualified: at 30 September 2001
These figures do not include the 116 Prosthetists and Orthotists currently providing services to NHSScotland, or practitioners from the other disciplines working in Local Authorities, Education, Voluntary Sector or other non-NHS environments.
While users of services and fellow professionals recognise and value AHPs' expertise, understanding of their functions and contributions to health care is sometimes vague and incomplete. Table 2 summarises what those main functions and contributions are.
"They treat me like an individual. They understand my problems and have really helped me to make progress since I had my stroke. It's been so good having my rehabilitation at home. I could come home earlier from hospital and it's helped my husband and me to cope at home. I really appreciate the specialist skills of the therapists and it is a real comfort to know that I can just pick up the phone at any time for advice." Stroke patient receiving rehabilitation from a dedicated community team |
Table 2 Main functions of AHPs
Profession | Main function | Patient/client groups |
Arts Therapists | Provide psychotherapeutic interventions which enable clients to gain insight and promote the resolution of difficulties through the use of art materials. | All age groups - mental health, learning disability, palliative care, and other community groups. |
Dietitians | Translate the science of nutrition into practical information about food. They work with people to promote nutritional wellbeing, prevent food-related problems and treat disease. | All age groups with special dietary requirements or those needing advice and education on nutrition. |
Drama Therapists | Encourage clients to experience their physicality, to develop an ability to express the whole range of their emotions, and to increase their insight and knowledge of themselves and others. | All age groups - especially mental health and other community groups. |
Music Therapists | Facilitate interaction and development of insight into clients' behaviour and emotional difficulties through music. | All age groups - mental health, learning disability, physical disability. |
Occupational Therapists | Assess, rehabilitate and treat people using purposeful activity and occupation to prevent disability and promote health and independent function. | All age groups where physical or mental functioning impact on everyday life, especially children, older adults and those with chronic disease. |
Orthoptists | Diagnose and treat eye movement disorders and defects of binocular vision. | Mainly children and older adults. |
Orthotists | Design and fit orthoses (such as callipers and braces) which provide support to parts of patients' bodies and compensate for paralysed muscles, provide relief from pain, or prevent physical deformities. | All age groups with injury or physical disability. |
Physiotherapists | Assess and treat people with physical problems caused by accident, ageing, disease or disability, using physical approaches to maximise the patient's recovery and alleviate pain. | All age groups - especially those with neuromuscular, musculoskeletal, cardiovascular or respiratory problems. |
Prosthetists | Provide care and advice on rehabilitation for patients who have lost or were born without a limb, fitting the best possible artificial replacement. | All age groups of those missing limbs or amputees. |
Podiatrists | Diagnose and treat abnormalities of the foot. They give professional advice on prevention of foot problems and on proper care of the foot. | All age groups - mainly older adults and those with chronic disease - e.g. vascular, diabetes. |
Diagnostic Radiographers | Produce high quality images on film and other recording media, using all kinds of radiation. | All age groups. |
Therapeutic Radiographers | Treat mainly cancer patients using ionising radiation and, occasionally, drugs. They provide care across the entire spectrum of cancer services. | All age groups - mainly individuals with cancer and tissue defects. |
Speech and Language Therapists | Assess, diagnose and treat people with communication and/or swallowing difficulties. | All age groups - especially children and those with neurological or cancer-related problems |
Speech and Language Therapists | Assess, diagnose and treat people with communication and/or swallowing difficulties. | All age groups - especially children and those with neurological or cancer-related problems |
AHPs are a growing force in modern health and social care services with practical expertise in assessment, treatment and rehabilitation. But the dynamic nature of healthcare demands that professions continuously review their roles to ensure that services are responsive, flexible and provide positive health benefits for patients. In response to this, AHPs have developed new ways of working in many specialist fields, including extended scope of practice for expert practitioners and extended roles for support workers.
"With the challenges that face NHSScotland to deliver services that offer faster access and shorter waiting times, AHPs are in a good position to use their expertise and extended scope of practice targeting priority areas, finding better ways of doing things and providing more responsive services." Chief Executive - NHS Trust |
For example:
Arts therapists are leading projects that focus on building confidence and self-expression, and which support social inclusion and community involvement.
Dietitian-led coeliac disease clinics have been developed, improving the responsiveness of the service to patients, supporting them in their management of this chronic condition, and reducing waiting times.
Occupational Therapists are providing rapid intervention at home for frail older adults to avoid hospital admission, and are enabling people to return home earlier from accident and emergency and medical assessment units through rapid assessment and discharge planning services.
Orthoptist-led glaucoma clinics have been introduced through 'shared care' arrangements and have been effective not only in helping patients to retain their sight, but also in reducing waiting times for patients who might previously have been seen by ophthalmologists.
Orthotists work closely with podiatrists within specialist diabetic teams to treat serious foot lesions associated with diabetes and to support and protect the 'at risk' foot, thereby avoiding more radical intervention and possible admission to hospital.
Prosthetists have used biotechnology to develop sophisticated functional prosthetic upper limbs which enable adults and children to have independent use of their limb in everyday activities.
Physiotherapists have developed specialist musculoskeletal services to enable speedy access for people with back problems and other injuries, resulting in significant reductions in orthopaedic service waiting times and earlier recovery from debilitating conditions.
Podiatrists have developed nail surgery clinics that have contributed to reductions in surgical waiting lists and have helped patients to regain their mobility.
Diagnostic Radiographers have undertaken additional procedures such as barium and ultrasound investigations, resulting in reduced radiology waiting times and shortened times for diagnosis.
Therapeutic Radiographers are planning and delivering fast-track palliative radiotherapy and undertaking reviews and management of patients receiving radiotherapy.
Speech and language therapist-led dysphagia clinics have been established and offer fast-track assessment and treatment for patients with swallowing problems, enabling them to achieve adequate nutrition and gain maximum benefit from multi-professional rehabilitation services.
Innovation and creativity in the roles AHPs perform is flourishing throughout Scotland, and enthusiasm for new opportunities and ways of working is evident. Changing roles will also provide opportunities for AHPs within health and social care teams. All professionals will have to respond positively to the challenges of delivering better and more responsive services to people, maximising their expertise in a variety of settings.
For instance, the introduction of AHP consultant posts - recognised within the report of the Review Body for Nursing Staff, Health Visitors and Professions Allied to Medicine (2002) and similar to those already developed in Nursing and Midwifery - looks set to provide new and exciting opportunities for expert practitioners. This positive development, when fully underway, will assist in retaining clinical excellence and mature skills within the service. Consultant practitioners will also play a pivotal role in the integration of research evidence into practice.
Similarly, the new role of Public Health Practitioner offers opportunities for AHPs to use their skills in the health improvement field and contribute more effectively to the public health agenda. AHPs have a key role to play in the delivery of public health interventions and they need to be supported in the development of this new and challenging role.
In tandem with these initiatives, new mechanisms are being developed to improve and integrate workforce planning and workforce development for all healthcare professions. This will be fundamental to the planning processes of the future.
Supporting and sharing the good practice that has been established and continues to evolve is also essential to the future development and delivery of services. Multi-professional networking has been established and now needs to be fostered to support the delivery of a shared vision for the Allied Health Professions.
As demand for the valuable skills AHPs bring to health, social care and education teams grows, the development of a carefully balanced skill mix within AHP services will become increasingly important. This has the potential to release clinical time and enable practitioners to utilise their skills appropriately, to the benefit of all those who use their services.
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