We need to keep wellbeing at the heart of all we do, and recognise that this is a ‘long haul’ aim.
Integration of health and social care services has been one of the most significant changes in how services are commissioned, delivered and experienced in the last 10 years. Whilst the guiding principles included ensuring dignity, individuals’ rights, person centredness and quality and safety in services which are proactively planned, flexible, anticipatory and asset orientated, the overarching principle is actually the pursuit of wellbeing. We know that a “wellbeing perspective facilitates innovation, earlier intervention/prevention and joined up policies and services” and that it can impact positively on peoples’ physical and mental health status, their use of services, their recovery from ill health and has implications for how services are arranged, delivered and funded. To set it as the overarching principle for integration was ambitious and requires a groundswell change in how we think, deliver and measure what we do.
What has this meant for allied health professions (AHPs) and how have we fared in the integration journey? As the third largest staff group in healthcare (and a small but significant group in social care), AHPs are a diverse group of professions who provide diagnostic, therapeutic and reablement/rehabilitation interventions across all sectors. When the Public Bodies legislation was enacted, AHPs were nearing the end of their first national AHP policy, which set out the case for AHPs as ‘agents of change’. Based on this programme’s success, the current AHP Active and Independent Living Programme (AILP) was commissioned by the Minister for Public Health “to make the contribution of AHPs more visible and accelerate the impact and spread of effective practice across Scotland, ensuring an explicit fit with the wider policy landscape”.
The programmes’ vision and 6 ambitions were developed in partnership with over one thousand stakeholders across Scotland, from people using and providing services, members of the public, informal carers, educators, the ALLIANCE, Scotland Fire and Rescue and the Care Inspectorate. We asked people what keeps them active, healthy and independent, what AHPs should do to support them with this, and what should we prioritise. Our resulting vision, ‘AHPs will work in partnership with the people of Scotland to enable healthy, active and independent lives by supporting personal outcomes for health and wellbeing’, will be delivered through AILP’s 6 ambitions: awareness, access, partnership, health and wellbeing, workforce and research and innovation.
People told us they wanted help to manage their own health and wellbeing – with access to our services easily and quickly when they needed them. Thus, in line with this and the Health and Social Care Delivery Plan (this link will take you away from our website) AILP seeks to look at how AHPs refocus their contribution across integrated services on prevention and early intervention. How do we achieve this given the considerable pressure on unscheduled, unplanned and emergency care? By having personal outcomes at the heart of our vision, AHPs are committed to working with people on what matters to them, on their priorities and to sharing our knowledge and skills in a more collaborative and empowering way.
To address peoples’ personal outcomes and their wellbeing needs often means that our priorities are not always those of people who use our services. Thus, we require a different way of thinking, of delivering and of measuring the impact of what we do. From a Three Horizons perspective, AILP aims to create a culture of ‘disruption innovation’ that will help move towards a new model of health and social care – with wellbeing at its core.
Examples of AILP work to date include:
- Partnership working with Scottish Ambulance Services to develop proactive, asset based pathways for people who have fallen but are uninjured, to prevent them being taken to hospital.
- Development of technology solutions for access to self management information and advice to support people with musculoskeletal problems including a GP decision support tool and the Musculoskeletal Advice and Triage Service based within NHS Inform.
- Developing existing vocational rehabilitation services to support people to get into or stay in work – addressing one of the health inequality precursors.
- In partnership with ISD develop a standard AHP activity dataset and national dashboard which will enable integrated services to understand their AHP workforce and service activity.
- Produce analysed nationally costed health and social care data of adults using AHP services matched to where they are on their ageing journey through the national AHP Lifecurve Survey, which will provide the baseline to drive services towards prevention and early intervention.
- Development of a Request for Assistance model, initially in Children and Young Peoples services, which focusses on wellbeing. This work has already seen a decrease in waiting times whilst demand is rising, an increase in self ‘requests’ and children and young people are getting the right level of help and support more quickly.
- Collaboration with NES to develop sustainable learning resources focussed on embedding personal outcomes across services.
What we know already from early Lifecurve Survey results is that most AHPs are intervening too late for people to reach their full potential through rehabilitation/reablement. Over 60 per cent of people who took part in the survey cannot walk 400 yards – this activity is often a ‘tipping point’ for increased difficulty with other everyday activities and increased use of health and/or social care services. We also know that around 25 per cent of people who see an AHP are fully active and independent in terms of Lifecurve, so what opportunities are there for a different conversation around wellbeing and active and healthy living?
Focussing on wellbeing requires seismic change: a move from being problem solvers to facilitators; from being ‘expert practitioners’ to partners who share knowledge and expertise; from being ‘change agents’ to ‘disruptive innovators’.
Integration principles recognise that people using and providing services are likely to need support, time and skills to work differently to be able to: identify what matters to people; what their outcomes are and; how to work within a relationship based approach to work collaboratively towards that. We need to keep wellbeing at the heart of all we do, and recognise that this is a ‘long haul’ aim.
Susan Kelso can be found on Twitter at @susankelsoAHP (this link will take you away from our website).
Susan’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.