Like most of my chief nurse colleagues, the professional leadership of allied health professionals (AHPs) is in my portfolio, and although I appreciate that a number of my colleagues have developed their future workforce strategies with AHPs fully included in their delivery plans, I would suggest that the majority of us have not. This is not surprising with nursing domination of the agenda with current nursing vacancies reported nationally as around 40 000, the constant day-to-day pressure on safe staffing requirements, and the Interim NHS People Plan deliberately starting with nursing (NHS England, 2019; NHS Improvement, 2019a). This aims to:
Through the nursing recruitment and retention workstreams that I have been involved in, it is increasingly evident that the actions that we are taking in nursing are wholly appropriate to apply to our AHP teams. I feel that we are missing a trick and need an integrated approach to expand our ‘non-medical workforce’ (as an aside, I dislike this term, we should not describe a group as ‘not something’). Fortunately, the national teams have been working on this potential for some time.
My first port of call to widen my understanding of the AHP arena is the NHS England (2017) ‘AHPs into action’ framework, which sets out the collective commitments and priorities to deliver significant impacts for patients, their carers and communities. The framework defines the impact of the effective and efficient use of AHPs for people and populations:
Health Education England (2018) published an impressive progress report in to how the AHP workforce is developing new roles to deliver a number of national priorities via new roles from apprentice to advanced practice. However, in my experience although there are a number of talented individuals, the NHS has not progressed the implementation of these roles at scale. The King's Fund (2018) criticised NHS history as sadly littered with examples of policy ambitions that were not underpinned by robust workforce strategies. In fact, it went so far as to say that there was no credible overarching strategy in place to address the mounting challenges facing the NHS. It sounded a word of caution that the (eagerly awaited) People Plan needed to be clearly linked to a strategy to address the workforce crisis, otherwise it would simply risk being a ‘wish list’ rather than a credible path to a sustainable future for the health service. The King's Fund asked: Is there a plan to strengthen workforce and service planning at all levels of the system, including alignment of the institutional accountabilities and responsibilities for these? The most notable NHS failure being the desire to shift care out of hospitals, as despite an overarching policy commitment to move care away from hospital and towards primary care, in the period from 2006 to 2014 the number of hospital consultants increased by almost a third (32%) compared with just a 5% increase in GP numbers.
The potential to improve patient care, and recruit and retain talented staff is huge, and if we wait around for the national stratergy to solve this for us we will spend some time waiting. So, what next? A 2017 blog from Jo Filingham hits the nail on the head for me:
‘My view is that it is just not possible for everyone to know the range of skills these wider professions can offer across the health, care and wider system and the impact they can make. But every organisation should have someone who does.’
With this in mind my Trust is now seriously reviewing all of the national learning, including from NHS Improvement (2019b) in the form of insights from Trust executives on the role of the chief allied health professionals and associated key questions and recommendations. It aims to enable boards and clinicians to review and improve leadership arrangements for their AHP workforce.