Allied Health Professions - At the forefront of improving care - a year in review 2017/2018

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Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Allied Health Professions
At the forefront of improving care -
     a year in review 2017/2018

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Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Allied Health Professions
                           At the forefront of improving care - a year in review 2017/2018
                                                                                                                               Page
                                                                Contents
Forewords                                                                                                                      3

Context and introduction                                                                                                       4

The contribution of AHPs to the HEE mandate priority areas – primary care, urgent & emergency care, mental health, cancer      7
and maternity

Supporting the small and vulnerable professions – podiatry, prosthetics & orthotics, orthoptists and therapeutic radiography   16

Workforce, career and professional development – Apprenticeships, Return to Practice, AHP careers and professional             22
Development and Advanced Clinical Practice

AHP National Programme                                                                                                         30

                                                                                                                                    2
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Forewords

In the last two decades, healthcare has been moving from being               There has never been a more important time to maximise the contribution
predominantly profession-centric care delivered in acute settings to         of AHPs in transforming the health and wellbeing of the population.
patient centric, team-based care increasingly delivered in community
settings. The Allied Health Professions (AHPs), with their long history of   AHPs are the third largest workforce in health and care in England. Our
team working, patient-centredness, kindness, compassion and reflection       national implementation programme, AHPs into Action, highlights the
on practice have been well placed to be role models for these changes,       transformative potential of AHPs within the health, social and wider care
all of which better serve patients and their families and acknowledge        system. Ensuring we have an AHP workforce in sufficient numbers, with
them as equal partners in decision making. There is still some way to        the right skills and experience, is critical to realising this potential and I am
travel before the goal of an integrated, team based system is reached,       delighted to be providing the overarching leadership for the significant
where cooperation not competition drive progress and improvement.            AHP work programme being driven by Health Education England (HEE).

This is the first update on HEE’s work with the AHPs towards this goal,      May I take this opportunity to thank AHP colleagues, HEE and everyone
providing a snapshot of the achievements to date and work in progress.       who has worked with them for all your hard work and commitment to the
Next year, we will publish a second report with input from key               Allied Health Professions. We have some real challenges to overcome
stakeholders, which will give a steer on where the focus for developing      and many opportunities to exploit. The development of our AHP workforce
and strengthening the AHP workforce will be and how it will                  is critical to the development of a sustainable health and care system and
contribute to HEE’s mandate.                                                 improving population health. It is reassuring to see that so much has been
                                                                             done and the proactive and important work being planned.
Anna van der Gaag
Non Executive Director and                                                   Suzanne Rastrick
Chair of the AHP Strategic Oversight Board                                   Chief Allied Health Professions Officer (England)
Health Education England

          Allied Health Professions are: art therapists, drama therapists, music therapists, dietitians, occupational
          therapists, operating department practitioners, orthoptists, osteopaths, podiatrists, prosthetists and orthotists,
          paramedics, physiotherapists, diagnostic radiographers, therapeutic radiographers, speech and language therapists. 3
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Allied Health Professions
                                                                                                                           Exploring the potential
At the forefront of improving care                                                                                        contribution to the four
                                                                                                                        AHPs into Action impact areas
A year in review 2017/18
                                                                                                                       Impact 1 – AHPs will improve the health
Welcome to our review of Health Education England’s (HEE) work during 2017/18 to develop and                           and wellbeing of individuals and
strengthen Allied Health Professions (AHPs) in England. We recognise the many vital ways in which AHP                  populations.
colleagues improve the health and wellbeing of the people they care for and support
                                                                                                                       Impact 2 – AHPs will support and
AHPs into Action (2017) articulated the AHP vision and many HEE-led workforce development activities have              provide solutions to general practice and
taken shape over the last year, one of which was to increase the AHP leadership capacity within HEE. This report       urgent and emergency services to
highlights some of the national work over the last year and sets the scene for next year’s activity.
                                                                                                                       address demand.
HEE will enter the Autumn of 2018 with a new national AHP team working collaboratively across the arms length
bodies and a new programme of work, guided by a national AHP strategic oversight group.                                Impact 3 – AHPs will support integration,
                                                                                                                       addressing historical service boundaries
The national work to date has involved differing levels of attention being paid across the HEE priority areas and      to reduce duplication and fragmentation.
professions as we prioritised activity. Our work has focused on profession-specific activity to stabilise, modernise
and advance many of the professions; develop areas of progressive workforce transformation; and lay the                Impact 4 – AHPs will deliver evidence-
foundations for future work. This work is supported by a large volume of work to develop the professions across        based/informed practice to address
the HEE regions that will be included in future reports.                                                               unexplained variances in service quality
                                                                                                                       and efficiency.
May I take this opportunity to thank everyone who has contributed to this report’s development; those who have
been involved in achieving so much; and to all the AHPs who are at the forefront of improving care and developing
the workforce.                                                                                                         #AHPsintoAction

Beverley Harden, National AHP Lead, Health Education England
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Allied Health Professionals

• work across every sector of the health and social care system – from social care to
    tertiary services.                                                                              Collectively, AHPs
                                                                                                    are the third largest
•   contribute to the diagnosis   and care of people at every life stage –            from before   workforce in health
    birth to end of life.                                                                           and care in England
                                                                                                    and comprise of 14
• work across all clinical specialities – from involvement in autism to x-ray imaging.              individual
                                                                                                    professional
•   provide clinical leadership at all        levels of the health and social care system – from    disciplines.
    direct patient care to chief executive.

                                                                                                                     5
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Health Education England’s mandate - to support the delivery of excellent healthcare and health by
ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the
right time and in the right place.

                             AHPs’ skills are central to the delivery of sustainable services – prevention; early
                        1.   diagnosis; the skills to maintain, restore and develop independence; return to
Why Allied
                             work/practice; and self management.
Health
Professions are              AHPs work across all life stages, within all sectors – so are ideally placed to take an
so strategically        2. active role in integrated, person-centred care.
important:
                        3. AHPs have a long history of intelligent skill mix and multi-professional team working
                             – key to service transformation.

                                                                                                                6
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
AHPs’ support to HEE’s mandate priority areas
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
AHPs’ support to HEE’s priority areas

Primary Care    The development of a population health approach across primary care offers new opportunities to
                redefine how to best use the workforce’s skills and attributes. AHPs’ focus on prevention and
                supported self management, restoration and development of independence, plus their autonomy
                of practice, makes their contribution within the team vital to improving clinical outcomes through
                early diagnosis and management, increasing capacity and providing care closer to home.

Urgent &        AHPs have significant potential to support the development of sustainable, integrated urgent care
                systems to help manage rising demand and improve care and access.
Emergency
                Providing the right response first time by the most appropriate health professional (often an AHP)
Care            to those in need of urgent care is key to reducing demand on urgent and emergency services.

                AHPs have key roles across the cancer clinical pathway, contributing to the lives of people affected
Cancer          by and living with, and beyond, cancer; promoting wellbeing, prevention, screening, diagnosis and
                treatment, alongside rehabilitation, survivorship and end-of-life care.

                The skills of AHPs are invaluable within mental health and learning disability services, yet are
Mental Health   often less understood. Development of the AHP workforce in mental health, learning disability and
                autism is a key area of focus for HEE in 2018/9.

Maternity       The AHP workforce offers vital support to maternity services and yet their vital contribution is so
                rarely seen; work to illustrate the roles and impact is ongoing.
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Primary Care
New ways of working
Workforce challenges within primary care are well recognised. We have been
exploring opportunities to utilise the skills and experience of AHPs in new ways to
build capacity, alleviate workforce pressures, improve access to early diagnosis
and treatment, as well as develop the AHP professions.

During 2017/8, HEE built upon the learning of the New Models of Care
programme and the opportunities presented by the GP Forward View (2016) and
Roland Report (2015) to scale up musculoskeletal practitioners and paramedics in
primary care. This involved working intelligently with the system to integrate AHP
clinicians within primary care and maximise their contribution.

The development of frameworks to identify and document core capabilities has
been key to setting the standards for safety and efficacy. The potential system       Pie chart here -
quality improvements and savings from getting care models right for citizens at       how the
the first point of contact are significant.
                                                                                      professions are
In 2018/19, work to develop frailty and dietetic related First Point of Contact AHP   split. Waiting for
roles will continue its early stage development.
                                                                                      this information.
Work with NHS England has been essential to ensure that proactive workforce
development, and creation of the evidence base, is supported by commissioning
modernisation across health and social care systems.

                                                                                                           9
Allied Health Professions - At the forefront of improving care - a year in review 2017/2018
Musculoskeletal practitioners in primary care
Delivering the GP Forward view - increasing capacity and improving access to primary care - by the
national implementation of musculoskeletal (MSK) first contact practitioners.

  Making the case for change    Core capabilities             Person centred skills               Educational
  Collaboration with NHSE       Multi-professional clinical   Person-centred approaches           support                 Next steps:
  including NHS RightCare,      core capabilities             framework developed to              Development of
  the Elective Care Board and   framework developed for       underpin a new way of working,      MSK First Contact       • Mapping to Advanced Clinical
  Getting it Right First Time   First Point of Contact MSK    centrally placing the skills of     Practitioner e-           Practice training routes including
  (GIRFT) to develop evidence   practitioners. The building   prevention, coaching, shared        learning package to       the apprenticeship
  based High Impact Guidance    block for the workforce to    decision making and care            support primary care    • Link to primary care Post
  for commissioning MSK         build towards Advanced        planning. E-learning and face to    working e.g. social       Graduate Medical Education
  services.                     Clinical Practitioners.       face learning.                      prescribing, frailty.     schools, work based learning and
                                                                                                                            clinical assessment
                                                                                                                          • National evaluation of impact
    National programme to support successful implementation of pilots in 2018/19                                          • ‘How to’ toolkit for employers
                               – one in every STP                                                                         • Work with partners to develop
                                                                                                                            health economic case
                                Skills modernisation                                                                      • Person-centred approaches
  Leadership                    Collaboration with the         Economic impact             Data for impact                  training
  Clinical fellowships          Department of Work             Development of an           Work with NHS Digital to       • Links with Occupational Health
  offering professional         and Pensions to embed          economic tool to model      establish the primary            and Emergency Medicine
  support and leadership        training to support the        the impact - both           care data set to integrate     • Working across podiatry,
  and advice, supporting        extension to the Fit           financial and patient       care and record activity         physiotherapy, osteopathy and
  local development of          Note for Advanced Care         flow radiology and          to evidence and monitor          occupational therapy
  educational pilots.           Practitioners.                 surgical services.          impact .                       • Prescribing support

Working in
partnership with
                                                                                                                                                 10
Paramedics in primary care
HEE is working to develop the profession and ensure paramedics work safely and effectively in
primary care.

  System impact – feasibility                  Capabilities framework                      Primary Care Employment
  A feasibility study has shown the            HEE working with system partners and        Toolkit                             Paramedic Prescribing
  potential system benefits of rotating        the professions have co-produced a          Guidance on the employment of       Changes in legislation in 2018
  Specialist and Advanced Paramedics           Primary and Urgent Care Core                paramedics to support system        means Advanced Paramedics are
  between ambulance services,                  Capabilities Framework scheduled to         working is being developed, in      now able to prescribe.
  community and primary care to                be published in Autumn 2018. For the        association with the Royal          HEE is working with the College of
  increase capacity, reduce silos by           first time, this will provide employers     College of General Practitioners’   Paramedics and the Association of
  building a more resilient system             and paramedics with a detailed picture      (RCGP) Council to be                Ambulance Chief Executives
  response, and sharing new skills and         of primary care competencies and            published later in 2018.            (AACE) to commission and develop
  knowledge across the system.                 inform the scope of practice.                                                   the additional support needed to
                                                                                                                               introduce non-medical prescribing
   Increasing and ensuring primary care competencies in order to maximise the                                                  and utilise the rotation, with
  contribution of paramedics in primary care as part of safe and effective systems                                             additional support, as a mechanism
                                                                                                                               to support skills development.
 Educational support                      Leadership development                    Primary Care Paramedic
                                                                                    Pathway                                    Arms Length Body Collaboration
 HEE has supported the                    Drawing on support from Education
                                                                                    A postgraduate part time pathway           The team is working with NHSI and
 development of a post-graduate           Training Hubs and Deanery
                                                                                    into primary care for new                  NHSE as part of system planning for
 diploma in primary and urgent care       colleagues, three Paramedic Clinical
                                                                                    paramedic graduates has been               winter, system capacity and
 with the College of Paramedics.          Fellows have been recruited. The
                                                                                    developed and is being considered          resilience building and as part of the
 The qualification will demonstrate       Fellows are making a positive
                                                                                    as a pilot. The pathway allows             Ambulance Improvement
 defined capabilities and support         contribution as professional clinical
                                                                                    students to continue to work within        Programme.
 aimed at Specialist Paramedic            leads, assisting in curriculum
 level. This is designed to assess        development; networking and               ambulance services or other
 the development of critical              supporting paramedics in primary          employers (e.g. urgent care
 reasoning in a primary and urgent        care, as well as working with regional    centres) on a part-time basis to
 care setting, underpinned by the         HEE leads to inform the development       maintain connections and breadth
 core capabilities framework.             of the paramedic workforce.               of learning.
                                                                                                                                                        11
Urgent and Emergency Care
Making the best use of paramedics’ unique skill set to increase capacity in both primary and
urgent & emergency care services, as well as provide more care closer to home.
Increasing system capacity - Rotating Paramedic Programme
Recognising that paramedics are ideally placed to help manage increasing demand
for primary and urgent care services and building on the Paramedics Evidence-                                         A rotational
based Education Project (PEEP), HEE has worked to develop the profession;                                             model example
designed and piloted a new rotational working model that offers a ‘win-‘win’ solution
for primary care and the ambulance service.

A new model of working is being piloted with HEE funding and support. It involves
specialist and advanced paramedics working in rotations across a variety of
settings, including primary and community-based care, as well as within the
ambulance service.

Many emergency calls that result in conveyance to accident and emergency
department could be avoided if paramedics/community teams were able to deliver
more patient care at the scene. The pilot aims to send the most appropriate
healthcare professional, with the appropriate skill set, to offer definitive care to
                        patients - the right response, first time.

                        The four pilots, running in collaboration with East Midlands,
                        North East, South Central and Yorkshire ambulance
                        services, show real potential to improve patient care and       Winner - Primary Care Innovation 2018
                        experience; reduce pressure on the NHS; improve
                        retention of paramedics across systems and improve
                        career opportunities for paramedics.

                        Phase 2 is now starting to further develop and spread the
                        rotational model, buddying with new rotational schemes,         Finalist
                        and it will be subject to detailed evaluation.                                                     12
Cancer
Maximising the essential role of AHPs in diagnosis, treatment, rehabilitation and transforming the
experience of living with and beyond cancer.
                                                          Sonography
                        Workforce planning
                                                          HEE is working with stakeholders
                        Development of the HEE
                        Cancer Workforce Plan
                                                          to develop pre-registration level 6                            Next steps:
                                                          routes to training; seek regulation
                        published in 2017 - sets out a
                                                          for the profession of sonography;                              •   Developing the career
                        course of expanding both
                                                          build training capacity; and                                       framework and educational
                        diagnostic and therapeutic
                                                          develop Advanced Clinical                                          support to build the profession
                        radiography by 2021.
                                                          Practice standards.                                                of sonography.
                        HEE aims to increase supply of
                                                          Pre-registration clinical standards
                        both diagnostic and therapeutic
                                                          were published in June 2018 to                                 •   Application for sonography to be
                        radiography by 800.
                                                          support both traditional and                                       considered for regulation.
                        HEE is investing in upskilling
                                                          apprenticeship pre-registration
                        300 radiographers into
                                                          pathways.                                                      •   National occupational standards
                        reporting roles.
                                                                                                                             to be published 2019.
 Ensuring that cancer care services have access to sufficient AHPs with right skills
                                  and experience.                                                                        •   Further ACP work to build skills
                                                                                                                             to support people living with and
                                                                                                                             beyond cancer .
 Advanced Clinical Practice (ACP)        Mammography               Supply                       Cross system
 The ACP framework will lead to          Return to Practice        Preparing level 6            HEE is working with      •   Significant programme of work
 more AHPs working across                work across HEE           apprenticeship               NHS England, the             with the Office for Students, The
 traditional boundaries to support       and PHE screening         standards in diagnostic      Cancer Alliances and         Society and College of
 care of people affected by cancer.      teams. Level 4            radiography and              Macmillan Cancer             Radiographers and wider
 Early work is developing standards      Mammography               therapeutic radiography      Support, building            partners to support Therapeutic
 with partners for ACP diagnostic        Associate                 to improve accessibility     upon their AHP               Radiography.
 radiography and therapeutic             Apprenticeship was        and growth.                  workforce survey.
 radiography and image                   approved in August                                     A number of short
 interpretation and reporting            2018.                                                  publications are being
 credentials for the wider workforce.                                                           developed.                                        13
Mental Health and Learning Disability (LD) & Autism
The transforming care agenda has highlighted the vital contribution of AHPs in mental health,
learning disability and autism services.

                AHP Work Plan
                The report ‘Stepping forward to 2020/21:     Understanding AHPs in LD          Promoting careers
                The mental health workforce plan for         The film ‘I am here with you.’    The WOW Careers
                England’ (2017) highlighted the vital role   was produced,                     show to support school
                of AHPs, the complexity of the agenda,       with the British Association of   children’s career
                and specific workforce challenges that       Drama Therapists, to start to     choices                  Next steps:
                require a considered approach. HEE is        develop the narrative of          https://www.youtube.co
                working with the Royal College of            AHPs working with clients         m/watch?v=wWZ5FNL
                Occupational Therapists and the British      with a learning disability,                                • Conference 2019 to develop
                                                                                               PP1s
                Association of Arts Therapists to engage     autism or both – due for                                     further the narrative for LD AHP
                AHPs in mental health across services to     release in late 2018.                                        role.
                inform key areas of work.                                                                               • Coproduction work to focus on
                                                                                                                          placements, work experience for
Raising the profile, understanding the contribution of AHPs and                                                           new and existing staff.
                                                                                                                        • ACP pathway development.
developing the workforce                                                                                                • Development of the career
                                                                                                                          framework and educational
               National TCP workforce                                   Advanced Clinical Practice                        support for new entrants into LD.
               HEE’s national AHP LD workforce summit in March          (ACP)                                           • Work with music therapy to
               2018 informed recommendations for the                    ACP pathways for both LD/Autism                   showcase the workforce and their
               Transforming Care Partnership (TCP) workforce            and Mental Health are in early                    impact.
               subgroup report which looks at the care of people        development to support AHP ACP
               with learning disabilities.                              roles and to enable transferable
               In June 2018, an AHP workforce paper was                 qualifications to be available and
               submitted and presented to the national TCP              linked (where possible) to the
               workforce subgroup, outlining the contribution of        Level 7 ACP Apprenticeship.
               AHPs to the modernisation of the LD workforce.                                                                                   14
Maternity
Understanding the contribution of AHPs in maternity and gynaecology services to maximise their
impact.
                                                                                                                  Exploring the potential
  Scoping exercise
  Maternity care scoping exercise commissioned by HEE to be carried out in 2018. Working                         contribution into the four
  with the professional bodies that represent the AHP professions, sonographer                                  AHP into Action impact areas
  professionals, as well as the Royal College of Obstetricians and Gynaecologists and the
  Royal College of Midwives to gain a greater understanding of:                                                Impact 1 – AHPs will improve the
  • the sectors and settings AHPs work in to deliver support to gynaecology and maternity                      health and wellbeing of individuals and
     services.                                                                                                 populations
  • access to AHPs by gynaecology and maternity services.
  • activities and interventions undertaken by each profession in gynaecology and                              Impact 2 – AHPs will support and
     maternity services.                                                                                       provide solutions to general practice
                                                                                                               and urgent and emergency services to
                                                                                                               address demand
      Maximising the impact of AHPs in maternity and gynaecology services
                                                                                                               Impact 3 – AHPs will support
      E-Learning Programme                                  Apprenticeships                                    integration, addressing historical
      HEE Maternity Programme E-learning for                Level 6/7 sonography apprenticeship in             service boundaries to reduce
      Health Care Courses Guide published – June            development and currently awaiting level           duplication and fragmentation.
      2018                                                  (expected to be available in 2019).
      Provides an overview of all of the e-learning         Other relevant apprenticeships under development   Impact 4 – AHPs will deliver evidence
      packages that are related to Maternity and            include Dietitians, Occupational Therapist,        based/informed practice to address
      Pregnancy - collating them in one place for           Operating Department Practitioners.                unexplained variances in service
      easy reference to improve accessibility and
                                                                                                               quality and efficiency.
      encourage their use.
Small and vulnerable professions
Small and vulnerable professions
Working with professions and their professional bodies to raise awareness, ease access and
develop the professions.

The Universities and Colleges Admissions Service (UCAS) has reported a 27% drop in      Using the HEE STAR tool to support the professions
applicants to healthcare programmes in the period 2014-18 placing some AHP              The HEE STAR is a tool to support workforce transformation,
programmes at risk. Many courses in the UK are uncertain they will be able to recruit   helping providers understand their workforce requirements and
to their cohort numbers and, in some cases, even to recruit a viable cohort.            also providing a range of potential solutions.
This comes at a time when the need for the skills of AHPs and the understanding of      The programme has applied the organisational development
their added value and potential is increasing.                                          methodology of the HEE STAR Tool, considering all aspects of
                                                                                        workforce transformation (supply, up-skilling, new roles, new ways
The Office for Students (OfS) recognises Therapeutic Radiography, Prosthetics and       of working and leadership) to address workforce shortfalls.
Orthotics, Orthoptists and Podiatry as the AHP small & vulnerable professions. HEE
is working closely with the OfS to monitor and support the market and to develop a
long term strategic plan to stabilise and develop these professions. The following
pages outline the action taken in relation to those professions in the last year.

Monitoring all the AHPs to ensure their continued success and viability, taking
appropriate action as required, is a key focus for HEE.

                                                                                                                                                   17
Podiatry
Supporting the podiatry workforce to offer limb and life saving support to people with high risk
lower limbs as a result of diabetic and cardio-vascular disease; and make significant contribution to
musculoskeletal pathways                                                          Next Steps:
 Career Framework                Support workforce                   Engagement                   Supply routes
 HEE development of a            Development of support roles        HEE have hosted two          Apprenticeship level 6    •   HEE/Office for Students to monitor
 Podiatry Careers                and extension of skills with        co-production events         podiatry is completed,        course uptake and the continued
 Framework including             training to support the needs of    with the College of          and being updated to          impact post Comprehensive
 Support Worker; Assistant       the service. Consideration of       Podiatry and                 incorporate the level 7       Spending Review and the impact of
 Practitioner; and               the opportunities for an            podiatrists in service       option. National              the apprenticeship over time.
 Advanced Clinical               associate podiatry role.            and education. Work          procurement and           •   Facilitate the implementation of
 Practice pathways to            Working with colleagues across      with the other               intelligent                   level 6 apprenticeships.
 create new roles and            the wider foot health landscape     representative bodies        implementation            •   Support leadership and learner
 widen career opportunities      to determine methods of             and independent              discussions have              support.
 - mapped to the                 upskilling.                         practice is ongoing.         begun.                    •   Develop and support current and
 apprenticeship agenda.                                                                                                         future educators.
                                                                                                                            •   Consider curriculum in light of
  Understanding the benefits of podiatry and supporting the profession to meet                                                  service acuity.
          the needs of a population with increasingly complex needs                                                         •   Ensure clear communication and
                                                                                                                                promotion of the return to practice
 Careers                      Advanced Clinical         Professional Image and            Office for Students                   programme across the workforce.
 New content on the           Practice                  Identity                          Strategic Interventions in        •   Develop innovative work experience
 Health Careers               The musculoskeletal       Work is ongoing to                Health Education                      opportunities.
 website, work through        pathway is now in         complement the Office of          Disciplines (SIHED) project       •   Determine ACP routes.
 clearing and into 2019       development               Students’ work, building the      to support small and              •   Placements capacity and work
 with the Medic Portal        The High Risk Foot        professional narrative.           vulnerable professions.               experience work to start with
 – showing AHP                work is in                Work to develop leadership,       This funding aims to                  independent practice representative
 careers as an                development               educators and researchers         support demand for, and               groups to develop responsibility
 alternative to               nationally and will be    within the professions            improve retention on, these           across the profession for supply.
 medicine Work with           ready in early 2019.      alongside the skills of           courses.                          •   Conference workshops are planned.
 ‘Inspiring Futures’                                    influence are essential.
                                                                                                                                                        18
Prosthetics and Orthotics
Raising awareness of the Prosthetics and Orthotics (P and O) professions and supporting and
stabilising the workforce to boost this vulnerable profession.
                                                                                                                        Next Steps:
                    One Year On report          Workforce data           Learner support         Office for Students    •   HEE/Office for Students to monitor
                    ‘The Future of the          Work with NHS Digital    E-learning support      Participation in the       course uptake and the continued
                    Prosthetic and Orthotic     to ensure occupation     to clinical educators   Strategic                  impact post Comprehensive
                    Workforce in England:       codes for P and O are    to support students     Interventions in           Spending Review and the impact of
                    One year on’ report         included in NHS          and preceptorship       Health Education           the apprenticeship over time.
                    published August 2018: -    workforce data. A data   will be published in    Disciplines (SIHED)    •   Facilitate the implementation of level
                    driving actions towards     sharing agreement is     autumn 2018.            project to support         6 apprenticeships.
                    improving the P and O       being developed          Further work will be    small and vulnerable   •   Scope new routes for P and O
                    workforce.                  between all providers    undertaken to           professions.               education which provide wide
                                                of NHS commissioned      support                                            geographical, cultural and social
                                                services.                apprenticeships.                                   access across the population.
                                                                                                                        •   Development of a core curriculum for
        Raising awareness, easing access and developing the profession.                                                     all pre-registration P and O courses.
                                                                                                                        •   Support leadership and educators.
               Stabilising the workforce and improving the service                                                      •   Ensure clear communication and
 Careers                  Apprenticeships                                        Careers                                    promotion of the Return to Practice
 Further materials,       Apprenticeships at level                               New content on. the Health                 programme across the P and O
 such as career           3 and 6 are in active                                  Careers website, work                      workforce.
 presentations using      development with                                       through clearing and into              •   Further scoping work to see how
 stories, which can be    implementation and                                     2019 with the Medic Portal –               other AHP professions can support
 delivered by P and O     national procurement                                   showing AHP careers as an                  delivery.
 professionals within     commencing. Significant                                alternative to medicine                •   Develop innovative work experience
 schools, colleges and    employer engagement                                                                               opportunities
 community groups are     and support to enable
                                                       Innovative careers work with the WOW Careers                     •   Determine ACP routes and work with
                                                       show live streamed to schools                                        military providers to support
 being developed by       nationwide provision and
                                                       www.youtube.com/watch?v=4s3FF1H9K2o                                  advancement of the profession.
 HEE and the British      increase training
                                                       Work with ‘Inspiring Futures’                                                                   19
 Association of APO.      capacity.
Orthoptists
Proactively managing the orthoptic workforce challenge to protect and nurture the profession.

Deep Dive                   Engagement       Image and           Supply routes          Office for Students
HEE has worked with         HEE and          Identity            The                    Strategic Interventions in
the British and Irish       BIOS plan a      HEE is supporting   apprenticeship         Health Education             Next Steps:
Orthoptists Society         further          BIOS to             level 6 orthoptists    Disciplines (SIHED)
(BIOS), orthoptists in      discussion       investigate this    trailblazer is         project to support small     •       HEE/OfficeNext      steps to monitor
                                                                                                                                           for Students
service, Higher             forum in the     and develop their   developing and         and vulnerable                       course uptake and the continued
Education Institutes        Autumn to        orthoptic           HEE will work to       professions. This funding        •   impact  post Comprehensive
                                                                                                                               Preceptorship
and student orthoptists     develop a plan   campaign to build   support                aims to support demand               Spending Review and the impact of
to start to understand      of action to     the professional    implementation in      for, and improve retention       •   the apprenticeship
                                                                                                                               Scope               over time.
                                                                                                                                       related training
the workforce issues        support.         narrative.          parallel to fast       on these courses.            •       Facilitate the implementation of
across the regions.                                              track opportunity                                       •   level 6 apprenticeships.
                                                                                                                               Training  capabilities
                                                                                                                     •       Support leadership and learner
       Ensuring that there sufficient orthoptists to meet the future demand                                              •   support.
                                                                                                                               Regulation
                                                                 .                                                   •       Develop and support current and
                                                                                                                             future educators.
                                                             Advanced Clinical Practice (ACP)                        ••      Consider   curriculum in light of
                                                                                                                               Leadership
Careers
                                                             Eye Health                                                •     technological
                                                                                                                               Educators advances.
New content on the Health
                                                             Working across the professions to build                 •       Ensure clear communication and
Careers website, work
                                                             upon the Core Common Competency                           •     promotion
                                                                                                                               Placementsof the  RTP programme
                                                                                                                                             leadership
through clearing and into
                                                             Framework to develop the ACP level of                           across workforce.
2019 with the Medic Portal
                                                             practice across four key pathways.                      •       Develop innovative work experience
– showing AHP careers as
                                                             Developing the training for the ACP                             opportunities.
an alternative to medicine
                                                             modules and working with the Post                       •       Determine ACP routes.
Work with ‘Inspiring Futures’
                                                             Graduate Schools of Medicine to                         •       Event in the Autumn to outline key
                                                             develop work based learning alongside                           areas of activity.
Innovative careers work with the WOW Careers show            multi-professional colleagues.
live streamed to schools
www.youtube.com/watch?v=4s3FF1H9K2o
Work with ‘Inspiring Futures’                                                                                                                        20
Therapeutic Radiography
The Cancer Workforce plan (2017) has called for more radiographers (both diagnostic and
therapeutic) to be trained. Therapeutic Radiography, as a vulnerable profession, needs to be
supported and nurtured.
 Supply                      RePAIR                          Engagement                  Supply routes
 HEE aims to increase the    (Reducing Pre-                  HEE and the Society         Discussions are                  Next Steps:
 supply of both diagnostic   registration and                and College of              beginning to determine
 and therapeutic             Improving Retention)            Radiographers are co-       the opportunity of an            •   HEE/Office for Students to monitor
 radiographers by 800 by     legacy project for the          hosting a discussion        Associate Therapeutic                course uptake and the continued
 2021 through local          vulnerable professions.         forum in November           radiographer role.                   impact post Comprehensive
 actions to improve          The learning from this          2018 to develop a           Apprenticeship level 6               Spending Review and the impact of
 retention, delay            programme is being              plan of action to           therapeutic radiography is           the apprenticeship over time.
 retirement, return to       developed for roll out          support the Cancer          nearing completion –             •   Facilitate the implementation of
 practice and national and   and support to                  Workforce Plan.             national procurement and             level 6 apprenticeships.
 international recruitment   departmental leads is                                       intelligent implementation       •   Support leadership and learner
 campaigns.                  being discussed.                                            will be key..                        support
                                                                                                                          •   Develop and support current and
Ensuring that there are sufficient Therapeutic Radiographers to meet the future                                               future educators
                demand, in line with the Cancer Workforce Plan                                                            •   Consider curriculum in light of
                                                                                                                              technological advances
                              Careers New content on the          Advanced Clinical         Office for Students           •   Ensure clear communication and
                              Health Careers website, work        Practice                  Strategic Interventions           promotion of the Return to Practice
                              through clearing and into           Work with oncology        in Health Education               programme across workforce
                              2019 with the Medic Portal –        and dosimetry to          Disciplines (SIHED) project   •   Develop innovative work experience
                              showing AHP careers as an           develop ACP roles         to support small and              opportunities
                              alternative to medicine.            to support workforce      vulnerable professions.       •   Determine ACP routes
                                                                  and retention with        This funding aims to          •   Event in November 2018 to outline
Innovative careers work with the WOW Careers                                                                                  key areas of activity and test the
                                                                  clear nationally          support demand for, and
show live streamed to schools                                                                                                 Associate Therapeutic Radiographer
                                                                  recognised training       improve retention on, these
www.youtube.com/watch?v=4s3FF1H9K2o
                                                                  pathways is               courses.                          model.
Work with ‘Inspiring Futures’
                                                                  commencing.
                                                                                                                                                     21
Workforce, career and professional
development
Workforce development
Proactively managing workforce challenges to ensure the skills of AHPs are available for
generations into the future

 Monitoring supply             Workforce data               Supply routes              Deep dives
 Office for Students           Current workforce data       Apprenticeship             HEE has
 and HEE will monitor          is unable to offer the       implementation and         commissioned work to
 trends and                    view of the whole AHP        support for employers      undertake a deep dive
                                                                                                                             Next steps
 take proactive                workforce. Data sharing      to understand their        into the Operating
 proportionate                 agreements are in            smaller volume             Department
                                                                                                                 •   Develop AHP supply data.
 and appropriate action        development and              workforce and the vital    Practitioners’ (ODP)
 at key points of the          conversations with the       nature of                  workforce challenges
                                                                                                                 •   Support the implementation of
 academic year to              HCPC is ongoing              apprenticeships in         and ensure that all
                                                                                                                     apprenticeships.
 ensure sufficient supply      working with                 maintaining the supply     intended action to date
 of AHPs.                      professional bodies.         pipeline.                  has been completed.
                                                                                                                 •   Develop work experience
                                                                                                                     opportunities.
 Ensuring that there are sufficient AHPs to meet the future demand and realise
                 the benefits to the system of AHP contribution                                                  •   To continue to support proactive
                                                                                                                     careers activity.

 Careers                                                                   Educators                             •   Preceptorships.
                                           Skill mix & team working
 New content on the Health Careers                                         HEE will continue work with
                                           HEE will continue to
 website, work through clearing and                                        the Council of Deans for              •   Support the future educator and
                                           support the development
 into 2019 with the Medic Portal –                                         Health to support existing and            academic workforce.
                                           of support roles and safe
 showing AHP careers as an                                                 future educators.
                                           and effective delegation of
 alternative to medicine Work with                                         Current work to determine
                                           activity through effective
 ‘Inspiring Futures’ has been                                              Educator leadership
                                           education and training.
 undertaken for all professions. A                                         opportunities and barriers will
 further campaign is in discussion for                                     report in 2019.
 the Autumn.
                                                                                                                                            23
Apprenticeships
Developing new ways for people to enter the AHP workforce to improve accessibility and growth of the
professions at a time when vital AHP skills are needed for NHS sustainability. HEE has supported all
apprenticeships to come to fruition.

 Approved:                   Under development: - Pre-registration                                                     Next Steps:
 Level 4 - Mammography       Level 6 - Sonographer                           Level 6 - Diagnostic Radiographer
 Associate                   Level 6 – Dietitian                             Level 6 - Prosthetists and Orthotist      • Support implementation of pre-
 Level 6 – Podiatrist        Level 6 - Operating Department Practitioner     Level 6 - Therapeutic Radiographer          registration apprenticeship across
 Level 7 - Advanced          Level 6 – Physiotherapist                       Level 6 - Speech and Language Therapist     the professions sharing opportunities
 Clinical Practice           Level 6 - Paramedic                             Level 6 - Occupational Therapist            and challenges.
 Support Worker AHP                                                          Level 7 – Arts Therapist                  • Monitor the market to ensure there
                             These have now been agreed to be level 6 or 7                                               is no further destabilisation.
                                                                                                                       • Work with professions and
 Ongoing development of apprenticeship standards for Allied Health Professions                                           employers to develop national
                                                                                                                         procurement opportunities to drive
                                                                                                                         safe and effective delivery at scale
                                                                                                                         across the nation, especially for the
 Under development: Support staff                   Pre expression of          Implementation:
                                                                                                                         smaller professions.
 Level 3 - Ambulance Healthcare Support Worker      interest:                  Prosthetics & Orthotics,
                                                                                                                       • The Office for Students will ensure
 Level 3 - Prosthetic/Orthotic Technician           Level 8                    OPD and Podiatry have
                                                                                                                         that all activities support both
                                                    - Clinical Fellow          started to determine
                                                                                                                         delivery models.
                                                    - Consultant               implementation plans
                                                    - Specialist in
                                                       discussion

                                                                                                                                                   24
Return to Practice
Expanding the AHP workforce by encouraging and enabling Health and Care Professions Council
(HCPC) eligible professionals to return to practice.

 Return to Practice              Returnee support            Workforce strategies
 HEE is leading on an            Returnees and               Providers are being
 innovative Return to            providers have access       encouraged to use
 Practice programme, to          to financial support        Return to Practice in all
 support 300 Allied Health       with additional support     AHP workforce
 Professionals and               for past returnees and      strategies. New ways of
 Healthcare Clinical             a social media              supporting returnees are
 Scientists (HCS) to re-join     platform. The               being encouraged and
 the Health and Care             programme has a             shared across the health
 Professions Council (HCPC)      national lead with a        and social care
 register by March 2019.         AHP background.             community to support.
                                                             workforce capacity.

        Supporting workforce supply by maximising AHPs’ opportunities
                             to return to practice
  Clinical placements             Sharing good practice                      Return to practice benefits
  Following HEE’s                 Supported organisational workforce         Early benefits of supporting
  successful pilot in the East    plans for recruitment and retention.       AHPs to Return to Practice are
  Midlands, the programme         Challenged current concepts and            that they are highly motivated
  has been expanded across        views about AHP/HCS return to              experienced practitioners that   See return to practice case studies at
  all of England, looking to      practice to drive and share innovative     can integrated into the work     https://hee.nhs.uk/our-wok/return-practice-
  signpost returnees with         employment models and mechanisms           place with minimal input and     allied-health-professionals-healthcare-
  placements with clinical        to attract returnees. Shared the           cost. Most returnees have a      scientists
  providers that could            learning across the health and social      variety of non-clinical
  potentially lead to             care community employing                   transferable skills they can
  employment opportunities.       AHP/HCS.                                   bring to the work place and
                                                                             patient care.                                                    25
Return to Practice
Current data from the National Programme for AHPs and HCS

                                                                      Average age of returnee             44 years
                                                                      Average number of clinical years’
                                                                      experience before returning         8 years
                                                                      Average number years away from      9 years
                                                                      practice

                                                                      Average cost per returnee            £1,080
                                                                      Average numbers of months to
  HEE AHP Return to Practice completers
        returning to employment
                                          AHP percentage enquiries
                                          breakdown by HEE region     undertake Return to Practice training        4.5
                                                    London            programme
            20%                                      10%

                                                             North
                                                              20%
                                                                      91%       returnees gain employment after RTP
                                                Midlands &
                     80%
                                                   East
                                                   33%        South
       Employed   Not employed                                 37%                                            26
Careers and Professional Development
Proactively raising awareness of AHP careers, particularly in response to the decreasing numbers
applying to undergraduate degrees. Securing the next generation of AHPs.
                                                                                                                         Next Steps:
 Social media               Engagement                          RePAIR programme
 Social media review        HEE is working with University      The Office for Students’                                 •   Establish innovative work
 of where and how           Technical Colleges to explore       Strategic Interventions in Health Education                  experience opportunities and to
 AHP careers                innovative ways to engage people    Disciplines (SIHED) and HEE RePAIR (Reducing                 encourage and support NHS and
 messaging was              in AHP careers e.g. career          Pre-registration Attrition and Improving Retention)          other providers to allow for
 shared on social           carousels, student engagement       programme to help the smaller and specialist                 accessible and interesting work
 media.                     projects, immersive weekends.       disciplines, which are more vulnerable.                      experience for AHP careers.
                                                                                                                             Working with the Office for Students.
Ensuring that the Allied Health Profession careers are recognised and understood                                         •   Review the branding of the AHP
by those in education, potential mature students and the general public                                                      professions e.g. Orthoptics. HEE
                                                                                                                             and British and Irish Orthoptics
 World of              Medic Portal          Engagement                                  Professional Skills                 Society are working with a marketing
 Work show             Working with          Engaging with AHP students, workforce       Working with the                    company to rethink image and
 New                   ‘Medic Portal’        and professional bodies at the Chief        Royal College of Speech             media profile.
 collaboration         which has 700K        Allied Health Professions Officer           and Language Therapists to
 with the World        visitors every year   conference, #150leaders event and via       upskill the work force with     •   Developing a careers resource for
 of Work               from those            twitter to explore the issue - asking       dysphagia knowledge and             graduate AHPs to support ambition
 (WoW) Show,           interested in         them: How did they find out about AHP       skills . These skills are now       and development and to show case
 which                 medicine as a         careers? How can we better encourage        in the new curriculum and           AHP career journeys.
                       career.               people into AHP careers?                    national standards are
 features on
 YouTube.                                                                                being refreshed.
 www.youtube.c
 om/watch?v=4
 s3FF1H9K2o

                                                                                                                                                      27
Advanced Clinical Practice
Driving new ways of working by developing Advanced Clinical Practice (ACP) to support individuals,
employers, commissioners, planners and educators in the transformation of services to improve
patient experience and outcomes.

                       Framework                                        ACP Academy           Equivalence
                                                ACP definition                                                     Academic
                       Development of a                                 System wide co-       routes
                                                A definition for ACP                                               Career
                       multi-professional                               production to         Links with NIHR,
                                                agreed that will                                                   Pathway
                       framework for                                    develop the           the Leadership
                                                support workforce                                                  Work to
                       advanced clinical                                Academy of            Academy and
                                                transformation in                                                  address and
                       practice in England’,                            Advancing Practice    Education to
                                                England across all                                                 clarify career
                       outlining the                                    to support the        map equivalence
                                                professions to                                                     pathways for
                       capabilities that
                                                support prescribing     governance of         routes to ACP        AHPs pursuing
                                                                                                                                         HEE, NHS
                       underpin ACP                                     training pathways     which use                             Improvement and
                                                where appropriate                                                  a clinical
                       practice – leading to                            and a mechanism       existing
                       the standardisation of
                                                and use of the Fit
                                                                        for equivalence.
                                                                                                                   academic             NHS England
                                                Note.                                         evidence.            career.
                       ACP across England.                                                                                          working together,
   Developing national training pathways, qualifications and governance structures to                                               along with a range
                   ensure consistent ACP practice and development                                                                   of partners across
                                                                                                                                       healthcare, to
Procurement                  Council of Deans           Trailblazer group      Pathways                 Consultant practice         develop Advanced
Co-production of a           Project with Council       Support of the         Development of key       Developing principles
national procurement         of Deans to support        ACP Level 7            advanced practice        for consultant practice       and Consultant
framework to                 Higher Education           apprenticeship         pathways e.g. Eye        in 2018/19.across the          level practice.
underpin all                 Institutes                 trailblazer group to   health ACP/ Surgical     professions to
apprenticeship               development of ACP         ensure equity of       ACP/ MSK ACP/            advance support to
training routes to           routes and update of       access to all          Paramedics in            this professional
become an ACP.               apprenticeships.           professional           primary and urgent       group.
                                                        groups.                care ACP/Frailty ACP.
Advanced Clinical Practice
Developing nationally recognisable Masters Level training pathways to underpin Advanced Clinical
Practice working with employers, ACPs, Professional Bodies, Royal Colleges and Higher Education
Institute partners. Pathway developments include:
Eye Health                              Musculoskeletal                    Radiography                  Frailty
Working across the professions          A core capability                  The curricula guidance       ACP clinical
to build upon the Core Common           framework has been                 to underpin the              components are in            The four pillars that
Competency Framework to                 developed across                   development of ACP           development with               underpin ACP
develop the ACP level of practice       stakeholders to guide the          diagnostic radiography       stakeholders to support
across four key pathways.               central content which              is in development with       the development of the            practice:
Developing the training for the         forms part of a suite of           system partners.             clinical components of
ACP modules                             Masters level learning to          Initially this will          the ACP route for               Clinical Practice
                                        develop ACP                        develop the national         frailty. This will support
                                        Musculoskeletal – this can         standards for image          cross system,                    Leadership &
                                        be tailored to primary care,       interpretation and           integration and primary          Management
                                        the emergency department           reporting for all.           care roles                         Education
                                        or occupational health.
                                                                                                                                            Research
   Developing national training pathways, qualifications and governance structures to
                   ensure consistent ACP practice and development                                                                      ACP training pathways
                                                                                                                                      place the service user at
Surgery                             Learning Disability                Mental Health                Other ACP pathways               the centre and are based
The development of the              Core and specialist                Core and specialist          Other pathways starting in          upon the knowledge,
surgical (non operating)            capabilities are being             capabilities will be         development include Acute           skills and behaviours
ACP curricula is ongoing            developed to promote the           developed to promote         Medicine, General Practice,       needed to fulfill the level
to develop both general             range of advanced skills and       the range of advanced        Nursing,                           of practice required by
surgical and specialty              knowledge in ACP roles.            skills and knowledge in       Paediatrics and                            the role.
specific skills to work             Implementation with Higher         ACP roles.                   Therapeutic Radiography.
within clinical teams.              Education Institutes (HEI)                                      Emergency Medicine is well
                                    partners will be key.                                           established
                                                                                                                                                     29
AHP Programme
New national funded work programme for 2018/9 and regional leads appointed.

A new organisational structure within HEE will take a nationally funded AHP
programme of work forward from 2018.

This will provide a dedicated focus on the AHP professions to maximise
their significant contribution to people’s health and wellbeing and to the
sustainability of the NHS.

The national and supporting regional HEE AHP teams will work with system
partners and the Arms Length Bodies. This work reports into a strategic
oversight group within HEE, ensuring alignment with HEE’s other clinical
programmes and workstreams. It will also report into the HEE Board and
Executive and the NHS England’s Chief Allied Health Professions Officer
and NHS England’s AHPs into Action Programme Board.

                                                                              30
Acknowledgements

Thank you to the large number of people outside of, and within, HEE who
have worked hard to help co-produce and deliver these programmes, which
are starting to show real impact.

To name people would risk forgetting someone, so instead - thank you to
everyone who has participated in our work together and to those now joining
the team.

November 2018

www.healtheducationengland.nhs.uk

   @NHS_HealthEdEng

     Sharon.Kibble@hee.nhs.uk or Vanessa.Cullen@hee.nhs.uk

                                                                              31
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