The AHP national delivery plan

AHP NATIONAL DELIVERY PLAN
2012 – 2015
“AHPs as agents of change in health and social care”

20:20 Vision
“The demands for healthcare and
the circumstances in which it will
be delivered will be radically
different in future years. We
must be bold enough to
visualise the NHS that will best
meet the needs of the future in a
way that is sustainable and
make the changes necessary
to turn that vision into reality”

Realising 20:20 Vision
AHPs will work
increasingly to transform
wellbeing and recovery,
promoting prevention,
earlier diagnosis and
reducing unnecessary
referrals and admissions
to hospital and care by
working upstream to
strengthen user and
carer capabilities and
assets in the communities
they serve.

We have a number of simultaneous shifts
• Patients expecting to be treated as
equals and expert in their own body,
and how their condition affects them.
• Specialist healthcare being delivered
in the community or patients own
home.
• Professional leadership coming from a
range of health professionals, like
AHPs.
• Rehabilitation, enablement, supporting
wellbeing and self management
delivering better and more cost
effective outcomes.
Affordable, sustainable
healthcare will depend on us
driving these paradigmatic
shifts through agents of
change.
Integration of health and social
care services is a real catalyst
to accelerate the pace of this
shift.
4

Background
• The NDP was
commissioned by the
Minister for Public Health,
with the support of the
Cabinet Secretary for
Health, Wellbeing and
Cities Strategy.
• Universal crossparliamentary
support
• It’s a first for Scotland and
for the UK.

Background
• AHPs are the only
professions bringing
expertise in rehabilitation
at the point of registration
• The Minister, the third
sector and majority of
respondents wished to see
significant strengthening of
AHP Leadership
• This requires corporate
support and recognition of
their role as Agents of
Change across health and
social care

Actions Include
• Each NHS Board to strengthen
and position appropriately the
AHP Director post as the
accountable officer for
implementation of the NDP -
CEL 27 (2012).
• AHP Directors will drive the
delivery of AHP waiting times
within 18 weeks from referral to
intervention, inclusive of all
AHP professions and
specialities
• AHP Directors will drive the
expansion of self referral to all
therapeutic AHP services as
the primary route of access

AHPs as Agents of Change
Six Action Areas; 27 Actions
1.Professional leadership to drive
innovation and delivery.
2.Reshaping care and enabling
independent living.
3.Improving health and well-being.
4.Supporting early years.
5.Maximising workforce engagement
and development.
6.Driving improvement: delivering
sustainable quality.
27/03/2013 The NDP: Falls prevention
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The National Delivery Plan for the Allied Health Professions in Scotland
2012 – 2015
May 2013 Update
NDP Situation
The National Delivery Plan for Allied Health Professions in Scotland
calls for AHPs to be more visible, accountable and impact orientated.
It aligns the AHP focus on deliver with the nationally agreed outcomes
for integration, and reflects the context of health and social care
integration.
As of March 2012, there were approximately 12,000 AHPs working in
acute and primary care setting across NHS Scotland. There were also
around 500 AHP practitioners in social care, predominantly
occupational therapist who, despite comprising only 1% of total social
care workforce, addressed 35% of all adult referrals.
NDP Key Milestones
- Nov 2011, Parliamentary Debate on Rehabilitation
- Dec 2011, NHS Lanarkshire go-live with MSK MATS
- May 2012, CAP Training National Leads
- Jun 2012, Launch of NDP
- Oct 2012, NHS Board NDP Self Assessments Complete
- Oct 2012, NHS Lothian & NHS Ayrshire & Arran go-live with MSK MATS
- Nov 2012, MSK National Guidance Pack Produced
- Jan 2013, NHS Board NDP Local Implementation Plans Complete
- Jan 2013, Appointment of National Lead Alzheimer's, MSK, Alliance Scotland
- Feb 2013, NDP CAP Training (Ayrshire & Arran)
- Feb 2013, DCAQ training, MSK Leads & AHP Directors
- Mar 2013, MSK MATS Evaluation Published
- Mar 2013, Presentation to Cross Party Group (MSK & Pain)
- Apr 2013, NDP National Key Performance Indicators agreed
- Apr 2013, NDP National Performance Measurements agreed
- Apr 2013, Strategy Deployment Toolkit launched (Hoshin Kanri)
- May 2013, Governance Board initiated for MSK developmental Heat Target
- May 2013, CHPO Board Visits begin
Operational Benefits
National Standardised NDP KPI & Performance Measurements
National NDP Management Control System
National Transferable Strategic Deployment tool
Assessment
MSK
4 Week developmental HEAT Target in progress
3 boards MATS Service implemented (Lanarkshire, A&A, Lothian)
National Minimum Standards await sign off
Lanarkshire are now demonstrating New appointment DNA of 3%,
(18% April 2012). Increase of 220 available clinical hours p/week.
Reduction of 100 back pain patients p/month into consultant led
orthopaedic surgeon. (NHS Lanarkshire)
A&A are showing a increase of Orthopaedic conversion rate.
MATS service providing increased capacity (4 WTE) within local
service.
FALLS
Implementation of Falls Bundles continues. (NHS Fife).
Falls National Minimum Standard Framework in consultation period.
Publication of Cost Consequence analysis.
ASSET (North Lanarkshire Partnership)
Data from the first 200 patients indicate:
over 75% of patients seen are able to be kept at home.
Avoidance of admission is currently running at 86%
Readmissions to date are reduced and are comparable with acute
care – Acceptability from patients and carers is also high
The impact on acute care demonstrates a reduced demand on
speciality beds (Feb12 – Jul12 = avg saving 20 beds per month =
£600k)
Recommendation
E-health investment for IT infra-structure for NDP performance
measurements and HEAT target development
Discussion with CEO’s re NDP outputs and impact
Training for all AHP Directors on the Strategy Deployment toolkit
Identify national programmes for economic evaluation (7 day
working, unscheduled care, implementation of physical activity
pledge, radiography reporting).
Work towards full implementation Heat Target 2015– MSK

Strategic Deployment Toolkit (Hoshin Karnri)

National Standardised RAG Status

Falls and fracture prevention in the community
•An SG commissioned economic evaluation currently underway suggests:
•The cost per fall is £1,720, per serious fall £8,600, per hip fracture £39,500 and other
fracture £21,960.
•In total, falls and fractures cost over £470 million a year, with the majority of the costs
(45%) being for long term care. NHS costs were estimated at £190 million (40% of the
total). This does not include falls and fractures in care home settings.
•Without action, due to the increased proportion of older people in the population over
the next 20 years, the number of fallers over 85 years could increase from 100,000 to
200,000, with an associated increase in direct costs from falls of £200 million.
•Evidence based falls prevention programme benefits include
1) reducing the morbidity,
2) reduced mortality
3) and psychosocial effects associated with falling, hence avoiding
significant costs for H&SC in the community

Impact of Falls Prevention
• Implementation of evidence based falls ‘care bundles’ has
the potential to be financially neutral across H&SC.
However an up front investment, mainly in people, is
required in prevention services before the benefits are
realised in the acute and long term care settings.
• Full economic evaluation available later this year

What does the economic evaluation report
tell us?
•Quantifies the potential benefits and the resources and associated costs of implementing and
sustaining the bundles, for
–Community Health Partnerships,
–NHS boards, and
–Scotland.
•Includes a summary of:
–wider benefits for older people and their families/carers, and
–impact on social services.
•A costing template will enable boards/CHPs to enter local information on
…enabling each area to tailor cost analysis to local conditions and prepare a robust business
case.
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ASSET North Lanarkshire Partnership
• Evidence shows that frailer older adults not in receipt of
CGA are more likely to die or be admitted to a care home
• Hospital admissions are rising and hospital beds are not
• Review of Admission Alternative Hospital to Home has
demonstrated that patients in receipt of CGA in their
homes have a reduced mortality rate and improved
patient /carer satisfaction at a lower cost.

ASSET Team
• Interdisciplinary, multiagency
team
• Key component of the
team is advanced practice,
with AHP and nursing staff
trained to FYI medical
level competencies.
• Morning virtual ward
rounds – led by the OT

The Service
• GP responding to a patient in crisis calls a single point.
• The emergency response centre for admission is offered
as alternative to admission.
• With a call to the ASSET team, who will respond within
one hour and provide the same level of care offered in
hospital, but in the person’s home.
• Assessment, diagnosis and management of the acute
episode is managed at home.
• Average LoS 4.7 days.

Outcomes
Data from the first 1,000 patients indicate:
• over 76% of patients seen are able to be kept at home
• Avoidance of admission is currently running at 86%
• Readmissions to date are reduced and are comparable
with acute care
• The impact on acute care demonstrates a reduced
demand on speciality beds
• Acceptability from patients and carers is high
• Mortality 6% in ASSET comparable to mortality at 9.7% in
Acute

It was like the
Cavalry
coming over
the hill...
P1 believed
that this was
the most
thorough
assessment
that she had
ever
experienced
And no danger
of some of
these awful
hospital bugs.
Oh I felt
as if I was
the queen
getting
all that
attention
sometimes
it’s easier
to get into
hospital
than it is
getting out
This is the
way
healthcare
should be
I think it is
amazingly
impressive
They were
marvellous,
absolutely
marvellous
I think just being in
your own
surroundings makes
you feel happier and
more confident and
able to cope.
Well it was either the
hospital or being in my
own home… there
was no choice. I mean
who would want to go
to hospital, when they
could be treated just
as well if not better at
home…

MSK Services for the Future
• Radical redesign of current services to meet future demand
• Centralised referral service utilising technology of NHS 24
• Equitable access and standards of care across NHS Scotland
• Reduction of referral into orthopaedic services
• Emphasis on supported self-management (NHS Inform, MSK zone)
• Clear identification of those actually requiring therapy
• True employability pathway
• Ability to measure the impact
• Reduction in waiting times

MSK Referral Process Re-Design
GOALS - What
•Ensure right treatment, right time, right place.
•Free up capacity within the MSK team.
•Reduce waiting times & DNA’s.
•Reduce sickness and absence rates.
•Improve Functional Outcome. (does not exist).
•Equitable Service
GOALS - How
•Central Referral Management System – Develop a new national standalone nonemergency
telephone service which will triage patients and promote selfmanagement.
•HUB – Develop a local MSK hub which will appoint patients to the appropriate
pathway.
•Minimum Standards -Pathways
•Measure Functional Outcome. (does not exist).
•External Agencies – Provide improved access to leisure and employability services
early in the rehabilitation journey

RESULTS
5% of demand
triaged to
Return to Work
and Leisure
programmes
DNA cut from
~13% (estimated)
to 3% return
Minimum
pathways
implemented –
cuts
rework/delays
15% of callers selfselected
Self-
Management
10% of demand
triaged to Self-
Management
Conversion to
surgery up from
~15% (estimated)
to 57%
NOTES ON RESULTS
•Pilots conducted at NHS Lanarkshire, NHS Lothian and NHS Ayrshire and Arran.
Each pilot was different, reflecting pre-existence of different parts of the redesigned
service in each board.
•All figures above relate to NHS Lanarkshire apart from Conversion which relates to
NHS Ayrshire and Arran.
•Cost savings are hard to calculate because of confounding factors eg ~6% increase
in background demand. KE estimates between £200k to £500k pa for a population
of 500,000 and implementation of all measures.
•Patient experience/outcome improvements captured but not yet analysed.
NEXT STEPS
•4 Week HEAT Target
•National Data Set - ISD
•National Productivity Trystorms
•New MSK National Lead
•National Lead Visits
•Minimum Standard Pathways
Ratification
•Evaluation
•National Test-Deployment of
Danny’s Tool
•Leverage the GE Approach to other
AHP National Priorities

Deliverables of the NDP for NHS Scotland
•Use health technology to support self-management,
effective triage of patients, avoidance of secondary care
referral, reduce dependency upon health professionals.
•Maximise utilisation of AHP skills as an asset across
health and social care, and contribution to preventative
spend
•Enable people to remain independent at home for as long
as possible
•Prevent unnecessary admissions to hospital or care
Evidenced by
•Health economic evaluation
•KPIs
•Local implementation plans
•Patient / user experience

The National Delivery Plan
Next steps…
Next Steps
• NHS boards and local
authorities are developing
local implementation plans.
• Engagement of AHPs across
health and social care.
• Development of national
measurement plan to
monitor progress.
• The CHPO will lead annual
reviews of progress against
plans.
The NDP: Falls prevention
26