The Specialist Multidisciplinary Management of Dysphagia

Dysphagia is defined as ‘difficulty in moving food, liquid, saliva or medication from the mouth to the stomach’ or ‘difficulty in swallowing’. Its consequences include dehydration, malnutrition, aspiration and asphyxiation. It can also have a negative impact on quality of life (Lecko 2014).

Approximately 8% of the world’s population is affected by dysphagia. In the developed world this amounts to 99 million individuals (Chichero et al, cited by Lecko 2014). Despite this the prevalence of dysphagia is perhaps under recognised amongst healthcare professionals, with research suggesting 30% of patients with stroke and 60-80% of patients with neurodegenerative diseases are affected (Martino et al, cited by Lecko 2014). Estimates also suggest that between 10 – 30% of adults over the age of 65 and 51% of the institutionalised elderly have dysphagia (Horner et al, cited by Lecko 2014).

The prevalence and effects of dysphagia bring challenges to its management. Recognising and diagnosing dysphagia is just the start; the language used in its treatment (i.e. how the thickness of fluids and food are described), the type of foods provided as a result, the nutritional composition of texture modified foods, and the administration of medications are some of the other long-standing problems. As a result of this Dietitians and Speech and Language Therapists (SLTs) are core members of the multi-disciplinary team (MDT) working with people affected by Dysphagia.

FeedbackThese professionals are keen to continue to build on their knowledge of the condition and improve nationwide practice in this area. As a result, and following the success of their joint conference in 2013, the BDA East and West of Scotland Branches and the Scotland Speech and Language Therapists’ Dysphagia CEN, will again join forces to host another stimulating conference of expert lecture and debate which you too can join.

As the theme of the conference suggests, this conference will be entirely relevant and informative not only to SLTs and Dietitians, but to all members of the MDT. The expert speakers come from a range of disciplines, including Physiotherapy, Pharmacy and Oral health, as well as Speech and Language Therapy and Dietetics. Together they will explore the updated evidence base in current topics that affect a great many patients with dysphagia, including medicines administration, enteral feeding and gastro-oesophageal reflux and debate approaches to dysphagia management.

Conference delegates will also have the opportunity to explore exciting new ideas and products in dysphagia assessment and care at a range of displays, including: a new decision-making tool for dysphagia patients by Talking Mats, and the opportunity to sample some of the dysphagia ranges by Appetito and Wiltshire farm foods.

Places are limited, so have a look at the timetable, the list of specialist topics and speaker biographies, and book your place ASAP so you can be a part of this exciting event:<>



Cichero J, Steele C, Duivestein J et al (2013) The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative Current Physical Medicine and Rehabilitation Reports 1 :280 – 291

Horner J, Alberts MJ, Dawson DV, Cook GM. Swallowing in Alzheimer’s disease. Alzheimer Dis Assoc Disord. 1994;8(3):177 – 89.

Lecko C. The Dysphagia Diet Descriptors – Development and Progress. Dietetics Today November 2014.

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63


Realising Potential Together

“Realising Potential Together – by Elaine Hunter. Published previously this month on Let’s Talk About Dementia Blog Screenshot 2015-03-22 11.38.41

Last week saw the launch of an allied health professional policy document called “Driving Improvement: Implementing Realising Potential an Action plan for Allied Health Professionals in Mental Health” (Scottish Government 2014). The policy document reflects on the progress that has been made through the implementation of Realising Potential (Scottish Government 2010) and considers how future AHP practice should be shaped.

However the policy document was always about harnessing allied health professionals creativity and energy and did not “ask AHP’s to do extra. It asks AHP’s to do differently”. (Scottish Government 2012). I am delighted to showcase the launch in this week’s blog and share a bit more about what and who the allied health professionals are.

“Making the invisible visible” through social media Screenshot 2015-03-22 11.38.48Realising Potential encouraged multidisciplinary and multisectoral team-working and helped people to understand the added value AHPs bring to mental health and dementia services.

A number of us tweet and on the day we used the hash tag #RealisingPotential2015 where we had some great conversations and interest in our work. Thanks to everyone who joined us.

Screenshot 2015-03-22 11.38.56“Tree of Celebration” Like all great work, “none of us are smarter than all of us”. On the day we launched our “tree of achievement”. For the next year we will take the banner around Scotland inviting colleagues to add a leaf and share what they are proud of.

“Journey to Work” During the launch we were reminded of the many ways AHPs are helping adults of working age to gain the confidence and skills to return to the work environment – or indeed to take up employment for the first time. We heard from Robert Reid how important that was when he read his poem.

Dementia Friendly Communities: ‘It’s just so AHP’ We heard and celebrated the partnership approach that has lead the way in dementia friendly communities in Scotland and heard from Sarah (@sarahahpmh) on the work in Highland to use technology to connect arts and health for therapeutic interventions in remote and rural communicated.  You can find out more by linking to this website.

Smile please

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On the day we had over 40 AHP’s there from all over Scotland, sharing their posters, their awards and their work. This is just some of the great photos.

Where next & what now “…..the Realising Potential story is far from over.  We have so much more to do and so much more to give” We heard these words on the day and will continue to look forward and build on the momentum created to ensure the benefits gained of working together as a collective group of AHP’s does not diminish or disappear. We were encouraged to inform people of who the allied health professionals are and what we can do with the aim to develop a shared understanding of the positive impact allied health professionals can have on the challenges facing services today. If you were to add a leaf on our tree of achievement what would you answer when asked?  “What are you proud of? What has made a difference? What do you want to shout about? 

References  Scottish Government 2010  Realising Potential Scottish Government 2012 Realising Potential: our own and others. Report from the National Allied Health Professional Mental Health Clinical Leads Group on Implementation of the Action Plan, 2010-2011 Scottish Government 2014 Driving Improvement: Implementing Realising Potential an Action plan for Allied Health Professionals in Mental Health

Links to Robert reads work are here

Weight or Words. Outcomes in weight management

by Joanna Teece Dietitian-Keep Well NHS Fife

# Outcomes # Nutrition and Dietetic Care Process

New Year, New Start, New resolutions. 


What does this mean to you?

UnknownHow do we show we have achieved the original goal of treatment, that we are successful, we have met our aims? Whose outcome is it? The service user or the service commissioner? What is more powerful? Number crunching such as patient contacts, % of weight lost or the words which tell and report patient experience.

As a Dietitian working in a changing landscape we are increasingly asked to prove our worth and sell our services. I work in weight management. January is traditionally a time of change, new ideas and new resolutions.  2/3 of the adult population are now overweight or obese.   Capturing the desire and motivation to lose weight in January is a key part of the weight management service I provide, but how do I measure this. What is our desired outcome?

Trust a DietitianAs a department we have started to look at the Nutrition and Dietetic Care Process . This has provided a framework to help structure, plan and measure our dietetic consultations. This is a step towards having and using outcomes we can easily measure and report.

So this is my resolution for 2015, a New Year, a new weight management group and a new approach to start consistently measuring and reporting on outcomes.  I’ve decided to go with both words and weight and to start small.


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Hopefully these outcomes will add weight to the words written in reports used to help plan, review and commission Nutrition and Dietetic Services.

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Screenshot 2015-01-07 16.29.36HAVE YOUR SAY

Whose responsibility is it to support patients and clients on weight management?

Take one minute to link to our AHPScotPoll by clicking here

Help us to get Scots walking in 2015





Paths for All is Scotland’s national charity promoting everyday walking. We want to create a happier, healthier Scotland, where increased physical activity improves quality of life and wellbeing for all.


We know these goals are well aligned with Allied Health Professions. Indeed, in 2012 we welcomed the AHP Director’s Physical Activity Pledge: “We will work with a range of partners to increase the level of physical activity in Scotland”.



Like you, we are committed to increasing physical activity in Scotland. We believe that everyday walking can be the key to improving the health and wellbeing of the Scottish people. By encouraging and supporting more people to take their first small step towards enjoying physical activity, we want to help fight some of Scotland’s most pressing health issues: obesity, cancer, heart disease, depression and dementia.


The case for promoting walking grows stronger and stronger

In Scotland, it is estimated that low activity contributes to around 2,500 deaths per year and costs the NHS £94 million annually. With the predominance of sedentary jobs, reliance on car travel and ageing population we need to take action to include physical activity into daily life, helping to prevent ill health and its cost.

The Scottish Government launched some important documents in 2014, including the Physical Activity Implementation Plan, National Walking Strategy and the Active Travel Vision. With plans and strategies in place we all need to work together to give us the reality of a more active Scotland.

We can help you to get Scotland walking!

Health professionals have a crucial role to play in promoting physical activity with patients and ensuring patients are offered safe and appropriate options.

paEncourage your patients to join a Health Walk

A Paths for All Health Walk is:

  • Short (around 30 minutes)
  • Easy, low level (no hills)
  • Accessible (good quality paths and pavements)
  • Safe – all routes have been risk assessed
  • Has a friendly walk-leader to show the way
  • Is completely free

We have Health Walks in cities, town and villages right across Scotland. We also have walks just for people affected by cancer with Macmillan Cancer Support. Find a health walk here.

Join or hold a Promoting Walking Workshop

  • Designed to help Health Professionals promote walking
  • We’ll show you resources, support and tools that you can use
  • Taking place Stirling on 26 January and Glasgow on 4 Feb
  • Contact us for more info or to arrange a course in your area

Walking your way to better strength and balance

  • A programme of strength and balance exercises for falls prevention
  • Leaflets, tools and training available

Use pedometers to help your patients set and aim for goals 

  • We offer packs with diaries, guidance and pedometers
  • Proven to affect behaviour change as part of a 12-week supported programme

Get active in your own workplace

  • Set up a workplace walking group
  • Take part in our team Step Count Challenge in Spring 2015



Whose responsibility is it to support patients and clients on weight management?

Take one minute to link to our AHPScotPoll by clicking here

AHPs In Scotland. Celebrating 2014

AHPScot – A pictorial blog of some of the highlights of our role, our work and our impact

One blog was almost not enough to celebrate AHP successes in Scotland in 2014. A wide selection of AHP stories were submitted. Sit back and enjoy. 


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Heather Hall, AHP lead for LTCs and Co-production at The Alliance sighs, smiles and celebrates success as the first National AHP, Third and Independent conference on “Coproduction, Partnership and Integration” draws to a close.




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Throughout the day a positive and exciting buzz was created as AHPs showcased their potential as leaders and active travellers in the journey of co-production.  The conference provided a wonderful platform to grow budding relationships between AHP and third sector organisations.



Age Scotland Conference

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Ask an AHP” was at the Age Scotland Conference



Health Service Journal Awards

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Sarah Mitchell and MSK work in Scotland made two finals






Waiting Lists

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NHS Ayrshire & Arran children’s OT team celebrate improvement work that reduced waiting times from 57 weeks to 8 weeks and delivered a more person centred service.





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Pat Harris, Physiotherapist and Kevan Fulton Clinical Associate in Applied Psychology for NHS Ayrshire and Arran were recognised for their work in establishing the Mindfulness Network. Kevan and Pat have brought together a network of individuals who are passionate about promoting mindfulness within NHS Ayrshire & Arran.


NHSScotland event

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John McConway, NHS Ayrshire and Arran showcases personal footcare poster at NHS Scotland event.




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Erika Diffenthal and Billy McClean showcase Ayrshire & Arran AHP delivery plan poster




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Judith Reid showcases Ayrshire & Arran MSK redesign at NHS Scotland event




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Andrea Dick and team showcase Ayrshire & Arran pocket ideas work




Advancing Healthcare Awards

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NHS Ayrshire & Arran AHP team celebrate having three finalists at the awards




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Lisa Greer AHP National Lead and Jean McQueen AHP Consultant, Forensic Network received the 2014 Advancing Health Care Award for improving quality measuring and demonstrating impact. This award sponsored by the Scottish Government recognises the work undertaken by AHPs around employability, mental health and forensic mental health.


Unscheduled Care

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For the first time AHP  Physiotherapists working as part of NHS 24 Unscheuled Care and are shifting the balance of care from Out of Hours Services towards Self Care


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NHS Tayside Front Door (A&E and Admissions Units) AHP Team was successful in getting extra funded staffing resource to support weekend working in this area.





Patient Outcomes

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NHS Fife physiotherapy staff from Whitefield Day Hospital, QMH, won the best poster at the Chartered Society of Physiotherapy Scottish Board Conference





MSK Self Care Resources

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MSK Zone has its half millionth page view




Vocational Rehab

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Jean McQueen AHP Consultant in Vocational Rehabilitation was awarded a PhD following her study into Alcohol Brief Interventions within General Hospital. This formed a mixed methods study and was supported by NHS Greater Glasgow and Clyde Public Health Division, Glasgow Centre for Population Health and the College of Occupational Therapists.




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OTs in Dumfries and Galloway “Getting Ahead for Work” in partnership with Support in Mind Scotland, poster presentation at “Work as a Health Outcome” event.




AHP Apps

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MSK App is updated and relaunched to include an MSK animation



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‘Apps for AHPs’ poster won the prize for best NMAHP eHealth project at The British Computer Society Conference in September 2014. The project evaluated a trial of ipad usage by Physio’s, OT’s and Pharmacists from a number of community specialties within NHS Fife.



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Up and About in Care Homes Project Celebrating Success with NHS Highland and NHS Dumfries & Galloway. The Up and About in Care Homes Project is an AHP lead project with the aim of reducing falls in care homes.


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Scottish Dementia Awards

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This year has been a real celebration for ‘Pocket Ideas…for a moment in time’ especially as our ‘Activity Team’ won an award at the Scottish Dementia Awards in the category ‘Best Acute Care Initiative’.


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The  picture is of the team and left to right is Jean Knox (Technical Instructor), Gillian Agnew (Occupational Therapist), Andrea Boyd (Occupational Therapist), Elaine Tizzard (Technical Instructor) and Darrell Line (Technical Instructor). NHS Ayrshire and Arran.




Scottish Health Awards

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Jennifer Taggart, an Advanced Practitioner Occupational Therapist from NHS Greater Glasgow & Clyde was awarded Quality Champion 2014 at the Scottish Health Awards for her work on dementia training for health care support workers.



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Best Community Initiative for OT Home Based Memory Rehabilitation program at the Scottish Dementia Awards 2014. NHS Dumfries & Galloway.




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The multi disciplinary IDEAS Team won the Practice Excellence Award for Dementia and Best Practice of the Year at the Mental Health Nursing Awards 2014 and runner up for Best Education Initiative at the Scottish Dementia Awards 2014.NHS Dumfries & Galloway.



Mental Health

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Christine Steel AHP Dementia Consultant and Sandra Shields Alzheimer Scotland Dementia Nurse Consultant  meet Ros Moore Chief Nursing Officer at their event to celebrate the success of dementia champions within NHS Greater Glasgow and Clyde.



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December 2014 saw the official launch of three new publications for Allied Health Professionals in Scotland: Agents of Change; Living Well with Dementia; and Living Well with Community Support. Published by the Scottish Government and Alzheimer Scotland, these publications highlight the impressive work carried out by AHPs in delivering improvement for people living with dementia and those who care for them, as well as leading change in practice. Elaine Hunter. Further information on the publications here

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Launch of Let’s Talk About Dementia Blog



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AHP Mental Health Priorities




Seven Day Working

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Some of the Golden Jubilee National Hospital Rehabilitation team celebrating winning a national award for seven day working



Appreciative Leadership

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NHS Greater Glasgow & Clyde  Forensic Directorate Occupational Therapists  Appreciative Leadership with Fiona MacNeill Associates.



Pulmonary Rehab

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The new self care resources for Pulmonary Rehab on NHS inform A-Z [click here to access] have been live one year. There has been a   130% increase in traffic to the new information from 3291 page views in 2012-13 to 7560 in 2013-14.



Occupational Therapy

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Angela Howard, Band 5 Occupational Therapist Mental Health Occupational Therapy Service, NHS Fife makes her first paper presentation at COT National Conference, Brighton, July 2014.




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RGU Occupational Therapy in Washington DC. Stephanie Morrison  Lecturer in Occupational Therapy, Robert Gordon University Aberdeen, presented at the 113th American Anthropological Association  in Washington DC  3rd  December 2014 ‘Discipline Care and Punish? Anthropological  Approaches to Suffering and Well-Being Along the Carceral  Continuum’.  On her work at HMP Aberdeen  ‘Prisoners’ Narratives’ Re-crafting Lives of Dignity and Hope Through Occupations of Meaning and Purpose

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An occupational perspective of health,’  for realising prisoners’ potential  to transform their lives and improve their health is now being delivered at HMP & YOI Grampian as the prison has a permanent half time occupational therapy post’




Chronic Pain

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Paul Cameron, Clinical Team Lead Physiotherapist, NHS Fife wins award at National Pain Meeting for Physiotherapist Prescribing pilot work.




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Sheena F McIntyre    Technical Instructor 3, NHS Fife, RIVERS Pain Programme proves to be a hit with patients






Screenshot 2014-12-22 09.09.38Thought the Dietitians Week and Trust a Dietitian Picture could be another wee plug for the blog? We could say how this year saw the BDA launch their new campaign “Trust a Dietitian” and the first ever Dietitian’s Week which generated international interest and support. It was also supported by AHP Scot Blog which featured 6 pieces/areas of work by dietitians working in Scotland. To read their blogs click here:

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Winter 2014 issue of MacVoice – A magazine for Macmillan professionals. This season the mazagine’s ‘In Focus’ section featured 3 pieces of work from across Scotland, all of which support the cancer rehabilitation theme. To read more click here





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(From L to R) Dr Jacqui Morris AHP Research Lead, NHS Tayside, Shona Robison MSP Health Secretary, Mandy Trickett Macmillan Specialist Physiotherapist, NHS Tayside meet to discuss how NHS Tayside are working to improve equity and access to physical activity therapy in palliative care and celebrate their PAHA award. For more information on their work and the award click here or to read our previous AHP Scot Blog on the topic here:


And finally

AHPScot Blog

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AHPScot Blog passes 10,000 views.

Here is to continued AHPScot successes in 2015



What’s in a blog? Lifting the Cloak of Invisibility

As AHPScotBlog moves past 10,000 views it is worthwhile to review blog #1 from Lesley Holdsworth and reflect on how far the blog has come in a relatively short time. Feel free to join us

We’ve created this blog to allow Allied Health Professionals (AHPs) from all over Scotland to share their personal thoughts, views, news and invite comment and reactions from anyone with an interest!

Over the next few months, the AHPScot blog will post contributions from AHPs keen, willing and brave enough to share their own thoughts. We hope you will find this of interest.

So, who are ‘we’? ‘We’ are an eclectic group of AHPs, mainly (but not exclusively) in positions of leadership in Scotland keen to provide better patient care, to develop AHP practice and raise awareness of the contribution we make.

So who am I? My name is Lesley Holdsworth and I’m an AHP Director most recently based within NHS 24. My remit was to develop AHP practice through the use of a range of technologies, things like the telephone, the internet, TV etc. You can read more about the work I am involved in here .

So, why start a blog page for AHPs? I’d like to share my own experiences of using social media. Just last year, I had no experience or even much of an idea about social media, things like Twitter and blogs but knew that others were actively using it. What I also knew however was that we AHPs have a bit of a problem. We are pretty much invisible. Very few people are aware of the roles we play particularly in supporting and enabling people and that extends to the public, fellow colleagues in health and social care and those that set policy direction and determine services.  While chewing over this meaty issue with three like minded AHP leaders, we decided to explore whether social media could help. The question we were keen to find out was: Can social media raise the profile of the AHPs? Could it help?


So the four of us wiling guineas pigs, embarked on an experiment and Project Gandhi was borne. Basically this involved learning and using new social media skills –  a steeper learning curve for some than others! To read about our progress, what we did and the results achieved look here. The upshot is that we have seen what social media has to offer and are impressed. We were able to reach audiences previously unavailable to us, we have established new networks with patients, the public, colleagues from all over the world and those who have influence in healthcare, for example health ministers and key policy makers. Although a regular tweeter @lesleyahpd I am not the most prolific blogger in our small group by any means but do check out Lynne and Elaine for great examples of really interesting AHP blogs. Another great place to view Scottish blogs can be found at (Ayrshire WordPress) with whom we will be directly linking this blog page with into the future. Although not a frequent blogger, at the end of last year, after pen to paper at the end attending a meeting that really inspired me, I did feel compelled to write about that experience and what it meant for me. My blog was about what healthcare could learn from the police about their use of social media. Within one week of posting the blog, it had escalated through Twitter to more than 4,000 people and discussed widely throughout the UK, Europe and other worldwide countries.

That experience further convinced me of how powerful social media can be –  that we need to be using all avenues available to us to engage, share and learn. Twitter and blogs for example are great ways of providing us with a very real opportunity to raise our profile, sharing and engaging with wide ranging audiences

The series of blogs planned for the next few months look really exciting and I look forward to reading what you think, your views and your news. Help us lift the cloak of invisibility that hangs around AHPs!

So, what do you think?


Join us on Twitter! @AhpscotBlog

Here are a few other Scottish AHPs active on Twitter to get you started:













Move More Scotland

Move More Logo

By Hazel Robinson, Macmillan Walking Development Officer @HazelMRobinson


We now know that being active during and after cancer treatment improves both physical and emotional cancer outcomes and reduces isolation. However, we also know that many people with a diagnosis of cancer lack the confidence to exercise and are nervous about building up their activity levels. We are also aware that a lack of suitable activities in local areas prevents people from getting out and moving more.

Macmillan Cancer Support has developed Move More Scotland to provide practical support and help to those affected by cancer so they can remain active throughout their cancer treatment, and afterwards.

To ensure there is something for everyone, there are four programmes to choose from, all of which have been designed specifically for people affected by cancer.


A form of adapted Chi Gung, an ancient Chinese practice of aligning breathing, physical activity and mental and spiritual awareness, and can be done as a seated exercise so it is accessible for people of all ages and abilities.



Walking groups

Low level, short, sociable walks led by trained volunteers which provide a supportive and friendly environment to become more active. Delivered in partnership with Paths for all.




Circuit Classes

Group based circuit classes delivered by Level 4 trained fitness instructors with specialist cancer and exercise training.



GardeningCommunity Gardens

Based within the community, they provide an opportunity for low level activity through participation in gardening.





All programmes are led or supported by volunteers and there has been a huge amount of support of the Move More Scotland programme from external organisations. Working in partnership with local authorities has allowed us to deliver Move More within local community libraries and leisure venues. This has helped to deliver the programmes in an environment which is community based, trusted, and non-judgemental and ensures that the classes and groups are accessible and welcoming to all – some can even be attended by carers and family or friends.

We are already delivering programmes in Glasgow, Dundee and Fife, with Aberdeen and Edinburgh soon to follow.

For more information please contact