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By Susan Kelso. AHP National Lead Early Intervention [Susan.Kelso@nhs.net]
Integration of health and social care was enshrined in legislation in 2014 and came into force in 2016. What has this meant for allied health professions (AHPs) and how have we fared in the integration journey thus far?
When we were asked to develop a programme to articulate and make visible the AHP contribution following a parliamentary debate on rehabilitation in 2015, we were building on the success of the National Delivery Plan (NDP) (1) – the first national policy for AHPs in Scotland which ran from 2012 to 2015. The Active and Independent Living Programme (AILP) was formally launched in April 2017 after a series of coproduced conversations with a wide range of stakeholders – people using services and people providing services. Health and social care integration guiding principles includes ensuring dignity, individuals’ rights, person centredness and quality and safety in services which are proactively planned, flexible, anticipatory and asset orientated, but the overarching principle is supporting wellbeing (2). People living with long term conditions were clear that health and social care services needed to change – and in the Multiple Conditions, One Life Report (3) seven principles were identified for service deliverers which broadly addressed wellbeing: listen to what matters, help people understand what’s happening with their condition/s and how they can support themselves, understand that people are more than their health conditions and have invaluable experience to offer, and make sure that those supporting people with long term conditions are included in discussions and plans.
Wellbeing has been identified by the World Health Organisation as having both subjective and objective dimensions and that it “comprises an individual’s experience of their life as well as a comparison of life circumstances with social norms and values” (4). Health is one of the top factors associated with wellbeing. So, with this as the background to the AHP engagement events –people were asked three questions:
What matters to you to keep you active, healthy and independent?
What should AHPs do to support this?
What should we focus on to make services the best they can be?
AILP is the result of distilling the 7000+ responses to these questions. Wellbeing is at the heart of AILPs’ vision and six ambitions:
How do you measure up?
Unlike the National Delivery Plan, AILP doesn’t provide a series of specific recommendations, but rather provides a broad framework to enable AHPs to articulate and make visible their contribution across integrated services and to demonstrate their impact to health and wellbeing (5). Each of the six ambitions describes the issues people asked us to address – so how does your service measure up against these ambitions? How aware are people of what you do? How easily can people get access to your service? Are you providing your service in partnership with people using services, with their families and carers, and with partner organisations? How equipped are staff in your service to deliver a wellbeing focussed approach, and how are you tapping into innovation – eg digital health and technology solutions?
The Scottish Government sets out its aim for health and social care as “ a Scotland with high quality services, that have a focus on prevention, early intervention and supported self-management” (6), and cites AILP as a key measure to deliver on improving public health – particularly to increase knowledge, awareness, understanding of what promotes and strengthens healthy lifestyles.
Addressing wellbeing is crucial in delivering improved public health: the New Economic Foundation states that “when we understand what makes people’s lives go well, see the positive things people bring to situations, and understand people’s emotional and social needs, projects and services can be better designed to respond to the many aspects that make up people’s lives” and have developed a dynamic model of wellbeing (7):
The National AHP Lifecurve Survey and the AHP Children and Young Peoples’ Intergenerational Cycle are two underpinning pieces of work across AILP that will support our focus on wellbeing. Early results from the Lifecurve Survey indicate that AHPs are intervening at three distinct points – pre-Curve, mid-Curve and end- Curve. This pattern is the same across Scotland. We know that in 2016/7 people who used AHP services had an average of 25 days as an inpatient (both physical and mental health admissions), an average of 63 prescriptions/person and had a total NHS cost of almost £80M. Deeper analysis of all the data will help to shape resources around prevention and wellbeing, earlier interventions and supported self management.
Work to interrupt the intergenerational cycle within AHP children and young peoples’ services has introduced a model which focuses on the child or young person’s wellbeing and directs help and support at the universal, targeted or specialist level. This is not only reducing waiting times (despite increasing demand for services), it is getting support to the right person more quickly and ensuring that individuals ‘resilience is enhanced and amplified. We are now starting to test this within adult services. This approach is crucial in addressing the challenges brought about by Adverse Childhood Events (ACEs). We know that where people have experienced four or more ACEs they are more likely to experience poorer health and to flourish less well (8).
Other examples of work within AILP includes:
- Partnership working with Scottish Ambulance Services to develop proactive, asset based pathways for people who have fallen but are uninjured, to prevent them being taken to hospital
- Development of technology solutions for access to self management information and advice to support people with musculoskeletal problems including a GP decision support tool and the Musculoskeletal Advice and Triage Service based within NHS Inform
- Developing existing vocational rehabilitation services to support people to get into or stay in work – addressing one of the health inequality precursors
- In partnership with ISD develop a standard AHP activity dataset and national dashboard which will enable integrated services to understand their AHP workforce and service activity
- Collaboration with NES to develop sustainable learning resources focussed on embedding personal outcomes across services.
How can AILP help you?
As an AHP, how can you use AILP’s ambitions to demonstrate your impact? As a partner, how are you connected with AHPs in your area? If you are intervening at the pre-Lifecurve stage what wellbeing opportunities are there for you – if, for example, you provide a diagnostic or therapeutic intervention? How does finding out ‘what matters’ or ‘what’s important’ to the person you are working with change how you work with them? How can a focus on wellbeing improve working practice for staff? The importance of ‘good conversations’ is equally as important for people providing services as well as people receiving services.
In November 2015, Robert Waldinger gave a TED talk on “What makes a good life?” based on the longitudinal Harvard Study of Adult Development which followed 724 men over 75 years to find out what keeps them happy and healthy (9). Waldinger is the fourth director of the study. The emerging evidence is that relationships are good for us. Social connections are “really good for us and loneliness kills”. People with good quality relationships are happier, are physically healthier, have better cognitive function and live longer. This is why personal outcomes are central to the AILP ambition – helping people to connect to what matters to them, to their friends and family, to their local community isn’t just the right thing to do – it promotes better health and is one of the best public health strategies we can employ.
- ‘Agents of Change for Health and Social Care – The National Delivery Plan for the Allied Health Professions in Scotland, 2012–2015’
- ‘Guidance on the Principles for Planning and Delivering Integrated Health and Social Care’ 2014.
- ‘Many Conditions, One Life. Living well with multiple conditions’ 2014
- ‘Relationship between health and wellbeing’ DOH 2014
- ‘Allied Health Professions Co-creating Wellbeing with the People of Scotland’ 2017
- ‘National Health and Social Care Delivery Plan’ 2016
- Measuring Well-being : A guide for practitioners (NEF) 2012