Scottish Government

Building on Success - Future Directions for the Allied Health Professions in Scotland

Shaping the Future
5. New Models of Care

Delivering the high quality integrated care people want and expect is a high priority for health and social care. It involves reassessing many of the assumptions which underpin everyday service provision. This chapter sets out how AHPs are contributing to the task of responding effectively to the changing demographic and social profile of Scotland to develop services designed to meet people's diverse needs.

5. New Models of Care

Many factors have been driving change in health and social care services in Scotland. Among the most significant are the recognition of Scotland's particular health problems and the effects of social exclusion. These are being addressed collectively as a matter of urgent national priority.

It is a challenge to refocus services from a traditional, reactive, illness-treating model to one that is more proactive, preventative, and health-promoting. But the challenge offers AHPs a significant opportunity to develop more innovative and creative ways to address long-established problems. By working in partnership with professional colleagues, they can help to overcome perceived boundaries between services and organisations, developing ways of working that will be of benefit to patients and the people who use services.

There is real potential for a collective approach to modernising and redesigning AHP services to make them more integrated and patient-focused, and potentially release capacity rather than increase workload.

Responding to changing demographics

Scotland's population is projected to fall by 2021, based on 1998 figures, with a 15% reduction in the number of children under 15 and an increase in the over-75 population of around 30%. We know already that cancer and coronary heart disease are predominantly illnesses of older adults. Over 75% of adults with cancer and 81% of those with coronary heart disease (CHD) will be over 65. Incidence of and mortality from these diseases are also strongly linked with levels of deprivation.

The Wanless Report (2002) predicts that the future generation of older adults will be less likely to smoke and will have had better access to healthcare than those of today. They are also likely to have enjoyed higher incomes. They will have lived, however, in a society with greater income inequality, and are more likely to have higher levels of obesity and engage in lower levels of physical activity.

In responding to these projections, healthcare systems will need to ensure that services are designed to reflect the changing need of communities and individuals. NHSScotland and local authority partners are already working to bring together all of their resources for older people (services, staffing, budgets, property and equipment) and place them under joint management. Ultimately, the aim of Joint Future initiatives is for single managers to be leading joint services on a day-to-day basis. These 'joint resourcing and joint management' arrangements will create the framework for more and better joint services, a model that is likely to be extended to other community care services.

AHPs are essential to the provision of assessment and rehabilitation services for older people and therefore have a major role to play in delivering the Joint Future agenda. They are well placed to share their learning with other team members based on their natural affinity with partnership working and their practical experience of multi-agency working, and will therefore need to engage fully in this change process.

>> In Perth and Kinross, people with physical disability now have access to a jointly funded Occupational Therapy service which has streamlined services and provided a single point of access for the service user. These integrated services are being developed as a partnership between Perth and Kinross District Council and Tayside Primary Care NHS Trust in response to modernising community care. <<

"We know that patients really benefit from rehabilitation from skilled Allied Health Professionals. We need to develop better access to rehabilitation services in the community." - GP

Involving people

The Scottish Executive is committed to ensuring that people are involved in decision making about their treatment and proposed changes to their services. Health and social care organisations will have to demonstrate how they are taking steps to improve further the involvement of patients, people who use services carers and communities in the planning, development and improvement of services.

Patient Focus and Public Involvement (2001) sets out the framework for change for AHPs and other professions to achieve these objectives. The development of good communication systems that include listening and talking to patients, the public and communities are central to this change process. Good communication was also highlighted as being highly valued by the service users who participated in the consultation process for this document.

"Services need to be more joined-up - ideally with one point of access. Sometimes it can be difficult to know who to speak to about what!" - Service user

>> Dunfermline LHCC Podiatry service undertook a user involvement project as part of 'Designed to Involve' to seek views on how the podiatry service could be improved. The project used focus group techniques to review priorities for a better service from users, carers and other disciplines. This resulted in the development of an action plan which tackled diverse issues such as transport, access, appointment systems and communication. <<

>> Forth Valley Speech and Language Therapists, working with three local authorities, have enabled user involvement in consultations through appropriately adapted communication strategies, including 'Talking mats' and 'Total Communication'. <<

NHS24, a new 24-hour telephone consultation service has been established for Scotland and aims, over time, to reduce inappropriate workload for out-of-hours GP services and Accident and Emergency departments. NHS24 will continue to work in close partnership with local healthcare systems and through the local service integration teams which are being pulled together in Health Board areas across Scotland. In the future, AHP services may be interfaced with NHS24.

AHPs need to ensure that the people who use their services have access to information about what they can expect, setting out options on flexibility and choice in delivery and defining standards of care. Information provided should always reflect individual communication, culture or language needs. AHPs also need to find ways to support people to communicate their views to inform planning, development and improvement of services.

Improving the patient journey

Feedback from service users and the voluntary sector gathered during the development of this document was unequivocal in highlighting the value people place on the services provided by AHPs. However, the feedback also highlighted key areas for improvement.

These were specifically found in two areas:

• difficulties in accessing the service, both in terms of waiting times and in location of services, sometimes compounded by transport problems. It was also frustrating for service users to have to access an AHP via another professional, such as the GP;

• lack of continuity experienced when moving from one part of the system to another, with dissatisfaction expressed about a number of issues related to multi-professional communication. This was echoed by the Primary Care Modernisation Group consultation process in 2002, in which the biggest single source of frustration was that services were not appropriately 'joined-up', either between health and social care or acute and primary care, between professional services.

"Some of our learning disabilities clients are among the most socially excluded people in this area. It can be a real challenge to support individuals to live independently. That's where the team-work comes in with Therapists, Nurses and Social Workers using their expertise to support these new ways of working in the community." - AHP participant - Learning Disabilities Review.

AHPs need to participate fully in redesigning primary care services and the patient journey as part of the implementation of Making the Connections, the report of the Primary Care Modernisation Group. The report defines the need to utilise the full range of skills provided by AHPs and other care staff in improving access to 'the right health care professional'. It also highlights AHPs' role in the management of chronic disease and mental health problems.

>> A direct access (self-referral) physiotherapy service was established at Westgate Health Centre, Dundee in 1998. Evaluation of the service concluded that direct access to Physiotherapy is feasible and highly acceptable to patients, the public, GPs and Physiotherapists. The main outcomes were that direct access patients were more likely to be male, younger, suffering from back conditions of a shorter duration and in employment with less absence from work. They achieved similar outcomes in fewer physiotherapy contacts and were more satisfied with their care. The impact on GP workload was also striking, with direct access patients having significantly fewer contacts; this resulted in a saving of GP time during one year of 88 hours. <<

>> South Ayrshire Council, in Partnership with the LHHC for North Ayr, Prestwick and Troon and the Ayrshire and Arran Primary Care and Acute NHS Trusts have developed the North Ayr Speedy Action Team to provide community-based rehabilitation and care. This multi-professional, multi-agency service is therapist-led and links closely with the hospital-based Rapid Response Team. It aims to support older adults to remain independent at home and avoid unnecessary admission to hospital. <<

AHPs also need to work closely with partnership agencies to introduce improvements in the transitions between service providers such as those in acute, primary care and community care settings.

"The staff have been really first class, very supportive and compassionate, but with a great sense of humour. They made a very stressful experience easy to cope with."- Radiotherapy patient