Section 2 AHP workforce making a difference
" Tallking with the speech and language therapist made it easier for me to talk to others and its made it easier for me to communicate with other professionals I see. "
What we said
Building on Success recognised that innovation and creativity in the roles AHPs performed were flourishing throughout Scotland. It highlighted that changing roles would provide opportunities for AHPs through, for example, the introduction of AHP consultant posts. Building on Success also indicated that new mechanisms were being developed to improve and integrate workforce planning and workforce development for all healthcare professions, and that these would be fundamental to the planning process of the future.
Where we are now
During the national stakeholder engagement process to support the development of Building on Success, it became evident that AHPs were highly motivated to improve services for service users and carers. Their innovation and creativity has flourished and has resulted in significant benefits for individuals and families and for the service as a whole. AHPs are using the capacity and capability created through the establishment of AHP consultant and advanced practitioner roles to provide clinical leadership and enhance patient pathways and the quality of service delivery. AHP assistant and assistant practitioner roles are also increasingly important and have played a key role in boosting clinical capacity in areas such as diagnostic radiography.
Trends in workforce from 2000 to 2010
Fig. 1 below highlights that the total number of AHPs in Scotland has increased from a headcount of 7086 in 2000 to 11 838 in 2010. The whole-time equivalent ( WTE) statistics are shown in Fig. 2.
Fig. 1 NHSScotland AHP staff headcount, 2000 and 2010
Fig. 2 NHSScotland AHP staff whole time equivalents ( WTE), 2000 and 2010
Fig. 2a NHSScotland AHP staff whole time equivalents ( WTE), 2000 and 2010
There has been a striking increase in the AHP workforce for NHSScotland in the past 10 years (Fig 2a). This can be seen when looking at the headcount figures which have increased from 7086 in 2000 to 11,838 in 2010, an increase of 67%, with the greater increases in occupational therapists, physiotherapists and radiographers.
The percentage proportions of the individual professions at September 2010 are shown in Fig. 3, and the professional groups are briefly described in Annex 1.
Fig. 3 Percentage proportions of individual AHPs, September 2010
Staff in post
The number of AHP staff in post at 30th September 2010 was 9,595.6 ( WTE), an increase of 16.1 (0.2%) from 30th September 2009. The corresponding headcount also showed an increase of 61 (0.5%) from 11,777 at 30th September 2009 to 11,838 at 30th September 2010 7. The largest profession ( WTE) was physiotherapy, at 27.5%. The second largest profession was occupational therapy (22.4%), followed by radiography (21.9%).
The AHP workforce is an important part of frontline diagnostic treatment and rehabilitation service delivery. AHP staff account for 7.0% of the total NHSScotland workforce and comprise approximately 12% of the clinical workforce. This is broadly equivalent to the number of hospital doctors in NHSScotland.
The AHP workforce modelling report 8 highlights that the overall number of AHPs is expected to increase by 2% between 2008 and 2011. AHPs in bands 1-4 of the NHS Career Framework for Health (see Annex 2) are predicted to increase by 6% between 2008 and 2011. An increase of 1% is predicted to the number of posts for AHPs in bands 5-9.
The increase in AHPs, although apparent across most age groups, is most striking in the 30-34 age group, with the 50-54 age group also showing a large increase with a decrease in the number of AHPs in the 25-29 age group.
In supporting senior NHS managers to maximise the capacity of their existing AHP workforce as part of wider initiatives designed to modernise the NHS workforce, it has been, and will continue to be, important to look at different ways of delivering safe, effective and person-centred care. This journey has started with the development of new roles for registered AHPs and other support staff: for example, at present there are now 22 AHP consultants working in NHSScotland. These roles provide a more flexible workforce better able to meet the needs of patients.
The consultant radiographer reports the majority of trauma images in accident and emergency (A&E) services, improving the turnaround time for trauma reporting. There are ambitions to introduce a "radiographer-led discharge service" in an attempt to develop interprofessional working and to expedite the discharge of minor injury patients from X-ray; this will impact on the patient's journey time, supporting A&E services in maintaining the government's four-hour targets.
Radiography assistant practitioners were introduced to NHS Scotland several years ago but they did not become "mainstream" staff members in radiography till the delivery of the Higher National Certificate ( HNC) education programmes (supported by NES) and the Certificate in Higher Education at Robert Gordon University. The assistant practitioner funding initiative from NES has already supported 41 trained assistant practitioners and is supporting a further 22 assistant practitioners in training. In effect, NHS Scotland will see the number of assistant practitioners grow from 2 in 2004 to 65 in 2011.
With the introduction of these new roles it is evident that service delivery and quality has been maintained. The team culture has improved and the new staff have been fully integrated into the department - partly due to the partnership approach with staff that allowed changes in the workforce at different levels of the career framework.
There is excellent audit evidence from the radiographer reporting chest x-rays where results (between June 2009 to February 2010) have highlighted image reporting statistics for accuracy (at 97.8%) sensitivity (at 97.1%) and specificity (at 98.1%) by radiographers to be extremely comparable to radiologist colleagues. This is seen as particularly important as reporting chest x-rays is still fairly new to radiographers.
New roles in Diagnostic Imaging Services
Mental health AHP workforce
A scoping exercise was carried out in February 2010 to identify the characteristics of the AHP workforce in mental health services in NHSScotland. The workforce audit at that time showed there were 922 AHPs working in mental health services in NHSScotland; this comprised 734.3 WTEs. Just over 11% of the NHSScotland AHP workforce was working in defined NHS mental health services. Almost 50% of arts therapists worked in mental health services (although there were only 21 arts therapists identified through the audit) and nearly one third of occupational therapists. Other staff involved in the workforce numbers were dieticians, physiotherapists and speech and language therapists.
Community AHP workforce
There is currently little national information collated about the AHP workforce in the community, making it difficult to recognise if changes are needed and to measure any shift from acute to community. An AHP community workforce project has been commissioned to scope the workforce in community/primary care, and within social care, to identify current issues. This baseline information will assist with future workforce planning and provide examples of good practice that can be shared nationally. Recommendations will be made about how to make best use of AHP resources to prevent inappropriate admissions to hospital or long-term care and to enable people to remain independent and healthy for as long as possible.