1. “It’s the Patient, stupid…….”
(with apologies to James Carville, 1992)
Suzanne Rastrick Chief Allied Health Professions Officer
Health Education Wessex - 24 April 2015

2. Patient Choice….

3. The Policy Case for Commissioning AHP Services in England…...
The NHS Mandate
The NHS Outcomes Framework
Patient Choice
The Five Year Forward View (October 2014)
The Forward View Into Action: Planning For 2015/16 (Dec. 2014) & Supplementary Information For Commissioner Planning 2015/16 (Dec. 2014)
‘Intelligence’ Based Commissioning Models & Approaches

5. NHS Outcomes Framework – 5 Domains

6. What does this mean for patients

7. NHS Commissioning Assembly…
“….as clinical commissioners we need to understand the outcomes that matter most to people in our communities – these “citizen outcomes” should guide our decisions….”
Gateway ref 01801

8. Commissioners are sighted on what “citizens” want.
Adapted from: Legatum Institute (2014) Wellbeing and Policy

9. How should providers respond to delivering these “citizen outcomes”?
Ensure those with Board leadership roles fully understand the AHP workforce in their accountability
Approach workforce planning strategically in conjunction with CCG or Sub Regional NHSE commissioners & LETBs
Move away from easy stereotypes of just more ‘doctors and nurses’ to ensure workforce has richness and depth of competencies that deliver ‘citizen outcomes’
Using Organisational Development approaches to fully engage with the existing AHP workforce & their professional bodies to develop both responsive services & multi professional leadership
Share, spread & celebrate AHP innovation

10. NHS Five Year Forward View
The NHS Five Year Forward View was published on 23 October 2014
One of its great successes was that it is a shared vision for the future of the NHS across six national NHS bodies
The challenge is now implementation; we know:
It will not be easy
We need to learn from the past
We’re going to need a different approach
AHPs are up for it!

11. Radical upgrade in prevention Efficiency & investment
The future NHS
The core argument made in the Forward View centres around three ‘gaps’:
Back national action on major health risks
Targeted prevention initiatives e.g. diabetes
Much greater patient control
Harnessing the ‘renewable energy’ of communities
Health & wellbeing gap
Radical upgrade in prevention 1
Care & quality gap
New models of care
Neither ‘one size fits all’, nor ‘thousand flowers’
A menu of care models for local areas to consider
Investment and flexibilities to support implementation of new care models 2
Implementation of these care models and other actions could deliver significant efficiency gains
However, there remains an additional funding requirement for the next government
And the need for upfront, pump-priming investment
Funding gap
Efficiency & investment 3

12. Principles of the New Care Models programme
Clinical Engagement
Patient Involvement
Local Ownership
National Support
The programme will be developed with a co-design approach – built with patients and the health and care system
It will seek to identify replicable standards, tool and methods so that scale can be reached;
It will use the transformation fund to maximise progress and pace through centralised support, especially in technical areas as well as leadership support and development for those local health and social care systems;
The national package of support to prototype sites will be offered with an agreed Memorandum of Understanding and mutual commitment to delivery on the ground, and a commitment to value for local people
It will establish an evaluation process to support testing and rapid learning
It will share early and continuous learning with the whole national health and care system through a wider community of support.

13. New Models of Care
Initially the new models of care programme will focus on:
Blending primary care and specialist services in one organisation
Multidisciplinary teams providing services in the community
Identifying the patients who will benefit most, across a population of at least 30,000
Multispecialty Community Providers
Integrated primary, hospital and mental health services working as a single integrated network or organisation
Sharing the risk for the health of a defined population
Flexible use of workforce and wider community assets
Integrated primary and acute care systems
Coordinated care for patients with long-term conditions
Targeting specific areas of interest, such as elective surgery
Considering new organisational forms and joint ventures
New approaches to smaller viable hospitals
Multi-agency support for people in care homes and to help people stay at home
Using new technologies and telemedicine for specialist input
Support for patients to die in their place of choice
Enhanced health in care homes

14. First cohort Vanguard sites
Care model
Applicant
PACS
Wirral University Teaching Hospital NHS Foundation Trust
Mansfield and Ashfield and Newark and Sherwood CCGs
Yeovil Hospital
Northumbria Healthcare NHS Trust
Salford Royal Foundation Trust
Lancashire North
PACs
Hampshire & Farnham CCG
Harrogate & Rural District CCG
Isle of Wight
MCP
Calderdale Health & Social Care Economy
Derbyshire Community Health Services NHS Foundation Trust
Fylde Coast Local Health Economy
Vitality
West Wakefield Health and Wellbeing Ltd (new GP Federation)
NHS Sunderland CCG and Sunderland City Council
NHS Dudley Clinical Commissioning Group
Whitstable Medical Practice
Stockport Together
Tower Hamlets Integrated Provider Partnership
Southern Hampshire
Primary Care Cheshire
Lakeside Surgeries
Principia Partners in Health
Care model
Applicant
Care Homes
NHS Wakefield CCG
Newcastle Gateshead Alliance
East and North Hertfordshire CCG
Nottingham City CCG
Sutton CCG
Airedale NHS FT

15. So, what are CAHPO team doing? ……Innovating Rehabilitation
2012 CAHPO asked by Sir Bruce Keogh to establish if there was a case of need to improve adult rehabilitation services in England
Examples of good innovative practice and service design, but poor adoption and dissemination
Clinicians and service users - unsure of services available and how to access them
More recent stakeholder engagement told us:
service not always focused on patient need
lack of focus on outcomes
commissioning structures an obstacle to care

16. Rehabilitation Innovation Challenge Prizes
“Open Mind Partnership”
Leicestershire Partnership NHS Trust
Leicester Open Mind in partnership with Fit for Work
- GP referral or Open Mind therapists
- Long-term MSK pain
- Cognitive Therapy and Mindfulness techniques
- Addressing physical, social and mental barriers such as depression and anxiety
“Fitness for Work Service”
Derbyshire Community Health Services NHS FT
- Self referral or by managers
- Assessment – physical activity, design of the workplace
- Phased return to work and duties where appropriate
- Service also offers MSK pain education and management, advice on equipment and educational resources
- ROI - £5 for every £1spent

17. Plans for Rehab Programme 2015/16
Publish the economic arguments for rehabilitation
Take forward recommendations from C&YP scoping project report
Publish commissioning frameworks:
Self referral and early intervention
Supported self management
Urgent and emergency care review
Older people’s programme
Living with and beyond cancer
Elective care
Return to work programme
Support development of regional networks

18. AHP Medicines Project
Proposals being taken forward across the United Kingdom
Independent prescribing by advanced radiographers
Independent prescribing by advanced paramedics
Supplementary prescribing by advanced dietitians
Exemptions from Human Medicines Regulations by orthoptists
Work to date
A case of need for each the above proposals has been developed and approved by
NHS England Senior Management Teams (June 2014)
Department of Health Non-Medical Prescribing Board (July 2014)
Ministerial approval to undertake preparatory work for four separate but simultaneously running public consultations (August 2014)
AHP medicines project board established (September 2014)
Development of consultations and supporting documents including
Draft practice guidance for each profession
Draft outline curricular frameworks for training programmes
Impact assessments for each proposal
Consultation summary documents
Alternative formats e.g. easy read versions

19. AHP Medicines Project - continued
Benefits of proposed changes
Provision of best care, first time, in the right place through timely access to medicines
Reduced need for additional appointments, onward referral and hospital admissions to access medicines required
Reducing risks and costs associated with delays in care
Supports new roles and service re-design that is patient-centred and cost-effective
More flexible, responsive and empowered workforce
Current steps
Ministerial approval gained to publish the four consultations in February 2015
Consultations on independent prescribing by radiographers and paramedics are running for 12 weeks
Consultations on proposals for dietitians and orthoptists are running for 8 weeks
Patient and public engagement events are being held during the consultation period (2 in England and 1 in each of the devolved administrations)
Following close of the consultations, responses received will be collated and analysed
The report on the responses to the consultation will inform a paper by the Medicines and Healthcare Products Regulatory Agency (MHRA) to the Commission on Human Medicines (CHM), asking them to consider the proposals in light of comments received
The CHM will then advise Ministers of their recommendations in relation to the proposals

20. Let’s talk about data...

21. AHPs are ideally placed to deliver many of the ambitions in the 5YFV
Two fundamentals AHP’s deliver on:
Innovation
Entrepreneurship
Some areas to strengthen:
Economic evaluation
Consistent outcome data
Developing networks to spread excellent practice

22. Effectiveness, from a different perspective
Connect… Be Active… Take Notice… Keep Learning… Give…

23. NHS England Chief Allied Health Professions Officer’s Conference
#CAHPO15 23 June 2015 The Kia Oval, London “Insights on Innovation & Entrepreneurship”