There are 14 Allied Health Professions (AHPs) in England¹ with approximately 170,000 AHPs working within the NHS².  Physiotherapists represent the largest group of AHPs with approximately 61,000 registered with the Health and Care Professions Council, whilst Prosthetics and Orthotics represent the smallest profession with approximately 1000 registrants³.  A plethora of AHP-centric guidance and strategies^2,4–11 have helped raise the AHP profile and provided a collective identity and position within the NHS workforce.

Hospital performance and the quality of care service users receive are all influenced by the quality of its leadership¹². AHPs must build the diversity of their leadership and step into these roles¹¹. Professionally diverse senior leadership teams are better equipped to meet the challenges the NHS faces and realise its long-term plans⁸. However, to do that there must be equity of access for all professions. The recently created ‘Chief AHP’ role which has been recommended to be implemented in every NHS Trust⁸ and has been widely adopted throughout the UK, does not have representation across all the AHP groups.

The recent AHP strategy recognises that the smaller professions may not be well known¹¹. The lack of understanding of what the smaller allied health professions can offer, their skills and how their services operate, combined with a lack of representation at senior leadership positions can lead to poorly understood services, underutilised skills and staff groups which are left feeling isolated and under-valued. For Prosthetists and Orthotists, there is often the added barrier of being employed by an external contractor whilst working in the NHS.  This can lead to staff feeling detached from their NHS-employed colleagues.  Where they hold a senior AHP position they can often find themselves excluded from the Trust’s AHP clinical lead meetings.  This is often an oversight, with senior managers viewing them as ‘external staff’.

This creates a double-edged sword, a lack of input from the clinical lead to drive services forward and a lack of access for the staff member to the senior AHP roles within the Trust. Ultimately resulting in a lack of true professional diversity among senior AHP decision-makers at a Trust, regional and national level.

Professional diversity at the Royal Wolverhampton NHS Trust

The Royal Wolverhampton NHS Trust (RWT) has a dedicated quarterly AHP leads meeting, attended by the head of each AHP service and led by the Chief AHP. The purpose of the meeting is to create a dedicated space for all clinical leads to share information, ideas and participate in shared problem-solving. National and Trust strategies are discussed, and direction and commitments are agreed. In light of professional diversity, the invite list was reviewed, and it was noticed that the clinical lead prosthetist who is contracted to the Trust had historically not been invited to the meetings.  This oversight was rectified as it was quickly realised that this staff member not only belonged at the meeting, but their absence meant the prosthetic service had not previously been privy to the proposed strategic aims of the AHP workforce and had not had an opportunity to provide their insight and knowledge.

Since addressing this oversight, both NHS and Commercial AHP service providers working at RWT have made a collective commitment to sharing best practice and agree on common goals for our AHP workforce as well as service users. Importantly, prosthetists finally have the opportunity to contribute to shared objectives, commitments and strategic documents through the AHP leads meeting, manager peer support meetings and individual supervision with the Chief AHP.  Furthermore, all AHPs employed directly by our organisation and AHPs subcontracted to work in our organisation will be included in our Allied Health Professions 18-Month Strategic Workforce Supply Plan to ensure that it is inclusive and reflects how AHPs work in multidisciplinary teams. This inclusivity is crucial to continually improve and redesign services and realise the workforce’s potential¹¹.

The recent AHP strategy for England¹¹ discusses four ‘enhanced foundations’ one of which is diverse and inclusive leadership.  Championing professional diversity in leadership roles.  The key message is ‘senior leaders must look around the table and recognise who doesn’t have a seat and offer them one’.  To ensure our AHP services are fully informed, and offer our service users the best possible care, we must ensure senior leaders of all professions input into Trust AHP strategies. Looking forward, we must ensure all our AHP groups have representation at a national level to ensure national AHP directives have included the expertise and opinion of all our professions.

References

1. Registrants Snap Shot: Health and Care Professions Council. Published 2021. Accessed December 10, 2021. https://www.hcpc-uk.org/about-us/insights-and-data/the-register/registrant-snapshot-sept-2021/
2. Dougall D, Buck D. My Role in Tackling Health Inequalities A Framework for Allied Health Professionals.; 2021. https://www.kingsfund.org.uk/publications/tackling-health-inequalities-framework-allied-health-professionals
3. The Health and Care Professions Council. Registrant snapshot – 1 December 2021 |. Published 2021. Accessed June 9, 2022. https://www.hcpc-uk.org/about-us/insights-and-data/the-register/registrant-snapshot-dec-2021/
4. NHS England. Allied Health Professions into Action. NHS England. Published 2017. https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf
5. Hindle L, Charlesworth L. UK Allied Health Professions Public Health Strategic Framework 2019-2024. Public Heal Engl Allied Heal Prof Fed. Published online 2019. http://www.ahpf.org.uk/files/UK AHP Public Health Strategic Framework 2019-2024.pdf
6. NIHR CRN Allied Health Professionals Strategy 2018-2020 | NIHR. Accessed June 9, 2022. https://www.nihr.ac.uk/documents/nihr-crn-allied-health-professionals-strategy-2018-2020/11530
7. Health Education England. Allied Health Professions ’ Research and Innovation Strategy for England. Published 2022. https://www.hee.nhs.uk/our-work/allied-health-professions/enable-workforce/allied-health-professions’-research-innovation-strategy-england
8. NHS England and NHS Improvement. Investing in chief allied health professionals: insights from trust executives. 2019;(July). https://improvement.nhs.uk/resources/investing-chief-allied-health-professionals/
9. NHS Improvement. Leadership of allied health professions in trusts: what exists and what matters. 2018;(June):1-16. https://improvement.nhs.uk/documents/2904/Leadership_of_AHPs_in_trusts.pdf
10. NHS England and NHS Improvement. Developing Allied Health Professional Leaders: A Guide for Trust Boards and Clinicians.; 2019.
11. Chief Allied Health Professions Office. The Allied Health Professions (AHPs) Strategy for England The AHP Strategy for England?: AHPs Deliver 2022 – 2027. Published 2022. https://www.england.nhs.uk/wp-content/uploads/2022/06/allied-health-professions-strategy-for-england-ahps-deliver.pdf
12. Kline R. Leadership in the NHS. BMJ Lead. 2019;3(4):129-132. doi:10.1136/leader-2019-000159