Are Chief AHP roles occupied by a diverse range of allied health professions?

By Dr Nicky Eddison, Dr Aoife Healy, and Prof. Nachiappan Chockalingam

The allied health professions (AHPs) in the UK comprise a specific group of autonomous, professionally diverse, distinct professions with their own professional bodies. AHPs make up the third largest clinical workforce in the NHS. In England, the term AHPs refers specifically to art therapists, drama therapists, music therapists, chiropodists/podiatrists, dieticians, occupational therapists, operating department practitioners, orthoptists, osteopaths, paramedics, physiotherapists, prosthetists and orthotists, radiographers, and speech and language therapists¹. In Wales, the term includes practitioner psychologists and excludes radiographers² and along with Northern Ireland and Scotland excludes osteopaths and operating department practitoners^3,4. For context, physiotherapists represent the largest group of AHPs with approximately 61,000 registered with the Health and Care Professions Council, whilst prosthetists and orthotists represent the smallest profession with approximately 1100 registrants⁵. AHP titles in the UK are protected and to use them staff must be registered with the Health and Care Professions Council (HCPC), with the exemption of osteopaths who are regulated by the General Osteopathic Council⁶.

AHPs practice in most clinical pathways across all stages of the patient’s pathway, working across organisational boundaries and contributing to the transformation of healthcare⁷. Leadership within the NHS is vital for patient care, resource use, collaboration, and innovation. Strong and effective leadership is therefore crucial. The introduction of senior AHP leadership positions in NHS Trusts/Health Boards (HBs) is more likely to lead to the sharing of AHP innovations contributing to a positive impact on patients’ and system outcomes. Moreover, the more senior an AHP leader, the more engaged AHPs are in improvement work⁸.

Our team at Staffordshire University set out to explore the relatively new role of the ‘Chief AHP’ within the NHS. The aims included (1) to determine which Trusts and HBs currently have a designated Chief AHP post, (2) what job titles were being used for the most senior AHP role, (3) the professional background of the post holder, and (4) if the position was included on the Trust’s/HB’s executive board.

Results

We received 160 responses from the 217 Trusts/HBs contacted. 81% (130/160) of Trusts/HBs reported that they had a Chief AHP post or equivalent. In response to the job title used for these posts, 50 different titles were reported. The most used title was ‘Director of AHPs’ (24/130, 18%), ‘Lead AHP’ (18/130, 14%), and ‘Chief AHP’ (15/130, 12%).

The majority of people who occupied these leadership roles were registered AHPs (110/130) the most of whom were physiotherapists (51/110, 46%), followed by occupational therapists (26/110, 23.6%). This means 70% (77/110) of the AHP registered staff occupying a Chief AHP role or equivalent in the NHS are physiotherapists and occupational therapists.

While drama therapists, music therapists, operating department practitioners, orthotists/prosthetists, orthoptists, and osteopaths did not hold any of the 110 AHP-occupied chief AHP (or equivalent) posts in the NHS in the UK, included in this study. Of the remaining 13% of occupied posts, the post holders are registered nurses, clinical psychologists, health scientists, healthcare sciences, and pharmacists, with registered nurses accounting for the largest proportion at 8% (10/130).

Of the Trusts/HBs who reported having a chief AHP role (or equivalent), 86% (112/130) did not have a position on the Trust’s/HB’s executive board.

Discussion

The aim of appointing strategic AHP leaders within the NHS is to provide the AHP workforce with greater visibility and voice and to ensure that the workforce can contribute to system-wide policies and initiatives⁹. Strategic Chief AHP leadership benefits improvement activity, as well as influencing the AHP workforce on the Trust’s priorities¹⁰.

However, to do that there must be equity of representation for all professions. 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 in senior leadership positions can lead to poorly understood services, underutilised skills, and staff groups which are left feeling isolated and under-valued. AHPs must build the diversity of their leadership and empower staff from all the allied health professions to step into these roles¹¹. Professionally diverse senior leadership teams are better equipped to meet the challenges the NHS faces and realise its long-term plans¹², and are crucial in avoiding groupthink.

Our study was the first to map the state of NHS AHP strategic leadership in the UK; identifying inequity in the AHP professions represented in this role, non-standardisation of a title for chief AHPs, and a lack of representation of Chief AHPs on Trust/HB executive boards. Changes are needed to enable AHPs to achieve ‘impactful, inclusive leadership’ which is identified as crucial to improve the contribution of AHPs to healthcare¹¹.

This study also formed part of the BAPO and Staffordshire University Research Hub, Nina Drake, Mary Jones, Millar Leask, and Gwen Roberts were the successful applicants who contributed to this study and are duly acknowledged in the published paper.

To read the full study please go to:

Eddison, N. et al. (2023) ‘Exploration of the representation of the allied health professions in senior leadership positions in the UK National Health Service’, BMJ Leader, p. leader-2023-000737. doi: 10.1136/leader-2023-000737.

References

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