Lord Darzi's report and AHPs

As the dust still settles on the review by Lord Darzi I sat down and read the thing myself, curious to see how the allied health professions had featured. Of course, having been floating around the healthcare system for a good few years now I knew not to expect explicit reference to any of our professions. The review is still, somewhat ironically for a document professing innovation, focussed on doctors and nurses. Hey ho, whilst a name check would've been nice (aside from the section on staff group sickness), the content of the paper is very much in the AHP wheelhouse. 

I won't rehash the context the report was delivered in, this is viscerally obvious to anyone currently working in healthcare. Although there is a cathartic sense of relief to have this documented and presented to the government. If nothing else Lord Darzi has unintentionally performed an act of therapeutic validation on the majority of NHS colleagues who battle with the broken IT, infrastructure and processes daily.

The challenges are also painfully familiar, to the point that they actually feel normal. A sense that GP access is a battle, waiting lists only get longer, A&E is considered the access point for all care, the management of most long term conditions is dire and funding of services is diametrically opposed to the stated national strategy. In short, it's a mess.

And the four main drivers of the challenges are also not strangers to most NHS folk. Shameful investment in capital and estates, frontline staff and patients forced to act as mere passengers amidst the pitiful planning, management structures that create lots of assurance but little action and of course the pandemic compounding everything. 

In fact the whole paper could be viewed as a massive “we told you so!” on behalf of most staff and patients, and for this reason I think the review has real value. The pressure will come when the much touted ‘10yr plan’ is unveiled. The NHS is never short of plans, guidance and operating procedures so whatever this new one eventually contains will need to be braver and fundamentally backed up with a sense of purpose and drive. This is where AHPs and the family of 14 professions must vocally step up.

The professional bodies who represent some of the allied health professions have rightly all put out statements in response to the review, and they each make the case for more occupational therapists, physiotherapists and speech and language therapists (RCOT, The CSP and the RCSLT respectively) as you would expect. And the other bodies do similar. I feel that collaboration between the professional bodies on a unified ‘AHP’ response to the report would create a more substantial sense of readiness and eagerness to be part of the proposed 10yr solution. And would offer a more sizable counterweight to the politically all engulfing Royal College of Nursing who of course responded similarly to the report with demands for more nurses. 

For me this is where the ‘AHP’ moniker has a flaw. It's a title that exists almost solely within the ecosphere of apolitical NHS England and other arms length bodies, which is great for clinical and professional networking and the progression of ‘national strategy’. Yet, when political influence and an AHP voice is required to robustly and publicly challenge the government or to advocate for our inclusion then it is left to the individual professional bodies. And they understandably eschew the unifying umbrella term of ‘AHP’ in favour of their individual professional identifiers. This dilution of the ‘AHP’ acronym and brand in any political or public-facing discussion results in the marketing equivalent of homeopathy, rendering its communicative impact inert to the point of uselessness. As such I believe the professional bodies should come together to champion the unified AHP case for inclusion in a new 10yr plan for health, much like they have done previously when forming the community rehab alliance.

The report offers up themes that are absolute bankers for AHPs, and not just themes where we have the potential to offer part solutions but themes where we could legitimately take the lead. The big one is the mythical movement of care closer to home and by definition moving it more into the community. If this government really can begin to resist the overwhelming gravitational pull of the acutes when it comes to funding then it may be possible. And AHPs are expertly positioned to deliver the effective, efficient and impactful community care that is required. AHPs do need to have the confidence to view themselves as clinicians that a service can be remodelled around, rather than simply being contributors to the more traditional medical and nursing led services. If AHPs shout about the interventions and services we can offer both immediately and potentially then we will be a potent force. And if we combine this with many thousands more enhanced, advanced and consultant level AHP practitioners then we will also benefit from the retention of our most senior clinicians and therapists. Not only will this enhance productivity (another key theme in the report), but being a clinical facing AHP will suddenly offer the potential for career and pay progression for a whole working life.

There are also huge opportunities around musculoskeletal services, where physios, podiatrists and osteopaths (amongst others) can deliver massive impact. But we need to be louder and more explicit about the national economic case for investing in our skills and services. Getting our populations back to work is a real priority for this government and AHPs can be key contributors to the future national prosperity. 

Health promotion offers more opportunity for AHPs to demonstrate huge added value, with our professions offering real expertise across the whole gamut of lifestyle and wellbeing factors that impact health. Moving decisively into this space as public health promotion experts is an opportunity that will require little extra upskilling on our part.

And health inequalities are the holistic challenge of our time having declined on pretty much every metric over the last 15yrs. And again as AHPs we have the skills, expertise and knowledge to lead on this front. And with many of our professions possessing crucial paediatric skills and knowledge we can deliver the improvements in child health and wellbeing (mental and physical) that have been so neglected of late.

For me the report helpfully summarises what is known about the NHS’s current challenges, and systematically chunks up the key issues and themes. In doing this Lord Darzi has offered up huge opportunities for AHPs ahead of the new 10yr strategy development. My only concern is that the lack of a unified AHP voice during the imminent political and consultative discussions about the new strategy will mean we simply continue along the familiar medico-nursing lines.