Allied health professionals’ contribution to the quality of care and service delivery

Allied health professionals

As a group of autonomous practitioners, AHPs work with a number of other professionals and also at many points along the care pathway. The report acknowledges that paramedics and other AHPs provide an integrated approach to care delivery; their roles usually depend on interfaces across care teams, as well as across sectors of care.

There were 19 955 paramedics registered with the Health and Care Professions Council (HCPC) in 2013 (HCPC, 2014). The Allied Health Professions Federation (2013) describes the role of paramedics as ambulance service health professionals who provide urgent and emergency care to patients. They assess and treat patients before transferring or referring them to other services, as appropriate.

The allied health profession workforce

The majority of AHPs work in the National Health Service (NHS), and in 2013 as a group they accounted for a salary bill that exceeded £2 billion (AHPs are also employed in the private and voluntary sectors). The role of the AHP is diverse, crossing a number of care domains that include a role in prevention, the promotion of health, undertaking a diagnosis, providing treatment, offering support and facilitating independence.

Data (Dorning and Bardsley, 2014) demonstrates that in 2013, there were 172 686 registered AHPs and 64 377 full-time equivalent (FTE) AHPs working in the NHS. The numbers of AHPs increased by 53% for the number of registered practitioners and by 34% for those FTE practitioners working in the NHS from 2002 to 2013. Some evidence suggests an increased share of AHP activity in the voluntary and private sectors since 2009.

Large variations between the number of AHPs working in England in the NHS per 1 000 people across the different AHP professions and across regions exist. In 2012, in the North East there were over 1.43 AHPs per 1 000 people; this is in comparison to the East of England where this statistic is 0.95 AHPs per 1 000 people (see Table 1). As there is no systematic way of standardising for population needs across professional groups this data is crude and should be treated with caution.

Policy formulation

The size and the importance of the AHP workforce is evident. Despite this, AHPs are seldom the subject of key policy discussions, and their contribution to care, it could be suggested, is sometimes hidden, overlooked or even possibly undervalued. QualityWatch considers AHPs collectively as well as the individual AHP groups (Dorning and Bardsley, 2014). AHPs, being grouped together under the collective ‘AHP’ banner, could be a contributory factor as to why this essential group of health professionals are often overlooked in, for example, policy and decision-making processes—these distinct professions have diverse roles. In 2013, 6% of the NHS workforce was made up by AHPs; however, from a national perspective there is little systematic information available about the quality of care that is delivered by AHPs. However, this is not always true of paramedics, as there is much more information available at the national level concerning this professional group, mainly around indicators concerning access to care provision. Monthly data on ambulance quality indicators is provided by NHS England (NHS England, 2014).

Paramedic: allied health profession

With regards to paramedics, the focus of this section of the report was on response times, demonstrating that in England, ambulance response times have varied over time. Category A (Red 1 and Red 2), benchmarked against national standard, sets out that 75% of these calls should be within eight minutes and should receive a response (NHS Choices, 2014). Between April 2011 and December 2013 there were 10 months during which this standard was breached nationally, equating to a breach in one month out of three. The incidence of breaches also increased year-on-year. In 2011/12 and 2012/13, the breaches primarily occurred during the December to March period; in 2013/14, however, the breaches first occurred during July 2013 (74%), after which the standard improved a little in August 2013 (75%), prior to being contravened again in September 2013 and continuing to decrease to around 72% in December 2013. There may be many reasons why these breaches occurred and there is need for further investigation that may help commissioners and managers grasp an understanding, but this must take into account the work load, increase in calls and the other often competing demands that are put on paramedics.

QualityWatch recommendations

QualityWatch (Dorning and Badsley, 2014) have highlighted a number of recommendations. The key suggestion is a call for the need to develop information systems that capture consistent and comparable information concerning all aspects of the quality of care provided by AHPs. The lack of data (this is true for most but not all AHPs) thwarts an ability to make any meaningful comment on how changes in the health system have come about as a result of the AHP workforce, their role and their dedication.

The work of AHPs has to be captured in the Community Information Data Set and the Commissioning Data Set so as to inform policy and the commissioning of services that see the patient at the centre of all that is done. There is also a need to ensure that AHPs are appropriately trained and provided with support to collect meaningful and consistent data, including access to technology to record the data as well as the training and support required to use such systems.

When data collection methods have improved regarding AHP activities, it is essential that this is translated into improved practice, ensuring, for example, that benchmarking is used and areas of best practice are highlighted. The data collected can also shed light on the possible reasons why national standards, such as response times, are not being met.