AHPs: embracing diversity, lobbying with one united voice

PB Research Executive Alicia Rojo Santos writes…


Alicia Rojo SantosAllied Health Professionals (AHPs) – the third largest workforce in the NHS – have been described as ‘the glue’ of the NHS. In fact, in recent years, they have been increasingly considered essential for the delivery of integrated care. This was made clear by the ‘AHPs into Action’ framework, published by NHS England last year to inform the system about how AHPs can be best utilised to support future health, care and wellbeing service delivery. Recent reports focusing on the improvement of health and social care services have also highlighted the value of AHPs, such as NHS England’s ‘Excellence in Continence Care’ guidelines, which emphasised the importance of physiotherapists and occupational therapists.

And yet AHPs are undervalued. In 2014, the Nuffield Trust conveyed how there are still ‘large variations between the number of AHPs working in the NHS per 1,000 people across the different AHP professions and across regions in England’. On a more personal level, many AHPs don’t seem too surprised when other clinicians look utterly confused after learning that they are ‘orthoptists’, ‘osteopaths’ or ‘drama therapists’ – job titles that are majorly unknown even in the health and social care sectors.

Unfortunately, waving a magic wand will not solve these challenges, which have been caused by many deep-seated issues – the majority of them relating to the F-word (funding, of course). Making sure that the ‘AHPs into Action’ framework is implemented is absolutely key. However, to what extent can we trust this will happen? AHPs need to be proactive and continue to work together to ensure that government organisations are constantly pressured by the significant workforce. Doing this right now is absolutely essential taking into account many of the recent political developments, including the announcement that the NHS in England will receive a funding increase, and Matt Hancock’s appointment. Whether you see these developments as a wonderful opportunity, or you regard these with concern, it is clear that direct and powerful lobbying is needed.

The importance of collaboration has been, of course, acknowledged already. The Allied Health Professions Federation (AHPF), which includes 12 professional bodies, was established to provide collective leadership and representation on common issues that impact its members’ professions. The AHPF works to convey and promote the importance of the professions, and works closely with major stakeholders, like the PHE.

However, collective representation may be challenging at times, as major obstacles may make it hard for the professions to work as a group and lobby with one voice.


Different needs

AHPs are a very diverse group of professionals. Finding common objectives may be hard taking into account the fact that each profession targets different needs and patients. It is hard to imagine what an art therapist may have in common with an orthoptist, and how a successful message that captures the needs of the individual professional bodies and the allied health professions collectively can be developed.

However, there is a reason why the 14 different allied health professions are grouped. Rather than focusing on the things that make them different, AHPs should step back and focus on the things that bring them together. They are all non-medical practitioners that assess, treat and discharge patients across the health and social care sectors. They all adopt holistic approaches to healthcare, and focus on prevention and improvement of health and wellbeing. Beyond these similarities, there is something else that should bring them together: each profession alone is relatively small. Physiotherapy is the largest allied health profession with just over 50,000 registered physiotherapists in the UK, which is a quarter of the number of registered doctors. Other professions like orthoptists, prosthetists or art therapists have less than 5000 registered professionals. Getting their voices heard may be hard when working alone. AHPs need to embrace diversity and consider it a powerful advantage to ensure that the NHS and the government take into account their important contribution to the health and social care sectors.


Individual professions not being understood

If nobody knows what a music therapist is, should we focus on promoting the profession, or on promoting the allied health professions collectively? The problem with the latter is that this may be dominated by the larger AHPs such as physiotherapy, which are generally widely understood by the public. Smaller professions may feel threatened by this. Nonetheless, the options are not mutually exclusive. Every profession should actively promote its own work, and explain what this entails. This activity does not mean that each AHP should fail to work collaboratively with the other AHPs to ensure that the importance of their roles are clearly conveyed.


Power struggle and the issue with resources

There is an additional potential risk: lobbying with one voice may be used by certain individuals to promote specific professions over others, using this instrumentally as a springboard to make new contacts and promote their individual messages. This raises a key question: to what extent should all professions have the same level of power and influence when trying to lobby on behalf of the entire group? When working within that role, it may make sense to believe that the opinion of physiotherapists or occupational therapists should prevail over that of orthoptists or art therapists. However, the ultimate aim is to ensure that the value of group as a whole is recognised and taken into account in the health and social care sectors. Power struggles are a waste of time and resources. Whilst it is inevitable that different professions will try to further their objectives in some way or another, AHPs should try to better understand the purpose and advantages of lobbying collectively.

Ensuring that the NHS recognises AHPs as key leaders is a key priority, as conveyed in ‘Leadership of allied health professions in trusts: what exists and what matters’, a report published by NHS Improvement in June. All professions should continue lobbying to ensure that the issues specific to them are acknowledged and addressed by the government and the NHS. They should also actively work to ensure that everyone is conscious of their work. However, it is essential for the allied health professions to lobby with one voice as well. The AHPF has an important role to continue promoting the brilliant work of AHPs, and to support individual professions working collectively. In the end, it takes two flints to make a fire.