Official Report: Minutes of Evidence

The Chairperson (Ms Maeve McLaughlin): I welcome representatives from the Allied Health Professions Federation (AHPF) who are here to brief members on workforce planning in the context of Transforming Your Care. We have Karen Middleton, chief executive of the Allied Health Professions Federation England; Rosalind Rogers, the education representative on the board; and Andy McFarlane, the elected representative of the College of Paramedics on the board. I hand over to you to make your opening remarks. Following those, I will open it up to questions or comments.

Ms Rosalind Rogers (Allied Health Professions Federation Northern Ireland): Thank you very much indeed. We very much welcome the invitation and the opportunity to speak this afternoon and to address your questions. The chair of the Allied Health Professions Federation, Kerry Clarke, sends her apologies. She is in Scotland unavoidably today.

You have had an opportunity to hear who my colleagues are. We want to give you a little bit more of a background. I am the education representative on the Allied Health Professions Federation. I have a background in workforce development from an educational perspective, and I am past chair of the Royal College of Speech and Language Therapists (RCSLT). Through that, I have sat on the Allied Health Professions Federation board in the UK. Currently, in my academic role, I manage a postgraduate course module, 'Improving my Service'. It is very much dedicated to allied health professionals (AHPs) bringing to the table a workforce issue from the service-user perspective and seeking to solve it. It is with the experience of 100-plus AHP postgraduate students, through that, that I can say that we are truly solution-focused. We seek to be flexible, adaptable and make a difference to the health care of the population of Northern Ireland. Karen Middleton is the CEO of the Chartered Society of Physiotherapy (CSP). She is also a physiotherapist by profession. She has had the opportunity to look at the other side of the table as the chief AHP adviser to the Department of Health in England for 10 years. Andy McFarlane is here representing the Allied Health Professions Federation, as are Karen and I. He is the also the College of Paramedics representative, and he is a practising paramedic.

We will not rehearse the briefing paper, because, obviously, you have it in front of you. The Allied Health Professions Federation is a UK-wide federation comprising the professional bodies of 13 AHP groups. In Northern Ireland, paramedics are not yet recognised as part of that AHP workforce in the DHSSPS, but, from the Allied Health Professions Federation perspective, they are, very clearly, part of the AHP family. That is why you might find a difference between 13 professions versus 12.

The allied health professionals in themselves have a depth and a breadth to their qualifications. They are qualified to degree level. They have a strong foundation in a medical model, but they also have a very, very strong value system around working in biopsychosocial models of care. We assess, diagnose, treat and discharge in our own right; we are autonomous practitioners.

With the flexibility and adaptability that is captured in the AHP workforce in the UK, and, specifically, here in Northern Ireland, we are very, very keen to be positioned correctly in the various structures that can influence and bring about the change that is needed. You can see from our briefing paper that we acknowledge very much that the contribution of AHPs to the delivery of Transforming Your Care (TYC) has been recognised in terms of the plan, but we are seeking to be able to influence it practically. We are not finding it easy to influence for good at that level. You will be as aware as we are of the changing demographics of the population. When you look at ageing and the complex needs that come about from a variety of long-term conditions coming together, you will see that the areas that are making a difference to the quality of people's lives are podiatry, speech and language therapy, communication, swallowing, physical mobility, independent living, and health and well-being. They are all parts of the remit and portfolio of AHP skills.

We have an economic argument, and you will understand why we are persuaded by it. AHPs are trained at a level with a postgraduate structure that allows specialism, but it is four times cheaper for us to reach advanced practitioner level than it is a GP, and we get to that level quicker than a GP, for example. Therefore we are seeking to help to do things differently, not to increase costs. We are seeking to find out how we can shift the flexibility of thinking and workforce profiling. AHPs are also taking on some evolving roles that are building on skills sets that have had quite a lot of piloting. We are very keen to see those translate into actual working practices and be rolled out more quickly than they currently are. Thank you.

The Chairperson (Ms Maeve McLaughlin): Thank you. Before I open it up, I ask members to be mindful of their mobile phones, because broadcasting is unable to pick up a lot of what is being said because mobile phones are interfering with the recording.

In our work around workforce planning, we have heard from a number of professional bodies. You touched on the major challenges around an ageing workforce and an ageing population generally and what that brings in terms of recruitment, retention and often working conditions too. Are those issues for you as well?

Ms R Rogers: Yes. There is very much an inconsistency between trusts. The workforce review or planning really needs each trust to have an opportunity to engage properly with the AHPs to find out what the local needs are. We are finding that there is a very inconsistent approach to workforce development —

The Chairperson (Ms Maeve McLaughlin): Is that inconsistency among trusts in how they —

Ms R Rogers: It is in how they are reviewing their workforce and how they are planning. There appears to us to be no strategic workforce planning. There is a lot of promise, but we are not seeing it happen in reality. Where it is happening in pieces, it is too small and too localised to actually have an impact.

Ms Karen Middleton (Allied Health Professions Federation): The issue is around the word "transformation" in TYC. To get real transformation, there needs to be a more strategic approach to workforce planning. The local differences and the local arrangements around workforce planning are not, in our opinion, going to deliver the transformation that is really needed. It needs to be something really quite different.

Think about the workforce situation in primary care, for example. The evidence from the Royal College of General Practitioners and the British Medical Association (BMA) highlights the dire scenario around the number of GPs who are leaving primary care and the lack of doctors wanting to train as GPs. Yet, we know that 20% to 30% of what any GP sees every day is musculoskeletal: back pain, joint pain etc. That 30% could be seen straight away by a physiotherapist, which we have calculated would free up nearly 100 million appointments a year UK-wide. That is capacity freed up, but it is a more strategic approach to workforce planning that looks at real transformation in how care is delivered. That strategic approach is about managing the demand on health care differently. In the example from primary care, it is about looking at a different way of supplying the workforce, whether it is podiatric surgery provided by podiatrists that has better value and better outcomes for patients, or physios providing primary care services. I am sure that Andy will talk about paramedics.

In managing the demand, the allied health professions take a much more holistic approach in combining the medical model — with surgery and the independent prescribing that physio and podiatry has — but it is also combining it with the biopsychosocial model, which is about keeping people physically fit, keeping them well, keeping them at work and off benefit and maintaining their independence. It is about all of those things that you get from taking a much more strategic approach and looking at the workforce supply completely differently.

Mr Andy McFarlane (Allied Health Professions Federation Northern Ireland): On strategy, there is quite a lot of reference to the implementation of TYC regarding the Ambulance Service but it rarely mentions the clinicians, the paramedics. The College of Paramedics has not been engaged in any sort of strategic direction regarding TYC. In fact, as Rosalind said, we are the only country in the UK where we are not recognised as allied health professionals. We are pushing that forward locally with the Department.

I agree with my colleagues that there are so many things that we can do that we are not being allowed to do within our local scope of practice; for example, advanced care paramedics and community paramedics running minor injury units and going out to people's houses and doing a minor assessment or a wound closure that would avoid an elderly person having to go to hospital. There are lots of different ways that we can be used, but we are still very much stuck in the transport model. Now, that is changing locally, which is good. There has been some investment locally, and we are changing. We are leaving people at home. We are referring people to doctors. We are referring them to the pharmacy, the falls team and diabetic nurses, but we need to be engaged in a strategic approach.

The Chairperson (Ms Maeve McLaughlin): If it is not strategic and there is a need to be strategic, whose responsibility is it to do that strategic piece? Is it the Department's? Is it the board's?

Mr McGimpsey: It is the Department's.

The Chairperson (Ms Maeve McLaughlin): I am asking them.

Ms K Middleton: We, representing the professional bodies of the third largest clinical workforce, which is what AHPs are, really want to be part of that support and engagement in the strategic workforce planning. We have the data on our members. We have the innovation from across not only the UK but the world. We can share best practice and the evidence in order to speed up some of this innovation. The issue is that we are not looking at something that is going to happen in the future and that we can start planning for and take our time with. This is happening now, and we have solutions now, if the professional bodies could be engaged.

The Chairperson (Ms Maeve McLaughlin): But it is ad hoc and inconsistent.

Ms K Middleton: It is ad hoc and inconsistent, and the professional bodies are not involved at all.

The Chairperson (Ms Maeve McLaughlin): I want to pick up on a point that you made and which we have also heard from the unions: that 20% of GP appointments are for musculoskeletal conditions.

Ms K Middleton: It is 20% to 30%.

The Chairperson (Ms Maeve McLaughlin): That is one of the issues that the Committee took issue with around the self-referral pilot for physiotherapy. On the face of it, that made absolute sense in terms of Transforming Your Care, but it turned into a bit of a tug of war to actually get it operational. What figure did you put on it? How many appointments would be reduced?

Ms K Middleton: One hundred million in the UK. In Scotland, 86% of the population have access to full self-referral and 14% have partial self-referral. It is 63% in Wales, while England is dragging behind on 40%. There is a real drive in England at the moment, because it has been calculated that, by introducing self-referral and doing nothing else, you save £25,000 for every 100,000 of the population.

The Chairperson (Ms Maeve McLaughlin): Has such a calculation been done for the North of Ireland in terms of the reduction in GP appointments?

Ms K Middleton: To my knowledge, no; not specifically for Northern Ireland. That is UK-wide.

Mr McCarthy: We all know the disappointment about self-referral not happening. I do not know where we got it from and whether it came from somebody at the Committee, but I have it in my diary that it was to be rolled out on 25 May, which was Monday past. Has it been done?

Ms K Middleton: As far as I am aware, the pilots have started.

Mr McCarthy: OK, that is progress.

Ms K Middleton: But that is not it rolled out. That is just the pilot. The pilots have been done all over the UK. It is tested and proven, so there really is no need to pilot it yet again.

Mr McCarthy: It was not rolled out on Monday.

Ms K Middleton: I presume that the pilot started, but that is just a pilot and not full roll-out.

Mr McCarthy: That is different. We will watch this space then.

Ms McCorley: Go raibh maith agat, a Chathaoirligh. Thanks very much for the presentation. The whole emphasis in your presentation was on doing things differently. Are you aware of any new service models being developed by the board under TYC or being used by trusts that will require AHP staff to do things differently?

Mr McFarlane: Yes, Rosaleen. As I say, locally, in the Ambulance Service, there has been some money put towards TYC. There are what we call appropriate care pathways. Instead of the normal transport model that we have focused on — whereby, if there is something wrong with you, we will take you to hospital — we have started to assess, treat and sometimes discharge at the home or at the scene; at the shopping centre or wherever it is. There are different referral pathways for different categories of patients such as diabetics and falls patients. That is happening.

It is quite patchy at the moment. I do not think that any of it is Province-wide. It is very much trust-dependent. We are very much linked with the trusts and whether they can accommodate our referral to an occupational therapist or physiotherapist etc.

Ms McCorley: Is there anything different that AHPs have to offer to emergencies and the whole crisis of A&E? Can they offer something that is not already available from trusts?

Mr McFarlane: With the advanced practitioner model, a lot of our colleagues in England, who are sometimes known as community paramedics, are actually running minor injury units. Some are mobile, as we are at the moment in a car, and deal with very low acuity calls. If you have a minor injury or illness, they will go out to assess and treat, and, if necessary, they will call for transport to hospital. However, if it is minor and they can deal with it, they will deal with it and refer you to your GP, pharmacist, falls team, diabetic team, or whatever. There are a lot of figures out there to prove that it reduces hospital stays, and that translates into a cash value.

Ms K Middleton: I have another example. One of the biggest reasons for people attending A&E is falls; for over-65s, it is the major reason. We have calculated that if you developed physiotherapy falls-led services, in Northern Ireland alone, you would save £8·2 million a year and prevent over 70,000 falls. Never mind the saving in money, think of the stress and the anxiety if one of your relatives has a fall and is admitted to hospital, besides the ongoing needs. The evidence shows that most scenarios like that do not end with people going back home; they tend to go into care. So, if we could prevent these falls through physiotherapy falls-led clinics, it would stop a lot of the demand for A&E, stop a lot of the expenditure on keeping people in care after a fall, and free up a lot of GP time. This is a demand on primary care that is unnecessary. We have calculated that for every pound spent on physiotherapy falls-led clinics, your return on investment is £1·50. The point that we are trying to make is that this makes good clinical sense — it is good for patients — but it is also good for the taxpayer and the system. That is what transformation is really about. It is about doing things radically different, but we are only going to get the difference if you engage the people who can innovate in the actual planning. If you do not, history tells us you just get the same old, same old; there is no transformation, just more of the same.

Mr McFarlane: I will give an example. One of my patients yesterday was an elderly lady who had fallen in the street. I assessed her, and she had no injuries, but she told me that it was her second fall in two weeks. As Karen said, the more falls you have, the more likely you are to break a hip and be hospitalised. In the course of my assessment, I advised her to go to her GP and have a falls referral through an OT or a physio. During the assessment, I took her pulse and found that she had an irregular heartbeat. I asked her whether she had atrial fibrillation, which is a heart condition, but she was not aware of that. Again, that is another thing that she will be telling her doctor, hopefully. But hopefully in the future there will be a system allowing us to refer someone to their doctor directly. At present, we are very much depending on that old lady, who might be forgetful or have poor self-care, to tell her doctor. If, however, I can directly refer her to her GP, who now knows that this is her second fall in two weeks and that she has atrial fibrillation, the doctor can treat that condition with medication, probably avoiding a stroke.

Ms R Rogers: At the moment, in Antrim Area Hospital, I think, physiotherapists are going in to ED at the weekend to support people with soft tissue injuries by advising them appropriately. This means that the person not only gets the best physiotherapy assessment in ED but also gets appropriate management, so that it does not become a chronic problem. There are those pockets of pilots that are taking place.

Ms McCorley: Do you think that there is an unhelpful resistance to new ideas or new ways of doing things?

Ms R Rogers: From my perspective, in looking at these 100 AHP projects coming to the surface, and from the AHPF's argument, we do not have AHPs positioned strategically at the right level to ensure that those very good and innovative new ways of working come to the surface. It seems disproportionately difficult for us to influence at Department level. There is only one AHP adviser for 13 professions — well, it is 12 at the moment, but I am sure that we will see sense and bring the paramedics on board. For those 12 professions, for one person to be seeking to advise on that number of professions is very difficult. That sits under nursing. So, even in the trusts, there is no model whereby AHPs, strategically, are positioned sufficiently to allow the agents of change, in band 5, 6 and 7 posts, to make a change. It is systemic. We see ourselves boxed as AHP input in the regional integrated care pathways as well; we are not consistently sitting round the table. It is not that we are not trying. We feel, as the AHPF, that we have been working very hard and cooperatively to engage that, but it is slow work.

Ms McCorley: As part of the shift left under TYC, the Department told us that around £25 million has already been shifted from hospital services to community and primary services in the areas of learning disability and mental health resettlements. Has that had any impact on AHP staff to your knowledge?

Ms R Rogers: We have no clarity regarding the dispersal of the money that you refer to. We would actually seek assistance in determining where the funding has been allocated. We are aware of some recent workforce spends, but we have no detail on a regional basis. That comes back to needing a more clear, open and transparent commissioning process to allow us to see what is happening at the moment. We are unaware of where the money has been spent. We do not know the breakdown, and we do not know who has benefited.

Mr McCarthy: Thank you very much for your briefing paper and your presentation. I am fascinated with your responses to Rosie's question about what you can do to help ease the burden in our A&Es. What you have told this Committee is unbelievable. Is nobody listening to what you have to offer and asking you to provide it and overcome the problems that we are hearing about so often in accident and emergency units?

Ms K Middleton: We are trying to understand why that is. It is such a compelling case, and I often describe it as a no-brainer, frankly. If it is in the interests of the person, the patients, the public, the taxpayer, the system etc, why would you not? I do not think that any other industry would not take notice of this sort of information, data and experience from other parts of the country. The conclusion that we have come to is that we are just not represented where we need to be.

Ros highlighted the AHP representation at the Department, which, again, is not at the top table. In trusts and in hospitals, once again, AHPs are not at the top table, so you are constantly pushing against "the way we have always done things". Wales, for example, has appointed a director for AHPs on every board, and then they have the profession-specific advisers below, because one person cannot possibly do it all for 12 professions and all the subspecialties.

There is something about a systemic need to look at who is represented and where. If it is only ever about the medical and nursing workforce, the likelihood is that you will only ever get medical and nursing solutions to the problem. I come back to that word "transformation": it has to be something different, otherwise we will be here in two years' time still talking about these problems.

Mr McCarthy: Thanks very much. I am sure that somebody is listening to what you have just said and that action will be taken. Surely our review report will point that out. We have heard it before from other people who presented to us. We know that neither you nor your other representative bodies for AHPs is represented on the regional workforce planning group. You have just told us that. To what extent do you think that the Department is taking the views of your workforce into account in developing the overall approach to workforce planning? The answer is probably that it is not.

Ms K Middleton: It is not evident in the sense that these solutions are not being rolled out in the way that they should. However, it is not only the Department. The commissioners also need to pay attention in commissioning different service models for the future. Again, when there is only one person at the Department doing this work and trying to make the case, it is also very hard for her. It is really about how we, as professional bodies, can help to advise and support this transformation and be engaged in an integral way, not as an outside stakeholder, with the regional workforce planning group and be part of it. That may bring about some of this change, because the evidence is irrefutable.

Mr McCarthy: Is any retraining of AHP staff required to meet the shift left to move more services into the community?

Ms K Middleton: No.

Mr McCarthy: Do you think that there are currently enough staff in the AHP workforce to be able to deliver the new service models envisaged in Transforming Your Care?

Ms R Rogers: That brings us to an example of the nub of this question. We are unsure of the staffing levels, because there has been no review since 2005. We have also not been part of the information-gathering process, so we cannot even endorse the figures from the trusts. If new staff have been employed, we do not know where they are. We need to be very careful when we discuss whether we have the right numbers in the workforce because we really do not know. We also know that the figures should reflect staff in post and not posts that are holding or where vacancies exist or have not been filled.

From what we have been saying today, you have picked up that we think that the focus should not be on the number but on a collective. It should be on the profiling of that workforce. It is almost a matrix approach; you have already moved some way towards condition-specific workforce profiling. It is that, along with what is needed in the uni-professionals, which is required. You need professional groups, for example, looking at the demographics in radiography to be able to predict and plan for those new ways of working. At the moment, we cannot answer that question, which is indicative of the challenge.

Mr McCarthy: Thank you very much for your presentation. I wish you every success. I hope that the powers that be are listening to this and will take action sooner rather than later.

Mr McGimpsey: Thanks for the presentation. It is revealing and is not dissimilar to the presentations that we have had from other groups in the workforce. You say that you can offer strategic planning solutions. Is there absolutely no contact at all from the Department about the workforce? It has set up a group for workforce planning. Is it not talking to you at all?

Mr McFarlane: From our professional body's view, we are not even recognised, Michael.

Mr McGimpsey: Are you not recognised through UNISON, other trade unions or something like that?

Mr McFarlane: They are unions, which are trade bodies. We are the professional body.

Mr McGimpsey: You are a professional body, you are not getting in in any other way, and you are not being talked to.

Mr McFarlane: We are not being recognised as allied health professions in Northern Ireland, so we are not party to any strategic documents.

Ms K Middleton: Even if you were, like we are, we are not recognised as professional bodies.

Mr McGimpsey: You do not have representation on the commissioning groups. That was an oversight.

Mr McFarlane: The employers might have representation, but the professional bodies do not.

Mr McGimpsey: To my recollection, there are pharmacists, and there was also an allied health professional.

Ms K Middleton: We need to be clear: I am saying that the professional body is not recognised. There may be clinicians, and, if there is one AHP, he or she is representing 12 professions and all the sub-specialties. We are specifically seeking to engage with and involve the professional bodies, because, as I said, we have that UK-wide, much broader international perspective on innovative solutions and a lot of the data.

Mr McGimpsey: The commissioning group here informs the commissioning plans as they go forward, and, if there is a pharmacist, a nurse, doctors and so on, there should also be a health professional. Do you reckon that you are represented on those? You should be.

Mr McFarlane: There may be professionals on those bodies, but the professional body as a whole is not represented.

Mr McGimpsey: Yes, but they are representing their professional occupation, shall we say. Anyhow —

Ms K Middleton: That might be as a collective. An AHP representative, say, of nursing or medicine, represents one profession, whereas we are 12 totally different professions. You are ranging from arts therapists —

Mr McGimpsey: A commissioning group comprises 12 people — I thought that it was 14 — and you could not have all 12 professions.

Ms K Middleton: No, maybe not all 12, but there should at least be some way to feed in from a profession-specific basis.

Mr McGimpsey: You gave us the UK total. We do not have that sort of cover whereby we can find the information about how many people we are talking about in Northern Ireland. What is your rough breakdown between secondary care and, say, community or primary care as far as your professions are concerned? Do you have any idea?

Ms K Middleton: No.

Mr McGimpsey: Do you have any idea where you think you would be once we move Transforming Your Care? Are you involved in any of that planning?

Ms K Middleton: As professional bodies, no.

Mr McGimpsey: It is very disappointing that you are not involved. I can see why you are frustrated. That is the key thing that you have to do, and you have to be in the middle of it.

Mr Easton: I understand how you feel about not being listened to. I used to be the Assembly Private Secretary in the Health Department, and, any time I talked to departmental officials, they would go away, come back and pooh-pooh any good idea I had, so I understand that a wee bit. So there you go.

Ms K Middleton: What are your top tips? [Laughter.]

Mr Easton: I do not have any. [Laughter.]

Can you give us an idea of the gender mix in the AHP workforce? Is part-time working an issue in the AHP workforce? Do you think that workforce planning at a departmental level takes into account the gender mix of staffing and the associated workforce patterns?

Ms R Rogers: The gender mix is predominantly female. Some of the professions have more of a male/female split than others. Speech and language therapy would be 99% female, and physiotherapy and radiography are different.

Mr McFarlane: The last figures that I saw stated that, locally, around 25% to 30% of paramedics are female. I do not think that part-time working is a big issue. It is fairly well accommodated.

Ms R Rogers: We are more interested in seven-day working because of a lot of the work that AHPs do. I am thinking particularly of speech and language therapists assessing swallowing in the acute hospitals. Very often, that swallowing assessment is the difference between someone being able to leave hospital or not, so seven-day working for some of our AHP colleagues in those sectors will help to make a difference with throughput. As a collective, the AHPF is very supportive of the ethos of a flexible workforce and, with a predominantly female gender mix, greater accessibility to work. We are also aware that seven-day working is very helpful with appropriate resources. It needs to be resourced as that. Paramedics are an optimal example of 24/7 working.

Mr McFarlane: We work 24/7, so it would be nice to have other professionals to whom we can refer our patients also to work 24/7, or at least work a seven-day week.

Ms R Rogers: There have been pilot schemes with OTs and physios working for seven days.

Mr Easton: How did that go?

Ms R Rogers: It went surprisingly well. With appropriate resource, it prevents that massive block on a Monday and the massive rush on a Friday. You are also able to provide the right support in a timely way, which is very helpful not only to families but to patients.

Ms K Middleton: We need to bear in mind that there is huge diversity in what people in the allied health professions group do, but the general ethos is to support independence and to maximise anybody's potential to work, to function, to get home and to do whatever they want to do. We do not create dependency like the medical model can, and we are often invisible because our success is based on a person being more independent and not relying on us as clinicians. Think about what happens over a weekend or an evening, for example. In my clinical practice, I can remember the difference between leaving an orthopaedic patient on a Friday and seeing him or her again on the Monday. There was deterioration. It was pain and discomfort for the person, and the length of time that that person was in hospital was elongated when he or she could have been at home being independent, starting to get back to work and so on. The other part of the transformation that we are talking about is not just about a different workforce and different service models but about a different way of thinking about health care. It is about empowering people to take control of their own health and well-being, with a focus on independence and work rather than dependence on a health-care system, because, otherwise, the NHS is constantly picking up the pieces. It is about a shift in thinking about health care. I read the TYC document, and that theme comes through. It is about care closer to home and de-medicalising our health and well-being, and that is where AHPs, particularly over seven days, have a real role to play.

Mrs Cameron: Thank you for your presentation. You have pre-empted my question, but I will ask it again for clarity. This review is looking at the desirability of seven-day working. Rosalind, you spoke about that. Is it an issue for allied health professionals? Obviously, it is not an issue for you as such, but there is a knock-on effect, and you would need other people to work in that fashion as well. Do you have any ideas as to how that would work or how those issues could be addressed?

Ms R Rogers: From the perspective of the AHPF, nobody in their right mind would expect the same workforce to move from five days to seven days, so it comes with the caveat of appropriate resourcing. We find it invigorating that, despite the pressures and stress of being in the front line — it is tough, as we know — there is still an absolute willingness to embrace a fundamental change in a pattern of working because it is making a difference. I think that the flexibility and commitment to being innovative, because it makes a difference to the person, is percolating through our memberships across our professional bodies, which is why I think that we can say with confidence from our Allied Health Professions Federation's position that we are fully supportive of it because it makes sense.

Ms K Middleton: You cannot, however, provide a five-day service over seven days for the same amount of money or the same service. It has to be different in some way.

Mrs Cameron: I appreciate that.

Ms K Middleton: The savings would be reaped further down the line.

Mrs Dobson: Thank you for your presentation. It was certainly very frank and honest.

My question relates to one of the terms of reference for the review, which is to examine the extent to which workforce planning is taken into account in recruitment issues for particular geographical areas. Rosalind, you referred to the inconsistency between trusts and the need to engage properly and locally. Obviously, workforce planning for geographical areas is crucial. Is this an issue for AHPs, and, if so, how do you propose to address it?

Ms R Rogers: At the moment, as we said, there is one seconded lead officer post who advises the Department and oversees the 12 or 13 professions. It is very difficult for us, as the AHPF, to know about recruitment issues for geographical areas. The reasons for that come back to the fact that we do not have an appropriately positioned and resourced Department-level advisory team. The very fact that that AHP lead post is not permanent speaks volumes. There is a potential crisis if that person is on leave or on holiday. I do not know of any other significant part of the workforce that does not have the capacity for Department-level advisory issues to be picked up. If that one person happens to be on leave or is unable to work, that affects 12 professions. That inconsistency in support between the groups, medics, nurses and AHPs is very real and is damaging our ability to transform how we deliver care.

Mrs Dobson: Essentially, if anything happens to that person, it falls apart.

Ms R Rogers: It absolutely does at departmental level. In each trust, the strategic position of the AHP voice differs, so no one model is consistent across the trusts. There are anomalies in that not all trust AHP representatives represent all AHP groups, so all 12 professions might not be represented in the trusts. For various reasons, the South Eastern Trust has been identified by the AHPF as a good structure in that there is an AHP lead who is able to give appropriate evidence on waiting lists and articulate targets and whether they are being met, looking at budgets and delivery across time frames.

Mrs Dobson: How do you then replicate that across the trusts?

Ms R Rogers: We are certainly interested in the Northern Trust because it is restructuring. It is talking about putting AHPs on to the nursing lead. As the AHPF, we would clearly be seeking to influence whether they are on a par. It is about getting that AHP lead role positioned in each of the trusts at the right level.

Mrs Dobson: I note your comment: "seeking to influence".

Ms R Rogers: Yes.

Mrs Dobson: How realistic is that? How do you make it happen?

Ms R Rogers: We are here today pooling the resources of our 12 professional bodies to work and campaign together and appropriately. We are working through our networks and special interest groups. We are working across condition-specific groups. However, I have to say that any leverage — at any level, anywhere, anyhow — would be greatly appreciated.

Mrs Dobson: There certainly has to be willingness in the trusts to make it happen.

Ms R Rogers: Again, we have a responsibility, as professional bodies, for ensuring that the very positive, can-do examples are promulgated.

Mrs Dobson: You talk about the need for a culture shift in language in referring to health and social care. Do you feel that, given current perceptions, it will take a long time to achieve that shift? Where do you see it starting? Do you see it starting from the top of the health service, or do you see it being patient-led and moving upwards? Such a joined-up approach is recommended by patients. They know how it works for them. If it is patient-led, will it take a long time? Do you think that this should be patient-led, or should it start with the health board?

Ms R Rogers: I will address that first and then hand over to my colleagues. When patients have very strong charities articulating their voice and lobbying for them — the Stroke Association is a good example — that is a powerful force, in partnership, for change. In my field of speech and language therapy, when someone does not have a voice, is not empowered and does not appreciate how much better it could be, it is impossible, at an individual level, to see how change can be brought about. Through a partnership such as the long-term conditions alliance, lobbying together could make that patient voice very vocal.

Mrs Dobson: People power is very powerful.

Ms R Rogers: It is, but that is in combination with the strategic planners, the commissioners, the PHA and the trusts.

Mr McFarlane: The Department must also be a voice for us to promote what we can do.

Ms K Middleton: People power is really powerful, except that the people whom these professions see over time are often the most marginalised in society anyway and do not have a voice or the ability to get to a place to speak and so on. Every now and then, you get a very vocal, articulate person in the public eye. Andrew Marr, for example, following his stroke, has done a huge amount to express what the allied health professionals, and physiotherapy in particular, have done for him. If you want culture change, you will find that it comes about as a result of change at the very top. People forget how important language is in terms of culture change. Simply repeating "doctors and nurses" will just reinforce the message that health care is about only doctors and nurses. We spoke about the experience in Australia where Ministers refer to "doctors, nurses and allied health professionals". The nearest we have ever got to that in the UK is "the unsung heroes", which speaks volumes.

Mrs Dobson: Is that the paramedics, then? [Laughter.]

Ms K Middleton: There is something about creating an expectation from the top that this group of professionals — the third-largest clinical workforce — would be involved. That needs to come from the top.

Mr G Robinson: I listened to the Queen's speech today and noted that the new Government propose seven-day working for the health service.

Ms R Rogers: I was delighted to hear that on the radio. I thought that that very much echoed our thoughts in preparing for today.

Mr McCarthy: At least the Queen is listening to you.

Ms K Middleton: I said that it had to start from the top. [Laughter.]

The Chairperson (Ms Maeve McLaughlin): Thank you all. The session has been very useful. As we conduct the review, a clear pattern is emerging. As well as workforce planning and the need for the federation and the professional bodies to be able to influence and participate in the process, there are issues about the system and the cultural shift to which you referred. It is bringing roles, remits and commissioning issues to the fore. That has been extremely useful for us today, so thank you for taking the time. We will reflect on your evidence.

Ms R Rogers: Thank you very much. We appreciated your time.