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Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 21st October 2008: Allied Healthcare Professionals Annual Conference

I’m delighted to be able to join you at what, I’m sure you will agree, is a quiet and tranquil time in politics.

This is the first time I’ve had the pleasure of addressing you at your annual conference, and I would like to begin by paying tribute to the incredibly important work you do in improving people’s health and life chances in this country.

I would also like to thank the Allied Health Professions’ Federation for their excellent leadership and advocacy on behalf of patients – you provide a strong and welcome influence on health policy, and your contribution to the Next Stage Review was invaluable. Your work doesn’t always receive the credit it deserves.

I understand your frustration when politicians are quick to praise doctors, nurses and even managers, but neglect to mention the physios, arts therapists, dietitians, occupational therapists, podiatrists, speech and language therapists and the many other health professionals who help millions of patients across the country.

There is an unfortunate precedent for missing you off the list that I want to correct today.  The original 1944 NHS white paper devotes many pages to hospitals and GPs. It made no reference to the services represented by people in this room today, save a scant few lines squashed between a paragraph about the treatment of venereal disease and a couple of pages on the service in Scotland, where it refers obliquely to: “the part of medical officers and others.”

No mention, then, of the role of physiotherapists, who received their Royal Charter in 1920. Or occupational therapists, who can trace their professional history back to the Enlightenment, and who played a vital role in rehabilitating injured soldiers and sufferers of common but potentially fatal diseases such as polio.

This was perhaps forgivable in 1944, when the focus was inevitably on detecting and treating infectious disease and when our knowledge of the physical and social determinants of health was not nearly as advanced as it is today.  But the challenges of 60 years ago are very different to the ones we face now and your role should not only be more prominent – it is indispensable.

In 1948, the over 65s made up less than ten per cent of the population, as opposed to almost twenty per cent today. The discovery of a causal link between smoking and lung cancer (not to mention cardiovascular disease) had yet to be made. Sixty years ago, when rationing was getting tighter, the idea that an abundance of cheap, processed food would cause a major health problem would have been unthinkable.

Health inequalities, finding more effective ways to support our ageing population and preventing lifestyle diseases such as obesity are new and very different challenges.

And the public is rightly more assertive today, with expectations of public services continually rising – this is not something that can be ignored by professionals. Providing services that are readily available, that give patients genuine choice and are personalised to meet individual needs is essential to tackling health inequalities, because it is only in this way that we will be able to reach the most vulnerable.

Life expectancy has increased by 11 years since the NHS was established, and to the great credit of health professionals across the country, survival rates for cancer and cardiovascular disease have risen significantly over the last decade. But we do not see health improvement purely in the stark terms of life expectancy, any more than we define good health by the absence of illness. It is not just a question of adding years to life, but life to years.

Allied health professionals hold the key to unpicking and tackling these challenges. Karen Middleton puts it very well when she talks about your ability to understand complexity – the complexity of supporting people with multiple health and care needs and the sometimes unnecessary complexity of marshalling the many different services they require. And above all, your ability to make sense of that complexity on behalf of the patients you work so hard for.

The Next Stage Review is one of the most significant new chapters in the history of the NHS. Its major themes – the need for greater personalisation, the focus on quality and prevention – are the natural territory for allied health professionals. Your services will play a vital role in their delivery.

In this speech, I want to set out how we will make sure that the services you provide are properly valued, easily accessible to patients and of the very highest quality. Today, we publish a document which sets out the three things that need to happen to improve access, availability and quality of allied health professional services.

First, we need to reduce excessively long waiting times for allied health professional services.

Reducing waiting times towards a maximum of 18 weeks is the most ambitious health target set by any government in the history of the NHS, and it has led to the single most tangible improvement in services for patients.  

A clinician I was talking to recently told me how in 1994, her chief consultant took his medical team out to dinner to celebrate the fact that they’d reduced the waiting time for hip replacements from five years to three years. It is appalling to think that as recently as eleven years ago, some patients would be more likely to die waiting for life-saving operations than ever receive treatment. Such a situation today is unthinkable.

I would like to acknowledge the incredible role that many allied health professionals have played in helping us meet the challenging targets around waiting times for consultant-led care – targets on the delivery of cancer treatment could not have been achieved without the dedication and commitment of radiographers, for example.

But that does not mean that long waits have completely disappeared. Some patients who need an NHS service are still waiting too long. It is not acceptable for young children to be on an 18 month waiting list to be assessed (not to access treatment – just to be assessed) for speech and language therapy, when it’s so vital to their development, or for an elderly person who needs to see a podiatrist to be prevented from leaving the house because their mobility is impaired.

While many AHP services have tackled long waits, I want to see more trusts bringing focus to this area. You cannot put a value on improving access to excellent podiatry services for older patients, particularly if it prevents falls and lengthy hospital stays that can threaten the ability to live independently. Or to speech and language therapy for the child whose communication difficulty could lead to them falling behind at school and developing behavioural problems.

Occasionally, there are waits because of a lack of local investment and resources.  But we need to see professionals doing more to get involved in local management and leadership of health services, in order to raise the profile of the services they provide. It is an expression of the growing influence of allied health professionals that East Midlands, the South West and the East of England SHAs have all stated in the strategic visions they published as part of the Next Stage Review, that they will prioritise reducing waiting times for the services you provide.

Examples across the country show that when local health leaders make these services a priority, waiting times fall. Royal Wolverhampton Hospitals NHS trust has reduced waiting times for physiotherapy and occupational therapy outpatient appointments from 25 to 3 weeks, despite a 30 per cent increase in referrals. Bolton’s Musculoskeletal Clinical Assessment and Treatment service has reduced the total waiting time for assessment and treatment from one year to 18 weeks.  

This is not a prelude to yet another target. As I said when I became secretary of state for health over a year ago, and again when we published the Next Stage Review, there will be no more top-down targets. The new offer I’m outlining today will require all SHAs, PCTs and Trusts to work with allied health professionals to improve access to these essential services. A key starting point will be more publicly available information about waiting times and better data collection, so health leaders can plan better how they meet demand for these services in order to reduce long waits.

Secondly, we want to make these services more accessible to patients. A key theme of the Next Stage Review was increasing patient choice and making services more flexible to meet their needs. At the moment, for allied health professional services in many areas, patients have to be referred by a GP or another doctor.

While GPs play an invaluable role in identifying and commissioning services that can help patients, in some cases, the process of getting a referral simply adds an additional bureaucratic layer. A patient who has put their back out and is unable to work, needs to be assessed by a physiotherapist, not a GP. And GPs shouldn’t have to waste their own time as well as their patients’ just to put a tick in a box.

There is no reason why more services can’t offer self–referral, where it’s clinically appropriate.  Those who favour referral systems have argued that self-referral will open the floodgates, that practitioners will be inundated with patients and won’t have resources to cope. But in parts of the country where patients are able to self refer for physio or podiatry services, this has proved not to be the case. In fact, evidence shows that not only do patients access services quicker, they are also more likely to complete their course of treatment and turn up for follow up appointments. City and Hackney Teaching Trust’s early years speech and language therapist service operates “talking walk-in” sessions for initial assessments so parents can see a specialist straight away.
In the long term, self-referral is also more cost-effective.


Finally, we want to work with you to improve the quality of allied health professional services. We already announced in the Next Stage Review that we would ask clinical teams to look at new ways of measuring the effectiveness of what staff do, so they can identify how services can be improved.

What patients say about their experience will for the first time be used to measure the performance of clinical staff – so, for example, the quality of nursing care will be measured by whether patients feel they have been treated with compassion and sensitivity and respect.

We have asked the allied health professional leadership team to identify new ways of measuring quality – or quality metrics, as they are commonly referred to. This draws on what’s already happening in many parts of the country. In Sheffield, speech and language therapists are developing quality metrics to evaluate how well they support people recovering from strokes. And South Devon and Devon primary care trust stroke service has been doing extensive research with patients and carers, which they are using to improve the quality of their services.

From June, we will pilot quality metrics for AHP services delivered in community settings – as announced in the Quality Framework for Community Services. We are working with allied health professionals to develop these metrics which will subsequently be incorporated into the new standard National Contract for Community Services.

The work of the frequently cited hospital doctors, GPs and practice nurses represents only a part of the NHS. The 60th anniversary commemorations have provided a golden (or more appropriately, diamond) opportunity to reflect not only the continued importance of a universal, comprehensive health service, but also on how it will continue to embody the values that underpinned its genesis 60 years ago – access to the best that modern healthcare has to offer for all, regardless of wealth, disability, ethnicity or class.

Allied health professionals will help us stay true to this ethos. The framework we publish today means the services you provide will get the focus they deserve, and that more patients can access the high quality, readily available services that are so essential to the health and wellbeing of our nation.