Our Allied Health Professional (AHP) Strategy 2017 - 2020 has been developed by our own staff, with consideration into how we can link to the national strategies for each of the professional groups and to our well established Quality, People, Sustainability(QPS)framework, whilst still maintaining the unique role that our professional staff have here at Warrington and Halton Hospitals.

Our ambition is that our AHP and Allied Professionals Strategy will be owned by the professionals and sets out a plan for over the next 3 years. Our aim is to empower the AHP and Allied professional workforce to ensure their voice is heard in relation to our Trust vision, objectives, and values.

Download our AHP Strategy below.

AHP Strategy 2017 - 2020

As one of the dietetic team within the hospital I find that there is no such thing as a normal day but every day has challenges and rewards. As part of my role I mostly work on 3 wards in the hospital, A1, A2 and C22 but because of our team size, I often end up on other wards as well! Apart from wards I also run a clinic in the outpatient department at Warrington Hospital and teach Cardiac rehab groups as part of a team of health professionals.

The day typically starts in the office with me sorting out which patients need to be seen that day, seeing if patients have gone home and awaiting the new patients’ paperwork to be sorted and divided amongst the team. Then once I have decided who is going to be seen that day I head up to the wards.

I really enjoy being on the wards, building working relationships with other staff such as doctors and nurses but also housekeepers and ward clerks who are integral to the care of the patients on the ward. For each patient, I spend some time gathering all the relevant medical information and then go to have a chat with the patient. For lots of patients this is likely to be about their weight, usually because people are underweight, (not overweight as people often assume!) Often I try to get a picture of their nutrition before they were admitted and then look at strategies to put in place in hospital to support them to have a good food intake while in hospital.

It can be challenging on the ward when people are confused and it is difficult to discuss information with them, but as much as I can, I try to engage people with the nutritional aspect of their care as sometimes it is the only aspect they have control over.

After a morning of seeing patients on the ward, I often have one of my other roles in the afternoon.

On clinic days I run a general clinic and provide dietary advice to a wide range of health conditions. A clinic appointment often starts off with assessing what people know about their diagnosis, talking to them about how food relates to their condition, explaining what changes would be beneficial and then working with the individual to create specific goals for them to put in place.

In clinic it is rewarding to work with people when they have all the flexibility of their normal life to make changes to improve their health. Working with people to show how they can make small, manageable changes can be really exciting. A lot of the work is about teaching people about the principles of good eating and guiding people to create their own goals so that they really own their treatment.

It can be challenging, working with individuals who don’t want to change and trying to explain things so that all the consequences of not changing are understood by people but overall I enjoy sharing knowledge and practical tips with people to help them have control over their own health.

As Occupational therapists we aim to facilitate people to return to their previous level of independence with their activities of daily living.  We look at peoples meaningful occupations and reduce any barriers that are stopping them from achieving these.   Working within Stroke services we treat patients who have had an acute stroke and patients with other neurological conditions including those with an acquired brain injury.

A typical day includes screening for new patients both on our ward on B14 as well as any stroke or head injury patients which have been identified on any other wards. Any new stroke patients must be seen within 24hours of admission, thus as soon as we become aware of them and notes have been screened we go to complete our initial OT assessment.  This involves gaining social history asking questions about their living arrangements, how they usually manage their activities for daily living (e.g. how they get themselves washed and dressed, how they manage their meals/drinks), shopping, domestic tasks and whether they have any hobbies.

Once social history is gained we complete a full therapy assessment usually in collaboration with a Physiotherapist to enable us to then assess their transfers.  We assess how they manage their chair, bed and toilet transfers. Assessing these transfers allows us to establish whether they are close to their usual baseline or whether they need further rehab to get back to achieving these transfers to how they used to.  Not all patients we will be able to assess all transfers on initial assessment due to their level of mobility.

Following initial assessments we then look at the patients cognition this involves completing a standardised cognitive assessment as able.  Patients who have a stroke can also have speech difficulties making some cognitive assessments more difficult.  There are a number of different assessments that can be used in these circumstances.  Following initial assessment we can then choose the most appropriate assessment to complete.  For brain injury patients again different cognitive assessments would be most appropriate.  As OT’s we have a good understanding of a number of cognitive assessments to ensure the most appropriate in used in each case.    We also then assess the patients’ mood and complete an assessment of any anxiety present.

To ensure that our patients are able to manage their daily living tasks we then ensure function assessments are completed. These include washing and dressing assessments and kitchen assessments usually but can also include feeding assessments or looking at further how they will manage with medication.    By completing functional assessments we can further assess patients’ problems following the stroke.  This could include memory, cognition, visual impairment, perceptual problems, and weakness in arms, legs or trunk, sensory deficits.   During these assessments we are then able to identify the level of support that is required on discharge. 

Once all assessments have been completed we hold a progress meeting with the patient and their family.  This gives us the opportunity to inform them of the assessments completed and discuss the patients’ problems.  We can then discuss with the patient and family about discharge and the support required so a care package can then be organised.  In some cases a social worker will be required to set up the care needed.

As OT’s we are very involved in the discharge of patients from the ward.  Not only do we identify the level of support a patient will need at home we also assess for any equipment they may need.  We often complete access visits to the patients property prior to discharge to assess the environment for suitability and any equipment or adaptations required to support the patient.  We also often complete home visit assessments where we take the patient home and assess their functional abilities in their own home.  This ensures the discharge is as safe as possible with the correct level of support to avoid readmission.  In stroke services we have an early supported stroke discharge team that can then continue therapy input on discharge to support the transition home as required.

Shruti Joshi works as a Specialist Physiotherapist in the MSK Outpatients Department based in Appleton wing, Warrington Hospital. She is also the Health and Safety Representative of the Chartered Society of Physiotherapists’ for the hospital. She has completed her undergraduate training in physiotherapy in 2012 and secured Gold in her university when she completed her Post graduate training in Musculoskeletal (MSK) Sciences and Manual Therapy in 2015. Shruti has recently completed her training as a Health and Safety CSP Representative at CSP Headquarters, London; marking the 40th year anniversary for the Health and Safety representatives. 

I have always been a passionate physio and part of this comes from my teachers. I am blessed to be trained under some of the finest physios at University and continue to work with talented senior physios at work. I believe in my profession because it gives me the opportunity to interact with patients and help them with their symptoms of pain and activity limitation with exercises. Physio is definitely successful in the longer term due to its adherence to healthy lifestyle habits. I absolutely love my job as it is interesting in so many ways and also teaches me to work in sync with the operating surgeons and the GP’s in the community with patients as the focus. I am constantly learning something new every day!

My day at work starts at 8 and I treat approximately 14 patients every day as per my clinic schedule. My work also includes conducting classes which is an interactive session between patients and physios where we focus on teaching the patient how to self-manage and progress their condition effectively. I also am an active participant on the on – call rota of the Respiratory Therapy Service which is very challenging in itself. I have also loved to be the Clinical educator for physiotherapy students as it allows me to reflect on my practise whilst sharing with them some evidence based treatment approaches. I am always there to help physios with any matters related to safe working practises and advise on dealing with stress in work.

Since becoming a CSP Health and Safety Representative, it has given me the opportunity to meet so many people across the Trust like the Staff side chair, health and safety advisors of the trust, fire safety members, colleagues from estate and the executive team of the Trust. With the help of my colleagues I have attended some very informative Trust meetings like the JNCC, Union meetings etc. I have absolutely enjoyed learning different procedures that the Trust follows to ensure safe quality care provided to the patients and also health and wellbeing of the staff.

It has been thrilling to supervise Deb and Stephen; the Health and Safety advisors of the Trust who have been so caring and welcoming. I learnt how to conduct inspections of work places with them which is a brilliant opportunity to help staff ensure safe standards of working. I now have my own caseload with targets to complete formal reports of inspections carried out at various areas across both sites and feedback to the relevant managers. I have also attended the Health and Safety Sub Committee Trust meetings which have been an eye opener on the various policies and procedures in place to ensure optimum standards of safe working being followed in the Trust.

I would like to thank my managers, CSP stewards and the Health and Safety advisors of the Trust to support me and encourage me positively to do my job well.

PROUD TO BE A PHYSIO! BECAUSE IT WORKS!

My day begins at 8am. The first part of my morning is spent prioritising new referrals and reviews on the general acute wards here at Warrington Hospital. Information for each patient is taken from our patient record system, Lorenzo. This includes case histories, relevant medical and family information, and how each patient is managing with recommendations we may have made.

Most of the referrals we receive are for assessments of patients struggling with their swallowing. This is also known as dysphagia. Referrals also request assessments of communication, although this is more typical for Speech and Language Therapists who work on the Stroke Unit.

Following this, I head to the wards.Top of Form I carry out bedside assessments and implement management of swallowing disorders, using highly specialised knowledge of the head, neck and thorax. This may include giving advice on adapting environment and posture and demonstrating strengthening exercises. We provide information to clients and Nurses/Health Care Assistants regarding modification of diet and safest feeding options.

Liaison with the Medical Team is often required, for example when managing the treatment of patients who are not safe to eat and drink and may require what is known as ‘Feeding at Risk’. This is a difficult decision made with thorough consideration of diagnosis and prognosis with patient, family and medical input. It allows a person with a potential risk of developing pneumonia to eat and drink for comfort.

I document my time spent with each patient on Lorenzo. After lunch, I continue my day in Community. I visit patients in their own homes and Nursing Homes. Assessment of swallowing and communication is carried out where needed. The following are examples of Community patients:

I recently assessed a client with dysphasia, a communication disorder that results from Stroke, with the Psycholinguistic Assessment of Language Processing (PALPA). I made the differential diagnosis of where the level of impairment was and developed a therapy programme specifically for this client .

I have also recently worked with a patient with Motor Neuron Disease who could only communicate using eye movement. I designed different formats of eye pointing boards and assessed him to establish which was most effective in allowing him to communicate with his family, friends and healthcare professionals. The goal of intervention was to allow this client to communicate in as functional a manner as possible using a communication aid.

I really enjoy my job. Every day is different and can be very rewarding. I am part of a small, but friendly and competent team. We work well together and support each other with learning.