Allied Health Professions productivity evidence for recommendations
The allied health professions productivity matrix grades the quality of the data and evidence available for the service examples provided and explains
assumptions for calculations made.
Key Deliverability:
1
not achievable
2
not achievable within 3 years
3
achievable within 2-3 years
4
achievable within 1-2 years
5
achievable immediately
Level of evidence available:
1
No evidence
2
Soft and anecdotal evidence
3
Practice based evidence (NICE L3)
4
Research evidence (NICE L2)
5
Multiple Research and/or RCTs (NICE L1)
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Current national work on tariff adjustments will incentivise commissioners to promote models of care that develop alternatives
to admission and reduce length of stay. This will enable widespread adoption of service changes such as interdisciplinary
input in emergency departments and early supported discharge teams as illustrated by the examples given below.
Description of service
1. Extended pathway and early supported
discharge for acute stroke patients has
resulted in a reduction of 18 days in the
average length of stay for stroke
rehabilitation and 3 days for the acute
phase (over 11 months).
Source: Berkshire
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Productivity assumptions
The pathway has been extended at an investment
cost of £300k (reduced from £650k).
 The additional funding was used to provide
additional therapy posts specifically speech
and language therapists and dietitians.
 Average length of stay for stroke patients has
reduced from 59.6 days to 42.1 days in the
SRU and from 9.4 days to 6.3 days in the
Acute Stroke Unit (ASU)
 17.5 days SRU @ £125 = £2187
 3.1 days ASU @ £250 = £7750
 =£9937 per patient
 Minus £300K investment per team
 £300K x 150 Trusts = £45M investment in
teams
 86,000 X £9937 = £854M minus £45M
development = £809M
 65,572 X £9937 = £651M minus £45M
development = £606M
Cash Releasable
Deliverability
Level of
evidence
available
National figure
in bold
1 =impossible
5 = easy
1 = no
evidence
5 = NICE level 1
£606M - £809M
nationally
3
3
2
2. To provide a therapy led discharge service
to accident and emergency and emergency
admissions:
Targets
 to prevent unnecessary admission
 to reduce length of stay




Improving capacity within the hospital and
reduction in length of stay.
Admissions prevented 141 over 12 months.
This equates to 1763 bed days.
Assume average bed day £250
Assume 150 acute trusts
1763 x £250 £440,750
per trust x 150 Trusts
Average length of stay reduced from 8 to 4.8
days.
Assume average bed day £250
Assume 150 acute trusts
Based on average £250
per bed day = £800 per
patient –
87,419 THR
74,606 TKR
= 162,025 x £800
4
3
3
3
4
4
3
4
£66M nationally
Source: North Staffordshire
3. Changes to practice allowing patients’
undergoing primary total hip & knee
replacements to have a reduced length of
stay.
 Patients seen in MDT pre operative
education group – occupational
therapy and physiotherapy assessment
and supply of equipment pre op, thus
avoiding delayed discharge.
 Mobilisation on day of operation, at 2
hours post return from recovery.
 Includes weekend working



£130M nationally
Source: North East SHA
4. Rapid response speech and language
therapy service in end of life care to avoid
admission into secondary care


Source: Sandwell
5. Intermediate care/community rehabilitation
service works with the client and carers for
a 6 week period to ensure they are as
independent as is possible for them as an
individual


Source: Rotherham

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The average length of stay for each end of life
admission is 10 days at a cost of £300 per
day.
Avoiding 75 admissions so far this financial
year has saved £225,000
£225,000 x 150 =
£33,750K for 6 months
If clients have an existing care package
funded by Social Services, the reduction in
the clients’ care needs at the end of the
intervention can be calculated and reported as
savings.
A saving of 648.75 hours was made over
2008/2009.
In 2008/2009 at est cost of £11.90 per hour
for care was £401,446.50
In 2008/2009 at est
cost of £11.90 per hour
for care was
£401,446.50
£67.5M nationally
National figure not
calculated or included
3
6. Intermediate care team, working alongside
nursing and medical staff in A&E,
successfully discharged 746 patients from
A&E to more suitable facilities in the
community. The team in A&E consists of
nurses and occupational therapists



In 1 year the Intermediate Care team,
discharged 746 patients from A&E to more
suitable facilities in the community.
Team costs £171K pa.
746 patients discharged directly from A&E
saving 14,136 bed days = £3,534K
£3.5M x 150 =
£340K net saving per Trust
Assume 150 Trusts
£340K x 150 =
3
4
5
4
£52.5M nationally
Source: Calderdale
7. Musculoskeletal triage, pathway led service
review and shift of care to community,
supplementary prescribing and triage to
reduce referrals to secondary care


£51M nationally
Source: Kirklees
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Quality Outcomes Framework/ Practice Based Commissioning could incentivise commissioning for alternative pathways of care
including community dietetic, podiatry and orthotic services to reduce referral and management in secondary care including
reduced need for surgery for some patients
Description of service
1. Dietetic prescribing and review of oral
nutritional supplements results in more
appropriate prescribing practices, the
prevention and treatment of malnutrition,
including reducing hospital admissions,
improving patient outcomes and reducing
GP visits.
Productivity assumptions



Source: London

2. Dietetic support for people in own homes is
enhanced via enteral feed through tubes
placed and managed by dietitians. Avoids
emergency admissions.
Source: Sheffield
3. Podiatry service redesign to develop
supplementary prescribing, community
vascular triage clinic, extended role and
integral public health role
Source: Kent and Derbyshire
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








Cash Releasable
Deliverability
Level of
evidence
available
National figure
in bold
1 =impossible
5 = easy
1 = no
evidence
5 = NICE level 1
In the last four years, London PCTs have
spent £50million on oral nutritional
supplements.
Audit data indicates between 57-75% of
prescriptions do not meet ACBS prescribing
criteria and are therefore inappropriate.
Trusts who have implemented demand
management initiatives have seen reductions
in spend of up to 23%
Based on these figures London could have
saved approximately £11M
£11M x 10 SHAs =
5
4
1 acute trust figures 214 definite admissions
avoided in 08/09 plus 64 possible admissions.
Based on Care of Elderly tariff of £2,334
£499,476 per acute trust
Assume 150 acute trusts
214 x £2,334 =
£499,476 per acute
Trust
= £500k x 150
4
3
4
3
Reduced secondary care referrals by 80%
Approx 70% of patients did not have surgery
Reduced attendance at A&E for this groups
patients by 60%
Annual saving per unit of £300K to £400K
Assume 150 Trusts
£110M
£75 M
£300K x 150 = £45M
£400K x 150 = £60M
£45M-£60M
5
4. Orthotic intervention for: ruptured tendo –
Achilles preventing surgery £1,975 per
patient
the diabetic foot cost £500 per patient v
cost of treating a foot ulcer or amputation
£6K for amputation lower limb
Orthotic intervention plantar
faccitis/fascosis £860 per patient




1.2M patients are referred to orthotists
annually
Number of clients who could benefit is
unknown but potential is significant
Cost saving potential between £2,000 and
£5,500 for specific groups
If only £2,000 per patient for 50% of patients
referred = £1.2M
£1.2M
3
3
Source: Based on projected savings from 3
case studies in Orthotic Service within the
NHS: Improving Service Provision York
Health Economics Consortium 2009
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All AHP services have self referral access to services unless there is a compelling clinical reason why this should not be the
case
Description of service
1. Musculoskeletal physiotherapy outpatient
services accepted self referral from the
public rather than the traditional route of
referral through a GP.
Source: Cambridge
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Productivity assumptions




Average costs per episode were lower for self
referring patients owing to less GP use of
prescribing and diagnostic tests.
75% of patients who self referred did not
require a prescription for medicines
Average savings £12K per GP practice
Assume 8,000 GP practices
Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
8,000 x £12K =
3
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
3
£96M
7
Reduce allied health professionals agency spend through establishment of master vendor by strategic health authority; AHP
staff banks for each NHS provider; allied health professionals in occupational health to reduce absence from musculoskeletal
sick leave.
Description of service
1. Establishing procurement framework for
agency allied health professions staff
Source: NHS North East
2. Establish allied health professionals staff
banks
3. Employing musculoskeletal
physiotherapists in occupational health to
deal with musculoskeletal disorders (8
hours a week). The results of the pilot
revealed a 50% decrease in sickness days
for staff due to musculoskeletal disorders
across the trust, down from 13.6 days to
6.8 days
Productivity assumptions





North East Strategic Health Authority
demonstrates £3M reduction over 3 years with
continuing downward trend
£1M x 10 = £10M
50% reduction in sickness days due to MSK
disorders
National annual spend on allied health
professionals agency staff was approx £156M
in 2008/09
If above measures could reduce agency use
by 50% = £79M
Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
Total £78M
3
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
4
Source: Gloucestershire
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Reducing falls and fractures through an interdisciplinary approach including adoption of the best practice tariff for hip fractures
Description of service
1. Paramedics complete a falls risk
assessment when responding to all fallers
and refer to falls service as required to
prevent a second
Source: North East
2. The role of specialist therapy assistant to
works in falls, rehabilitation of older people
and chronic respiratory disease
Source: Sheffield
3. An A&E Falls Team prevented the
admission of 8% of the elderly patients
attending A&E after a fall.
The team consists of an occupational
therapist, a physiotherapist and 2 falls
technicians.
Source: High Wycombe
4. Multi-factorial falls assessments carried out
on all residents in the care homes receiving
input from the service. Modifiable risk
factors acted on or referred for specialist
assessment by secondary care. education
and training provided to care home staff.
Productivity assumptions







Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
In first 18 months 4,000 less falls a year with
saving to ambulance trust of £400K in 18
months
£270,000 per ambulance Trust = £2,970K per
annum
£270K x 11 = £3M
3
In year 1 a reduction in A&E attendances of
223 and reduction in admissions of 37
resulting in a saving of £33,010 after funding
team.
Average annual saving £20K
Assume 150 Trusts
In 1 year the team assessed 1257 patients,
who after a fall had attended the A&E and as
a result 96 (8 per month) admissions were
prevented
Assume 150 Trusts
£20K a 150 = £3M
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
4
96 X Care of elderly
tariff £2,334
= £224K X 150
= £33.6M
£ unknown at present
but significant potential


Reduction in admission to hospital from care
homes
Total cost savings for 2 homes (Nov 2008 to
March 2009) = £113,688 (36 less referrals to
hospital) minus cost of team
Reducing falls total
£40
Source: Rotherham
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There is an opportunity for Trusts to maximise the potential for extended scope practitioner roles and assistant practitioner
roles across all professions e.g. Radiography 50% of all x-rays should be reported by radiographers; currently 16% reported by
radiographers and 10% of films go unreported
Description of service
1. Utilising role development in radiographers
to meet service needs and provide
maximum cost effectiveness. Use of
assitant practitioners to provide capacity for
other team members to develop advanced
roles
Productivity assumptions

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

Source: Society of Radiography

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

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Radiologist salary £100K
Reporting radiographer salary band 7 £34K
Assistant practitioner band 4 £19K
In one Breast Screening Service, 34 sessions
of activity are delivered by advanced and
consultant radiography practitioners that
would otherwise be provided by breast
specialist consultant radiologists, ie. an
equivalent of 3.4 wte medical consultants.
The base salary cost for the team of
radiography practitioners is £160,000.
3.4wte consultant radiologists would equal
approx. £340,000
Saving of £180K per team
Assume 80 Breast screening clinics in
England
This could be replicated for other radiological
services and other professions
Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
£180,000 x 80 =
£14.4M
4
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
4
£14M
11
Description of service
2. Fast track business case for independent
prescribing for podiatrists, physiotherapists
and radiographers and supplementary
prescribing for dietitians; speech and
language therapists, orthoptists and
occupational therapists.
Source: Allied Health Professions,
prescribing and medicines supply
mechanisms scoping project report
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Productivity assumptions


Early indications demonstrate extending
prescribing to AHPs may reduce overall
number of prescriptions as alternative
modalities of care are at their disposal.
Reducing A&E attendance through
management in community; reduced demand
on GP; more efficient pathways of care; fewer
prescriptions, physiotherapy treatment
reducing need for pain relief; more efficient
and effective use of oral nutritional
supplements.
Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
Not yet quantified
3
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
5
12
Intermediate care and rehabilitation services should be aligned to reduce admission rates for diagnostic conditions that could
be managed in a community setting for example people with respiratory conditions, people with dementia and fallers
Description of service
1. Locality review of intermediate care and
rehabilitation benchmarked against
variation admission rates of diagnostic
conditions that could be managed in a
community setting identified significant
variation in cost effectiveness and scope to
reorganise to increase effectiveness
Productivity assumptions


Savings from treating top 10 conditions
suitable for community management in the
community and not acute hospital
Review identified potential £12M in one
locality allowing for additional investment in
community teams and that full potential will
not be achieved this suggests a more
conservative potential of £10M per PCT
Cash Releasable
Deliverability
National figure
in bold
1 =impossible
5 = easy
150 PCTs x £10M
50% = 4
50% = 2
Level of
evidence
available
1 = no
evidence
5 = NICE level 1
4
£1.5B
Source: Dorset
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