AHP Acute

North Ayrshire Council · 19 June 2025
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Integration Joint Board 
19th June 2025
Subject: Allied Health Professions within Acute Settings 
Purpose: • Awareness
Recommendation: It is recommended that the Integration Joint Board 
a) Note the contents of this report. 
Direction Required to
Council, Health Board or
Both
(where Directions are required
please complete Directions
Template)
Direction to :- 
1. No Direction Required x
2. North Ayrshire Council 
3. NHS Ayrshire & Arran 
4. North Ayrshire Council and NHS Ayrshire & Arran 
Glossary of Terms 
Please use this box to ensure that all acronyms etc are set out in full.  All acronyms must be
set out in full the first time they appear in a paper with the acronym following in brackets. 
Some examples have been listed below. 
AHP  Allied Health Professions
CMT Corporate Management Team 
HSCP Health and Social Care Partnership
NHS AA NHS Ayrshire and Arran
SPOG Strategic Planning and Operational Group 
1. EXECUTIVE SUMMARY 
1.1 The purpose of this report is to provide an update to members of the IJB in relation to
work that has been progressing to optimise arrangements for Allied Health
Professionals working within the acute setting. 
Whilst these services are currently under the remit and management of East and
South Ayrshire HSCPs they are effectively led and delivered within acute services on
behalf of all three HSCPs.  In addition, the anticipated benefits of the proposed
changes will also benefit the residents and patients from North Ayrshire. 
There are no direct changes proposed currently to any AHP services in North Ayrshire
currently managed by Sharon Hackney as our Lead AHP, including our AHPs who
support inpatient areas including community hospitals and Mental Health settings.

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2. BACKGROUND 
2.1 NHS Ayrshire & Arran hosts nine Allied Health Professions (AHPs) delivering services
across health and care: diagnostic radiographers, dietitians, music therapists,
occupational therapists, orthoptists, orthotists, physiotherapists, podiatrists, and
speech and language therapists. AHPs work with people of all ages, often within
multidisciplinary teams, across hospitals, community settings, prisons, and outpatient
services. 
With the integration of health and social care, the majority of AHP services including
dietetics, occupational therapy, orthotics, physiotherapy, podiatry, and speech and
language therapy were devolved to the Health and Social Care Partnerships (HSCP)
under lead partnership arrangements.  Each HSCP hosted a Senior AHP Manager
led by and professionally accountable to the Associate Director of AHPs.  Radiography
and Orthoptics remained within Acute Services, each led by a Head of Service, also
professionally accountable to the Associate Director of AHPs. 
In 2017, a principle of maximum devolution was applied to further integrate AHP
services within the HSCPs.  This was with the exception of MSK and Orthotics which
were retained as pan-Ayrshire services hosted by East Ayrshire HSCP due to their
strong links with primary care. It was also agreed in 2017 that responsibility for AHPs
within acute settings would align with the HSCP in which the hospital site was located;
South Ayrshire HSCP for University Hospital Ayr and East Ayrshire HSCP for
University Hospital Crosshouse. 
Despite these arrangements, challenges emerged in ensuring appropriate leadership,
visibility, and strategic alignment of AHP services within acute services. In 2023, in
response to consistent feedback, a temporary Chief AHP role was introduced within
Acute Services. This role enhanced visibility, influence, and access to AHP leadership,
but challenges remained, particularly regarding decision making proximity, AHP
workforce integration into acute transformation, and the optimal utilisation of resource. 
In July 2024 NHS Ayrshire & Arran’s Strategic Planning and Operational Group
(SPOG) approved the establishment of a stakeholder group to: 
• Map current AHP resources in acute.
• Define a future and transitional model for AHP services in acute.
• Consider a commissioning model with clearer expectations and measurable
outcomes.
• Clarify professional leadership and management arrangements. 
A Steering Group, and an Expert Reference Group, were subsequently convened to
lead this review. 
Key findings and themes from the initial Acute AHP review included:

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• Lack of alignment between where acute AHP services are delivered and where
decisions are made.
• A sense of limited influence within Acute Services over AHP provision, despite
daily impacts and associated risks.
• Missed opportunities to fully embed AHPs within acute leadership models and
associated transformation.
• Ongoing staff stress and operational pressures.
• AHPs as the only professional group delivering services in acute settings whilst
being managed through the HSCPs. 
There has been clear consensus on the need for change. While it is acknowledged
that structural shifts alone may not deliver transformation, closer alignment of
leadership and decision making to service delivery has been agreed as essential. 
To progress beyond the initial review, a number of further workshops, listening
sessions and engagement sessions were progressed between October 2024 and
March 2025 in ensuring wide contributions and exploring potential ways forwards.   
With support of Viridian, several potential ways forward were considered with a multi
stakeholder group.  Several options, including a lead partnership model, and change
only for one acute site were discounted by the group early in the process.   
Although not unanimously, it was noted that the establishment of clear service level
agreements and formal commissioning expectations was expressed as the preferred
route for the majority of the AHP Senior and Service Managers; with the HSCPs
retaining accountability for acute AHPs.   
An Acute led model was consistently expressed as the preferred way forwards for
Acute colleagues from both a multidisciplinary clinical, and management perspective. 
The current disconnection was regularly highlighted as a barrier to realising the full
contribution of AHPs within acute transformation. 
While the merit in supporting a service level agreement/commissioning approach was
acknowledged, this was judged to not go far enough in ensuring that decisions are
made as proximally to service delivery as possible, or to adjust the fundamental issues
of AHPs in acute being disconnected from the wider acute management team, and
from ongoing transformation activity.   
To retain accountability for acute AHPs within the HSCPs, the existing HSCP AHP
management teams would require to significantly increase presence and strategic
input within acute divisional transformation.  This has the potential to occur at the
expense of focus and attention on community based services, which is where such
input is required in ensuring continued progress towards early intervention, prevention
and enhanced community provision.

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On balance, and with consideration, the Corporate Management Team agreed a move
to an Acute Led model for acute AHP staff as the preferred way forwards – in
maximising the contribution of AHPs in both the HSCPs and Acute services as part of
a whole system, and considering experience and outcomes for both staff and service
users. 
3. PROPOSALS 
Responsibility and accountability for AHP services currently delivered within the acute
setting, inpatient and front door will transfer to acute services.  The resource currently
supporting the Chief AHP role in acute will be utilised to recruit to a permanent AHP
Senior Manager role for acute.  The acute AHP Senior Manager, and three HSCP
AHP Senior Managers will continue to work as a whole system collective
professionally with the Director of AHPs, in maximising the contribution of AHPs for
the people of Ayrshire and Arran.     
Further engagement is progressing with the AHP leadership team in refining the detail
of an Acute led AHP Structure.  The Organisational Change policy will then be
followed in ensuring no staff are disadvantaged through these changes.  It should be
underlined that there is no intention to reduce the number of AHP staff, or to change
staff bases through this process.   
3.1 Anticipated Outcomes 
In summary of the rationale for change, and intended benefits for the people of North
Ayrshire: 
• Strengthen Quality, Safety and Clinical Voice: In the current context, with
persistent challenge across health and care, quality, patient safety and strong
clinical voice is imperative.   The planned changes ensure strong AHP
professional voice and influence within each part of the health and care system
in Ayrshire and Arran.  
• Manage Risk Proactively: Acute AHP risk at University Hospital Ayr (UHA) and
University Hospital Crosshouse (UHC) are currently held by South and East
Ayrshire HSCPs respectively, despite risk exposure and impact being felt within
acute services. The proposed model aligns accountability with the setting of
service delivery, enabling faster, more responsive decision making and more
effective risk mitigation.
• Maximise Leadership Focus and Capacity:    With responsibility for acute and
community AHP services currently sitting with the South and East Ayrshire HSCP
AHP Senior Managers, there is an expectation of visibility and responsiveness
within acute, whilst also progressing the AHP contribution to early intervention
and prevention, population health and community services.  The planned
changes support clarity of role and focus, with attention of the HSCP AHP Senior
managers centred on community activity, and additional AHP senior leadership
capacity in acute.

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• Embed AHPs within Acute Transformation: The critical function of AHPs in the
acute setting is recognised in supporting rehabilitation, reducing the potential of
deconditioning, reducing length of stay, supporting system flow and minimising
impact on delayed transfers of care.  The disconnection between operational
management and service delivery has hindered AHP integration within acute
transformation programmes. By embedding acute AHPs directly into the acute
leadership structure, the model ensures their contributions are harnessed as part
of multidisciplinary planning and delivery, positioning AHPs as integral to the
redesign and improvement of hospital-based care.
• Address Inequity:  There has been varied investment in acute AHPs by South
and East Ayrshire HSCPs in recent years.  There have also been several shifts
within acute services, with Orthopaedic trauma, acute stroke care and the highest
levels of critical care now delivered at UHC for all Ayrshire residents, including
those from North Ayrshire. While this proposal does not seek to redistribute the
full AHP workforce across both acute sites, there are ambitions around reducing
the current inequity, and managing risk, which oversight of the full acute AHP
workforce will enable.   
• Strengthen Clinical and Operational Governance: AHPs are the only
professional group working in acute services while managed externally. This
model strengthens governance by aligning professional accountability and
service management within the acute structure, enhancing oversight, assurance,
and the ability to respond to clinical issues as they arise. 
This proposal is fully supported by both the Executive Nurse Director and the Director
of Allied Health Professions, who recognise the change as a clinically necessary step
to improve safety, effectiveness, and quality of care. Both agree that aligning AHP
services more closely with acute service delivery strengthens clinical governance,
enhances accountability, and ensures AHPs are optimally positioned to contribute to
whole-system transformation. The model addresses current gaps in leadership
proximity, supports more agile decision making, and ensures AHP expertise is
embedded within acute redesign and improvement activity. 
3.2 Measuring Impact 
Staff and patient experience will be key indicators of success. 
In addition, embedding acute AHPs directly into the acute leadership structure, this
model ensures their contributions are harnessed as part of multidisciplinary planning
and delivery, positioning AHPs as integral to the redesign and improvement of
hospital-based care. 
Maximised AHP contribution in the acute setting:
• supports rehabilitation, 
• reduces the potential of deconditioning, 
• impacts positively on length of stay, 
• supports system flow, and

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• minimises impact on delayed transfers of care.   
4. IMPLICATIONS 
4.1 Financial
This proposal seeks to make best use of available finance.  No additional resource is
being requested from North Ayrshire IJB, or NHS Ayrshire & Arran Board for this
proposal.  There will be no financial detriment to North Ayrshire HSCP as a result of
this change. Any adjustments required for safe AHP leadership arrangements within
acute would be absorbed through multidisciplinary workforce planning within acute
services. The South and East Ayrshire HSCP AHP Senior Managers are supporting
due diligence in clarifying the HSCP AHP resource currently delivering service within
acute services, which would transfer to Acute under these changes.   
4.2 Human Resources
This proposal seeks to maximise the contribution of AHPs to whole system service
delivery and ensure best use of resource available in the current context.   This
proposal creates clarity of role, stability and positions AHPs as key, integrated
elements of their respective directorates, HSCP and Acute for workforce planning and
diversification within existing resource.   
Partnership representation has been provided throughout the exploratory, informal
stages of this process to date.  The formal organisational change process will be
followed in enacting this change.   
4.3 Legal
None. 
4.4 Equality/Socio-Economic
The activity outlined in this report has been progressed with the ambition of improving
access to AHP services and to ensure sufficient strategic focus across all parts of the
health and care system. 
4.5 Risk
There are a number of acute AHP workforce risks currently being held on HSCP risk
registers in South and East Ayrshire HSCPs.  Whilst accountability for these risks, and
the approach being taken to treat or tolerate currently sits with the relevant HSCPs,
the impact of these risks is experienced within acute service delivery.  The intended
changes seek to balance risk, accountability, and proximity to service delivery.   
Enacting this proposal transfers the accountability for acute AHP services, and any
associated risk to Acute services.   
4.6 Community Wealth Building
None.

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4.7 Key Priorities
Planned next steps are as follows: 
• Update on these planned changes are being brought to all three Ayrshire IJBs in
June 2025, for awareness.
• The final detail of the proposal is being refined with the AHP Senior and Service
Managers.
• The final version of proposed acute AHP structure will require approval of the
Director of Acute Services prior to initiation of formal process. 
• Due diligence is progressing with support of finance and HR colleagues.
• The formal notification of organisational change will be made in June 2025, with
subsequent process followed thereafter.
• It is intended that these new arrangements will commence in September 2025.   
5. CONSULTATION 
There has been significant engagement with all parties through this process, including
a number of recent workshops facilitated by Viridian, and robust discussions at SPOG
and CMT. 
AHP Trade Union and Professional Committee colleagues have been actively
engaged through the informal process to date.   
Regular email communication has been distributed to all AHP staff throughout the
timeline of the Acute AHP review.  These communications have been sent jointly from
the Director of Acute services, Director of Allied Health Professions, AHP Trade Union
and Professional Committee representatives. 
Specific informal information sessions have been held with AHP service Managers,
AHP Team Leads, and AHP front door colleagues.  The AHP Senior Leadership
Team have met with AHP Service Managers in their pan ayrshire uni-professional
groups to ensure contribution to defining the detail of the final proposed structure.   
Early guidance and support has already been sought from Human Resources.  The
need for continued, transparent and sensitive communications around this matter is
appreciated.   The formal organisational change process will be initiated once the final
proposed structure is confirmed.   
Alistair Reid, Director of Allied Health Professions, NHS Ayrshire & Arran,
Alistair.Reid@aapct.scot.nhs.uk   
Sharon Hackney, AHP Senior Manager/ Lead Allied Health Professional,
North Ayrshire HSCP   Sharon.Hackney@aapct.scot.nhs.uk