Supporting Allied Health Professions Research

Prof Roland Petchey

Director, Centre for AHP Research

Outline

• The present state of AHP research• Their performance in RAE2008

• Issues• Identity • Organisation • Education

• Conclusions

RAE 2008

• Health warningIncomplete partial and distorted representation of research

activity

• Institutional ‘gaming’ of submissions in response to perceptions of likely rewards• Whom to submit?• To which Unit of Assessment?

• Greater selectivity?• Prioritisation of quality indicators (Star ratings) over

volume?• Prioritisation of status over finance?

Sub-panel commentary: Nursing & Midwifery

“transformation in strategy, performance and output quality, evident in many of the submissions since 2001”

BUT• Greater selectivity• Number of submissions DOWN on 2001

• 35 (out of 80 eligible) vs 43 in 2001• Limited number of staff submitted as research activeNumber of individuals DOWN on 2001

• Evidence of uneven development• BUT also of maturation

Sub-panel commentary: AHPs

“heterogeneous in both substantive and methodological terms”

“very wide distribution of quality”• Biomedical science, nutrition and optometry singled out

for special mention• Submissions (68) UP (by 18) on 2001• Staff submitted UP by 40%

“a lack of strategic focus, with often disparate research groupings”

• Immaturity (teenage growth spurt)?

RAE 2008: Activity by quality level (Staff-adjusted mean)

0

5

10

15

20

25

30

35

Activity (%)

4* 1*

Quality level

N&M

AHP

3* 2* Unclassified

0

5

10

15

20

25

% of submissions

0 10 20 30 40 50 60 70 80 90

% of outputs rated below international quality

N&M

AHP

N&M Median = 15% AHP Median = 35%

RAE2008: Submissions by outputs below international quality

How did they get here?

• Issues• The identity problem• The organisation problem• The education problem

Who are they? Well…….

• Department of Health• Art therapists, drama therapists, music therapists,

chiropodists/podiatrists, dietitians, occupational therapists, orthoptists, paramedics, physiotherapists, prosthetists & orthotists, diagnostic radiographers, therapeutic radiographers, speech & language therapists

• Health Professions Council• Arts therapists, biomedical scientists,

chiropodists/podiatrists, dietitians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, prosthetists & orthotists, radiographers, speech & language therapists

NHS (England) clinical workforce (WTEs)

Nurses

Doctors

AHPs

AHPs by NHS (England) numbers (WTEs)

Physio

O.T

Radiography

S&LT

Chiropody

Dietetics

Orthotics

Arts therapies

AHP heterogeneity II

Biomedical orientation

Organisation Visibility Interfaces

Clinical Sectoral

Physiotherapy High High High High High

S&LT Medium High High Medium High

Radiography High Medium Low Low High

Low

O.T. Medium Medium Low High High

Arts therapies Low Low Low Medium High

Organisation

AHPs Nursing Medicine Dentistry

‘Representation’ MultipleIndependent colleges

RCN BMA BDA

Regulation(UK)

HPC NMC GMC GDC

Regulation (EU) General system

‘Sectoral’ ‘Sectoral’ ‘Sectoral’

EU professional regulation

• ‘Dual’ system

1. ‘Sectoral’ professions• Medicine• Nursing (General care)• Midwifery• Pharmacy• Dentistry

2. ‘General systems professions’• The Rest (including AHPs)

‘Sectoral’ professions

• Regulated by profession specific Directives which acknowledge professional uniqueness and special requirements

• Agreed “job specification”• Harmonisation of education and training• Automatic recognition of qualifications and right to

practise

• A doctor is a doctor is a doctor……

General systems professions

• General system of regulation• Applies to ALL other professions (from accountants to

zoo technicians)• No harmonisation of education/training

• Major differences• Recognition of qualifications via case-by-case

consideration of individual applicants• ‘Compensation measures’

• Right of host state to require a test of aptitude or period of adaptation (≤ 3 years)

Revision of regulations (Lisbon process) under DG Markets & Competition NOT DG SANCO

BUT for AHPs…..

• Defining AHPs• Profusion/confusion of

professional titles

• Determining equivalence • Or, “When is a dental

technician not a dental technician?”

The only authentic 'title' of a regulated profession is that of the language of the country in which the profession is regulated. Any translation of this

title on this website is purely indicative.

Two regulated professions under the same profession heading can cover different activities.

At the same time, two regulated professions falling under separate profession headings can cover similar activities.

EC Europa website

• Important differences remain, such as• Scope of practice• Multidisciplinary team-working• Professional autonomy• Subordination to medicine• Values and practice regarding

• Patient autonomy• Patient confidentiality• Psychosocial dimensions of health & illness

Even for ‘identical’ professions

AHPs by HEIs (England only)

0

5

10

15

20

25

30

35

40

HEIs(%)

1 2 3 4 5

Number of Professions

The localisation and micro-mapping of copper and other trace elements in breast tumours using a synchrotron micro-XRF system 

The pupillary response of cephalopods.

Treating children with expressive phonological disorders: Does phonological awareness therapy work in the clinic? 

Conclusions I

• Fragmentation• Isolation• Lack of effective national leadership• Underdeveloped• Overlooked

Even by the Department of Health!!

Even the Department of Health!

Conclusions II

• Lack of strategy or coherent research focus• Weak leadership and under-developed governance• Undeveloped research infrastructure• Isolation from the main body of research and research

groups in the disciplines [and lack of insight into this]• Small and disparate research groups / lone researchers• Researchers [dabbling in] other disciplines to their work,

rather than collaborating with disciplinary experts