The allied health professions (AHPs) in the UK comprise a specific group of autonomous, professionally diverse, distinct professions with their own professional bodies.  In England, the term AHPs refers specifically to art therapists, drama therapists, music therapists, chiropodists/podiatrists, dietitians, occupational therapists, operating department practitioners, orthoptists, osteopaths, paramedics, physiotherapists, prosthetists and orthotists, radiographers, and speech and language therapists¹. In Wales, the term includes practitioner psychologists and excludes radiographers² and along with Northern Ireland and Scotland excludes osteopaths and operating department practitoners^3,4.  AHP titles in the UK are protected and to use them staff must be registered with the Health and Care Professions Council (HCPC), with the exemption of osteopaths who are regulated by the General Osteopathic Council⁵.

The HCPC’s main purpose is to protect the public. It does this by setting and maintaining standards of proficiency and conduct for the professions it regulates. Ensuring AHPs meet a standard of training, professional skills, behaviour, and health, so that they are fit for practice. Operating department practitioners and paramedics are the most recent professions to achieve registration with the HCPC in the UK, being recognised as an AHP in 2017⁶. The allied health professions vary in size. The largest group are physiotherapists, with 61,132 registrants and the smallest is prosthetists and orthotists with 1098 registrants⁷. Although the professions themselves, in terms of skills and scope of practice, are diverse, the workforce which makes up the professions lacks diversity^8,9, having been shaped by a set of distinct social forces, relics of a post-industrial era. At the start of the 21^st Century, the stereotypical AHP is still predominately middle class, white and female¹⁰.

AHPs are in a prime position within healthcare, with approximately 170,000 AHPs working within the NHS, accumulating over four million patient contacts per week¹¹. AHPs work across multiple points on the care pathway, in different sectors and settings⁶. Providing treatment at all stages of the patient journey including health prevention, health promotion, diagnosis, treatment, support, and enabling independence. They can be first-contact or sole-contact practitioners, with some professions having prescribing rights. Making them integral to most clinical pathways.

Figure 1: AHPs work across a variety of healthcare services

However, despite being the third largest workforce in the NHS, having a plethora of diverse skills, and their prime position across healthcare, the talent and skills of AHPs have historically been underutilised¹².  The launch of the first AHP-centric strategy in 2017¹³ was the catalyst in identifying the transformative potential of AHPs. The strategies and guidance which has since followed^11,14–20 have provided a platform to enable the workforce to expand and diversify their roles.

Confusion on which professions are considered AHPs

Many of the allied health professions have ancient origins but aligning the professions as a collective group is relatively recent. The professions which make up the collective term ‘AHPs’ differ nationally and internationally, with no universally accepted definition. In the United States (U.S) allied health is defined as those “health professions that are distinct from medicine and nursing”²¹. Including a wide range of professions which contribute an estimated 60 per cent of the U.S healthcare workforce²¹. Similarly, in Australia, allied health is defined as “a broad range of health professionals who are not doctors, dentists, nurses or midwives”, regulated through either a national agency or a professional body²².

In the UK, the way AHPs are defined and understood varies considerably. Some NHS Trusts, including professions beyond the 14 recognised by NHS England, such as psychologists, psychotherapists, biomedical scientists and social workers¹⁸. To add to the confusion the terms ‘AHPs’ and ‘therapies’ are often used interchangeably. The term “therapy” is defined as “a treatment that helps someone feel better, grow stronger, etc., especially after an illness, e.g., occupational therapy, speech therapy, group therapy”, or “treatment to help a person get better from the effects of a disease or injury e.g., physical therapy”²³. This definition excludes several of the allied health professions. However, the use of the term persists in the UK, with the advertisement of Director of Therapies posts, and events such as Benchmarking & Good Practice in Acute Therapies conference²⁴.  Where the NHS Benchmarking Network delivered their 2019/20 findings covering Physiotherapy, Dietetics, Occupational Therapy and Speech & Language Therapy.

Despite the lack of standardisation and definition of who the allied health professions are, AHPs appear to have a strong inner identity of what and who they are and are often bemused that the public and colleagues from other professions do not have such a clear understanding of their roles¹⁰. Often leading to AHPs feeling the need to educate and inform others about their role. In contrast, medical and nursing professions appear to have a much stronger identity and brand and consequently appear to be better understood and more readily recognised for their skills¹⁰.

The confusion around who and what AHPs are most likely comes from how the collective professions emerged from the wider group of professions who were “allied to medicine”, “supplementary to medicine” and “medical auxiliaries”¹⁰. The origin of AHPs in the UK started in the 1940s with the voluntary request from several healthcare groups, aspiring for professional status, to align themselves to medicine. By the 1960s these groups were legally recognised as professions ‘supplementary to medicine’. Over time, the professions supplementary to medicine were sufficiently independent of medicine to merit the title ‘allied to medicine’. This term was later amended to ‘allied’ in recognition of further independence. Leading to the ‘allied’ professions becoming independent practitioners¹⁰.

Despite the now established use of the term ‘allied’ the meaning remains elusive. ‘Allied’ tends to be interpreted as meaning a commonality of sorts. However, there is still no clear understanding to whom they are allied. The only thing they appear to have in common is their exclusion from medicine and nursing.   Unlike medicine and nursing, AHPs have the dual task of negotiating their unique professional scope of practice and working within the boundaries of the AHP collective. The professions included as an ‘AHP’ is also subject to change, with the addition of new professions over the recent years.

Summary

The publication of the plethora of AHP-centric strategies has gone a long way in providing AHPs with stronger branding and a collective identity. The standardisation of terminology describing AHPs is also important for their identity and to ensure the collective skills of AHPs are fully utilised.  To ensure equity of inclusion for all the AHP groups, we must also re-consider using the term “therapies” to describe AHPs, and NHS Trusts must ensure their senior leaders are aware of which groups constitute the collective allied health professions.

References

1. NHS. NHS England?» The 14 allied health professions. https://www.england.nhs.uk/ahp/role/. Published 2017. Accessed August 15, 2022.
2. Welsh Government. Allied health professionals framework for Wales. https://gov.wales/sites/default/files/publications/2019-04/a-healthier-wales-our-plan-for-health-and-social-care.pdf. Published 2020. Accessed August 14, 2022.
3. Northern Ireland Government. Allied health professionals (AHP) | nidirect. https://www.nidirect.gov.uk/articles/allied-health-professionals-ahp. Accessed August 14, 2022.
4. Scottish Government. Allied health professionals.
5. The NHS. NHS England?» About AHPs. https://www.england.nhs.uk/ahp/about/. Published 2021. Accessed August 15, 2022.
6. Allied Health Professions the workforce and the services they provide. 2017;(March). http://www.alliedhealthsolutions.co.uk/PDFs/ProjectOutputsAndPublications/AHPsTheWorkforceAndTheServicesTheyProvideGuide.pdf.
7. Registrants Snap Shot: Health and Care Professions Council. https://www.hcpc-uk.org/about-us/insights-and-data/the-register/registrant-snapshot-sept-2021/. Published 2021. Accessed December 10, 2021.
8. Eddison N and Leslie R. The Challenge of Diversity in the Allied Health Professions. The Institute of Health and Social Care Management. https://ihm.org.uk/2022/06/08/the-challenge-of-diversity-in-the-allied-health-professions-by-dr-nicky-eddison-and-dr-ros-leslie/. Published 2022. Accessed August 15, 2022.
9. The Health and Care Professions Council. HCPC Diversity Data Report 2021: All Professions.; 2021.
10. Susan Nancarrow and Alan Borthwick. The Allied Health Professions?: A Sociological Perspective. Bristol University Press; 2021.
11. Dougall, Buck. My Role in Tackling Health Inequalities A Framework for Allied Health Professionals.; 2021. https://www.kingsfund.org.uk/publications/tackling-health-inequalities-framework-allied-health-professionals.
12. The NHS Long Term Plan. Published Online First.; 2019. https://www.longtermplan.nhs.uk/.
13. NHS England. Allied Health Professions into Action. NHS England. https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf. Published 2017.
14. Hindle, Charlesworth. UK Allied Health Professions Public Health Strategic Framework 2019-2024. Public Heal Engl Allied Heal Prof Fed. 2019. http://www.ahpf.org.uk/files/UK AHP Public Health Strategic Framework 2019-2024.pdf.
15. NIHR CRN Allied Health Professionals Strategy 2018-2020 | NIHR. https://www.nihr.ac.uk/documents/nihr-crn-allied-health-professionals-strategy-2018-2020/11530. Accessed June 9, 2022.
16. Health Education England. Allied Health Professions ’ Research and Innovation Strategy for England. https://www.hee.nhs.uk/our-work/allied-health-professions/enable-workforce/allied-health-professions’-research-innovation-strategy-england. Published 2022.
17. NHS England and NHS Improvement. Investing in chief allied health professionals: insights from trust executives. 2019;(July). https://improvement.nhs.uk/resources/investing-chief-allied-health-professionals/.
18. NHS Improvement. Leadership of allied health professions in trusts: what exists and what matters. https://improvement.nhs.uk/documents/2904/Leadership_of_AHPs_in_trusts.pdf. Published 2018.
19. NHS England and NHS Improvement. Developing Allied Health Professional Leaders: A Guide for Trust Boards and Clinicians.; 2019.
20. Chief Allied Health Professions Office. The Allied Health Professions (AHPs) Strategy for England The AHP Strategy for England?: AHPs Deliver 2022 – 2027. https://www.england.nhs.uk/wp-content/uploads/2022/06/allied-health-professions-strategy-for-england-ahps-deliver.pdf. Published 2022.
21. Association of Schools Advancing Health Professions. What is Allied Health? https://www.asahp.org/what-is. Published 2015. Accessed August 15, 2022.
22. Commonwealth of Australia. About allied health | Australian Government Department of Health. https://www.health.gov.au/health-topics/allied-health/about. Published 2022. Accessed August 15, 2022.
23. Cambridge. Therapies meaning, definition in Cambridge English Dictionary. https://dictionary.cambridge.org/dictionary/english/therapy?q=therapies. Accessed August 22, 2022.
24. 2019 Acute Therapies event review — NHS Benchmarking Network. https://www.nhsbenchmarking.nhs.uk/news/2019-acute-therapies-event-review. Accessed August 22, 2022.