Leadership for impact: developing leadership agency of senior AHPs to transform quality and safety across systems.

The Allied Health Professions (AHPs) represent the third largest clinical workforce in the NHS in England, comprising of 14 registered professions. As the NHS navigates pressures around performance, workforce, and integration, senior AHP leaders are essential in influencing quality and safety outcomes across systems. The last five years have seen significant developments in senior AHP leadership at regional, system and provider levels, with 50 per cent of integrated care boards (ICBs) having a chief AHP role and 86 per cent of providers having a nominated AHP lead.  These structures continue to evolve with senior leaders navigating the quality and safety agenda in complex healthcare systems.

To support senior AHPs in recognising the agency they hold to lead within this space, the National Chief Allied Health Professions Office (CAHPO), in collaboration with NHS Confederation and NHS Employers, co-produced the Allied Health Professionals Quality and Safety Senior Leadership Development Programme.

Delivered over six modules, the programme brought together around 60 senior AHP leaders from regional, system, and national teams, aiming to build leadership capability, clarity, and collective agency in the quality and safety space.

Why now?

The case for AHP leadership in quality and safety

National reviews such as The Ockenden Report show that a lack of effective clinical leadership contributes to poor-quality care and safety incidents. There is compelling evidence that AHP clinical leaders embedded in operational governance play key roles in shaping care, mitigating risk, and improving outcomes. Despite progress in embedding AHP leadership within provider and system structures, they remain underrepresented in governance forums, board-level quality discussions, and national safety reporting, which limits their influence. Indeed, recommendations and findings of quality and safety reviews in England have consistently overlooked the role of AHPs as part of this system and multi-professional team. Despite guidance from the Patient Safety Incident Response Framework, which calls for a whole-system approach.

A framework for developing leadership and strategic influence

The AHP Quality and Safety Senior Leadership Development Programme priorities were to:

• develop a shared understanding of quality and safety governance across national, regional and ICS levels
• strengthen leadership skills to articulate AHP quality and safety impact, including staffing, retention and learning environments
• improve understanding of AHP risk identification, escalation and governance processes
• support the recognition of personal leadership agency and build confidence in influencing the quality and safety agenda at system level.

To achieve these priorities the programme focused on supporting senior AHP leaders to better understand the quality and safety national frameworks for the NHS, and to build leadership capability to confidently lead and embed them within their organisations and teams. The programme blended leadership development, systems thinking, multi-professional collaboration and the practical applications of quality and safety governance to support these leaders to encourage meaningful change.

Programme evaluation

Programme evaluation demonstrated participants reported significant growth in their leadership capabilities and confidence in leading quality and safety initiatives across all the competencies identified for the programme:

• Understanding of senior AHP responsibilities within the NHS England priorities and operational planning guidance increased from 55 per cent to 100 per cent.
• Familiarity with NHS England’s Quality Strategy rose from 22 per cent to 96 per cent.
• Confidence in applying complex system approaches to safety improved from 66 per cent to 88 per cent.
• 88 per cent of the cohort detailed that they had improved confidence in leading quality and safety initiatives as part of their role.
• 99 per cent of participants valued the networking opportunities provided by the programme.

Emerging themes and insights

The cohort explored several inquiry questions to better understand factors influencing their leadership practice, insights are as follows:

1. Leading in ambiguity

AHPs are increasingly being asked to lead in spaces where governance is still evolving. Many reported navigating ‘undefined responsibilities’, calling for a clearer articulation of their role in relation to clinical risk and safety.

“[The programme is supporting in] modelling a really dynamically evolving leadership eco-system in development and I’m really grateful for the input and reflective will”.

2. Articulating risk

A consistent theme was the challenge of defining and escalating AHP-specific risks in a way that aligns with wider governance. Re-framing risk around patient outcomes and population health, not just professional interventions.

 “[The programme] has been extremely useful in applying some of the complex information into real examples & real situations. In particular, the challenge of identified risk and safety issues, and having to balance it with issues that seem unsolvable e.g. financial restrictions/staffing shortages etc”.

3. Collaborative leadership

Trust, visibility, and shared language across professions remain essential. Participants discussed the need to move from siloed advocacy to integrated influence, ensuring the AHP place in strategic forums.

4. Values vs. performance pressures

Many AHP leaders shared their experiences of maintaining values-led leadership amid intense financial scrutiny. They expressed the need for tools and peer support to navigate governance spaces confidently and sustainably.

5. Creating a shared narrative

Perhaps most powerfully, the cohort called for a consistent, system-facing AHP narrative that transcends professional identities and speaks to patient safety, risk mitigation, and whole-patient-pathway impact.

Conclusion

From reactive to strategic leadership

The NHS is in a moment of transition. Structures are changing, and clinical leadership needs are growing. To utilise the full potential and leadership capabilities of AHPs, they must be seen and supported as experienced, multi-professional, system-focused clinical leaders.

“AHP leadership uniquely unites clinical expertise across physical, psychological, and social domains to drive holistic, preventative, and rehabilitative care that transforms outcomes, reduces system pressure, and delivers personalised, value-based healthcare”.

The AHP Quality and Safety Leadership Programme marks a turning point, shifting from reactive to system-focused mindsets, and from isolated leadership to a networked, strategic AHP community who can lead in the quality and safety agenda with clarity and compassion.

The challenge now is to ensure this momentum is not lost, the CAHPO team have identified a series of actions to implement. As the reforms to NHS England and the ICB model continue to evolve, AHPs must be part of a shared commitment to improve patient outcomes through integrated, values-based clinical leadership.

Find out more about how NHS Confederation is making a real difference in leadership and improvement.

Louise Wheeler is head of leadership development at the NHS Confederation.

Sarah Cooper is an AHP adviser to the chief allied health professions officer at NHS England.

This article first appeared in BMJ Leader on 23 June 2025.