“We teach people to dance, not just walk.”
That’s how Rebecca Lewis (above left) describes being an occupational therapist (OT). She doesn’t (quite) mean it literally, but her profession is so varied that it’s difficult to tie it up in a neat definition.
The point she’s making is that occupational therapy isn’t just about helping people get by – it’s about enabling them to live fulfilling lives, whether that means empowering them to leave, or stay out of hospital, maintaining their independence, improving their confidence – or giving them the support and tools to go dancing.
This week (starting Monday 4 November) is Occupational Therapy Week 2024, run by the Royal College of Occupational Therapists (RCOT). This year’s theme: ‘The power of occupational therapy – transforming health and social care’.
What does an OT do?
Occupational therapy is a science-based, health and social care profession that’s regulated by the Health and Care Professions Council (HCPC).
OTs work with adults and children, who have a wide range of conditions. Most commonly, they help those living with mental health conditions, or physical or learning disabilities.
Says Rebecca: “OTs help people of all ages who have challenges with the activities of daily living. Our overall aim is to maximise, maintain and achieve independence [for the patient] by setting meaningful goals.” They specialise, she adds, in “managing discrepancies in activities of daily living which are important to a patient.”
These activities are what’s known as ‘occupations’, hence the name occupational therapist. These occupations can range from the physical, like being able to get out of bed to wash or go to the toilet, to the psychological, like having the confidence to be able to take the bus into a nearby town to go shopping.
OTs provide expert advice and support on the adaptations and strategies which people can use to continue to do these activities. That can mean advising on and implementing physical mobility aids or rehabilitation plans, or developing mental health plans around relaxation, group work and graded exposure to improve confidence and capability.
They can be based in any number of settings – in the NHS, social care, schools, academia, prisons, hospices and more.
And depending on the service they’re in, the job can look very different.
Rebecca gives examples: “Within acute hospitals, you’ve got different specialties – so there’s artificial limb and appliance, burns and plastics, respiratory and medical, paediatrics.
“Whereas within community services you’ve got more long-term complex needs, a lot of manual handling, mental health, older adults, children, alcohol and drugs, veterans – and that’s just to name a few. There are pockets of OTs everywhere.”
Rebecca works with Tina Stanton (above, right). They are band-6 OTs who work for Hywel Dda University Health Board in Carmarthenshire. They are both RCOT and UNISON members.
Specifically, Rebecca and Tina work in the intermediate care service in Carmarthenshire. It’s a multi-disciplinary team (MDT) containing a mix of health and social care professionals from OTs to physiotherapists, social workers, nurses, home care staff and more.
The team, “bridges the gap between hospital and home,” says Tina. “We facilitate discharges from hospital, and we’re involved in ‘admission avoidance’ as well.”
Rebecca explains: “Patients are referred to the intermediate care service from both hospitals and from the community. The referrals are then triaged by an MDT consisting of a therapist (either an OT, a physiotherapist or a dietician), a social worker, a senior nurse, and seniors from the home-based and reablement teams.
“We also have GPs, advanced nurse practitioners and paramedics within our team to support with medical advice.”
That MDT will triage the patient and place them within the most appropriate ‘pillar’ of intermediate care to meet their need.
A normal day?
Image: Bigstock
Their work comes in two basic forms: planned visits, supporting patients within the pillars of intermediate care mentioned above, who have identified occupational therapy needs; and unscheduled crisis response.
Planned appointments involve visiting patients who are at home or in one of three rehab facilities located in Carmarthenshire: one 14-bed residential reablement facility, and two community hospitals that the intermediate care team support.
Whether scheduled or unscheduled, there is always a basic structure to the work of OTs – assessment, planning, intervention, evaluation.
Tina says: “Within the NHS we do focus on basic needs. It’s Maslow’s ‘Hierarchy of Need’ – if you achieve the basic needs then people’s lives can improve in many ways. It gives them a baseline to achieve the rest of the things that are important to them.”
Rebecca continues: “So, the things we’ll assess initially are personal care, washing and dressing, toileting, getting out of bed, on and off chairs, meal prep and medication.
“How can we ensure that you can manage with your basic care needs so that it doesn’t result in your going into hospital and keeps you safe and well?”
When it comes to crisis response, Rebecca says: “Sometimes we have to change our whole day because a crisis will take priority. And when we say crisis, what we mean is that we have a four-hour response – can we prevent that patient from going to hospital within the four hours?”
Tina recalls a recent example, when she quickly changed her schedule to respond to a crisis call.
“The person was being supported by a family member, but had become unwell quite quickly and it was beyond their capability to look after them. They were previously completely independent but were now unable to walk without being physically held by the family member.
Tina sourced other mobility equipment from their equipment team and went there to meet the home-based team and the patient. “We decided, from a functional perspective, we could support them as an intermediate care service with visits three times a day.”
“There was a functional need. And generally, where there’s a functional need there’s a medical need as well. So, we waited for her GP to come out and review [the situation] from a medical perspective.
“Unfortunately, that person was later admitted into hospital – that’s just the way it goes sometimes, we can’t stop all admissions. But that was an admission from a medical perspective, everything was in place to support them at home safely if they had been able to remain there.”
No one-size-fits-all
In that situation, Tina had been given some information about what was needed and what to expect, but often this isn’t the case.
Rebecca says: “Sometimes we don’t know what we’re walking into, and that could be an unsafe situation as well. Every home and every person are so different – there is no one-size-fits-all for any of it.
“And it’s not about making every situation a perfect one. It’s making every situation right for that person and to meet their needs.”
Tina adds: “I think people around us are starting to understand the value of what we can offer. Our skills, our training and how we can apply that going forward.
“The focus is so heavily on keeping people at home, helping them to be independent, it’s very challenging and very complex depending on the individual, and I think that is where we best fit.”
Promoting the OT workforce
Highlighting the key role OTs can play in the health sector is a priority for RCOT and is the focus of Occupational Therapy Week 2024.
Karin Orman (pictured above) is director of practice and innovation for RCOT. She describes RCOT’s role as “The professional body for OTs. Our drive is to ensure that everybody who needs occupational therapy and would benefit from it can access the profession.
“We work with leaders and members to generate knowledge, share best-practice, identify gaps in the evidence and push forward research to meet those gaps.
“It’s really about being a professional movement, working together. So that we’re positioning occupational therapy and ensuring that the profession is sustainable and modernised to meet population need.”
The future of occupational therapy
RCOT has around 36,000 members throughout the UK who also enjoy joint membership of UNISON as a result. The organisation is currently heavily focussing on workforce strategy in the sector.
Karin says: “We saw that a lot of occupational therapy services, like many other services, were moved into dealing with the pandemic.
“And then, when the lockdown started to lift and services started to open up again – we described it as a tsunami – there were many, many people living with ongoing health conditions – some undiagnosed, others diagnosed – that were really in need of rehabilitation.
“Not only assessment, but also rehabilitation, support and advice on how to live and manage their lives. Services were suddenly being presented with people with quite complex needs because of this delay in assessment and intervention.
“So, we started a piece of work to look at the data of the workforce. We spoke to occupational therapists, and more widely, looking at the pressures and the challenges within the system. And we have pulled together our first ever workforce strategy.”
RCOT’s vision is for an expanded OT workforce. “Of course, we would say that,” Karin adds, “but it’s also about positioning [OTs] to have maximum impact in improving people’s lives, and health and wellbeing.
“A lot of OTs working in hospital services feel that they are just discharge coordinators and they’re not fully using their expertise. They are feeling incredibly busy, but that they’re not really delivering occupational therapy.”
Karin notes that this could be one factor in the recruitment and vacancy issues in the NHS: “We’re also getting data, from the Health Foundation review of workforce, which identified that 21% of newly registered OTs were leaving the NHS within the first two years.
“But we’re not seeing that mirrored in the number of OTs registered with the Health and Care Professions Council. So, we are assuming that they’re staying as OTs, but not working in the NHS.”
‘Once you know what an OT is, you don’t want to lose them’
The workforce strategy comes in four sections:
- Optimising occupational therapy
- Demonstrating value and impact
- Retention and career development
- Effective workforce planning.
The campaign promoting the power of occupational therapy to transform health and social care starts with Occupational Therapy Week and will last for the next 12 months.
“We’ve got a UK action plan and we are publishing plans for each nation,” continues Karin, “But what I really hope from the week is that people are able to download the different briefings and the key messages, and that they’ll take an action.
“They’ll go away and think about what’s within their sphere of influence? Who might they talk to and what message do they want to give about the profession?
“For instance, in England – we’ve got a whole raft of new MPs out there. We would love those MPs to visit occupational therapy services, so that they understand that the health service is more than doctors and nurses, and they understand the role of social care.
“We are a profession that is often hidden, people aren’t aware of us. My favourite quote is from a GP that employed an OT for the first time even though they did not know what occupational therapy was. They said: ‘Once you know what an OT is, you don’t want to lose them.’”
When asked about the future of occupational therapy Karin says: “We would like to see a shift from OT being primarily based in hospitals with more in the community, delivering rehabilitation interventions at that early stage.
“So, we want to see more occupational therapists in GP surgeries, in primary care. They’ll do assessment screening and then, if necessary, signpost people to community services, while giving them easy access points into occupational therapy if they need further intervention.
“We also want to see OTs embedded in community services such as schools, or supporting work coaches in Job Centre Pluses. Just more access routes into occupational therapy in the system, where people can get advice and benefit from our expertise.”
‘I absolutely love this job’
Image: Bigstock
Back in Carmarthenshire, being involved in the community through the intermediate care service has allowed Rebecca and Tina to channel their passion for making a difference to their patients.
“We all talk about it – there is some sort of magic within our team. We all have the same vision and we all really care about what we do. I’ve learned so much from the people that we work with,” says Tina.
Both are quick to emphasise the wider team in Carmarthenshire – from the other health and care workers in the intermediate care service to their equipment team and the integrated approach they have with both hospitals and community teams.
“I absolutely love this job,” says Tina. “Ultimately, I know that I can do something for the patients that come into our service. Whatever that looks like, there’s always something we can do.
“It’s not always a physical outcome, sometimes it’s just that empowerment and autonomy that they can access support should things become difficult in future.
“I think with our team specifically, and [dealing with] crisis responses – we are seeing a lot of people at their absolute worst. They’re at that point where they’re going: ‘If you can’t help me, I’m going to end up in hospital or something’s going to happen’.
“And we get to step in and help them just take a breath, understand where their issues are, understand what’s important, and work out how we bridge the gap between the problem and where they need to be.”
For Rebecca: “It’s seeing the journey from start to finish.
“We did some case studies the other week and I was looking at this one lady. From where she began – she couldn’t even walk when we first had her as a patient – to where she is now – catching the bus into town – for me, the satisfaction of enabling that patient, that’s my job done. I’ll die a happy woman.
“We don’t win them all, we can’t win them all. But we win more than we lose.”