Occupational therapy faces recruitment challenges amidst evolving healthcare needs, prompting a strategic shift towards community-focused roles, writes Karin Orman

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The NHS must rethink the role of Occupational Therapists

 10 April 2024

 

Occupational Therapy faces recruitment challenges amidst evolving healthcare needs, prompting a strategic shift towards community-focused roles, writes Karin Orman

Like many professions, occupational therapy is struggling with recruitment and retention. We’ve become inured to the headlines declaring a health and social care crisis, but the mismatch between changing demographic needs and the numbers of health and social care staff required to meet them makes this a crisis that cannot be ignored.

The profession cannot grow quickly enough, and the funding and structure of the system are not designed for our ageing population, increasingly living with long-term health conditions. Despite policy focussed on prevention and early intervention and the ambition for community-based delivery, funding and focus are trapped in supporting acute and hospital services.

Reimagining occupational therapy in healthcare

Following diagnosis or medical intervention, people need help with recovery and rehabilitation and managing changing needs when living with a disability or ongoing health conditions. Part of the pressure on recruitment is down to the growing recognition and expanding roles for occupational therapy. Roles focussed on working with individuals, families or groups to do the occupations they need and want to do have higher satisfaction and retention rates than roles where occupational therapists are primarily completing tasks that don’t need their expertise. We see this particularly in acute inpatient services and this is reflected in the satisfaction and retention rates.

High vacancy rates in these services result in a reluctance to further “rob Peter to pay Paul” when systems plan to expand occupational therapy within primary and community services. With no guarantees within the NHSE’s workforce plan and 21 per cent of occupational therapists leaving the NHS within two years of registered practice, we need to rethink where we are positioned within the health and care system.

There is fair and equitable access to needs-based, therapy-led rehabilitation, whether that is tackling mental health, physical health, social or vocational needs

As a professional body, we don’t have ownership of NHS or social care workforce data, modelling and commissioning. This raises questions about what we can realistically influence. Adversity is, however, a driver for innovation, and approximately 48,000 occupational therapists are working across the health and care system who can collect and share data. Over the last 18 months, we’ve spoken to occupational therapists and held discussions with national and regional leads responsible for workforce modelling and planning. The resulting workforce strategy is designed to reposition the majority of the occupational therapy workforce into primary and community services.

By 2035, the ambition is to ensure families and schools have access to occupational therapy to prevent physical, learning and mental health difficulties escalating. We want education environments to be more inclusive, supporting more children and young people to attend school with their peers. People can access occupational therapy assessment, advice, and rehabilitation through their GP, including advice on returning or remaining in work and driving. There is fair and equitable access to needs-based, therapy-led rehabilitation, whether that is tackling mental health, physical health, social or vocational needs.

Empowering occupational therapists for systemic impact

There is a role for occupational therapy in hospitals, but it needs to be more defined. In our review of hospital services in 2016, we identified the value and impact of therapy teams preventing admission at the front door; ensuring rehabilitation starts from the earliest stage in critical care, and working within specialist rehabilitation pathways and therapy-led rehabilitation units. Increasing numbers of occupational therapists are working effectively in these areas in addition to existing services. We need to rethink the role of supporting discharge across wider hospital services and explore alternative models. Initiatives already in progress involve upskilling support staff, testing in-reach models or having teams rotating across communities and the hospital.

The strategy provides a framework for us to work across the UK collecting examples of change, including the ones that have failed. As a professional body, we can be the conduit for sharing learning. Reviewing the role and activity of one profession holds a candle up to the wider system. The significant variation in occupational therapy representation and leadership at a systems level results in disparity in understanding how and where occupational therapy can have the most impact. To understand the numbers and skills mix needed within hospitals as well as the requirements for community services, we need occupational therapists as AHP workforce leads driving the collection of data and planning.

There may be a reluctance to work with professional bodies as they advocate for one profession, but unlike integrated care boards, we do not have the pressure of delivery. We can work with our members and contribute to evolving the health and care system