Planning integration services for the future – are we in danger of missing an opportunity?

Written by: Alison Keir, Policy Officer – Scotland, Royal College of Occupational Therapists

Published: 17/06/2018

Occupational therapists have much to offer and are uniquely placed to contribute to the integration agenda.

Occupational therapists work across agencies, therefore integrated working is key to our success.  The core training of occupational therapists includes both physical and mental health skills – this dual role makes occupational therapists ideally placed to work with the “whole” person to help them achieve what is important to them.  Occupational therapists have always worked in health and social care settings with adults and children of all ages with a wide range of conditions; most commonly with those who have difficulties due to a mental health illness, physical or learning disabilities.

Occupational therapists in Scotland have differing experiences of integration.  In some areas there has been significant work to review current occupational therapy practice and there is good learning from this.  In Glasgow, the outcome of the review ensured that there was no duplication of services for people, with occupational therapists being employed in different roles across systems.  Core competencies have now been developed in Glasgow to help standardise care and onward referrals – this was made possible through more integrated ways of working. Regardless of area of work, all occupational therapists have the same undergraduate training to equip them to work in both health and social care and thus are uniquely placed to contribute to the integration agenda.

Occupational therapists support people to remain at home and in their communities by working with the person to improve their confidence and abilities to continue with occupations through the use of strategies, techniques, and equipment.  Increasingly the evidence supports working with people earlier, as we know that this helps them maintain function and to self manage.  Occupational therapists are experts in assessing the person’s abilities to help them to manage to safely remain at home, reducing the length of hospital stay and delaying the need for residential care.

The “Lifecurve” work stream of the Scottish Government’s Active and Independent Living programme (ALIP) clearly demonstrates this need for earlier intervention when people first have difficulties with everyday tasks, and therefore endorses the need for earlier referral to occupational therapy, and to support Health and Social Care Partnerships (HSCPs) to keep people in their own communities.  Traditionally, referrals to occupational therapy tended to be made once people were struggling or in crisis, but we must make better use of our occupational therapy resource across HSCPs and make earlier referrals to occupational therapy.  By using services earlier, when people are able to make maximum functional gains, we will support people in a more appropriate way to self manage, have better health and wellbeing outcomes, achieve personal goals and will use resources more efficiently.

Increasingly, occupational therapists are working with different partners such as Fire and Rescue Services and the Scottish Ambulance Service.  By working in partnership, occupational therapists are using their skills to work with others to prevent admissions and to reduce risk.  Occupational therapists have the skills to support Primary Care services and by working more closely with GPs, such as the pilot project in Lanarkshire, we are able to work with people who would benefit from occupational therapy much more quickly, which has been shown to produce better outcomes.

Occupational therapists are working with communities to help them develop their skills to support residents locally.  For example, this might be working with teachers by providing training packs to help improve motor or social skills, or it might be supporting staff in care homes to run groups to decrease isolation.  Such training provides quicker access to universal support for more people whilst freeing up and reducing waits for occupational therapists to provide very specialised interventions.   The emerging possibilities for technological solutions to support people to stay safe and independent are also assessed for, trialed by and supported through occupational therapists.  One example is the looking gas cooker valve which prevents a gas cooker from being unintentially turned on or left on.

Occupational therapists have much to offer, and the skills and experience to lead transformational change.  As such, we must be considered key players in service planning.  Occupational therapists should be at the table to help inform and drive the direction of future travel rather than be asked to consult on decisions made by others on what they believe occupational therapists can offer.  This is a missed opportunity.  Occupational therapists welcome integration and embrace the opportunity to continue to improve services to ensure improved health and wellbeing for people living in Scotland.

Alison Keir can be found on Twitter at: @RCOT_PolicySco (this link will take you away from our website).

Alison’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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