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HEE Workforce Planning and Strategic Framework (Framework 15)
2015/16 Call for Evidence
In 2015/16 we are inviting organisations for submissions which address not only immediate
workforce planning and education commissioning but which look further ahead and cover
wider workforce strategy. For this reason the 2015/16 form covers not only ‘conventional’
supply and demand concerns, but invites organisations to comment on the wider context of
drivers of change and the strategic response. It is organised as follows:
Section 1: Current and future workforce demand and supply
Section 2: Drivers of service demand change
Section 3: Patients and population
Section 4: Models of care
Section 5: Future workforce characteristics
Section 6: Any other evidence
Submissions should be completed and returned to HEE, using this form, by 30th June (see
below for more information).
We acknowledge that this is a bigger task than in previous years, and it may entail a higher
level of internal deliberation and consultation for your organisation. This is deliberate: we
want to learn as much as we can about what organisations are thinking about the long term
and the big picture, while simultaneously gathering thinking about the here and now and
the more immediate future which will be influenced directly by HEE’s commissions in the
short term.
Making your submission
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We ask that, to maximise input, your submission is completed and returned to HEE by
the end of June
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To submit your evidence please, complete this form. You can provide extracts of
reports into the free text boxes below, or submit whole reports. Where an extract is
provided, please reference the source.
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In submitting evidence you are invited to take into account the following:
HEE’s workforce
planning guidance
HEE’s strategic
framework
(Framework 15)
The NHS Five Year
Forward view
HEE Planning Guidance. Due to the restrictions around the
election we have not been given permission to put this on our
web site. It has been widely circulated but please contact
[email protected] if you do not have a copy.
http://hee.nhs.uk/2014/06/03/framework-15-health-educationengland-strategic-framework-2014-29/
http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfvweb.pdf
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Once you have completed the form and/or prepared your ‘pack’, please embed it in an
email and return it to [email protected] and in the subject heading
please use this convention:
HEE CFE 2015/16 from [your organisation’s name in full – avoid acronyms] [Sub version x]

Please note, it is not compulsory to complete all sections for you to submit a response,
but in order to inform HEE’s 2015/16 education commissions, section 1 must be
completed and returned by the end of June
Your contact details
Before completing the form below please submit your contact details here:
Name
Job title/role in organisation
Organisation (in full please)
Contact email
Contact number
Submission version )if you resubmit at any point)
Date
Julia Skelton
Director of Professional Operations
College of Occupational Therapists
[email protected]
02074502327
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26th June 2015
Data Protection and Freedom of Information
The information you send us may be made available to wider partners, referred to in future published
workforce returns or other reports and may be stored on our internal evidence database.
Any information contained in your response may be subject to publication or disclosure if requested
under the Freedom of Information Act 2000. By providing personal information for this review it is
understood that you consent to its disclosure and publication. If this is not the case, you should limit
any personal information provided or remove it completely.
If you want the information in your response to be kept within HEE’s executive processes, you should
make this clear in your submission, although we cannot guarantee to be able to do this.
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Section 1 – Current and future workforce demand and supply
Use this section to input evidence into the forecasting of future workforce numbers. Report here your perspectives on either;
i)
the high level indicators; supply, demand, and any forecast under / over supply
or if available
ii)
the more granular components of these three components e.g. retirement rates, output from education relative to attrition
1.1 Summary forecasts
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Forecast Workforce Demand
Forecast Workforce Supply and Turnover
Forecast Under / Over Supply
Overview on Workforce Demand for Occupational Therapists
Occupational therapists work in a range of sectors due to the bio-psychosocial nature of their unique training and as a result work within a range of different statutory
sectors and non statutory sectors e.g. health trusts (in both physical and mental health), social services departments, housing departments, education, Department of
Work and Pensions (DWP) commissioned welfare benefit assessment providers, care homes and prisons. Within the non statutory sector occupational therapists work
in a range of voluntary agencies that play an important role in keeping people out of hospital and independent e.g. The Stroke Association, Age UK and Home
Improvement Agencies to name a few. The independent sector occupational therapists can be found working for example for: independent providers delivering
reablement and other assessments commissioned by health, social care, DWP provider sector and the medico-legal sector. Occupational therapists work with children
and all ages.
The profile of the occupational therapy workforce in England is very approximately split into 75% working in Health (a third of which works in mental health services);
13% in social care with the remainder (12%) working in other settings as described above. In consequence HEE only takes into account 75% of the demand needs for
occupational therapists. We are well aware that locally LETBs receive less than robust information on social services workforce needs in relation to occupational
therapists working in this sector. In addition there is no workforce information for the growing demand for occupational therapists working within commissioned DWP
providers to deliver PIP assessments and Work Capacity Assessments.
In 13/14 occupational therapy commissions were cut by 1% (15 individuals less) and this year 14/15 increased by 1.2% (18 individuals) so in effect in two years we have
gained 3 additional commissions over the previous occupational therapist commissioned numbers; despite the evidence produced.
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Occupational therapy student commissions for the health, DWP and social care workforce for 2019/2020 will need to be based on far greater and robust information
on the occupational therapy workforce taking into account statutory sectors other than health. HEE will need to consider the workforce data it commissions to be
provided in order that more accurate predictions inform commissioning to ensure there are enough occupational therapists to meet the needs of all statutory
organisations.
In considering the Five Year Forward view (5YFV) the areas where occupational therapists can make a key contribution in keeping individuals well, and out of statutory
services by providing care out of hospital are significant e.g. prevention, promoting choice and control by using their own health and care personal budgets, reablement,
rehabilitation, assisting GPs with primary care; and in urgent and emergency care.
As occupational therapists are dual-trained in both in mental and physical health they provide additional value in the health and social care sector and the opportunity
to use their skills in new models of care and ways of working would enhance patient experience and productivity.
Occupational therapists are key providers and assessors that will deliver the Better Care Fund. This will be done by enabling people to live independently ensuring that
they have the right equipment, adaptations, assistive technology to help people get home quickly from hospital and safely with the correct moving and handling
equipment in place.
Workforce Supply and Turnover
From statistics supplied from Health and Social Care information we know that in England:
NHS employs 18,002 occupational therapists ,and
Social Care employs 2,500 (WTE) occupational therapists
There will be approximately 1,450 of students qualifying this year in England (589 have already qualified this academic year)
It is anticipated that 204 occupational therapists will be retiring in 2015 (this is taken from our membership database and based on retirement at 65)
Occupational therapists are not on the shortage Occupation List and employers are finding it very costly (approximately £6,000) to employ from international sources
where they have had significant recruitment problems for some time.
HCPC should be able to supply data on European supply, however the supply in Europe is mixed with only a few of the European countries having significant numbers
who may wish to practise in England and have the language skills to do so.
Workforce Under and Over Supply
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We are not in a position to report an oversupply.
The College of Occupational Therapists (COT) is frequently being asked as to how we can help employers find occupational therapists, this has been borne out by an
increase in the COT’s recruitment advertising of approximately 20% over the last year with many adverts offering more than 1 post.
However, there is a critical shortage in London of occupational therapists. COT produced a report for the Migratory Advisory Committee as part of their review
(attached for information). In the past the London occupational therapy workforce was frequently supplied by occupational therapists from Australia, New Zealand,
Australia and South Africa who would work in London for a couple of years using this time to visit Europe before they returned home. From the survey the London
ADASS group did in 2014 they reported a vacancy rate of occupational therapists in social care as up to 48%. From the 8 Health trusts that responded to the COT call for
information; there was evidence of 61 longstanding unfilled posts and over all band levels. Head occupational therapists also reported that many staff at lower grades
left only to come back as a locum on higher pay due to the expense of living in and travelling to London.
In The Migratory Advisory Committee’s response they noted that both the TUC and the BMA stated that the shortages within occupational therapy were causing a
strain on health services.
Currently COT is working with the London LETBs on commissioned quantitative and qualitative research into the shortage of occupational therapists In London. The
outcome of the research will not be known until the Autumn. However early indications from the research currently underway on the London shortage problem would
indicate that vacancy rates in A&E are at 29% and mental health 15% (further information will be available at a later date).
The College is due to hold a Jobs Fair for London Occupational Therapy vacancies at their offices in the Autumn and will be advertising this in three European countries
in the hope to attract interest in filling these vacancies. We are working closely with HR departments in Health Trusts and social services to attend this event.
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1.2 Detailed / Component forecasts
Forecast Workforce Demand
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Service Demand drivers
Change in use of temporary staff
Addressing historic vacancies
Skill Mix / New Roles
Workforce Productivity
Service Demand Drivers
To highlight service demand drivers this will be broken down into the four key areas where occupational therapists are employed: Health, social care, DWP/welfare
benefit assessment. Information on occupational therapists working g in diverse roles in the third sector is at the very end of this report.
HEALTH
Urgent and Emergency Care:- Occupational therapists
Occupational therapists and physiotherapists in A&E services have been significantly effective in preventing the number of admissions and re-admissions into
hospital. Occupational therapists are increasingly being employed in Accident and Emergency services, where they have a key role in rehabilitation as part of a
multidisciplinary team and through their links with community and social services teams; prevent unnecessary re-admissions to acute care wards (Edwards 2010).
In A&E services, where patients may present with social issues and require minimal medical input, occupational therapists play a key role in determining whether a
patient is safe to be discharged or needs a hospital admission. Occupational therapists also have a breadth of knowledge relating to local community and voluntary
services so can refer patients for appropriate support such as reablement, rehabilitation or packages of care within their own environment (Barber-Miller 2010).
The introduction of extended hours and 7-day working has increased access to therapy services in A&E departments; this has resulted in high levels of patients being
discharged home (Eckford, Bartrum and Gargett 2010).
Example
Discharge to Assess Model – Sheffield
Occupational therapists have made a dramatic impact on the length of hospital stays in Sheffield, reducing the average wait for discharge ward from 6 days to 6
hours. Occupational Therapists at Sheffield Teaching Hospitals NHS Trust work together within a multi-disciplinary team on an acute medical ward to get people back
home and back to daily life as quickly as possible using a model of ‘Discharge to Assess.’ This approach improves the ‘flow’ of patients from A&E into the hospital and
ultimately back to their own home. Planning care around the patient has shown to improve health outcomes, as well as reduce the rate of falls on the ward by 30%.
The cost benefit in avoidable admission is well known.
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Stroke
Demand for occupational therapists working in stroke services continues. Research has proved that occupational therapy is a clinically effective treatment for people
who have had a stroke (Legg et al 2006, Walker et al 2004). Cochrane systematic reviews (Legg et al 2006) have demonstrated that functional limitations can be
reduced with targeted occupational therapy interventions such as dressing practice (Walker et al 1996), outdoor mobility (Logan et al 2004) and activities of daily
living training. Occupational therapy improves performance and significantly reduces risk of deterioration after stroke. Occupational therapists help those with a
stroke learn how to manage within their home again and in all areas of daily living (Legg et al 2007).
Community occupational therapy has significantly improved daily living and leisure activities for people who have suffered a stroke (Walker et al 2004).
Hand Therapy
Occupational therapists are major contributors to the multi-professional approach that is required in the delivery of specialist rehabilitation to people with conditions
affecting the hands or upper limbs (IFSHT 2010); 73% of members of the British Association of Hand Therapists who have achieved the award of Accredited Hand
Therapist are occupational therapists. This is reflective of the large contribution that this profession makes to the field of hand therapy.
The range of conditions that may receive hand therapy is considerable, and includes congenital abnormalities, traumatic injury, degenerative conditions, soft tissue
damage, burns and nerve injury (IFSHT 2010).
The focus of occupational therapy intervention is to assist individuals in maintaining or regaining the ability to participate in their desired occupations such as work,
activities of daily living, educational pursuits, leisure, play and social participation (Amini 2011).
NICE (2014) recommends occupational therapy for support with activities of daily living, and individuals can be enabled to manage their pain through an occupational
therapy-led intervention combining splinting, education, training in joint protection techniques and the use of adaptive equipment (Roundtree 2011).
The use of orthotics in the conservative management of people with rheumatoid arthritis is commonplace and effective.
Occupational therapy-led hand therapy services can improve the patient pathway by providing early access to a specialist opinion for diagnosis and management of
specified hand conditions, thus improving access to care and service delivery. The implementation of this patient pathway is intended to support cost efficiencies
(Rose and Probert 2009).
There is a significant demand for this area of practice.
Long Term Conditions (LTCs)
With a growing aging population is the consequential rise in the number of people with two or more long term conditions. Occupational therapists work in a large
range of areas where their contribution to the safe management of long term conditions has significantly reduced the need for further health and social care
interventions; enabling service users to have an increased independence and quality of life. Following assessment of the individual’s needs a multi-disciplinary
treatment programme is planned. Occupational therapy interventions enable people to manage their conditions (e.g. musculoskeletal, neurological, rheumatological,
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amputee), to live as independently as possible minimising the demands on health and social care services. This is done through: Working across the acute and
community interface; delivering integrated services across health and social care; supporting people to manage their own conditions to prevent admission; supporting
early discharge from hospital; provision of equipment and adaptations that promote independence and management of the condition; fatigue management, and
helping those with long term conditions to remain or return to work. Those with LTCs will require more occupational therapy provision, both within hospital and in
community settings.
Recent research on occupational therapy interventions with people with a traumatic brain injury has shown remarkable success in return to work, without a large
increase in health costs. (Phillips et al 2011).
People with long term conditions are regularly seen and managed by Allied Health Professionals and not Drs or nurses. If we are going to enable the health, wellbeing
and independence of those with LTCs then investment in AHPs is required, which includes occupational therapists.
Rehabilitation is a core treatment for those with LTCs and needs to be provided in a meaningful way in order to maximise independence; prevent admission to
hospital and vocational rehabilitation that either helps return to work or engagement in other community activities.
Cost benefit:
 Postponing entry into residential care by just one year through adapting peoples home saves £28,080 per person (Allen and Glasby 2010)
 Housing adaptations can reduce or remove the need for daily home care visits, with savings ranging from £1,200 to £29,000 a year (Heywood and Turner 2007).
 A fall at home that leads to a hip fracture costs the state £28,665 on average, over 100 times the cost of installing hand and grab rails (Heywood and Turner 2007).
 It is estimated that just one year’s delay in providing an adaptation to an older person costs up to £4,000 in extra home care costs (Audit Commission 1998).
Children and Young People
Occupational therapists work in a range of children settings across health and social care and in schools.
OT with preterm infants
There is significant evidence relevant to the fact that occupational therapy delivered within neo natal units can impact on an infant’s occupational performance (e.g.
sensory, cognitive, social-emotional, neurological and musculoskeletal domains) and reduce complications occurring.
The Children and Families Act 2014
Occupational therapists are key players in the new outcome focused Education, Health and Care plans (EHCPs). Occupational therapists are being employed as
Designated Clinical Officers in preference to Designated Medical Officers, having the required skills to fulfil this role and being resource efficient (i.e. cheaper than
doctors). Occupational therapists are uniquely placed to lead, being the one professional that sees the child in all three environments, education, and health and at
home settings.
By 1 April 2018, local authorities must have transferred all children and young people with statements of SEN to the new SEN and disability system following a
‘transfer review’ – that is an EHC needs assessment in accordance with the Special Educational Needs and Disability Regulations 2014 (SI 2014/1530). It is expected
that the vast majority of children and young people with statements of SEN to be transferred to an EHC plan. Currently there are over 235,000 children with
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Statements of Special Educational Needs. In order for this to be achieved, unprecedented demand will be placed on existing services and occupational therapists
working in children’s services will be required to review, assesses and contribute to new EHCPs.
Mental Health
Occupational Therapists are one of the 5 key professions delivering mental health services and the only Allied Health Professional (AHP) to work in any significant
numbers in mental health services. Following the launch of the Mental Health Act (2007), opportunities were opened up for occupational therapists to work as the
responsible clinician (RC) and approved mental health practitioners (AMHP). This is due to the fact that occupational therapists have core skills in assessment,
planning, intervention, evaluation and occupational performance. These skills, combined with the ability to be flexible, creative and responsive, have enabled
practitioners within mental health services to take up the challenge of new roles within a modernising and changing workforce. The drive towards bringing secure
services and PICU back into local areas will impact on the demand for occupational therapists. Occupational therapists report an increase in requests for their
involvement in Trust repatriation schemes to ensure service users are appropriately housed and supported back into local community options. It is predicted that this
trend will continue as it offers cost savings to have service users locally placed with the correct levels of support (identified by an occupational therapists) rather than
in secure services, which cost on average £2500- £3499 a week.
Occupational therapists also work within secure psychiatric settings and have been acknowledged as a core part of this service provision. (DH 2002, DH 2007). The role
of occupational therapy in forensic settings has been defined as helping people to engage in occupations, which give their lives meaning and value, and mitigate
alienation and antisocial behaviour (Couldrick 2003). Duncan (2008) additionally suggested that occupational therapy should assist people to develop their
interpersonal capacity, pro-social values, their personal identity and skills for life participation. The secure environment in which occupational therapy is provided
demands a balance between therapy and security, while still maintaining the validity of occupation for patients.
It should also be noted that occupational therapists are working with war veterans within organisations such as Combat Stress.
London Mental Health Trusts are also facing a critical shortage of occupational therapists(vacancy rate is approximately 15%).
Dementia
The estimated rise in the number of cases of dementia is well documented. The Dementia Strategy has raised the profile in the importance of activity, memory
services, and electronic assistive technology all of which occupational therapists deliver and have evidence base for their success. With the growing numbers of older
people and rise in dementia, occupational therapy intervention will be needed if care costs are to be contained. Occupational therapists are prescribers of Assistive
Technology (AT) – people can stay at home for longer with AT to assist with medicines management, remote monitoring of conditions, wandering, memory minders
etc. Occupational therapists also provide memory services to minimise problems with remembering and help those with dementia stay out of services longer (Martin
2010). The Memory Service in Belfast audited the occupational therapy rehabilitation programme for early stage dementia patients and recorded evidence of taught
techniques still being used 24 months on from treatment (McGrath and Passmore 2009);
Occupational therapists advise and recommend electronic assistive technology, equipment and adaptations to enable service users to retain independence and reduce
care costs and remain safe in their home (Martin 2010) (Alzheimer’s Society 2011). Occupational therapists provide appropriate exercise or other activities that are
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graded to an individuals’ capabilities to increase their quality of life, preserve their identity and provide them with a positive emotional outlet.(NICE 2008)
Cost Benefit: Providing 10 sessions of occupational therapy to those with dementia over 5 weeks improves functioning and reduces burden on the care giver. Effects
remain significant after 3 months (Graff et al 2008).
End of Life Care
Within end of life care occupational therapists advise on lifestyle management, for example pacing activities, posture and sitting position. They assess the person’s
pressure care needs in relation to their activity, provide advice on posture, pressure relief, and appropriate seating and assist with bed mobility and transfers.
Occupational therapy interventions allow the person to take part in desired activities and improve quality of life, relieve pain and lessen emotional distress, for the
person and the burden on family/carers by reducing the need for manual handling.
In addition for those in early stages of cancer occupational therapists advise on vocational rehabilitation and continuation at work.
There is an increasing role and demand for occupational therapists in End of Life Care as they enable people to remain at home safely.
PRIMARY CARE
Occupational therapists are primarily based in the community and are a key profession within Multi Speciality Community Provider teams that are looking to prevent
admissions and provide reablement, rehabilitation and signpost people to alternative community support. Many of the clinical areas above are delivered within the
community by occupational therapists, who are key within intermediate care teams, rehabilitation teams etc- helping to keep people out of hospital.
The Kings Fund has recently called for a rapid growth in the community workforce to deliver the 5YFV. Occupational therapists (who are dual trained) can work within
community physical and mental health services and can provide support at home that avoids admissions to hospital.
Occupational therapists are one of the key AHPs working within primary care.
Prevention
Occupational therapists are key to prevention services due to their dual training and being experts in rehabilitation, reablement, and recovery. There is a current and
continued demand for occupational therapists to lead and deliver preventative initiatives and this section will also include public health preventative initiatives.
Occupational therapists reduce the need for care packages by 90% and ongoing health support via provision of reablement (Allen and Glasby 2010) (SCIE 2012),
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rehabilitation, assessment of equipment, assistive technology (AT), and major adaptations (Heywood et al 2007).
Prevention of falls initiatives that include occupational therapists have shown a reduction of up to 50% of subsequent falls, and in consequence can save significant
inpatient costs.
Occupational therapists also help with prevention of obesity through exercise with key groups (NICE 2015) and in managing those with weight problems within the
home from their understanding of bariatric equipment.
Helping to promote the ‘well elderly’. The National Institute for Health and Clinical Excellence (2008) recommends that older people should be offered regular group
and/or individual sessions by occupational therapists to identify, construct, rehearse and carry out daily routines and activities that can help to maintain or improve
their health and wellbeing. Given the aging populations there is potential how occupational therapists work within communities to promote health aging and be able
to identify problems occurring and offering more immediate assistance. Being connected to a GP Surgery will provide a named person for patients to contact when
they do not want to bother the GP. The GP also has someone to refer to assist with minor mental or physical health matters and preventative work that may impact
on a patient’s wellbeing. There are examples of occupational therapists working within GP surgeries around the UK countries and the College has had interest from
GPs to have occupational therapists based in their surgeries
Occupational therapists may use a variety of methods to achieve improved occupational participation for people classified as obese, such as through adaptations and
equipment, consideration of safe moving and handling, health promotion, behaviour modification, energy conservation and improving stress intolerance (Foti 2004,
Clark et al 2007, Todino et al 2104, Gregory 2014, Ormston 2007).
SOCIAL CARE
Occupational therapists have been named as assessors for Care Act Assessments and also in prevention activities which is high priority in the Care Act and 5YFV. In
consequence there is a demand for occupational therapists to lead this work and they are often seen as the preferred profession in some authorities to deliver the
Care Act requirements. The demand for occupational therapy expertise will as a result increase. The economic importance of the occupational therapists role can be
seen not only in reablement but also in determining any AT or equipment requirements to maintain independence plus undertaking Health and Safety Executive
assessments for moving and handling equipment. Through their assessment expertise; occupational therapists have been able to reduce the number of carers through
improved provision of moving and handling equipment (Mickel 2010).
In addition the assessments for Disabled Facilities Grants (DFGs) continue and are normally assessed by occupational therapists in social care but some occupational
therapists are also employed in housing. The funding for these grants now sits within the Better Care Fund. A DFG will help a disabled person live independently by
enabling access to their home. Most DFG s will commonly fund stairlifts, ground floor toilets, level access shower facilities and ground floor extensions with specialist
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equipment. There are also new requirements within the Care Act e.g. assessing Care and Support needs of those in prisons etc and assisting with return to work that
require skills of occupational therapists. These are additional requirements not previously factored into the workforce in social care.
The Adult Social Care Workforce Development Board has recently identified as a priority area for action the recruitment of occupational therapists for the social care
workforce.
Care Homes
The Living Well through Activity in Care Homes toolkit ( produced by COT and on their website) promotes meaningful activities and has been widely endorsed and
promoted by statutory agencies. This toolkit supports the Nice quality standard for mental wellbeing of older people in care homes. Occupational therapists are now
being sought to provide advice on activities within care homes due to the positive impact this has on residents mental health and wellbeing. The additional skills they
bring to this sector are: training staff on meaningful activities and delivery, reablement skills that ensure care staff have the skills to support older people to carry out
daily routines and maintain their independence. Residents in care homes are at greater risk of falls and by reviewing and providing training to staff occupational
therapist advice on reducing hazards within the care home and encourage safer transfers and mobility through seating and positioning and the correct use of
equipment.
Occupational therapists can also support care homes to improve the quality of life for residents living with dementia by evaluating communal spaces in care homes
and improving the environmental design to help compensate for impaired memory, learning and reasoning skills. This helps reduce the levels of stress experienced by
people with dementia and their carers and improves the quality of individuals’ daily lives (Barber-Miller 2010, Morgan-Brown et al 2011).
Expectation and anecdotal evidence supports the view that there will be a growing number of occupational therapists needed within this sector. The recent study by
Newcastle University on Aging and Health has predicted that care homes will need to double in the next 20 years to cope with demand. There are approximately
15,000 care homes currently. If occupational therapists were to cover just 10% of these then a further 1,500 occupational therapists would be needed.
DEPARTMENT OF WORK AND PENSIONS (DWP)/WELFARE BENEFIT ASSESSMENTS
Personal Independent Payments (PIP)
Due to the skills occupational therapists have in functional capacity assessment and independent living; occupational therapists have been recognised as the
profession to assess for Personal Independence Payments. DWP has commissioned independent providers to deliver these assessments and we are in constant
demand to assist in providing occupational therapists in this area. The Independent Review on PIP assessments acknowledged that occupational therapists were ‘in
fact better placed and qualified to assess functional impact’ (DWP 2014).
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Recent discussions with providers indicate that the roll out volumes for PIP assessments will be increasing in significant high numbers with one provider indicating the
need for an additional 50 occupational therapists in addition to the 300 they already employ.
Work Capacity Assessments (WCA)
The Select Committee reported last year that work capacity assessments should be opened up to occupational therapists in the recognition of their dual training in
both mental and physical health and their success with assessments for PIP. The DWP commissioned independent providers for these assessments who are now
looking to employ occupational therapists to undertake WCAs. The numbers requiring a WCA review are in the region of 1 million and if contractors are required to
meet targets; occupational therapists along with others will be in demand.
There is no known data other than anecdotally only 4 assessments could be achieved in a day. Based on this information; if occupational therapists undertook 25,000
assessments of this amount based on the numbers per day then 6,000 occupational therapists would be needed over the next 2-3 years.
Return to work/Occupational Health
There is an increasing emphasis on the occupational health of the health and social care workforce (The King’s Fund 2015 p25). In additions demand for the
occupational therapy role in statutory services to address mental health and MSK problems. Anecdotally COT is also noting increasing requests from smaller
companies wanting to employ occupational therapists to carry out bespoke return to work programmes for individual employees.
COT has worked with other Allied Health Professional Colleagues to develop the AHP Fitness to Work Advisory Report. This report is available on completion for the
patient to use with their employer to discuss return to work arrangements and provide detailed information that the GP can use to complete the Med 3 form. In
moving forward and mindful of the demand on GPs time it is suggested that AHPs are allowed to also be signatories to the Med 3 form, which would release valuable
time from GPs workload.
Change in use of temporary staff
As mentioned previously In London many trusts have reported that many occupational therapists on lower grades have left their employ only to return as a locum on
higher pay due to the expense of living in, and travelling to London. Many health and social care organisations still fail to offer flexible working arrangements which
locum agencies are able to offer. If there is to be reduction of temporary/agency staff then health care organisations need to offer improved flexible working
arrangements.
Addressing Historic vacancies
In the past when there were significant shortages of the occupational therapists; new posts were developed and in health known as Occupational Therapy(OT)
Technicians and OT helpers. In social care they were known as OT Assistants and more generally known as OT support workers. Their training has evolved over the
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years from ‘on the job training’ to OT helpers’ courses and currently via BTEC courses. These long established posts now have a range of different nomenclatures
although some remain the same. They will be supervised by an occupational therapists and have specified work delegated. These posts equate to the Assistant
Practitioner role.
Our current critical shortage is in London for occupational therapists and the actions to assist with this are mentioned above.
SKILL MIX / NEW ROLES
Occupational therapists are the only profession able to work across the triple areas of integration (as described in the 5YFV) on graduation. New graduate
occupational therapists are prepared to work within the new models of care.
The College would wish to support new skill mix and roles for occupational therapists within GP surgeries and A&E departments.
The Advanced Practitioner role can offer occupational therapists the chance to demonstrate their multi professional and evidence based approach to patient care.
Post registration funding will be needed and available to support the development of these roles.
In Hospital
Within hospitals occupational therapists are employed in a number of ways and at all levels. Occupational therapists are also supported by and supervise nonregulated occupational support staff who have a range of different nomenclatures. These occupational therapy support staff are very skilled and assist in productivity;
ensuring efficient and effective patient care. However there is a shortage of occupational therapists at Advanced Practitioner level although we have 15 Consultant
occupational therapists. Investment in post-registration training that could be uni-professional/or more generally for AHPs; would assist at enhancing skills at this
level and allow occupational therapists as AHPs to have greater flexible within the healthcare workforce.
Occupational therapists can use Patient Group Directions for prescribing but COT is currently collecting evidence to support supplementary prescribing.
Key areas for new skill mix and roles are:
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Occupational therapist in accident and emergency (the rationale is evidenced on page 6). The College would wish to see occupational therapists in every A&E
department in England.
Long Term Condition co-ordinators to ensure a whole system approach to managing these conditions
Occupational therapists in neo-natal departments
Advanced Practitioner roles for Long term conditions
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Occupational Therapists as part of ambulance services responding to falls and to those not requiring urgent medical attention so that individuals can remain
at home with relevant follow up services organised and equipment /adaptations provided. There are a number of models of this type already delivering
excellent results. This model needs to be rolled out across England.
Using occupational therapy support staff/assistant practitioners to support the occupational therapists; allowing them to focus on areas where they impact
most and add value.
Increased use of occupational therapists on acute psychiatric wards
In primary care
Occupational therapists play a key role within primary care and mental health settings. As occupational therapists are also employed in social care they play an
important role within the integration of services. In the physical health primary care settings their key role’s encompass rehabilitation, reablement, management of
LTCs, stroke rehab; fatigue management, prevention of falls, end of life care; the main outcome is enabling independent living and prevention of admissions thus
making savings.
In mental health primary care settings occupational therapists are one of the 5 key professions working in mental health. Occupational therapists focus on recovery
and occupation centred practice, and on the restoration of roles that are important to that individual; this has secured a speedy recovery, return to work and reduced
admissions.
Occupational therapists also work with adults and children with learning difficulties. Occupational therapists will be key to repatriating adults from health institutions
back into the community. Occupational therapists have an understanding of the housing sector, adaptations and rehabilitation programmes that will help those to
manage to self care and live independently in a community that will also include participation in leisure activities.
Occupational Therapists working in GP practices
England’s General Practitioner GP (GP) practices are under massive strain, providing an estimated 370m consultations every year to a growing and ageing population,
more than 60m more than they were five years ago . A British Medical Association (BMA) survey found that over 90% of GPs said their heavy workload has negatively
impacted on patient care, with one in three saying it is unmanageable . With the rising number of consultations GPs are spending almost a fifth of their consultation
time on patient’s non-health issues, translating to costs of nearly £400 million to the NHS .
Occupational therapy practitioners are well prepared to contribute to the collaborate care approach through multidisciplinary care teams addressing the primary care
needs of service users, particularly those with, or at risk of, one or more chronic conditions. Occupational therapy practitioners’ distinct knowledge of the significant
impact that habits and routines have on individuals’ health and wellness will make their contribution to primary care distinct and valuable.
Occupational therapists are able to support GPs in a primary care setting in a number of ways:
15
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Fitness to Work: - Occupational therapists are already using the AHP Fitness to Work Advisory Report to provide advice to GPs and employers on fitness and
requirements to return to work. Occupational therapists could be alternative signatories to the Med 3.
75+ Checks: Occupational therapists could undertake these assessments and also do hazard assessment checks for falls and organise supply of equipment and
small adaptations. They could also be trained to take any relevant straightforward health checks as required in one visit. The same type of assessment could
be applied to those deemed at risk.
Health Checks for people with Learning Disabilities: Many occupational therapists are involved and working with people with learning disabilities who will
have a range of complex medical needs. GPs are required to carry out these checks as part of transition into adult services. It is suggested that HEE pilot some
work looking into the alternative skill mix needed for health checks for people with learning disabilities.
Mental Health Problems: where GPs may provide medication for those with mental health problems not requiring the direct intervention of a mental health
team- it may be useful to use the key skills of occupational therapists as they are trained in mental health and psychology to work with individuals delivering
occupation centred practice to help them through goal setting and focusing on those things that are important to them to regain the occupations (the things
they are and do). This could have a direct impact of the quality of care provided and reduce long term need for medications.
Early intervention: to prevent disease or disability, reduce the impact of an illness, and help support individuals in maintaining their healthy lifestyles.
Provide services that extend the ability of GPs, and nurses to provide holistic care, focusing on identifying how symptoms are actually affecting function and
participation.
Improve patient satisfaction by addressing a broader array of patient issues and thereby demonstrating a concern for more than simply symptom reduction.
Provide simple interventions that can be done at home or with intermittent supervision before referral for extended interventions, thereby decreasing overall
GP costs and workloads.
Enable or improve participation in occupations through activity modification or adaptive equipment and techniques.
Provide group education or intervention sessions to address prevalent issues among the population served.
Case Study
Proactive Care is a new way of supporting people with long-term conditions or complex health and social care needs. Their aim is to put the person at the centre of
the care pathway and to work together with them more proactively to meet their health and social care needs. The care team will agree a plan with each individual
they work with so that that can support them to manage their own care as well as identifying sources of help.
Occupational therapists are ideally placed within these care teams, and one example is the “Proactive Care” model being used in West Sussex. The approach brings
together NHS and social care professionals into joined-up teams to work alongside GPs and ensure that people with long-term health conditions and social care needs
get the right support at the right time and from the right care professional. Occupational therapists work alongside community nurses and matrons, physiotherapists,
pharmacists, mental health professionals, social workers and the prevention assessment teams. As far as possible, all team members are based in the same location,
16
such as a health centre or GP practice.
Early indications for patients with higher likelihood of admissions shows that this proactive care model can significantly reduce the strain on local health services.
These services will translate into significant workload reductions and overall costs in primary care settings, while at the same time improving the quality of care for
patients.
In summary there is a real opportunity to consider how occupational therapists can assist and could contribute to improved care within GP practices and reduce some
of their workload so that they can concentrate on key areas of medical care and diagnosis. Further discussions with HEE would be welcomed to consider in detail
evidence and pilots.
WORKFORCE PRODUCTIVITY
Occupational therapists can provide potential savings and productivity in the following areas that have been highlighted earlier in this document:
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Freeing up GP time
A&E Departments
Providing effective reablement and rehabilitation that improves health wellbeing and independence and reduces care packages and admissions to hospital
Through skilled moving and handling assessments can reduce need for two carers and enable swift discharge
Providing equipment, AT and adaptations helps living independently, reduces falls, enables swift discharge and need for care packages/or residential care
Assessing return to work helps people with mental health or physical problems get back to work quicker
Welfare benefit assessments by OTs are focussed, thorough and less likely to go to appeal
Providing patients with a good experience of health and social care
Occupational therapists in social care manage 40% of the referrals to social care yet make up only 2%(DH 2008) of the workforce which demonstrates efficiency
and effectiveness
Working in care homes by minimising risk of falls, appropriate moving and handling instruction and meaningful activity and exercise
References
Allen K, Glasby J (2010) The billion dollar question: embedding prevention in older people’s services: 10 ‘high impact’ changes. (HSMC Policy Paper 8)
Birmingham: Health Services Management Centre and University of Birmingham. Available at: http://www.birmingham.ac.uk/Documents/college-socialsciences/social-policy/HSMC/publications/ PolicyPapers/Policy-paper-8.pdf Accessed on 20.02.13.
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Amini D (2011) Occupational therapy interventions for work-related injuries and conditions of the forearm, wrist and hand: a systematic review. The American Journal
of Occupational Therapy, 65(1), 29-36.
Barber-Miller C (2010) An evaluation of service provision. OTnews, 18(5), 26.
Clark F, Reingold F S, Salles-Jordan K (2007) Obesity and occupational therapy (Position paper). American Journal of Occupational Therapy, 61(6): 701-703.
Couldrick L (2003) Personality disorder: a role for occupational therapy. In: L Couldrick, D Alred, eds. Forensic occupational therapy. London: Whurr. 207–220.
Department of Health (2002) Mental health policy implementation guide national minimum standards for general adult services in psychiatric intensive care units
(PICU) and low secure environments. London: DH. Available at:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4060440.pdf Accessed on 02.01.13.
Department of Health (2007) Best practice guidance specification for adult medium secure services: Health Offender Partnerships 2007. London: DH. Available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_078744 Accessed on 16.04.12.
Department of Health. (2008) Occupational therapy in Adult Social Care: Sustaining a high quality workforce for the future. London. DH
Duncan E (2008) Forensic occupational therapy. In: J Creek, L Lougher, eds. Occupational therapy and mental health. 4th ed. Edinburgh: Churchill Livingstone Elsevier.
513–534.
Eckford SR, Bartrum S, Gargett K (2010) Reducing unnecessary admissions. OTnews, 18(5), 31.
Edwards A (2010) Demonstrating quality and efficiency in A&E. OTnews, 18(5), 24.
Foti D (2004) Caring for the person of size. OT Practice, February 7th, 9-14.
Graff M J, Vernooij-Dassen M J M, Adang EMM, Thijssen M, Dekker J, Hoefnagels W H L, Jonsson L, Olde Rikkert M G (2008) Community occupational therapy for older
patients with dementia and their caregivers: cost effectiveness study. British Medical Journal, 336(7636), 134–138.
Gregory S (2014) Obesity: a permanent and substantial disability? OT News, 22(8), 27
Grey P,(2014) An Independent review of the personal independence payment assessment. Department of Work and Pensions. London
Heywood F, Turner L (2007) Better outcomes, lower costs: Implications for health and social care budgets of investment in housing adaptations, improvements and
equipment: a review of the evidence. London: Her Majesty’s Stationery Office.
International Federation of Societies for Hand Therapy (2010) International profile of hand therapy clinical practice. [s.l.]: IFSHT. Available at:
http://www.ifsht.org/fr/node/228 Accessed on 14.09.14.
The Kings Fund (2015) Workforce Planning in the NHS London,UK http://www.kingsfund.org.uk/publications/workforce-planning-nhs
Legg L, Drummond A, Langhorne P (2006) Occupational therapy for patients with problems in activities of daily living after stroke. (Cochrane Review) Chichester, UK:
John Wiley & Sons, Ltd. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003585.pub2/pdf
Legg L, Drummond A, Leonardi-Bee J, Gladman JRF, Corr S, Donkervoort M, Edmans J, Gilbertson L, Jongbloed L, Logan PA, Sackley C, Walker MF, Langhorne P (2007)
Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. British Medical Journal
(International Edition), 335(7626), 922.
Martin S. (2010) Innovation and creative solutions. Occupational Therapy News,18(4),39.
McGrath M, Passmore P (2009) Home-based memory rehabilitation programme for persons with mild dementia. Irish Journal of Medical Science.178( Suppl 8), S330.
Mickel A (2010) A ticking timebomb. Occupational Therapy News. 18(5) 38-39
Morgan Brown M, Ormerod M, Newton R, Manley D (2011) An exploration of occupation in nursing home residents with dementia British Journal of Occupational
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Therapy 74(5) 217-225
National Institute for Health and Clinical Excellence (2008) Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of
older people primary care and residential care. London: NICE.
National Institute for Health and Care Excellence (2014) Osteoarthritis: care and management in adults. (NICE Clinical Guideline 177). London꞉ NICE. Available at:
http://www.nice.org.uk/guidance/cg177/resources/guidance-osteoarthritis-pdf Accessed on 26.09.14.
National Institute for Health and Clinical Excellence (2015) Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of
older people in primary care and residential care. Evidence Update75. London: NICE
Ormston C (2007) Developing healthy lifestyles. Mental Health Occupational therapy, 12(2), 72-73.
Phillips J, Radford KA, Drummond AE, Sach T (2011) Employment after traumatic brain injury (TBI): Cohort comparison and economic analysis. Clinical Rehabilitation
25; 957-8
Roundtree LC (2011) Making a difference: hand therapy. Rehab Management 1 April. Leawood, KS. Available at꞉ http://www.rehabpub.com/news2/15704-making-adifference-hand-therapy Accessed on 26.09.14.
Walker MF, Gladman JRF, Lincoln NB, Siemonsma P, Whiteley P (1999) Occupational therapy for stroke patients not admitted to hospital: a randomised controlled
trial. The Lancet, 354(9175), 278-280.
Walker MF, Leonardi-Bee J, Bath P, Langhorne P, Dewey M, Corr S, Drummond A, Gilbertson L, Gladman JRF, Jongbloed L, Logan PA, Parker C (2004) Individual patient
data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients. Stroke, 35(9), 2226-2232.
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1.3 Forecast Supply from HEE commissioned education
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Assumed training levels
Under recruitment
Attrition
Employment on completion of training
Assumed training levels
In the HEE workforce plan (HEE 2014), there is a forecast supply graph for 2010 to 2019 (p37) for occupational therapy. This graph shows an approximate differential
shortfall of 1,200 by 2018/19 based on current demand and commissioning. As the commissions now will impact on the workforce in 2018/19 this needs to be taken
into account. The wording under this graph states that this graph mirrors a similar pattern for Speech and Language Therapists, Physiotherapists and Dieticians all of
whom received higher percentage commissions for 14/15 than occupational therapists. It is difficult to understand this rationale especially given the demand for
occupational therapists.
Over a two year period we have seen an overall increase of 3 places on our overall commissioned numbers; this is not justified.
2014/15 commissions =1,523 (-1%=15 places less)
2015/16 commissions =1,541 (+1.2%=18 additional places) therefore overall increase over two years is 3 places
In order to ensure that there is some movement to attain a level of supply to meet new ways of working, acknowledgement of the recruitment difficulties in London,
demand for occupational therapist and mitigate against retirement; then an appropriate supply of occupational therapists is needed to meet all statutory sectors. This
investment will bring savings in the long term as evidenced in this document. It is proposed that commissions increase by 10% so that we have at least another 154
occupational therapists in the system if not more; in addition to the current commissioned numbers for 15/16. A significant level of growth is required in the workforce
by 2018/19 if the level of demand in a range of statutory settings is to be met and cost benefit realised.
Under recruitment/ Employment on completion of training
We have not had any reported under recruitment, which suggests that there is an undersupply.
We do not collect any formal data on the first job of graduates however the following has been reported:
2013/14 – Leeds Beckett University, Masters programme, ‘I thought you’d like to know that 100% of our very recent graduates from the MSc Occupational Therapy (prereg) programme have managed to secure posts as Occupational Therapists, mainly within the NHS, 80% are local posts. This is particularly a great achievement in light
of the fact that they only graduated at the end of January!’
2013/14 – University of Bradford, BSc (Hons) programme, ‘12.5% of the final graduates were in positions with title of Psychological therapists.’
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A significant number of new graduates are moving into diverse roles in the voluntary and independent sector and where we have no data.
Attrition
The table below shows the attrition, under recruitment and employment statistics for those accredited programmes in England during the previous 5 years which is
monitored annually by COT. The attrition rate has reduced for occupational therapy students.
Academic
Year
Attrition
Under-recruitment
(No. of validated
places minus No. of
starters)
OT employment
(job title includes
Occupational
Therapist)
Non OT employment but using
OT skills (job title does not
include Occupational Therapist)
2013/14
10%
2%
81%
9%
2012/13
14%
8%
82%
11%
2011/12
16%
13%
76%
13%
2010/11
17%
12%
68%
18%
2009/10
13%
1.5%
82% *
6% *
* These are national figures; breakdown by Country was not recorded at the time.
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1.4 Forecast Supply – Other Supply and Turnover
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From other education supply
To/from the devolved administrations
To/from private and LA health and social care employers
To/from the international labour market
To/from other sectors / career breaks and ‘return to practice’
To/from other professions (e.g. to HV or to management)
Increased / decreased participation rates (more or less part time working)
Retirement
From other education supply
Worcester is providing a pre-reg occupational therapy programme and receives no commissions from HEE and places are fully subscribed.
From the devolved administrations
2012/13 – Glyndwr University, BSc (Hons) part time route, reported ‘100% employment as qualified occupational therapists with all graduates gaining employment
within Chester and North West England. This is of particular relevance as this a Welsh Government funded programme, but all graduates gained employment in
England
To/from private and LA health and social care employers
There are a small number of commissions that are taken up by social care employees. Some HEIs provide independently funded places for pre-reg occupational
therapy courses.
The international labour market
As mentioned previously it is very difficult from OTs working in Australia, New Zealand, South Africa, and the United States to now work in England due to not being
on the shortage occupation list. It is also an expensive and time consuming route for employers, so we need to ensure that we train enough occupational therapists
in the UK.
The European market is also limited in its ability to supply the UK with more occupational therapists as mentioned previously.
22
To/from other sectors / career breaks and ‘return to practice’
Career Break
The College has a career break category which averages at about 300 members a year (this category is only available for a year). However a number of occupational
therapist taking a career break do not always apply for this category but leave our membership and return when they are ready.
Despite the efforts COT and HEIs have made to encourage diversity amongst the profession, the majority of occupational therapy students are woman and inevitably
they disappear from the workforce for periods of maternity leave.
Return to Practice
There are a number of occupational therapists who wish to return to practice each year. However, the requirements set by the HCPC are often difficult to meet as a
returnee is required to do some supervised practice, which requires an opportunity to work in a health or social care setting. The mechanism for doing so is
complicated and some work as volunteers as well as temporary support workers. The complexity to organise a placement and the mechanism for achieving this is
counter- productive and many potential returnees are put off. HEE could promote discussions with HCPC and NHS Employers to consider the use of an ‘Honorary
Contract’ or something similar to aide Return to Practice.
On average 120 occupational therapists return to practice. Further accurate figures can be supplied by HCPC.
To/from other professions (e.g. to HV or to management)
There are a number of occupational therapists who move into senior management posts and a small number in consultant posts. There are of course some who may
choose an academic career pathway into research and those who work on the education sector.
Increased / decreased participation rates (more or less part time working)
No new data other than that provided last year.
Retirement
From our membership data and assuming 65 the retirement date we note that 204 are likely to retire. This of course could be higher as many still have the option to
retire at 60.
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Section 2 - Drivers of service demand change
Framework 15 message:
We believe that our population is
getting older, and that for our
workforce, preferences for a change in
patterns in working is increasing.
The influence of technology is growing
in healthcare and beyond, with staff
and patients using it to increase
personalisation and control in their
life. What will be its possible impact in
healthcare in the years ahead? The
influence of genomics and research
will also play a vital part.
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Our population is getting older, but so is our workforce.
Occupational therapists are also providing 7 day a week
services. There does need to be greater flexibility in working
patterns for all ages.
With more older people to support, we will need more
occupational therapists but working differently in
communities to enable healthy aging and being active
citizens to maintain independence
Workforce will need specialist knowledge to assess for,
source and order/prescribe assistive technology and
monitor whether it continues to meet people needs;
particularly for those with dementia.
Training in use of technology to ensure effectiveness will be
required.
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How do you think this will have an impact as a driver of service
demand?
There will be a greater need to consider technological advances
that improves patient care but reduces patient contact time so
that we achieve greater productivity.
Working with groups and in communities with active older people,
more delivery of services via community settings.
There will be more people in hospitals who are more dependent
and unwell, so will need occupational therapy intervention to
recover and get home.
In addition there will be more older people in care home settings
and the use of occupational therapists in these settings will be
essential.
How will technology and innovation impact on service demand in
the near future, and what education/training will the current
workforce need to meet that demand?
As patients become more aware expectation rises. The choice and
control agenda for patients and service users will also drive up
demand for technology as older people will remain working.
Inefficiency will not be tolerated as technology is in the workplace.
Access to appropriate IT in order to support delivery and recording
of health and social care interventions is a driver now to improve
efficiency. Training will also be required for those staff who don’t
have existing high-level IT skills.
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Framework 15 message:
Wider factors are creating global
pressures to constrain the cost of
publicly funded healthcare, with the
wider concept of wellness increasingly
taking root which people will expect
health service to respond to.
Patients are going to want high quality
services anytime, any place,
anywhere, with a more equal (and
challenging ) relationship with staff,
but one still based on care and a better
work life balance.
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
NICE guideline ‘Occupational therapy and physical activity
interventions to promote the mental wellbeing of older
people in primary care and residential care’(NICE 2015)
In order to provide this greater investment in technology,
different and flexible ways of working will be required to
meet these expectations,
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
Economics will play a part in influencing service skill mix and new
roles and NHS funding will shape service demand in the near future
(QIPP, funding, economics). Access to funding for health
economists would be welcomed for the AHP professions.
What is the shorter term impact of changing patterns of
expectations on service demand?
Many OTs already working 7/7, and in A&E in order to prevent
unnecessary hospital admissions.
The general public have a higher expectation and are better
informed; and in consequence will demand high quality services
and delivered in a timely manner. Resourcing this expectation will
be an issue and staff will need to be equipped to be able to provide
high quality information and use technology to ensure patients are
well informed.
There may be more legal challenges and greater media coverage.
The need to maintain good staff morale will be essential.
25
Section 3 – Patients and population
Framework 15 message:
With people living longer with more people
living with multiple and complex conditions
(and with our workforce being currently
predominantly trained to treat distinct and
different disease in isolation after a health
crisis has occurred). How can we
educate/train the workforce to support the
prevention of ill health and, where ill health
occurs, support staff to work across
organisational boundaries to support high
quality care for people with a range of health
needs (across physical, mental health and
social care)?
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
An addition/change to this message is recognising the
skills you have within the health care workforce – AHPs;
and start to consider how their use could release medic
time.
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
What are the possible/likely impacts on service demand –
activity and epidemiology?
HEE is predominantly focused on doctors and nurses and before
new health nomenclatures are invented; there is a need to
consider the assets within the AHP workforce. Despite the
evidence produced in the ways that AHPs can assist health
outcomes with high patient satisfaction; this has not been
widely recognised within HEE. AHPs cost less to educate than
doctors and nurses but have a wider level of input to health and
social care. Occupational therapy education is predicated on
person-centred goal-setting and, as a profession, occupational
therapists are educated already to work across the health and
social care divide, and are dual educated to work in both
physical and mental health areas.
By capitalizing on the existing strength of the occupational
therapy workforce, and extending the remit into prevention
services, we believe that many service users can be enabled to
lead active and fulfilled lives. There is a considerable evidencebase to demonstrate that occupational therapy interventions
with ‘well-elderly’ result in retention of more independence
and fewer GP visits.
26
Framework 15 message:
Our patients and population are likely to be
at different stages of being informed, active
and engaged in their own healthcare
(including using for example, data and online
records), with our challenge being to support
the development of a workforce which can
support high quality care for all patients.
Patients will increasingly be members of a
community of health, with the number of
carers projected to rise significantly in the
years ahead. Five Year Forward View
highlights four ways in which we can engage
with communities and citizens in new ways,
to build on the energy and compassion that
exists in communities across England,
namely:
 better support for carers
 creating new options for health-related
volunteering
 designing easier ways for voluntary
organisations to work alongside the NHS
 using the role of the NHS as an employer
to achieve wider health goals
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How will needs identified by patients and the public affect
service demand in the shorter term?
Those using personal health budgets are more likely to use this
to purchase AHP time. This could have a significant impact on
the structure of the health workforce.
The increasing requirement for individuals to remain in
the workforce till they are 68 or older, to maintain their
income, will impact on the availability of the carer or
volunteer workforce
The employment of occupational therapists within the
voluntary organisation workforce will grow.
How will these trends affect service demand in the short term
and how can we support patients and communities of health
through our lever of workforce planning?
Occupational therapists have always worked with carers or
families of their service users, occupational therapy
interventions can reduce care strain and reduce the risk of
harm to the carer and the service user
Many occupational therapists now work in the voluntary
organisation sector which are commissioned in a number of
areas by health and social care organisations.
27
Framework 15 message:
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Developing substantial community
provision to bring about a substantial
reduction in the numbers of people with
learning disabilities placed inappropriately in
institutional care is a central part of Sir
Stephen Bubb’s report in 2014
(‘Winterbourne View – time for change ).
Parity of esteem for Mental Health will be
supported through delivering improvements
in areas such as integration, waiting and
access targets and in the area of psychiatry
liaison
This statement could also add acknowledgement and
recognition of the skills within the workforce currently
that could be used.
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
What will be the service demand impact of the changes to
transform care for people with Learning Disabilities (such as
those outlined in Transforming Care for people with Learning
Disabilities)?
Occupational therapists are key part of the learning disability
workforce, supporting people to acquire life skills and maintain
independence as well as improve quality of life.
Occupational therapists will be a key part of the workforce to
ensure successful repatriation within the community for those
still in institutional care for reasons previously stated.
What education/training does the current workforce require to
be able to make parity of esteem a reality?
Occupational therapists are dual trained to work in mental
health and physical health as students, so on joining the
workforce they are ready to go! 30% of the occupational
therapy workforce in health; works in mental health. Their skills
in this area need to be more widely recognised and used.
What help can HEE offer to assist in promotion of occupational
therapy skills in mental health.
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Framework 15 message:
Five year forward view draws attention to
the NHS being committed to making
substantial progress in ensuring that the
boards and leadership of NHS organisations
better reflect the diversity of the local
communities they serve, and that the NHS
provides supportive and non-discriminatory
ladders of opportunity for all its staff,
including those from black and minority
ethnic backgrounds.
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
In 15 years there will be an expectation that every CCG
and Health and Wellbeing Board will have AHP
representation.
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How can we use our levers in the short term to support this
commitment?
There is a real need to recognise that the very large AHP
workforce is not recognised in CCGs or on Health and Wellbeing
boards. If there is a shift to be made in doing things differently
and new ways of working is essential then representation at
this level is essential for leadership and implementation.
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Section 4 – Models of care
Framework 15 message:
Five Year forward View outlines a number
of possible future service models including
• multispecialty community providers
(MCPs), which may include a number of
variants
• integrated primary and acute care systems
(PACS)
• additional approaches to creating viable
smaller hospitals
• models of enhanced health in care homes
The expertise to support the piloting and
introduction of these models need to be
considered. Existing NHS services and areas
of the healthcare workforce may work with
others in new and different ways (e.g.
community pharmacy).
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How could future service models develop in the short term in
line with these developments and the learning from the
Vanguard sites, and what education/training will the current
workforce need to make these models work?
Occupational therapy already has a key role in working in
integrated and multi-speciality sectors but has a low profile in
relation to the skills of the existing qualified workforce to deliver
in these key areas.
Future service models need to consider the breadth of skills of
the existing workforce and capitalize on this, rather than solely
focussing on the seemingly preferred ‘doctors and nurses’
perspective currently held.
Actively promoting AHPs to lead these models would be
welcomed. In addition an improved model of workforce planning
that for occupational therapists includes the demand for where
they work which is not just in health services.
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Framework 15 message:
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Services are likely to become increasingly
integrated in the future, enhanced through
policies such as the Devolution of Local
health and social care budgets, the
integrated care pilots and integrated
personal commissioning. Partnerships will
become increasingly important, including
with partners beyond NHS and social care.
We may increasingly see centres of
specialisation in some specialties in some
areas.
We will see the ongoing development of
services in the area of urgent and
emergency care
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How could future service models develop in the short term in
line with these drivers, and what education/training will the
current workforce need to make these models work?
There is certainly evidence in some areas, such as
Traumatic Brain Injury that having a more specialist
rehabilitation service will result in the return of
individuals with fairly early TBI to the workplace or
education. This also allows their carers to return to work.
Occupational therapists are seen as a key member of the
A&E workforce.
Occupational therapists are the only AHP working in social care
and in mental health in any significant numbers.
Examination of the existing occupational therapy workforce will
demonstrate that you already have a workforce able to work in
an integrated way across health and social care that is already
delivering in these key areas.
There is also growing evidence base of occupational therapists
being employed in new and emerging areas where their skills
complement the more traditional existing health/social care
sectors.
There is a need for greater awareness by employers of the scope
of occupational therapy skills so that these can be utilized to
better benefit.
How could future service models develop in the short term in
line with these drivers?
Identify where more specialist staff are indicated as these will be
able to deliver better outcomes both for the service user and also
the public purse.
How could future service models develop in the short term in
line with these drivers?
Employ occupational therapists in every A&E dept in England and
note the reduction of admissions.
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Framework 15 message:
Five Year Forward View highlights new
developments such as the evidence based
diabetes prevention service and
encouraging new capacity in under
doctored areas.
Timescale/time horizon
Longer term – to 15 years
Are you aware of any new evidence which impacts in the
light of this - do you think there is the need for a different
message for Framework 15?
Please detail your evidence about the longer term
Shorter term to 5 years
Please detail your evidence about the shorter term, specifically:
How could such approaches affect service models in the near
future?
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Section 5 – Future workforce characteristics
Framework 15 message:
Below are the 5 future workforce
characteristics set out in Framework 15
The workforce will include the informal
support that helps people prevent ill health
and manage their own care as appropriate.
Have the skills, values and behaviours
required to provide co-productive and
traditional models of care as appropriate.
Have adaptable skills responsive to evidence
and innovation to enable ‘whole person’
care, with specialisation driven by patient
rather than professional needs.
Have the skills, values, behaviours and
support to provide safe, high quality care
wherever and whenever the patient is, at all
times and in all settings.
Deliver the NHS Constitution: be able to
bring the highest levels of knowledge and
skill at times of basic human need when care
and compassion are what matters most.
Timescale/time horizon
Longer term – to 15 years
In your evidence please highlight any or all of the
following:
- Are these workforce characteristics still valid?
- Any evidence you are aware of work which is
underway and which contributes to the
achievement of the workforce characteristics
- Any gaps you are aware of
Please detail your evidence about the longer term
Shorter term to 5 years
Please detail your evidence about the shorter term education
and training needs required for the current workforce to meet
these characteristics:
We have already raised profile of public health and prevention is
core to occupational therapy training.
Occupational therapists are trained in the social model and work
in social care so very used to the values and behaviours
associated with co-productive models of care.
None – occupational therapy students are already educated in
this model.
None – occupational therapy students are already educated in
this model.
None – occupational therapy students are already educated in
this.
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Section 6 – Any other evidence not included elsewhere
Occupational therapists are increasingly working in diverse roles in primary care and the third sector. Some of these roles include working for/or as:
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Help for Heroes
GP Link Worker
Wellbeing Advisor in student Support Services
Mental health co-ordinator
Advanced Practitioner in Criminal Justice Team
Housing Commissioner an inclusive design specialist
Cambridge Ambulance Service
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