Work to produce the long term conditions strategy has highlighted a number of key challenges. One is how to deliver integrated services, so that the person with one or a number of long term conditions experiences understanding and continuity in their care. Another is to how to commission high quality services for conditions that are rare and/or difficult to diagnose, such as many neurological conditions.
Occupational therapists, along with their Allied Health Professional (AHP) colleagues, have much to offer this agenda. Occupational therapists tend to take a functional approach when working with an individual. This means that they have an understanding of the person’s condition(s) and how they may be affected physically, cognitively and psychologically. They then work with the individual, recognising his/her strengths as well as problems, to identify and achieve goals that are important to that person. Such goals could be anything from being able to get around the house more safely and easily to getting back to work.
These interventions can make a big difference in improving that person’s quality of life and independence, and they can help the person to be seen ‘as a whole’, rather than exclusively according to his/her condition. Techniques used may be rehabilitative (enabling a person to regain reduced abilities) educational (for example, managing fatigue that may be associated with the condition) or adaptive (for example, finding new, easier ways of carrying out tasks, often using equipment or assistive technology).
Occupational therapists have traditionally been employed in both health and social care services (see the College of Occupational Therapists [COT] factsheet ‘Occupational therapists adding value within social care’ [pdf]) and also work for integrated teams, housing, and vocational rehabilitation services. They are therefore well placed to promote integrated working. They also work collaboratively with or for a whole range of ‘third sector’ agencies, for example care and repair services, and charities for people with specific conditions, to enable people to maintain or increase their independence.
Another challenge for the long term conditions strategy is to enable people to remain in the community rather than being admitted to hospital. Although in some instances admission to hospital is necessary, occupational therapists help to prevent avoidable admissions, and promote good quality of life in the community, for example through reablement (see COT position statement on reablement [pdf]), falls prevention (read about falls prevention on the BAOT/COT website) and through working in accident and emergency departments (read more about accident and emergency on the BAOT/COT site).
Although occupational therapists contribute to the long term conditions agenda, the long term conditions strategy will need to address further challenges to enable occupational therapists and AHPs to contribute their skills effectively. These include:
- use of functional as well as condition specific outcomes and indicators; use of outcomes for people who have rare and/or progressive conditions
- measures of activity, which need to capture the numbers and types of intervention carried out with each person, and their effectiveness, as well as broader measures of how many people are seen and how quickly
- evaluation of the strategy, which needs to be inbuilt and ongoing. Value can be measured in different ways – do we provide value for money? Are we meeting aims and objectives? Are we achieving the right outcomes? Are we engaging with people who have the greatest needs? What do people think about our services?
- ensuring that the strategy complements the other policies that have either been published or are under development, for example, the Outcomes Frameworks for NHS, Public Health and Adult Social Care and the disability strategy that is currently being produced
Occupational therapists are important members of multi-disciplinary teams that also include nurse specialists, physiotherapists, speech and language therapists and other AHPs. Often it is the range of skills that can be offered by these teams that are important for people with long term conditions. They are frequently a key to providing the responsive, flexible and accessible services that people need. (See the COT factsheet ‘Occupational therapy for people with long term conditions’.)
Amy Edwards is Professional Affairs Officer for Long Term Conditions at the College of Occupational Therapists