Occupational therapists and the long term conditions agenda – Amy Edwards

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

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5 Responses to Occupational therapists and the long term conditions agenda – Amy Edwards

  1. Mel Terry says:

    As an MDT team working with people with Chronic Fatigue Syndrome/ME, with the majority of the team being OT’s, it is well recognised that the work OT’s do to enabe people with CFS/ME to manage their symptoms is invaluable. As OT’s we offer a combined therapeutic intervention of Graded Activity Management, Cognitive Behaviour Therapy and Graded Exercise Therapy (as per NICE guidelines). As the condition has biopsychosocial components by way of a multitude of symptoms, including post exertion fatigue, malaise, sleep problems, anxiety, depression and pain we use a biopsychosocial approach to develop unique treatment plans. This approach would also benefit other Long Term Conditions with similar features, such as chronic pain, and chronic fatigue, and as OTs we understand the complex components of a persons lifestyle and difficulties living with a LTC that we can match their management plan to facilitate optimum function and minimise symptoms. At a crucial time with changing commissioning bodies, OTs need to market their skills and outcomes in order to ensure they are providing the services to people living with LTCs, and early enough in these people’s diagnosis to prevent unhelpful activities/lifestyles that will not only reduce their chances of managing their symptoms, but could exacerbate the LTC and increase morbidity and mortality.

  2. Maggie Winchcombe says:

    I would like to add my voice to bring neurological impairments to the minds of policy makers and commissioners who are developing the LTC Strategy. There is still a long way to go to support people with neurological conditions effectively by ensuring they have the continuity of care that is vital to them. There is a body of evidence that demonstrates this. Funded by The Department of Health – 10 different studies over 8 years investigated the needs and experiences of people with neurological conditions and their carers [All the reports from the studies, along with an Overview Report that distils the findings can be found at http://www.ltnc.org.uk/ ] This research initiative has produced important information and evidence for policy makers and commissioners to consider when they configure services that truly meet the needs of their local communities.

  3. Pru Jones says:

    I work within social care for children and young people looking at housing and environmental needs within school and short break settings, equipment needs for children and young people with long term conditions and disabilities. I assume that the needs of children and young people are to be covered in the LTC strategy – although this is not explicitly stated. One area that needs work currently is transition from childrens to adult services – young people entering adulthood with life long conditions. It’s difficult to comment on the aim of the LTC strategy as the shared aims are all ones we would agree with; however it would be interesting to see how the goals will be met, what processes can be developed, in a time of funding cuts and dwindling resources, and when the focus currently seems to be how savings can be made and how resources stretched over a greater number. It’s a huge challenge for any LTC strategy.

  4. Jo Ball and Gwyn James says:

    We are a group of Occupational Therapists who specialise in working with people with learning disabilities. We are keen that people with learning disabilities and their additional needs are not forgotten in this strategy.In part because having a learning disability is a long term condition which has a significant impact on all areas of a persons life. There is much evidence that people with learning disabilities are more disadvantaged than other people with disabilities. And also, because people with learning disabilities are much more likely to suffer with a range of other long term conditions such as autism and epilepsy.

    We are keen that the government remembers the additional arrangements people with learning disbailities need to help them understand and take responsibility for their own health needs. Information needs to be provided in more accessible ways, appointments might need to be longer for example.

    As Occupational Therapists our goals working with this group match most of those proposed in the strategy and measuring outcome are an essential part of what we already do. Our added value to the process would be in advocating for this group and also in working with others to empower them, where ever possible, to take control of their condition. This requires a range of approaches in which we are skilled based around the individuals’ biological, psychological and social needs. We work alongside the individual, facilitating. informing and creating opportunities for independance looking across the span of their present and future needs. We support them to develop skills and abilities which allow them to be socially included, independant as possible, in control and to succeed to their best possible level in occupation – education, daily living activities, work/occupation.

  5. judith knott says:

    I am one of four OT’s working as part of a psychological therapies (IAPT) team in East Lancashire. I acknowledge what has been said about the important role Occupational Therapists offer to clients with LTC and the also the importance of not separating physical and mental health when providing treatment for people. As OT’s we are trained to be able to see the client as a whole and also assess and provide interventions that acknowledge the person in their wider occupational and life contexts. We have seen an increase in the clients being referred to the service with co morbidity and where their physical long term conditions impacting upon their mental health. We have evidenced that the functional, holistic, creative and collaborative approach we offer is valuable to these clients where a “talking therapy” alone may not be sufficiently effective especially at a later stage of a clients illness.
    The challenge for us is not only to be recognised as the valuable resource OT’s are and could be in IAPT teams and services (we are not aware of any other OT’s in the country currently working within IAPT teams) but that the existing IAPT service framework does not support the flexibility of time frames, integrated and collaborative ways of working that are essential for better outcomes with this client group. The other challenge is to be able to offer Primary care interventions to clients with LTC soon after diagnosis. Occupational Therapists with their holistic skills and training are best positioned to lead on the LTC agenda in primary mental health and hopefully this new strategy will support more OT’s being employed within primary mental health services and IAPT teams?