RCOT responds to FT coverage on fit note reform

Our response to the Financial Times' article on fit note reform

The Royal College of Occupational Therapists has written to the Financial Times to challenge how occupational therapists were represented in recent coverage of fit note reform. 

The article describes occupational therapists as recommending ‘job coaching and therapy such as exercise or gardening’. This presents a narrow and misleading picture of the profession and does not reflect the reality or scope of occupational therapy practice. 

In our letter, we set out that this risks undermining public understanding at a time when occupational therapists play a critical role in supporting people to stay in and return to work. 

We also challenge the suggestion that this approach is new. Supporting what people can do rather than what they cannot has long been central to occupational therapy and is already delivering the outcomes these reforms seek to achieve. 

Accurate representation matters. Mischaracterising occupational therapy risks diminishing confidence in both the profession and the wider reforms and overlooks the expertise already in place. 

Read our full letter to the Financial Times 

Dear Editor, 

Misrepresentation of occupational therapists in fit note reform coverage 

Your recent article on fit note reform misrepresents the role of occupational therapists and risks undermining public understanding of a profession central to supporting people to stay in and return to work. 

The statement that sick workers will be sent to occupational therapists and social prescribers who recommend job coaching and therapy such as exercise or gardening presents a narrow and trivialised account of occupational therapy practice. This wording reduces a regulated clinical profession to informal activities and creates a misleading impression of limited expertise and impact. 

Occupational therapists are degree qualified health professionals trained to assess the complex interaction between a person’s health, their work and their environment. Their role is not to suggest generic activities but to deliver evidence-based interventions that enable people to function safely and sustainably in work. This includes assessing work capacity, advising on workplace adjustments, planning phased returns and working with employers to address barriers. 

Presenting occupational therapy in simplified terms is not a neutral choice of language. It misrepresents the profession, diminishes its contribution across health services and workplaces and risks reinforcing misunderstanding at a time when clarity is essential to the success of reform. 

The article also suggests this approach represents a new direction or alternative to a system described as a dead end. In reality, the shift from focusing on what people cannot do to what they can do has been central to occupational therapy practice for decades. This is not an emerging concept but an established, evidence informed approach already delivering the outcomes these reforms seek to achieve. 

Work is not simply an economic outcome. It is a vital occupation that supports health, identity and wellbeing and provides structure, purpose and social connection. Occupational therapists are uniquely placed to enable this, bridging health and employment in a practical and outcome focused way. 

At a point of significant policy change, accurate representation matters. Language that mischaracterises occupational therapists risks diminishing confidence in both the profession and the wider reforms and overlooks the existing workforce capability needed to deliver change at scale. 

Fit note reform presents an important opportunity. Its success will depend on recognising and fully utilising the expertise already in place. Occupational therapists are central to that effort and should be represented accordingly. 

Yours sincerely, 

Odeth Richardson
Chair of Board of Trustees

Gary Waltham
Chief Executive