RCOT's response to the APPG on the AHPs call for evidence
Neighbourhood health
The Royal College of Occupational Therapists (RCOT) is the professional body for occupational therapists across the UK, representing more than 36,000 members.
Occupational therapists support people of all ages to do the everyday activities they want, need or are expected to do, by addressing the practical, physical, social and environmental barriers that affect participation. They work across health, social care, housing, education, employment, the voluntary and community sector, and public health.
RCOT welcomes the opportunity to submit evidence to this inquiry. Occupational therapists are already contributing to neighbourhood health across the UK, helping people prevent deterioration, maintain independence and participate in the activities that matter to them in their everyday lives.
Neighbourhood health should ultimately be judged not simply by whether care has moved closer to home.
We believe the success of neighbourhood health should ultimately be judged not simply by whether care has moved closer to home, but by whether people are supported and enabled to live the lives they want and need to live.
People's health is shaped by far more than their clinical needs
There is a risk, however, that neighbourhood health becomes too heavily shaped by a traditional medical model. If it focuses primarily on diagnosing and treating illness, it will not deliver the wider shift towards prevention, maintaining wellbeing and encouraging participation that neighbourhood health is intended to achieve.
People's health is shaped by far more than their clinical needs. Whether someone can:
- remain well
- return to work
- participate in education
- care for others
- stay socially connected
- live safely at home
... is influenced by factors including their environment, relationships and access to community support.
Designed around people and communities rather than organisational boundaries.
Neighbourhood health must be designed around people and communities rather than organisational boundaries. The NHS has an important role, but effective neighbourhood health depends on genuine partnership with local government, social care, housing, education and voluntary and community organisations.
It requires a broader approach that connects clinical care with the practical and social conditions that enable people to participate in everyday life. This is where occupational therapists and other Allied Health Professionals (AHPs) have an important contribution to make.
Key points from our response
- There are examples of occupational therapists beginning to deliver neighbourhood health in practice.
- Examples include: integrated neighbourhood teams, frailty prevention, neighbourhood mental health, children and family hubs, primary care prevention, creative community-based support, physical activity programmes and work-focused early intervention.
- These examples demonstrate what is possible, but are not yet consistently commissioned or embedded at scale.
- Occupational therapists bring a distinctive contribution by connecting health, function, participation and environment. They consider what matters to people and the practical barriers that affect whether someone can participate in everyday activities, including education, work, family life, social connection and community life.
- Neighbourhood health must be more than an NHS service model. It should be built through equal partnership between health, social care, local government, housing and community organisations, with AHPs represented in leadership and decision-making.
- Success needs to be measured by outcomes that matter to people and communities. Alongside activity and waiting-time measures, neighbourhood health should value prevention, independence, participation, wellbeing, carer outcomes, community connection and reduced escalation of need.
- Barriers to successfully delivering neighbourhood health include workforce capacity, fragmented commissioning, disconnected digital systems, insufficient AHP leadership, pay and banding disparities, limited protected transformation time and a lack of sustainable funding for prevention.
Case studies that demonstrate occupational therapy’s contribution
The following examples demonstrate the potential contribution of occupational therapy.
They should be understood as examples of promising practice rather than evidence that these models are consistently available at scale. Detailed case studies for each of the below and more are available on request.
Recommendations
- Make formal AHP leadership and representation a core requirement of neighbourhood health governance, planning and commissioning. AHPs should be involved in pathway design, workforce planning, evaluation and decisions about how neighbourhood services are developed.
- Treat local government and social care as equal partners in neighbourhood health. Neighbourhood models should be jointly designed, commissioned and evaluated across health, social care, housing, local government and community organisations.
- Fund protected transformation capacity and prevention. Occupational therapy and other AHP teams need time and resources to build partnerships, co-produce services, test new models and evaluate impact. Prevention and early intervention should receive sustainable funding rather than relying on short-term pilots.
- Protect rehabilitation and occupational therapy capacity. Community and neighbourhood teams need sufficient staffing, with clear escalation arrangements where capacity falls below safe levels.
- Measure what neighbourhood health is intended to achieve. Evaluation should include participation, independence, wellbeing, carer outcomes, community connection, reduced escalation and reduced inequalities alongside traditional activity and access measures.
- Invest in the infrastructure needed to work across organisational boundaries. This includes shared digital systems, information governance, population health data and accessible community estates, alongside workforce approaches that address pay, banding and career progression.
Conclusion
Occupational therapists are ready to help deliver neighbourhood health, but the policy environment must enable their contribution.
Neighbourhood health must be designed around everyday life, participation and prevention
If neighbourhood health is to improve outcomes, reduce inequalities and shift care closer to home, it must be designed around everyday life, participation and prevention. Occupational therapists bring the practical expertise needed to translate neighbourhood health ambitions into support that works in people’s homes, communities, schools and workplaces.
Occupational therapists bring practical expertise in understanding what enables people to participate in daily life and how homes, workplaces, schools, services and communities can be adapted to support independence and wellbeing.
Their ability to work across health, social care, housing, education and community services makes them an important part of the neighbourhood health workforce.
The priority now is to move from isolated examples of good practice to systematic AHP leadership and delivery.
Our central recommendation is therefore that AHP leadership and representation should be embedded within neighbourhood health governance, planning and commissioning. This should be supported by equal partnership with social care and local government, protected capacity for prevention and transformation and measures that assess whether neighbourhood health is helping people to participate and live well in their communities.
Neighbourhood health will succeed only if it focuses on people's functional needs, not just their clinical needs.
Whether someone can remain independent, return to work, participate in education, care for family members or avoid escalating need is often determined by factors beyond healthcare alone.
This requires a neighbourhood approach that brings together different professions and sectors around shared functional outcomes, rather than organising support around individual conditions, services or organisational boundaries.