See highlights from day two of Annual Conference 2021.
If you want to make a difference and have some influence at leadership level, get involved with RCOT Council
In a fully subscribed roundtable session on leadership, at Annual Conference 2021 on Wednesday 30 June, RCOT Council members Kim Atkinson, Lisa Ledger and Dr Kee Hean Lim talked about their own leadership journeys and how being an RCOT Council member has contributed.
When it comes to being a council member, Kim Atkinson, who is currently Vice Chair, said that “it helps to be a relatively experienced member of the profession”. She stressed that you “need to be able to hold your own” as well as being “firm in your own opinions” and being “able to articulate them”.
Other key leadership qualities that would also stand you in good stead as a member of Council include having a broad perspective, being passionate about the profession and valuing diversity, she added.
Holding the position of Council member gives you an opportunity to work alongside some very skilled occupational therapists, “it has developed my contemporary knowledge and has lifted me out of my own bubble” she SAID. While, crucially, being a member of Council “gives you a perspective on the future direction of travel for the profession”.
But what does a ‘senior’ or ‘experienced’ member look like when it comes to joining Council, the panel was asked. Is it years qualified or the impact of your work?
The consensus was that it is not really about how long you have been in post, or what areas you have worked in, but about what you can bring to the role and how you can contribute.
Dr Kee Hean Lim said the most meaningful aspect of being on Council was being able to make a difference or a change; you have the opportunity to have an input and represent other people.
“You might thing that you are not equipped for the role, as it seems like a big step...but it’s a good start to do little things,” he said, suggesting that a good pathway is to start by volunteering for a Specialist Section, for example, in different roles, or getting involved in consultations on behalf of RCOT.
“Those things build your confidence and also help you to understand how the Royal College works,” he said.
“That gives you confidence, leadership or experience”, to put yourself forward for bigger things. “There’s never a good time, or a right time,” he exclaimed. “But if you want to make a difference and be involved in the change, it’s a good opportunity to be involved, because that is one of the most meaningful things – for me at least.”
The final word went to Kim who said of the commitment: “I would say I’ve got more out of it that I’ve put in…I’ve really enjoyed it tremendously and have learned a lot.”
How close are occupational therapists to using data intelligently?
Suzy England, RCOT Professional Adviser in Health Informatics, has urged people to identify data champions “at every level” and connect with RCOT if you want to help lead on this work - as we need people willing to understand, lead and negotiate.
In an Annual Conference session looking at how close occupational therapists are to using data intelligently, Suzy set out to explore two critical questions: has the profession’s use of data evolved in line with the wider health and care community? And what measures need to be in place to support the profession to measure its impact and cost effectiveness?
But what does ‘intelligent use of data’ mean? Suzy explained that this is about information that we can use to extract insights and make better decisions about how we can structure services.
She added that data comes from a wide variety of different sources – such as clinical data, workforce data, population health data – before asking: “How confident and skilled are occupational therapists to be able to use this knowledge, to answer the question, does my service meet the needs of the local population and how do I know everyone can access it in the way they need to?”
She pointed to four common barriers: multiple stakeholders; multiple systems; a changing landscape; and information and systems organised for other users.
Using RCOT’s published, but now archived, vision for information by 2024 as a benchmark, Suzy said that “it’s fair to say that the pandemic has brought us on in leaps and bounds in terms of the digital tools available”.
While we are working and thinking very differently today in terms of our use of digital tools, we are lagging behind when it comes to our use of data, she suggested.
“The best way to describe the state of data in the AHP world is that we have this deep, dark, murky, unclean lake of information – with pockets of excellence – that we really need to start to clean if we are going to be able to gain meaningful insights from it,” she said.
But it’s not all a bleak picture. She suggested that there are five things that everyone can be doing locally: ring fence time to prioritise data; understand the different stakeholder perspectives on information; start with the end in mind – identify what you want to know about your service and work backwards to configure the right systems; focus on information sharing – ‘how do we record our data in a way it’s easily shared?’; and identify who can help you outside of the sector.
Advocating a tiered approach, she ended by stressing that all occupational therapists have a role in this agenda and that every organisation needs to have an AHP/occupational therapist specialist – somebody who is driving the innovation forward and driving the exciting links outside of the sector.
She urged delegates to think about what they can do, to identify champions and most importantly, connect with RCOT.
Look at what you need to do to become an authentic ally, delegates are told
Race and racism in our society is not an issue to be dealt with specifically within healthcare; it’s an issue that needs to be dealt with across our society and across the globe.
This was the opening comment from Yvonne Coghill CBE, Race Adviser, NHS Race and Health Observatory, in a keynote on the 7 A’s of Authentic Allyship.
“The NHS Constitution is to provide a high-quality service,” she stressed. “Since the inception of the NHS, we have had people from all over the globe come to help us, to support us and to make sure that we can deliver high quality care to our populations,” Yvonne said.
The statistics show that the NHS is the biggest organisation in the UK: 13% of all allied health professionals (AHPs) are from Black, Asian or minority ethnic groups – but this is still less than the 15% of the total UK population and a lot less than the 21% of staff from those backgrounds in the NHS as a whole. Meanwhile, only 9% of Black, Asian and minority ethnic staff are occupational therapists.
So, Yvonne went on, “what we know is that the proportion of occupational therapists who are from a Black, Asian or minority ethnic background is much lower than in the general population, and much lower than in other areas of the NHS.”
“But why is this important and does it really matter”, she asked. Looking specifically at employee engagement and NHS performance she said that there is “a spiral of positivity in the best performing NHS trusts”.
Quoting from the authors of the King’s Fund paper, she said, “The extent to which staff are committed to their organisations and to which they recommend their trust as a place to receive treatment and to work is strongly related to patient outcomes and patient satisfaction. Climates of trust and respect characterise these top performing trusts.”
In other words, the experience of Black, Asian or minority ethnic staff “is a very good barometer of the climate of respect and care for all within NHS trusts”.
“When I saw this I thought, this is fantastic, people will recognise that everyone, regardless of their background, must be treated well and with dignity and respect. It’s a must have,” she exclaimed. “In order to do this in an increasingly diverse population we need to make sure that our workforce is diverse and that they feel fully included.”
Explaining why diversity and inclusion are so important, she said there are four cases: legal, moral, quality care and financial. She added: “We are all in this together – last year, after the George Floyd incident and Black Lives Matter came to the fore, people were asking me, what do we do about this? That is why I wrote the 7 A’s of Authentic Allyship.”
She went on: “It’s about how we all of us work to make sure that everybody, regardless of their background, feels included and part of our NHS. About all of us recognising that there are things for us to do and ways to behave in order to support and help our colleagues in the workplace.
“When I say that people from BAME backgrounds across the board in the NHS have a worse experience of working within the NHS, I am hoping you will believe that. As director of WRES, we collected data for five years and found that doctors, nurses, AHPs, and administration, they had and reported a working experience worse than their NHS counterparts.”
In a strong statement for change she added: “In order for us to have an NHS that is going to be fully inclusive, an organisation that’s going to give of its best to patients, we have to make sure that everybody understands the importance of working together to get to that place.”
The ‘7 A’s’ (Appetite, Ask, Accept, Acknowledgement, Apologise, Assume, Action) help people “who don’t know or don’t understand what they need to do in order for us to get to this place”.
Yvonne concluded: “In order to become an authentic ally, it’s about looking at what you need to do, in order to support other people, so that ultimately everyone can be the best that they can be in order to deliver high quality patient care, patient safety and patient satisfaction.
“Race equality is not an easy thing, but I’m hoping using the 7 A’s will help people get from where they are to a place that they can start to help to support each other.”
We need to develop the research and evidence the strengths of pulmonary rehab as an intervention for people with post-COVID-19 symptoms, delegates hear
Professor Sally Singh, Head of Pulmonary and Cardiac Rehabilitation at University Hospitals of Leicester NHS Trust, delivered the opening plenary at RCOT’s 44th Annual Conference, which is taking place virtually for 2021, for the first time ever.
Sally is leading ground-breaking national research on pulmonary rehabilitation and digital interventions to support rehabilitation and recovery.
Pointing to the fact that pulmonary rehabilitation has conventionally been provided within hospital and community settings – where there is a strong evidence base for it – she said the new pandemic situation of the last 18 months “has changed all that”.
“There is limited evidence in the field for virtual rehabilitation,” she said, which means there is limited evidence and guidance. However, she stressed, this means that there is potential to increase the scope.
Using a number of different studies, Sally showed delegates that pre-COVID-19, the vast majority of pulmonary rehabilitation in the UK – 98%– took place at a centre, and while 34% did offer home-based rehabilitation, only 1.6 % of people took up the offer.
While recognising that Long COVID is a complex disease, and that “we are learning on the job”, she used data from Italy to ‘nail down’ the main symptoms to be fatigue, breathlessness, and joint pain.
But importantly for allied health professionals, she said, ONS data has shown that there has been a huge impact on people’s activity levels, with 30% of the COVID-19 population having “significant, enduring impact on their ability to do tasks”, citing fatigue, breathlessness, cognition and impairment in exercise capacity.
“But what are we going to do to support these people,” she asked. Referring to a recent article published in the BMJ, she said that pulmonary rehabilitation has been suggested as a “preferred intervention” for a number of these people.
Specifically, an interdisciplinary programme of care for people with chronic respiratory disease, what is so important about pulmonary rehabilitation, she stressed, “is that it is individually tailored and designed to optimise an individual’s physical and social performance and comprises an individually prescribed exercise and education package.”
Looking at the existing data and what the need for pulmonary rehabilitation need might be, she said: “We think that about 25% of hospitalised patients will have a self-identified need for rehabilitation – which is a huge population.
“And very early evidence is suggesting that people with COVID-19 will benefit from pulmonary rehabilitation intervention, both in terms of quality of life and a return to activities,” she concluded.
Early on in the pandemic, she said, there was a survey of healthcare professionals to try to understand what an assessment and package of care might look like for people post-COVID, and she noted that there is “huge debate as to how we manage the post-COVID patient”.
Some of the areas of concern considered to be unique to this population are fatigue, psychological and cognitive disturbances – not only because of the impact of the disease itself, but also lockdown and social isolation. But it was acknowledged that there is evidence for rehabilitation reducing anxiety and depression by increasing people's ability to engage again in activities and participate in daily life.
In terms of the benefits of rehabilitation being delivered via face-to-face groups, on digital platforms, or even by ‘paper-based’ programmes, she acknowledged that COVID-19 has likely influenced the digital habits of pulmonary rehabilitation service users, and that there is “lots of work to be done” in the areas of ‘novel tech’, such as virtual reality.
But a key ‘take home’ message from the session was around the importance of shared decision-making: “It is important that we support our patients to choose the right options and to make the right decision that suits them, that will maximise their engagement and hopefully the impact,” she exclaimed.
COVID-19 has encouraged the development of digital models for pulmonary rehabilitation – and challenged services to better meet the needs of their service users – but we need now to develop research and evidence the strengths, and services need to accommodate their preferences.
“Research is needed to develop engaging digital interventions to support symptom reduction and behaviour change,” she said.
Occupational therapists are challenged to ‘showcase their skills’ at advanced practice level to help open up opportunities
If they want to drive change – any change – to their scope of practice, to the health system, to funding levels or their own levels of autonomy, occupational therapists need to navigate the social and political systems that have defined the profession.
This was the clear call to action - based on a quote from Nancarrow and Borthwick (2021) - to come out of a lively RCOT Insights session on ‘Advancing practice and new ways of working’, on the first morning of RCOT’s 44th Annual Conference on Wednesday 30 June.
The session focused on the developments with advanced and consultant levels of practice across the UK and kicked off with the three speakers defining advanced practice and how it differs in the four nations, in alignment with the newly-published RCOT Informed View and the RCOT Career Development Framework (CDF).
RCOT’s view, in a nutshell, is that occupational therapists working at advanced or consultant levels of practice have an advanced and critical understanding of the complex interplay between the person, their occupations and their environment. Furthermore, occupational therapists at this level are able to deal with the complexity across all four Pillars of Practice, as laid down in the CDF.
Speaker Dr Stephanie Tempest, Company Director of Stephanie Tempest Consultancy Ltd, kicked off the debate saying this is all about new ways of working within a multi-professional context.
“The allied health professions are still relatively young,” she said. “We need to understand our history in order to understand interprofessional dynamics. As practitioners we need to embrace new ways of working – the systems we work in can’t stand still...”
Looking at the debate around the use of language, and acknowledging that not everybody is in agreement, she explained that the use of the word ‘specialist’ is about “a scope of practice, not a level of practice”.
She said: “Some people specialise – and you can change specialisms - while some people choose to advance their career and become experts.”
Paul Cooper, RCOT Lead Professional Adviser, urged occupational therapists to use the RCOT Informed View on advancing practice “to articulate the offer”.
Referring to a delegate chat box question about what steps RCOT might suggest are taken to increase the low number of occupational therapists in the very advanced responsible clinician role in mental health, Paul added: “The numbers may be small, but it is an important strategic role…and the numbers can be used as a strategic example of what can be done.”
While Stephanie added: “We know when we get occupational therapists into these very high levels, we can use them as exemplars, and learn from them about how to affect change.”
Karin Orman, RCOT Assistant Director – Professional Practice – stressed that it is vital to make sure that people starting out on their career in occupational therapy are aware of these [advanced and consultant] role models, as then “we will start to see traction”.
When it comes to these advanced and consultant roles, Stephanie concluded that “these roles need advocating for”. She said: “They need to be created; we are not at that stage in our profession where we are sitting with a bank of job opportunities to slot ourselves into.
“We need to analyse the needs and make the business case. Boldly go and say ‘Look at my skills, I can fill this population need’. Let’s go out and showcase what we are capable of doing and showcase these opportunities.”