RCOT Annual Conference 2023 – highlights from day two

In a Special Plenary session designed to help delegates ‘take some stress out of stress’, Siôn Stansfield, Mindset and Performance Coach at POINT3 Wellbeing, used the session to explore the concept of stress and the stress response cycle.  

Siôn was introduced to delegates by Odeth Richardson, RCOT Chair of Council, who reiterated how important it is to support colleagues to maintain our mental health and wellbeing.  

She said: ‘As OTs we are very good at looking after others, but sometimes we need to pay some attention to looking after ourselves’.  

Siôn kicked off by noting that simply having a conversation around stress can be a stressful experience in itself. But, he said, by having the right tools and understanding, we can support ourselves at those times when we do experience stress.  

POINT3 Wellbeing’s mission is to make as many people as possible ‘stress less and smile more’, he explained. ‘We know that by building your awareness, knowledge and your understanding it’s going to help you be a little bit better today than yesterday, a little bit better tomorrow than today; knowing it’s not always going to go according to plan.’  

Exploring the theory of stress and the stress response cycle, he asked what the benefits of stress are. ‘With awareness of stress comes power,’ he said. ‘Awareness enables us to be in the driving seat, rather than the passenger seat, to those moments where stress comes in.’  

He asked delegates to self-reflect and build their own ‘personal stress signature’ – how stress shows up for you in three areas - noting down how you physically feel, think and behave at the time of a stressful situation.  

He pointed out that stress isn’t just a negative experience, it’s a normal part of the human experience, and there are benefits. ‘It’s simply when it flips over to being a negative,’ he explained, ‘and we don’t have that control, and we don’t respond in the right way, that it starts to impact us negatively.’  

Moving to describe the stress response cycle, he brought it to life with a tunnel analogy and how our ancestors would have reacted being faced with a stressful situation: Beginning: stressor or fear; Middle: fight, flight or freeze; End: safety, or home. In modern day society, he pointed out, ‘that stress is just sitting there’.   

Siôn then shared six ‘scientifically proven’ ways – or practical tools – for busy professionals to use every day to complete the stress response cycle:  

• move: consider how to bring small micro-movements into our everyday  
• connect: make connections with other people, to ‘talk it out’  
• breathe: practise ‘focused breathing’  
• laugh: seek out way to make you laugh  
• cry: if you find yourself on the urge, don’t resist the urge to cry  
• create: bring yourself into the present moment by tapping into your creativity.  

He told delegates, these tips are ‘pocket science, not rocket science’; that is, small things that you can introduce to your every day.   

To conclude, he said ‘we are all going to experience stress’, but raising your awareness of your personal stress triggers is helpful. While the stress response cycle has a beginning, middle and end, you can avoid chronic stress by ensuring you complete the full cycle.  

And he urged everyone, in a time of stress, to move, hug, breathe, connect, laugh and cry.  

In an RCOT Insights session titled, ‘Unregistered not unqualified: Valuing and developing our support workforce’, delegates heard the strong message that our occupational therapy support workforce is a vital, valued, yet untapped resource.  

The panel – who all have different experiences of working with or as part of our support workforce – comprised of Hannah Spencer, Occupational Therapist, Olufunmilayo (Olu) Oludare, Occupational Therapy Apprentice, Professor Richard Griffin, Professor of Healthcare Management at King's Business School, Luke Capon, People Participation and Engagement Lead, East London NHS Foundation Trust, chaired by Nikki Daniels, RCOT Head of Communities and Connections.  

Our occupational therapy support workforce is a ‘skilled, experienced, valued and vital part of our OT community’, and essential to delivering safe, effective services, Nikki said at the outset of the session.   

Hence, she stressed, why it was reinforced in the title of the session that, ‘although support worker colleagues may not be registered, they most certainly are experienced, skilled and qualified for these important roles.’  

RCOT has listened to the stories and experiences of members of our Support Worker Project Advisor Group, Nikki explained. ‘We want to ensure that RCOT activity is inclusive of and accessible to our support workforce, and the support workers feel they belong as seen members of our professional body,’ she said.  

‘And we want everyone to understand their role in achieving this vision, in valuing and developing colleagues in support roles,’ she added.  

The panel were asked to talk about their roles and experience, why they feel this conversation is important, what challenges those in support roles face, and ways to overcome these.  

On why this conversation is vital, Luke kicked off by pointing out that ‘for many years, the AHP support workforce has been overshadowed by healthcare support workers.’   

Olu added: ‘Within the support workforce role, we have a pool of untapped resources… I believe that developing our support workforce will reduce the cost of recruitment. [By] upskilling and retraining them in the next five years, we could have a good return on investment.  

‘We have good support workers that have the knowledge, skills and behaviours to be able to help our patients, who are at the centre of our care.’  

Professor Griffin wholeheartedly agreed, saying the phrase ‘"untapped" is brilliant’. He said: ‘There’s a massive shortage of OTs and we know the consequences of that… [and] we’ve got this fantastic resource that’s already in the workplace [that are] so critical for patient care and helping registered staff in terms of the roles they do.’  

He added that the support workforce is significant, both in terms of its size and the local labour market – potentially making it more diverse.  

Hannah added to this saying, ‘visibility and representation in all kinds of aspects is a vital cue to inclusion’. They went on: ‘So for me, having a support workforce focus at RCOT conference is visibility, is representation, is a cue towards inclusion and belonging.’  

They added: ‘…people need to see and hear possibilities, to see and hear themselves and know that their skills, circumstances, who they are and what they bring, matters and are valued.’  

Recognising that while there may be some support workers in the audience, the majority tuning in would be registered, Nikki asked the panel what they would say to them about how to value and developed this ‘untapped potential’.  

Luke responded by saying, in terms of development opportunities and progression, ‘one of the major gaps is options.’ He urged people to harness the motivation and commitment of their current staff, and to create ‘an environment where development opportunities become commonplace and common practice.’  

Hannah added to that saying, while they acknowledge the support workforce is a vital pipeline for our registered workforce, there’s a historical narrative that ’If I don’t want to train, then I can’t progress.’ That needs challenging.  

Still on the topic of career progression, Olu said that results of a scoping exercise within her trust suggests support workers are classified into two groups; those that are looking for career progression and those that don’t.  

‘What we are missing is getting it right at the point of recruitment, the organisation must be able to scope the support workforce to really know what is their why,’ she exclaimed. Their ‘why’, she said, is our driving force that helps align it to the organisation’s values.  

Professor Griffin went on to reflect on the lack of national policies for support worker development, that’s led to inconsistent job design, access to education and career progression opportunities.  

‘We can get this right now,’ he urged. ‘You’re absolutely right, it’s not all about everybody wanting to progress, it’s about being the best you can at whatever level you’re at. And having the opportunities to have a rewarding, satisfying job.’  

If we get this right, he concluded, it’s a ‘win-win’ for everybody. He said: ‘Australian research has suggested that 11%-24% of all tasks that registered AHPs, including OTs, currently undertake (clinical and non-clinical), they don’t need to; they could be safely and effectively delegated to support workers.’  

Occupational therapists have an essential role supporting people to recover and rehabilitate following acute hospital admissions, but our skills aren’t always put to best use in acute settings. In addition, community teams can struggle to keep pace with discharge rates.  

Lauren Walker, RCOT Professional Advisor, set the scene, touching on some of the insights from RCOT’s recent workforce survey and summits, delving into some of the challenges OTs working in acute settings face, along with some of the opportunities for meaningful change for the OT role in hospital discharge.  

‘RCOT’s workforce survey and the series of workforce summits told us that OTs are seeing increased demand and complexity and significant workforce shortages,’ she said. ‘In addition, there is poor recognition out there of the unique occupational therapy role and a lack of OT and AHP leadership.’ 

Lauren said, ‘RCOT is hearing that people feel undervalued in the acute setting, that their primary function has become discharge co-ordinators, they don’t feel they are able to ‘do therapy’, and they aren’t able to intervene with people in a way that’s rehabilitative and supportive to enable them to engage and participate in occupation.’  

‘This,’ she said, ‘is leading to people leaving the acute setting and is a barrier to people working in the acute setting in the first place.’  

That said, ‘there is an overwhelming sense of pride in what we do and what we can bring … that leaves me to strongly believe that it isn’t the profession that’s the problem, it’s the systems and the structures that we work within that are causing us to feel undervalued.’  

‘So, what needs to change?’ she asked. ‘The status quo isn’t sustainable or desirable!’ Lauren exclaimed. She said that OTs need to ‘be positioned where they have the biggest impact, be able to focus on occupation, stop undertaking tasks that dilute our unique role – and are better completed by other multidisciplinary team members, and confidently demonstrate the unique value of OT within current and development structures.’   

The lively panel discussion explored when, where and how OTs can make best use of their expertise and achieve the best outcomes for people leaving hospital.  

Lauren’s first question the panel was: ‘If we are saying the role of OTs in hospital isn’t working and needs to change, what’s our essential role in hospitals and what might we need to let go of?’  

Louise Watson, Site Lead at Inverclyde Royal Hospital and Chief AHP Clyde Sector/Occupational Therapy Professional Lead (acute), NHS Greater Glasgow and Clyde, said an OT’s essential role is as a senior clinical decision maker.  

‘OTs should be at the forefront of clinical decisions for patients about their discharge and ongoing rehab needs,’ she said. ‘In essence, if a patient presents either at the front door or on to a ward, they should be seen by an OT, who is part of that decision making, based on assessment of functional needs to that patient.  

‘What is it that matters to that patient? What’s required to turn that patient round as soon as their medical needs have been met to discharge them safely? We shouldn’t be holding on to people for rehab if rehab can be done in a more appropriate setting in the community.’  

Nikki George-Powell, HARA Service Manager Community Hub, Harrogate and District Foundation Trust, was asked, based on her work in Harrogate, whether she felt more occupational therapy should be taking place in the community, rather than on hospital wards and how do we make that happen?  

She said that ‘starting at the end’ and thinking about ‘Home First’ at every opportunity in a patient’s journey is key. This helps improve patient outcomes, shortens length of stay and avoids hospital admissions.  

Reflecting on previous RCOT work and the conversations that took place at the workforce summits, Karin Orman, RCOT Director of Practice and Innovation, added that ‘while we know OTs are incredibly busy ensuring discharge, they are not really working as OTs.’ She asked: ‘How do we address that?’  

‘We need to think about auditing what we do’, she said, calling on people to ask: ‘What is it that only we can do?’ She said we can’t ‘suddenly just stop doing and pull out of our teams,’ but we can highlight the percentage of our time that is doing roles that are based on low value decisions for occupational therapy.   

‘If we focus what we do on better value decisions,’ she went on, ‘then we would be able to better demonstrate what we would be offering.’ 

Emma Ashton, Hospital Patient Transfer Team Manager, Powys County Council, was asked to consider our role in encouraging and enabling positive risk taking and leadership.  

‘Education [with wider multidisciplinary team colleagues] is such a big part of this,’ she said. ‘As OTs we always analyse… it’s in our nature and we assume everyone else does it as well, and they don’t.  

‘What we can do is to look at alternative options? Think outside the box. What can we do to get people home? It’s about encouraging more of the multidisciplinary team to have those conversations and enabling them to have those thoughts.’  

She urged that people ‘work together and have those combined assessments; if we share our information a person has a meaningful hospital stay,’ she concluded.  

Lauren’s final question, before taking delegate questions was: ‘How do we move all this forward and what needs to be a priority?’  

Jo Richardson, Therapies Improvement Manager, Emergency Care Improvement Support Team, NHS England, framed her response around the risk appetite. ‘For all this to work we have to embrace it and share it,’ she said.    

Karin Orman added that OTs in acute settings need to reach out and establish relationships with occupational therapists in the community and social care, ‘get into the room’ and start to have the difficult ‘what if’ conversations.   

Nikki George-Powell went on: ‘You need buy in and it needs to be at all levels.’ She urged people to come up with the solutions first, then get the buy in after. ‘There’s currency around, “if you aren’t there anymore, what would be missed?”’   

At the end of a 'wonderful’ two days of learning, debating, discussing and connecting, RCOT Chair, Odeth Richardson, and RCOT Chief Executive, Steve Ford, closed the 46th Annual Conference with their reflections on this year’s stand out highlights and our vison for the future of the profession and professional body.  

Odeth shared her highlights of this year including, the session on how we use our expertise to achieve the best outcomes for patients leaving hospital, the excellent work in Sheffield to get OTs into GP surgeries, Eluned Morgan (Member of the Senedd), Minister for Health and Social Services, talking about achieving good health for all, and Venus Madden’s leadership journey.  

She said: ‘It looks like you’ve all had a wonderful and amazing conference ... like me, you’ll have many take aways to reflect on and implement in some areas. But there’s no rush! There’s six months to access the information on the platform.’  

Thanking delegates for their engagement she added: ‘Without you we would not be here today ... you make the conference what it is by getting involved from the start, by helping us shape the themes that have driven the fantastic content that we’ve seen.  

‘We thank you all for your valuable contributions and the connections you’ve made.’  

Steve Ford ended by pulling some of the conference themes together and sharing some of the trending tweets.  

‘I love the way that @RCOTGen talked about this being a primary care party,’ he reflected. 'That’s been a really strong theme. There are so many exciting opportunities now to really get occupational therapy in front of so many more people.   

‘But [I’m] aware that continues to put strong pressures on our workforce and the struggles people are facing.   

‘It was great to see the response around the session on support workers and how we need to be more creative around how we use our workforce.’   

He added: ‘There’s so much innovation going on and our Innovation Hub can really support the development, dissemination and sharing of new ways of working across the profession, so that we can be really agile in our response to challenges.’  

He went on to say it was ‘fantastic’ to see the impact of people’s personal stories – and the encouragement we all get when we can identify with those stories. He went on to commend the primary care plenary session, and how powerful that sense of teamwork is.  

‘Wasn’t it brilliant to see the way OTs are working with university colleagues, students and GPs, and so many others, to really create change? That’s a real lesson and inspiration for us all.’  

He went on to talk about the journey RCOT is on. 'It’s all about delivery now,’ he exclaimed. ‘For me, personally, it has been fantastic and really inspiring to be part of last two days ... it just highlights what a fantastic privilege it is to do this role, but what a responsibility I have to lead an organisation that’s fitting for the work you all do.’  

Saying he wants to make RCOT the professional body ‘all members deserve’, that gives you the resources, support and encouragement that you need to carry out the ‘vital role’ you are doing.He focused on how we are trying to respond as an organisation ‘to what I think and what I hear you’re looking for.’ 

‘As an organisation we are on a journey,’ he told delegates. ‘The first stage was listening, then positioning, and now it’s all about delivery,’ he explained. ‘We do need to change and move forward if we really are to show the world the power of occupational therapy.’  

He added: ‘People were looking for a much more forward-looking organisation that shares and celebrates the powerful outcomes of occupational therapy, that’s giving that bold leadership, and is inclusive, welcoming and one that everybody feels that they belong.’  

Re-sharing RCOT’s vision, strategy and values, financial strategy and the new leadership structure, he said that we need to ‘reimagine’ what membership looks like.  

He concluded: ‘For me, the power of having our fantastic membership – and all your insights and experience – working with and being supported by an increasingly well resourced team that we have at RCOT – I think really does give us some fantastic opportunities for the future.  

‘I want the last voice to be with ClaireHedleyOT (@ClaireAHPed) who Tweeted: “This year at #RCOT2023 to me there is an absolute thread… we need to be brave, confident and take a risk. Show everyone with evidence and impact what OT can offer. So exciting!”.  

‘I think she’s right; that confidence comes because we’ve had two days together, that encouragement and support we all get. And that is the message I take away from conference this year; building that sense of community and constant connection that we have so we can all be increasingly confident and together show everyone the power of occupational therapy.’