This time last year the College was dashing around the UK launching our reports: Reducing the pressure on hospitals at the national parliaments and assemblies. The reports highlighted the value of occupational therapy in preventing vulnerable groups (frail, older people and people living with long-term conditions) from being unnecessarily admitted into hospital and the profession’s role in successfully returning people home following admission.
With this winter fast approaching, has the College’s call to deploy occupational therapists to achieve optimum patient flow through hospital services made any difference? 12 months on from the launch, we contacted the services featured in our reports to find out.
To reduce the number of admissions into hospital we recommended partnership working between paramedic and occupational therapy services. East Lancashire Hospitals NHS Trust’s Falls Response Service (featured in the report and on television) now runs a 7 day a week service. Highlighting their model has led to the development of other services, with occupational therapists responding to 111 or 999 calls alongside paramedics. The Early Intervention Vehicle (EIV) in Norfolk Community Health and Care NHS Trust, following a successful pilot, is now preventing 75% of patients from coming into hospital and the service has been commissioned more widely across Norfolk.
Occupational therapists are increasingly embedded within multi-disciplinary rapid response, acute and emergency care teams. Out of 239 emergency departments in England, only 30 do not have occupational therapists based in their teams. Occupational therapists are offering wider cover across the week and extended hours. The Rapid Response Service at the Royal Free London NHS Foundation Trust now runs 7 days a week, with extended evening hours. The team is achieving a 58% admission avoidance rate after 5pm. Whilst in Plymouth, the Livewell South West Service, Community Crisis Response Team offers alternatives to hospital admission 7 days a week, as does the Acute Care at Home service in the Southern Health and Social Care Trust in Northern Ireland.
Another key call from the College was to foster leadership within the profession, recommending therapy led initiatives and services to achieve successful discharge for people with complex healthcare needs. The Royal Marsden Hospital has been running a Frailty Project and within the project occupational therapists carried out pre-operative assessments of patients who were scheduled to undergo surgery for their cancer treatment. The occupational therapists were able to correctly predict level and type of need for support 91% of the time. This allowed for referral and support to be put in place prior to the operation, leading to a timely discharge and smoother transition home.
In Cwm Taf University Health Board, the mental health liaison occupational therapists’ assessments enable the multi-disciplinary team to identify needs and to provide recommendations for discharge. People are offered the most appropriate service to meet their needs and hospital length of stay has been reduced on average by 3 days. The occupational therapists also provide education and training to the wider multidisciplinary team and the service is being replicated across Wales.
In NHS Grampian the consultant occupational therapist continues to provide clinical leadership on both stroke rehabilitation units and is now the lead for the Stroke Managed Clinical Network in Grampian.
12 months on, the College is asking occupational therapy leads to review where the occupational therapy workforce currently sits within a typical patient journey. Could they have more impact based at different entry points? Where are they best placed to prevent admissions? Are there roles occupational therapists should take to make the most of applying our skills set, for example: managing rehabilitation units, acting as discharge co-ordinators? Within the College we are considering what we can do to foster confidence and leadership to support our members to take up these positions.
To commissioners and providers, our ‘ask’ is that they give lead occupational therapists support to think more widely, so they can consider the pinch points within services and how occupational therapists could be deployed to find solutions.
RCOT has produced 12 months on update leaflet which will be available on our campaign website in late November.
Comments or feedback?
If you have any comments or feedback on any of the questions raised in this article, then we would love to hear from you. You can drop us an email on ILSM@rcot.co.uk or you can contact Karin on Twitter @KarinOrmanOT