Scotland 2026: Six steps to a healthier nation

1. Refocus resources to strengthen community-based teams

What must the next government do?

Ensure community occupational therapy teams delivering prevention and early intervention are fully resourced. 

What action is needed?  

• Expand and invest in occupational therapists in primary care, community rehabilitation and reablement teams including the Home First Agenda and Hospital at Home teams.
• Protect and strengthen children and young people's specialist services – including Children and Adolescent Mental Health Services (CAMHS) – to support the future population to flourish.
• Ensure local authority occupational therapy teams are funded and supported, with support from the National Social Work Partnership.

What must the next government do?  

Build a sustainable workforce from the ground up to meet the needs of our communities. This includes expanding routes into the profession – including developing apprenticeship programmes. And provide equitable support for learners, so the workforce is supported, resilient and fit for the future.

What action is needed?  

• Develop graduate apprenticeship programmes for occupational therapy.
• Provide financial support to our learners, ensuring equity with nursing and paramedicine learners.
• Ensure parity of pay and conditions across NHS and Local Authority settings. 

To meet Scotland’s future needs, we need to grow the occupational therapy workforce from the ground up. Starting with inspiring school leavers, investing in learners and creating clear, supported routes into the profession including developing graduate apprenticeship programmes.  

Occupational therapy must be open to people from all backgrounds. This includes supporting learners in remote and rural communities to access education, placements and career development, and tackling barriers such as travel, delivery routes and costs that can make learning harder. 

But it’s not just about numbers. Occupational therapists need fair access to career development and leadership opportunities. Allied Health Professionals should have equal access to advanced clinical roles, specialist posts and leadership positions across NHS and local authority settings. Pre-registration occupational therapy students should also receive fair bursary support, in line with nursing and paramedicine, so the profession is open to everyone. 

We also need to close the gap between NHS and local authority roles. Differences in pay and progression currently limit opportunities for occupational therapists in local authorities, drawing people away from vital early intervention and prevention roles. 

By investing in people now, we can build a strong, sustainable workforce for the future and make sure occupational therapy can meet Scotland’s growing needs and deliver everyday breakthroughs for communities. 

Why this is vital for Scotland

A stronger, more diverse workforce ready to meeting Scotland's growing health and care needs.

What must the next government do?  

Create national workforce planning tools based on population needs, backed by targeted investment in recruitment, retention and training. This will secure a strong pipeline of occupational therapists for today and tomorrow.  

What action is needed?  

• Collect workforce data consistently across NHS and local authority services at a national level and make it accessible for workforce planning.
• Develop a professional judgement tool to guide safe staffing levels in line with other health professions.
• Set minimum staffing requirements based on population need. 

Scotland needs a clear, coordinated plan to make sure we have enough occupational therapists now and in the future. That means using population data to spot where support is needed most and matching this with the right number of trained professionals. 

For that, we need to invest in recruitment, retention and training.  

What must the next government do?  

Enable occupational therapists to develop new ideas, build the evidence base and improve outcomes for people and communities. 

What action is needed?  

• Fund occupational therapists to undertake research.
• Ensure protected time for occupational therapists across NHS Boards and local authorities to be involved in and undertake research and innovation projects.
• Strengthen the partnership between NHS and local authority workforce, universities and research institutions to allow them to grow the evidence base. 

Occupational therapists are committed to improving care and making services better for everyone, but they need the right support to turn ideas into action. Limited time, funding and opportunities to share learning can hold back research and innovation.  

By giving occupational therapists the time, resources and support they need, we empower them to lead research and drive innovation. This enables them to share new ideas across health and social care, build on proven approaches and strengthen services. The result is better outcomes and life-changing breakthroughs that people rely on every day. 

Why this is vital for Scotland

Evidence-based breakthroughs make services better and improve lives across Scotland.

What must the next government do?  

Help the workforce adapt and respond to climate and sustainability challenges, so services remain resilient and future ready.  

What action is needed?  

• Take a ‘digital first’ approach wherever possible to reduce travel and save green miles (including NHS Near Me).
• Build environmental literacy across the workforce to support greener ways of working.
• Embed a ‘Reduce, Reuse, Reprocess, Renew, Recycle’ approach in organisational operations. 

The climate and sustainability crisis is one of the biggest challenges facing our communities and health services. Occupational therapists need support to adapt their practice and help people live healthier, more resilient lives.  

The next Scottish Government must provide training, guidance and resources on sustainable approaches in health and social care. To do this, health and care services need to be supported to reduce waste, promoting energy-efficient solutions and making smarter choices about equipment – so we avoid low-cost items that wear out quickly. 

Sustainability should shape the future of housing adaptations. A more flexible approach can unlock properties that were previously overlooked, especially when housing stock is limited. By equipping occupational therapists to lead on these changes, we can protect the environment while continuing to deliver high-quality care. 

Why this is vital for Scotland

Greener, more resilient services protect the environment and support healthier communities.

Challenge 

Many people leaving hospital or experiencing a crisis need short-term, targeted support to rebuild independence and avoid long-term packages of care.

Approach

A dedicated Reablement OT service within the Care Services Assessment Team provides intensive, short-term intervention across three localities. OTs work with homecare managers and trained care teams to set goals, deliver functional rehab (mobility, personal care practice, equipment provision) and support positive risk-taking that restores confidence.

2. NHS Lothian wholeschool OT reduces waiting lists and builds capacity 

Challenge

A school in an area of high deprivation faced long OT waiting lists and growing needs, impacting classroom participation and home routines. 

Approach 

OTs engaged school leadership for a strategic reset and embedded practical, universal supports across classrooms. This included wholeschool training on classroombased strategies to increase learner engagement and the codesign of environmental adaptations with learners, parents and staff. Updated resources were also provided to ensure new staff could continue the approach consistently. 

Impact 

OT requests dropped sharply from 20 to three in 2022/23 and have remained low since (six in 2023/24 and three in 2024/25). Staff, parents and learners reported better alertness, calmer behaviour and improved readiness to learn. The model is now being rolled out to other schools, creating capacity for targeted OT where it’s most needed.

Why it matters 

Placing OT expertise upstream in communities and schools prevents issues from escalating, reduces waiting lists and builds sustainable capacity by upskilling the people closest to learners. 

Employees with emerging health concerns risked deteriorating to sickness absence, with personal, employer and system impacts. 

Approach 

The service provides rapid access vocational rehabilitation, enrolling most employees within days. Interventions focus on job retention: pragmatic workplace adjustments, graded activity, symptom management and liaison with managers to keep people safely in work. 

Impact 

Over five weeks, the pilot saved 1,100 bed days – around £300,000 savings. Projected across a year: 11,440 bed days could be saved, 9% of unscheduled inpatient bed days for people 65 and over, equating to roughly £3.1 million in savings. Recruitment is underway to make this a permanent role. 

Why it matters 

Robust data and proven outcomes enable smarter decisions: targeted investment in preventative, work-focused OT keeps people in employment, reduces sickness absence and supports fairer, healthier communities. 

Unnecessary admissions and extended stays increase bed pressure, particularly for people aged 65 and over, when functional needs could be met safely at home. 

Approach 

A five-week pilot (March–April 2025) implemented functional criteria for discharge in the emergency department. OT and physiotherapy led needs-based assessments and enabled discharge with proportionate care at home. 

Impact 

Over five weeks, the pilot saved 1,100 bed days – around £300,000 avoided costs. Projected across a year: 11,440 bed days could be saved, 9% of unscheduled inpatient bed days for people 65 and over, equating to roughly £3.1m in avoided costs. Recruitment is underway to make this a permanent role. 

Why it matters 

Therapy led discharge moves support closer to home, prevents avoidable admissions and uses clear data to make the case for sustainable service change.