Wales 2026: Five steps to a healthier nation

We’ve worked with our members to develop a Workforce Strategy action plan for Wales

Five steps to a healthier nation

Wales’ health and care system is under sustained pressure. Demand is rising, waiting lists remain too long and too many people are receiving care later than they should – in hospital, rather than earlier and closer to home.

Nearly 7,000 patient pathways have waited more than two years for treatment. While waiting lists are beginning to fall, pressure across primary and secondary care remains high, with services stretched, finances under strain and staff morale impacted.

Wales needs a different approach – one that shifts care closer to communities and prioritises prevention and early intervention. Occupational therapy is central to this shift.

Explore our five asks Download our full Wales manifesto

The power of occupational therapy in Wales

Occupations give life meaning, purpose and structure – but the impact of occupational therapy extends far beyond the individual. Supporting older people to remain at home reduces pressure and cost across the Welsh NHS and social care. Early support for children who have experienced trauma improves outcomes in the classroom, enabling teachers to teach and students to thrive. By taking a holistic view of people’s health, work and environments, occupational therapy supports people to return to employment, strengthening the wider Welsh economy.

We’re the Royal College of Occupational Therapists (RCOT), the professional body for occupational therapists in the UK. We represent more than 36,000 members across the UK, including nearly 2,000 in Wales.

We’ve worked with our members to develop a Workforce Strategy action plan for Wales. This sets out the current position of the occupational therapy workforce and identifies a clear gap between national policy ambition and the reality of service delivery. Closing this gap requires clear action to align the occupational therapy workforce with Wales’ long-term health, care and wellbeing priorities.

Read the impact stories

The next Welsh Government must:

1. Embed OTs in every cluster

Strengthen community-based and primary care services by embedding OTs in every cluster

What must the next Welsh Government do?

Double the number of occupational therapists working in primary care, ensuring every GP cluster has an embedded OT by 2030.

What action is needed?

Expand and invest in occupational therapists within primary care, community rehabilitation and reablement teams.
Strengthen community-based occupational therapy roles that prevent crises, reduce pressure on GP services and improve patient flow.
Protect and grow specialist services for babies, children, young people, adults and older people to ensure needs are met earlier and closer to home.
Ensure local authority and health board community OT teams are sustainably funded so support is available where it makes the greatest difference.

The issue

Occupational therapists have been increasingly embedded in GP clusters over the last decade, providing early intervention that reduces GP workload, prevents issues from escalating and avoids unnecessary hospital admissions. But provision remains inconsistent across Wales and in some areas, community OT roles in primary care have been reduced – limiting the impact OTs can have on prevention and patient flow.

Why this is vital for Wales

Earlier access to occupational therapy prevents crises, reduces pressure on GPs and hospitals and helps people stay independent at home.

This strengthens a primary care system focused on prevention and better use of limited resources.

2. Transform workforce planning

Build a complete and accurate picture of the OT workforce to transform workforce planning

What must the next Welsh Government do?

Ensure occupational therapists are consistently recorded across all settings and introduce safe staffing levels for key services.

What action is needed?

Continue the work of Health Education and Improvement Wales (HEIW) to ensure OTs are accurately recorded across the Welsh NHS, local authorities, social care and independent practice.
Introduce safe staffing levels for occupational therapy
Use robust workforce data to model population need and deploy OTs where they have the greatest impact.
Ensure a sustainable range of pre-registration occupational therapy programmes at Welsh universities.

The issue

Wales has nearly 2,500 occupational therapists working across the Welsh NHS, local government, social care and the independent sector. But inconsistent and incomplete workforce data makes it difficult to plan and deploy OTs where they deliver the greatest impact and there are also no minimum staffing levels for occupational therapy in key services, such as stroke rehabilitation.

Why this is vital for Wales

Accurate workforce data ensures occupational therapists are deployed where they make the biggest difference – improving planning, closing gaps in provision and supporting safer services.

Stronger workforce planning means earlier prevention and a workforce aligned to population need and use resources more effectively across Wales.

3 Prevention & early intervention first

3. Put prevention and early intervention at the heart of health and care

What must the next Welsh Government do?

Shift health and social care towards early support by expanding occupational therapy-led prevention across communities, primary care and education.

What action is needed?

Increase capacity in community occupational therapy teams to provide early, proactive support that builds skills, resilience and independence.
Embed occupational therapy in schools, primary care and community mental health services so needs are identified and addressed earlier.
Support health boards and local authorities to redesign pathways around prevention rather than crisis response.

The issue

Occupational therapists across Wales already deliver early intervention that prevents escalation, reduces repeat admissions and helps people stay at home longer, but provision varies widely and many services remain focused on crisis response rather than prevention.

Why this is vital for Wales

Early intervention prevents escalation, reduces admissions and helps people manage long-term conditions and build resilience in daily life.

4 End inconsistencies in provision

Ending inconsistencies in provision with long-term innovation and improvement funding

What must the next Welsh Government do?

Guarantee long-term funding for proven occupational therapy interventions, so effective services are sustained rather than lost when short-term programmes end.

What action is needed?

Commit to long-term funding for occupational therapy-led innovation and early intervention programmes that demonstrate improved outcomes.
Replace short-term grants with stable investment that enables services to scale, embed and deliver consistent population-level impact.
Support health boards and local authorities to retain skilled staff and maintain expertise by avoiding stop-start funding cycles.

The issue

Short-term funding models such as Regional Integration Funding (RIF) and cluster grants mean effective occupational therapy services often run for only 2-3 years before being disbanded, resulting in the loss of specialist expertise, community impact and proven benefits to hospital flow, despite allied health interventions delivering up to £34 return for every £1 invested.

Why this is vital for Wales

Long-term funding protects effective services, retains specialist expertise and gives people consistent support. Sustaining proven interventions improves outcomes and reduces avoidable hospital use.

5 Open leadership pathways

Open leadership pathways and remove barriers that exclude OTs from senior roles

What must the next Welsh Government do?

Ensure occupational therapists have fair access to senior leadership roles across health and social care, supported by clear development pathways and national leadership roles.

What action is needed?

Ensure OTs are not excluded from senior roles unless there is a clear clinical reason, particularly where the role involves occupational therapy services.
Develop and deliver a leadership programme specifically for occupational therapists to support progression into senior and strategic roles.
Immediately re-open recruitment for a Chief Allied Health Professions Officer (CAHPO) within Welsh Government.

The issue

Occupational therapists have the skills and expertise to lead services focused on prevention, person-centred care and improved patient flow. However, current barriers that limit access to strategic leadership roles mean Wales is missing system wide expertise essential for tackling health inequalities and addressing the social determinants of health – factors that directly affect quality of life and life expectancy.

Why this is vital for Wales

OT leadership ensures decisions are shaped by professionals who understand prevention, rehabilitation and person-centred care. This strengthens service design and supports Wales’ shift toward community-based, preventative care.

Download our full Wales Manifesto

Want the detail behind our five asks, impact stories and recommendations for strengthening occupational therapy across Wales?

Download our full Wales manifesto (PDF, 2.2MB)

The PDF is in English and Welsh.

Illustration of women reading book sat in armchair

Real OT impact across Wales

Occupational therapists are driving real change across Wales. These case studies show the difference timely OT makes – from restoring independence to easing pressure on services. Explore the stories to see the impact in practice.

Integrating community support in Carmarthenshire

Integrating community support to enable people to stay at home in Carmarthenshire

Challenge

Supporting people to stay independent at home helps reduce avoidable hospital admissions and leads to better long‑term outcomes. Too often, people faced delays or had to contact multiple services before getting the right help.

Approach

The Integrated Community Multidisciplinary Team (ICMDT) brings health, social care and voluntary sector professionals together in one place. By acting as a single point of access, the team makes it easier for people to get timely intermediate care, with practitioners discussing each referral directly and agreeing the next steps together.

Impact

The team’s shared approach means people receive faster, more coordinated support. Practitioners pool their knowledge, assess needs jointly and put tailored plans in place without duplication or delay. This joined‑up way of working extends into local hospitals and community services, strengthening continuity of care across the whole pathway.

Why it matters

When people receive the right support at the right time, they can stay independent for longer – easing pressure on acute services and reducing reliance on residential care. The ICMDT’s rapid response helps prevent crises, cuts demand on emergency services and improves people’s experience of care.

Empowering teachers and students in Neath Port Talbot

Challenge

Education authorities do not routinely have occupational therapists based within their services. This leaves teachers without the practical support they need when students struggle to fully take part in classroom activities.

Approach

Neath Port Talbot Local Education Authority set up an agreement with Swansea Bay University Health Board to bring OTs into primary and secondary schools. The OTs provide universal and targeted support – from group sessions to one‑to‑one advice – and provide practical training so teachers feel more confident addressing handwriting, sensory needs and coordination challenges.

Impact

OTs have delivered hundreds of advice clinics and trained thousands of staff across local schools. Teachers report a clearer understanding of the barriers students face and were able to confidently apply strategies in the classroom. Students benefit from quicker adjustments that help them take part, learn effectively and feel included..

Why it matters

When students can participate fully in school life, they develop confidence, creativity and stronger learning outcomes. Giving teachers easy access to OT expertise builds inclusive education environments and reduces the need for more intensive support later on.

Promoting proactive activity in Pembrokshire

Promoting proactive activity and embedding preventative intervention with Pembrokeshire's Primary Care Project

Challenge

People often couldn’t get specialist support they needed until they were already in crisis. This increased pressure on services and led to poorer outcomes for the individuals who needed help

Approach

The Health Board – working with the County Council, PAVs and Primary Care – strengthened upstream access to occupational therapy by proactively identifying people who were increasingly presenting at GP surgeries. By taking a holistic view of each person, their environment and their daily occupations, OTs provide practical self‑management tools that help individuals manage their conditions earlier and adopt preventative strategies that reduce the risk of future crises.

Impact

Early intervention and preventative OT support has reduced medication use, avoided hospital admissions, lowered repeat GP appointments and prevented referrals into community services. Reviews show strong results: 84% of people report improved function, 85% increased confidence and there has been a 71% reduction in return GP contacts. Importantly, 80% of those initially considered for hospital admission were safely diverted from hospital.

Why it matters

Investing in early intervention eases pressure on GP appointments and emergency departments. Falls and functional decline place significant demand on the system; proactive OT involvement helps people stay safe, well and independent, improving long‑term physical and mental health.

 Enhancing preventative care in Flintshire

Enhancing preventative care and empowering care home staff in Flintshire

Challenge

When care home residents are admitted to hospital, they face risks such as deconditioning, hospital‑acquired illness and complicated discharge – all of which affect their independence and wellbeing.

Approach

Flintshire reshaped how occupational therapy is delivered in care homes by focusing on early intervention and staff development. OTs work directly with care home teams to build skills and confidence, helping them recognise changes early and support residents to stay active, engaged and improve their quality of life.

Impact

On average, residents saw improved functional ability, with interventions slowing or reducing functional decline by 44% and in some cases by as much as 80%. Earlier action meant several residents didn’t reach crisis point, avoiding paramedic call‑outs and preventing hospital admission.

Why it matters

Around 35 to 45% of emergency admissions from care homes are avoidable. Preventing unnecessary hospital stays protects residents’ wellbeing and relieves pressure on local hospitals. The six‑month trial saved an estimated £115,000 – demonstrating the value of preventative care and skilled staff within care homes.

Right Support, Right Time: Unlocking the Power of Occupational Therapy

Timely occupational therapy prevents crises, reduces hospital admissions and tackles health inequalities. Our Right Support Right Time campaign calls for OT to be embedded in communities, schools, housing and workplaces – so people get help before problems escalate.

Join us and make change happen

Building Wales’ OT workforce for the future

A stronger occupational therapy workforce is essential to delivering the vision set out in our Welsh manifesto. Explore the Wales Workforce Strategy Action Plan to see the practical steps underway to support recruitment, retention and sustainable OT services across Wales.

Read the Wales Action Plan