Why we need to change
Where occupational therapy is today
The occupational therapy profession is experiencing a crisis. Parts of the south east of England and London are reporting up to 40% vacancy rates and higher in specific services.
This is down to a wide range of factors, including fewer recently registered occupational therapists choosing to work in the NHS beyond two years, and a widening of opportunities putting pressure on the existing occupational therapy workforce.
The shortage of affordable housing and the rising cost of living makes it challenging to recruit, not only in cities, but in rural and coastal areas, particularly in community services where a car is essential.
Funding mismatch
Health and care policies are already in place to move towards preventative, personalised delivery supporting people to avoid long-term conditions or to live well with existing health conditions or disabilities.
Occupational therapy’s focus on what matters to the person, and what they want and need to do, is a good fit for this public health approach, but current funding continues to be spent disproportionately on hospitals and crisis care.
A sizeable number of the workforce are based in services and in roles where they’re not using their occupational therapy expertise but are filling gaps to meet demands within services.
This leads to dissatisfaction, eroding of professional identity and confidence. Too many newly registered occupational therapists are employed in environments where they’re not able to apply their full scope of learning and practice, creating a disadvantage to the people they work with.
The UK has approximately six occupational therapists per 10,000 head of population. Annual growth of the profession has typically been at around 2% but governments now recognise that this doesn’t meet population and service need. For example, the Welsh Government has increased the number of commissioned pre-registration places by 10% for 23/24 and Northern Ireland has seen a 15% increase.
Commissioning of the workforce is based on numbers for the NHS, although other sectors such as social care are vital to key NHS activity and in tackling the social determinants of health that impact on society and productivity. Current solutions, such as recruiting internationally, are not sustainable in the long term. While return to practice initiatives only result in small numbers (for example 117 between 2017–2019).
Assistant practitioners, pre-registration apprenticeships, a wider range of pre-registration routes to registration and widening career pathways are starting to extend our pipeline, but this is only in England. The number of learners undertaking pre-registered occupational therapy programmes from previously under-represented backgrounds has risen to 25% but are not yet reflected across career levels.
Education and training are vital for securing a future workforce and for retaining and maximising the confidence and capability of the existing workforce. Educator capacity in higher education institutes, and across occupational therapy practice, is struggling to meet demand.
Data gaps and the need for research
There is also significant variation in occupational therapy representation and leadership at a systems level. This can result in gaps in understanding how and where occupational therapy can have the most impact. This is further compounded by limited UK-wide data on occupational therapy workforce numbers, and their positioning and spread across sectors.
We need more accurate recording of occupational therapy workforce data across education, social care, the private and voluntary sector, as well as in the NHS, to understand numbers and skills mix needed within hospitals and the numbers required to move to community services.
Allocation of resources and recommendations for evidence-based practice is hampered by the lack of research and real-world impact evidence for many areas of occupational therapy.
There isn’t a consistent culture of support and opportunities for research, learning and innovation at every level. Although many occupational therapy practitioners are problem solving and driving change within their organisations, practice is not being adequately captured, reported, and built upon.
How the UK will look in 2035
Improving population health and wellbeing is vital to the health and economic sustainability of the UK.
By 2035 the UK population is projected to be 70 million, with two-thirds of adults aged over 65 living with multiple health conditions. This means that life expectancy will increase by three years, but healthy working life expectancy will be shorter. Without proactively improving how we manage our health, policies and initiatives to extend working lives are likely to fail.
We’ll still be seeing health inequalities. People living in more deprived areas will continue to have shorter lives and spend more time living with ill health, with people of Pakistani, Bangladeshi and Black Caribbean ethnic backgrounds most affected.
Inequalities in health start at an early age, with higher rates of mental health conditions and chronic pain developing as early as the late teens.
Substandard homes and the digital divide
We will need over four million extra homes by 2035 and the UK government’s target of building 300,000 a year has yet to be realised. Much of our existing housing stock is old, with four million people living in substandard accommodation and more than half of homes not meeting energy efficiency rating C or above.
Living in housing that is poorly insulated increases the risk of a range of preventable health conditions, such as respiratory and cardiovascular diseases.
The UK will be affected by global changes in climate and competition for resources, by migration and changes to the economic order, including technological transformation.
With the advance of Artificial Intelligence (AI) and digital technology, the impact on education, employment and our daily lives will be significant. AI and digital technology are seen by governments as part of the solution to meeting health and care needs.
Technology enabled care is already providing telecare, telehealth and telecoaching but further application of this technology is potentially restricted by the limitations in digital capability within the current workforce. And while digital inclusion is increasing, people with physical and learning disabilities, or mental health conditions, are disproportionately affected by the digital divide.
By 2035, the older population will be more digitally literate but without targeted intervention, that divide may still be present for people with lower incomes and people living with disabilities.
Multiple needs and occupational therapy as a solution
We can therefore assume the number of people with multiple, complex health, housing and social needs will increase, within a society adapting to rapid global change and evolving technology.
We will need to improve access to advice and expertise to make sure people can continue to contribute to society and fulfil their roles and responsibilities while managing their health and wellbeing. That combined expertise already exists in a registered health and care profession – occupational therapy.
Empowering people to live well
Occupational therapists work with people to improve their performance and ability to take part in occupations. They consider if the environment (for example home, work or school, social and familial) supports taking part in those occupations or hinders and needs adjustments, either modifications, strategies or technology.
Focusing on occupation leads to improvements in people’s ability to do the things they need and want to do, their social relationships, communication and connections as well as mobility, mood, rest and sleep. These are the vital elements that allow people to live well, be productive, feel connected and belong.
Going forward, occupational therapy has a vital role to play and should be included in the strategic planning and allocation of resources to manage health, education, housing and care needs across the UK.