Frances Leckie, editor of Independent Living, writes about using occupational therapy services, and getting the most from them. Frances is a “DH Guru” who’ll be sharing a monthly column on independent living!
Whether you are born with an impairment, or acquire it as a result of an accident or illness, anyone with a long-term condition will need the services of an Occupational Therapist (OT) at various stages of life. So what exactly do they do?
Going back to the fundamentals, if you consider the name of this health professional, you might be forgiven for thinking that an OT was only interested in the working environment and how people manage their employment. For some in the profession, this IS their area of specialisation, but many more are involved in other aspects daily of life – helping people to manage their conditions and live as independently as possible. What occupational therapists do have in common is a view of people as “occupational beings” who benefit from activity, so they try to support their clients to lead lives that are productive and fulfilling, enabling them as far as possible, to develop, recover or maintain skills for daily living.
Your first contact with OT services may well come about when a social worker, GP or hospital doctor suggests a needs assessment, so that you can access equipment, services, or housing adaptations, to make life easier or safer. And right from the outset, one of the major challenges with OT services is fragmentation. Not only are they divided geographically, but also between needs that are perceived to be “health”, and those which are designated as “social care”. This division inevitably comes about because traditionally, the NHS has picked up the tab for health needs, which are provided free at the point of use, whereas local authorities are responsible for social care, and charge for these according to the scale of need and ability to pay. For some time, people have been trying to find ways of providing a service that is more joined up, with initiatives such as the Joint Equipment Service, which provides a pool of lower cost aids which can be accessed by both health and social care OTs.
If you have a condition which entails ongoing significant healthcare needs, you may be eligible for NHS Continuing Healthcare, which means that the NHS will pay for your needs, wherever they are met – including in your own home. It is your local Clinical Commissioning Group (CCG) which will decide, following a full assessment of your needs, most likely by an occupational therapist. Even if you don’t qualify for NHS continuing healthcare, but you do have health care needs, the NHS may pay part of the cost: sometimes called a joint package of care.
Coming in April, there is the Better Care Fund – an initiative designed to focus resources (which have been taken from existing NHS and local authority budgets) on delivering better, more joined-up local services, to support people to live healthily at home, minimising long hospital stays, and reducing emergency admissions. How this will work in practice is hard to say: there is no central programme for the Better Care Fund, rather, the 151 local health and well-being boards have been charged with coming up with their own innovative local solutions – so that probably means 151 different ideas about the best way to manage things! It will be interesting to follow the progress of the scheme: certainly, it is a positive aspiration to provide more integrated care, and occupational therapists will most likely be in the front line, as usual.
This new development is, of course, in addition to the changes in OT services already wrought by the Health & Social Care Act, and those anticipated with the Care Act, which also comes into effect in April. So OT services are in a state of upheaval at the moment, which probably makes it more of a challenge than usual, both for the professionals working within the service, and for people trying to access them. How do you make sure that you get the best from OT services, under current circumstances? There has been considerable research undertaken which proves cost-savings on care packages, if appropriate equipment is provided. Equally, housing adaptations, making your environment more independently manageable, can save significantly on the need for personal support. With this in mind, it ought to be easier to obtain the equipment and adaptations that you need, but sadly, OT services are under budgetary pressures, just like every other aspect of health and social care, so you may well have to wait, weeks if not months – both for a needs assessment, and for provision of any recommended equipment. You may need to be quite persistent in requesting the support you are entitled to, and it is a good idea to get into the habit of keeping copies of correspondence and logging phone calls, so that you have an accurate record of your dealings, should you need it.
Increasingly, independent occupational therapists are providing services that would once have been the province of the NHS or local authority, as people find the wait too long, or want their own independent needs assessment to support their claim for equipment or adaptations. However you access their services, a well-informed OT should be up-to-date with the latest developments in assistive technology which may be of benefit to you, and should also be able to help with access to different sources of funding. For example, a Disabled Facilities Grant may be available if you need significant alterations to your home – something like an accessible shower facility, ceiling track hoist, or ramped access. The OT can advise about making your application, as well as assessing your needs in the first place. Equally, for some pieces of equipment, such as highly functional powerchairs, for which you would not get funding from the NHS, there may be charitable trusts that can help.
Some occupational therapists specialise in a particular area, for example seating assessments, to ensure that people get the right seating to provide postural support and minimise the risk of pressure damage. Ironically, this individual expertise creates an extra area of difficulty in providing OT services that are more integrated and straightforward to find your way through. How do you pull together disparate services and provide a clear pathway for users, while also making sure that you can offer specialised support when required? At what stage in the process should users be directed to an OT with particular expertise, rather than a more generalist practitioner? And who decides?
The first thing I learnt when I originally became involved with organisations providing products and services to help manage life with a disability is that occupational therapists are the ultimate gatekeepers. Whether they work in health or social care, public or private practice, highly specialised or more general, a good OT is your key to identifying and gaining access to the support you need to live your life well. The College of Occupational Therapists has a Code of Ethics and Professional Conduct, by which practitioners should abide, and OTs also come within the remit of the Health Professions Council, which maintains standards for healthcare professionals in the UK.
By Frances Leckie