APPENDIX 15
Memorandum submitted by the College of
Occupational Therapists (EDP 22)
1. INTRODUCTION
1.1 The College of Occupational Therapists
(COT) is pleased to provide a written submission, as occupational
therapists are key members of the NHS and Social Care Services
concerned with enabling disabled people to continue playing valued
roles and responsibilities within society.
1.2 The COT represents over 23,000 occupational
therapists that are either working or studying across the United
Kingdom. The College also supports a number of support workers
who are known as associate members. This response has been a joint
collaboration with the executive committee of Occupational Therapy
in Work Practice and Productivity (OTWPP) a Specialist Section
of the College of Occupational Therapists. Members of OTWPP work
with individuals to gain a meaningful role through engagement
in work based occupations and assisting in the access or return
to work to employment of injured or disabled clients.
1.3 Occupational therapists are regulated
by the Health Professions Council, and work with individuals of
all ages with a wide range of occupational problems resulting
from physical, mental, social or developmental difficulties. Occupational
therapists (OTs) work in the NHS, Local Authority Social Services
and Housing Departments, schools, primary care settings and a
wide range of vocational and employment rehabilitation services
including voluntary and private sector Job Broker schemes working
with insurance companies. The philosophy of occupational therapy
is founded on the concept of occupation as a crucial element of
health and well being.
2. BACKGROUND
ON THE
CHANGING NATURE
OF REHABILITATION
SERVICES
2.1 With the focus of NHS medical care and
discharge now being on "medically stable", not necessarily
on "able" has countered the benefits of rehabilitation,
which is the purpose of occupational therapy. Occupational therapy
within acute health care settings is focused largely on facilitating
discharge, participating in a range of intermediate care services
now being developed in the community. These are often seen as
"proxy" for rehabilitation with services often dominated
by needs of older people, despite policy direction that services
should also to be extended to working age adults. These changes
are happening at a time of significant unemployment, compounded
by a lack of political focus on the rights of disabled people
to return to or retain employment, has lead to a fragmentation
of services and a lowering of expectations of those with disabilities
in regard to employment. These infrastructural changes do not
necessarily facilitate social inclusion and independence, both
of which are fundamental to the philosophy of Occupational Therapy.
2.2 The NHS Plan focuses on older people
and children; adults of working age are conspicuously absent and
therefore likely to continue to be neglected by strategic planners
in NHS, and to some extent also social care. This has had a profoundly
undermining and restrictive affect on occupational therapists'
practice, with a marginalisation of the holistic rehabilitation
work that they are trained to deliver. There is evidence that
parts of the NHS do not see vocational rehabilitation as their
business and services are being cut. For example: within Surrey
Oaklands NHS Trust, a Beacon site recognised for its work in vocational
rehabilitation, the work projects collectively known as Priority
Enterprises are being disengaged from the Trust as they are no
longer seen to be conducive to the core function of a health care
provider. The future is uncertain as they fall between departments,
the NHS, Social Services and the Department for Work and Pensions
(DWP) and their funding comes from various insecure sources and
European incentives. The lack of a lead agency is a fundamental
problem which we would wish to be redressed in the future.
2.3 There is a range of ways in which assistance
for return to work and re-skilling schemes are delivered. These
are often based on local commissioning arrangements with varied
funding streams. This has led to services being uncoordinated,
fragmented plus lack of stability and sustainability. Time limits
and funding restrictions hinder the development of cohesive and
sustainable services very difficult. Professionals waste their
time bidding for funding, to secure service continuity. This has
had a negative effect on staff, in recruitment and retention,
training and development issues and service delivery. It also
gives a message to service users of their lack of importance when
services are discontinued or disjointed, due to lack of resources.
2.4 Occupational therapists have a track
record of collaborating with the employment service to develop
innovative services. eg In Jersey this tendency within the disability
section of the Employment Service has been recognised and occupational
therapists regularly support employment staff in placing perceived
difficult clients. In addition, to overcome these gaps occupational
therapists working with learning disabled people and those with
mental health problems, have developed employment services themselves.
They work with employers directly to place clients who would be
seen as unemployable by the Employment Service staff.
3. THE COLLEGE
OF OCCUPATIONAL
THERAPISTS VIEW
OF CURRENT
ENVIRONMENT
3.1 As occupational therapists we support
The Green Paper "Helping people into Employment" especially
the focus on capability not incapacity. This is in line with our
main philosophy and it is welcome to see a focus on ability once
more. It is not clear who will take ultimate responsibility for
service developments nor does it give details of the process by
which they will be delivered. In absence of this there could be
fragmentation and uncertainty around service development and delivery.
Funding problems could arise and good services will not be possible
to replicate in other areas due to authority issues. There is
also a lack of focus on the role and responsibilities of the employer
and the part they will play in the recruitment and retention of
staff. The paper focuses on disabled peoples access to work but
fails to when employees become vulnerable and how they could be
supported to prevent job loss.
3.2 The College of Occupational Therapists
fully endorses the spirit behind Joint Investment Plans, and "Welfare
to Work". unfortunately there is little evidence that these
policies have lead to substantial change. However the need for
inter-agency planning and collaboration is vital.
3.3 Jobcentre Plus has not rolled out to
most job centers. It is still a lottery whether or not a person
will receive the help and guidance they require to get back to
work. There is an assumption that everyone can progress to full
employment. Workstep also endorses this view and does not allow
for those who need some support/sheltering to remain at work.
For some disabled people, there are other valid outcomes such
as part-time work, or voluntary work.
3.4 Lessons learnt form the New Deal for
Disabled People have only further identified the gap between health,
social care and employment services. In Avon and Wiltshire a joint
pilot scheme between the Employment Service and Occupational Therapy
was established and a project report produced. This demonstrated
the value of joint working, especially with more complex cases.
This practice could and should be extended to other Job Center
Plus sites.
3.5 Occupational therapy skills lie in assisting
those with complex needs to identify their work needs and helping
service users to achieve their goal taking into account the residual
effects of illness and disability. Occupational therapists through
this practice promote social inclusion and participation within
the workplace.
3.6 Work rehabilitation is a complex area
for users and services due to the number of different types of
agencies involved and the need for some type of coordinator role
is evident. Given the diversity of needs, a spectrum of services
should be available to enable individuals to progress or return
to employment.
3.7 Early intervention to maximize the possibility
of success and prevention of the individual being trapped in a
long term culture of dependency is essential.
3.8 The Disability Discrimination Act is
seen as a positive move, however, more time is needed to evaluate
its effectiveness in terms of assisting disabled people back into
employment. There remain a number of misconceptions such as: all
disabled people are in wheelchairs; costs are high to make reasonable
adjustments (experience has proved that this is not the case);
plus the stigma that continually surrounds people with mental
health problems. Ignorance and fear still create barriers and
education plus training for employers is required to remedy these
concerns. In other countries disability law has led to the introduction
of further legislation regarding workplace rehabilitation.
4. CONSIDERATIONS
FOR THE
SELECT COMMITTEE
4.1 There is a critical need for clear strategic
direction from Government. This should set out the respective
roles of the NHS, education, employment services and local authority
social services in relation to the employment rights of disabled
people.
4.2 There needs to be a recognition that
a core function of the NHS is helping people achieve, regain or
retain normal roles in life as part of their continuing health
care. Rehabilitation should be focused on more than recuperation
but also to returning people to work or other forms of occupation.
4.3 The shift towards workplace based rehabilitation
programmes in Australia evolved following legislation, that shifted
the focus from compensation to rehabilitation of the injured person.
There is evidence to suggest that outcomes from these programmes
(often delivered by Allied Health Professionals) demonstrated
an above average return to work. Making return to work and work
retention an employer responsibility has been effective in Australia.
The UK could learn a lot from their system. It is also worth noting
that occupational therapy work practice in Canada, America and
Scandinavia demonstrates the potential of occupational therapy
within the workplace.
4.4 Urgent work needs to be done. The information
to inform a future approach can be achieved through a mapping
exercise to establish which services are currently in operation
and where they might fit and develop. A national profile for what
a satisfactory range of provider services might look like for
different client needs should also be established. All services
should be underpinned by national standards and good practice
guidelines, on the quality of service to be delivered by (approved)
providers. Benchmark standards should be set, against which approved
providers can be evaluated to ensure consistency and quality of
service eg: in Australia whether you live in a suburb of Sydney
or a sheep farm in the outback you will receive exactly the same
level and quality of service in regard to vocational rehabilitation.
This is due in the main to the method in which services are delivered,
the professional qualifications of those employed in the service
and the fact that a lead agency exists and funding is secure.
4.5 Investment is required to identify and
address the significant gaps across all agencies, including the
Department of Work and Pensions (DWP), to overturn deficiencies
and erosion in employment rehabilitation services and ensure people
are given appropriate individual assistance when they require
it.
4.6 There needs to be a clear signal given
to Allied Health Professionals (AHPs) that their knowledge and
core skills are recognised and that they are seen to be important
to this process. It is vital that occupational therapists are
used within new service developments.
4.7 The green paper is an important starting
point and will form a foundation for action and evaluation.
5. WHAT OCCUPATIONAL
THERAPY CAN
OFFER?
5.1 The Select Committee enquiry is important
to the College of Occupational Therapists as it focuses on many
issues close to the practice of the professional body. As seen
in examples given in Appendix one, occupational therapists have
traditionally been at the forefront of vocational rehabilitation,
health and safety and employment matters and continue, despite
the difficulties outlined. With their focus on independence, social
inclusion and functional ability, occupational therapists are
well placed to provide a critical interface with the Department
for Work and Pensions (DWP) in the assessing and advising on capability
to work.
5.2 It is important that we learn from good
practice and especially service users perspectives, to further
develop services within the UK. This knowledge and experience
is vital to the development and delivery of employment services
and is a valuable resource.
5.3 The College of Occupational Therapists
is keen to play its part in leading change. The College is committed
to the importance of occupation but needs a signal from Government
that they are in agreement with this and support a proactive and
radical approach to establishing effective services for disabled
people in regard to employment. This must include a commitment
to developing an infrastructure through which research can be
undertaken; personnel trained; services delivered; service users
have a voice to state their needs and preferences; employers and
business are able to recruit the best people for their vacancies;
and that there is a sustainable foundation to the proposals based
on long term commitment to altering the social culture around
disability and inclusion.
5.4 In conclusion the College of Occupational
Therapists would request the opportunity to provide oral evidence
to the Select Committee. Evidence related to this submission is
either referenced below or attached. [17]
Sheelagh Richards
Chief Executive
Maya Hammarsal
Chairperson OTWPP
15 January 2003
17 Not printed. Back
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