Occupational Therapy News OTnews July 2019 | Page 24

PROFILE PROFESSOR KEITH WILLETT
Autonomy, culture
change and the long view
What is the future role for occupational therapists in emergency care and
rehabilitation? Professor Keith Willett, NHS England’s director for acute care,
tells Andrew Mickel about where he sees the profession’s future possibilities
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Professor Keith Willett
24 OTnews July 2019
rofessor Keith Willett knows more than a
thing or two about rehabilitation. In 1994, he
pioneered seven-day working in trauma care
at Oxford’s John Radcliffe Hospital, ensuring
patients would not encounter delays in their care
when they most needed it.
As the Department of Health’s first national clinical
director for trauma care from 2009 to 2012, he
established the regional trauma networks and major
trauma centres, including the rollout of rehabilitation
prescriptions that ensured patients would have a plan of
action within 48 hours.
And in his current role as NHS England’s director
for acute care, he has national medical oversight of
everything from ambulances to accident and emergency
(A&E) and maternity to national major incidents.
‘I have spent my 40 years in the NHS recognising
rehabilitation and trying to improve it,’ he says. ‘But it’s
unfortunately always been very difficult to get it as high
on the agenda as it would be ideally placed.
‘Back when we were putting together the major
trauma networks and centres in England, for every
meeting at national and regional level, we reversed the
order so that rehab was always the first workstream on
the agenda.
‘That meant people focused on rehabilitation as it
was the final outcome for the patient – and that framed
what we were doing with the ambulance service, in
resuscitation or in critical care.’
Taking that long view of what is the right care of the
patient means it’s little surprise how he has come to
champion allied health professionals.
‘I’ve always been a strong support of allied health,’
he says. ‘If you look back at how I set up the trauma
service in Oxford in 1994, we built facilities specifically
for the occupational therapists on the trauma unit.
‘We went to seven-day services which at the time
was seen as very radical, but we worked out that
patients who were not getting that support over the
weekend, and that had a more than compounding effect
on their stay in hospital.
‘Allied health professionals and occupational
therapists in particular have a role in the passage of
patients through the systems for better outcomes.
But they also have that potential, which I think is still
underutilised in the health service, in terms of the wider
autonomous role.’
A more autonomous future?
What happened in 1994 frames his view of what could
happen now; the word autonomy comes up time
and again on how he thinks occupational therapists
can flourish in the health system of 2019, reflecting its
inclusion in the NHS’s Interim People Plan.
‘When we look at the acute care sector, there are
numerous points of contact in a patient’s pathway
which really do not require a medical decision,’ he says.
‘They are very much in the domain and the appropriate
skill set, responsibility and capability of allied health
professionals like occupational therapists.
‘There’s an awful lot happening at the community/
hospital interface, which I know is where occupational
therapists do a lot of their work – and I think there’s a lot
more that could be autonomous.’
That includes services such as falls response
ambulances. On a visit organised by RCOT, Keith
visited the East Lancs falls response service, where a
paramedic and an occupational therapist work together
to see people in their own homes to see what solutions
can prevent hospital admissions – both at that point in
time and in the future.
He says: ‘I watched them turn around what was
a struggling home circumstance for a patient whose
condition had deteriorated to the point that the husband
wasn’t coping. There was enormous anxiety there, and
that would have resulted in multiple calls to 999 over the
coming months that no doubt would have resulted in
numerous inappropriate admissions to hospital, because
actually what the patient needed was an assessment
in their home environment – the last thing they needed
was to be put in that sterile, false environment of a
hospital.
‘Looking at the provision that was needed, seeing
what support was needed for the husband and
turning what was an imminently catastrophic situation
something that was really positive: that’s massive.