Occupational Therapy News OTnews July 2019 | Page 25

PROFESSOR KEITH WILLETT PROFILE
‘This is where I think the occupational therapy profession can
cross over to that more autonomous role – we can go far, far further
and far, far quicker.’
Making the case for occupational therapy services
That autonomy will be something lots of occupational therapists
will be champing at the bit to have – but there has been the
longstanding problem that it is very difficult to secure investment in
such preventative services.
Many commissioners just won’t fund services that save difficult-
to-count sums downstream, particularly if it is other organisations
that would be saving the cash.
However, Keith thinks that occupational therapists could now
be pushing at a more open door to change as previously separate
budgets are brought together.
‘Historically, allied health has been seen as one of the areas that
you can cut without being seen to cut the front line when that has
been necessary financially – and that has been a mistake,’ he says.
‘Obviously the down the line costs are greater for sure. I also think
the payment model and the way budgets and commissioning has
been in recent times has worked against integrated services.
‘We’re seeing a really significant shift in the NHS in the way
we’re commissioning services. We’ve seen sustainability and
transformation partnerships form, we’ve seen integrated care
systems develop; when they are all in the same pot and say ‘what
is the right way to commission a pathway for patients’, you can see
that you would want to go about that a different way.
‘I think we need therefore to break out of the traditional team
models that we’ve had, and I think occupational therapy is one of
the professional groups that can really step forward into that space.’
That could help resolve another recurring problem for
occupational therapists in the current health system. Some have
found seven-day working has brought limited benefits as social care
partners don’t work at evenings and weekends. But Keith thinks that
the current realignments in the healthcare system will flush out such
problems and make it easier to change them for the better.
Culture change
So autonomous working could hold great promise for occupational
therapists – but that will only happen if managers make the case.
‘That’s going to change a bit of a mindset in the profession,
because you will be looking for people who will be willing to step
up and carry responsibility and not have the backup or medical
oversight for things that professionally they are more than able to
accountable for,’ says Keith. ‘Historically, we’ve restricted that and I
think that’s been a mistake. ‘
So there is room for occupational therapists to bring their
preventative, money-saving, patient outcome-boosting services to
the fore. But don’t necessarily expect this change to come from the
national level.
Keith is keen to note that there is no single design that needs
deploying everywhere – and occupational therapists are going to
have to make that case in their own area.
‘The individual designs have to be quite local,’ he says. ‘You will
often find strengths and weaknesses at different points in a pathway.
Sometimes an intervention you do in one part of the pathway can be
an absolute no-brainer on paper, but in practice it doesn’t have the
impact you expected. Then it gets taken down or decommissioned
and you think, why didn’t that work? Because it has to be part of the
whole pathway change.
‘Sometimes if the community occupational therapy service and
a rapid response team is running well, then maybe an occupational
therapy service in A&E has far less impact than you would expect.
It’s about working out what your pathway looks like and what the
right level is for putting an occupational therapist in there.’
Keith speaks of a ‘compounding effect’ of building pathways
that work, integrating all these possible changed elements such
as falls response teams, front-door teams at A&E and integrated
orthogeriatric teams to help people return home from hospital safely.
Those examples are already in action around the country, although
no single system has pulled them all together yet.
But that sense of a new system taking shape is perhaps the
clearest message on the future of occupational therapists in acute
care: make your case now to really make an impact.
‘That’s a culture change that needs to come, and I think it would
be great if the occupational therapists drove that,’ he says. ‘And that
needs to be quite quick. These windows open once every decade,
probably, for professional groups to really take up a challenge. It’s all
there – the latent energy and latent enthusiasm, and there are some
great pioneering examples. My challenge to occupational therapists
would be to get sorted and step into that space.’
Brexit
Professor Willett also carries the heavyweight title of NHS EU
Exit strategic commander. So what planning is there around
Brexit for two key occupational therapist areas: equipment
and the workforce?
He hopes Brexit won’t impact on occupational therapist’s
access to all-important activities of daily living (ADL)
equipment, with manufacturers planning to carry buffer
stocks. Stockpiling equipment locally ‘is the worst thing
people could do’, he says.
All NHS equipment, including ADL equipment, are covered
by the same high-profile plans to bring medicines to the UK
by cross-channel ferry if other plans fail, so he says their
supply should not be interrupted.
He is also hoping there is a ‘silver lining’ that could come
from current planning for potential NHS workforce shortfalls if
EU nationals leave. ’Passporting’ staff from one organisation
to another, allowing them to carry certain checks and training
over without starting from scratch, could become possible.
‘Occupational health records, DBS checks and mandatory
training all have to restart, even if you are just changing the
organisation you work for locally. It makes short-term or inter-
organisational working very difficult to set up,’ he says.
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