PICS is supporting a UK-wide campaign to celebrate the crucial role of Occupational Therapists who are ‘on the frontline of health equity’, empowering and enabling the recovery and management of health and wellbeing.

Championed by the Royal College of Occupational Therapy, #OTsForEquity highlights how the pandemic has widened the health inequalities faced by some of our most vulnerable communities, including care home residents. Recognising the power of specialist roles within multi-disciplinary teams, we celebrate Occupational Therapists (OT) who tackle ‘health inequalities every day, supporting and helping those most in need.’

Evidence gathered over recent years demonstrates that Occupational Therapists can have a key role in Primary Care, particularly working with individuals with complex presentations that maybe driven by social need, like financial or housing issues or broken down relationships.

During the pandemic, PICS has been working with GPs and Clinical Directors across Nottinghamshire to design, support and integrate OT roles within primary and community care. PICS now employs eight people who all have a grounding in occupational therapy on behalf of the Primary Care Networks we support, including:

  • Four Clinical Care Home Leads;
  • One Clinical Care Co-ordinator;
  • One Cognitive Behavioural Therapist in our managing pain service; and
  • Two PCN Mental Health Occupational Therapist.

The roles are some of many new and exciting positions and services that are being developed in general practice and the community to make it easier to access a wider range of help from general practice, closer to home, by phone or online. Funded by the NHS Long Term Plan’s Additional Roles Reimbursement Scheme that became available from 1 April 2019, our shared vision is to offer people more choice and more joined-up healthcare.

What is Occupational Therapy?

It’s often a misunderstood profession, not just about ordering mobility equipment or testing whether employees are fit to return to work. OT therapies and support help people accomplish their entire range of daily tasks and activities. Catherine Seals, PCN Mental Health Occupational Therapist within the Mid Notts Integrated Care Partnership, explains:

The activities that people do throughout their day provide them with roles and routines and give them a sense of value, purpose, achievement and self-worth. They include washing, dressing, eating , drinking, house-keeping, sleeping, employment, volunteering, studying and learning, hobbies and interest, resting and relaxing. Occupational Therapists can help when a person’s engagement or functioning is disrupted due to illness, disability, trauma, ageing. We break down an activity and look for barriers to help people adapt, so they can do that activity independently.

Mini-triumphs mean a lot

When patients take the time to work on accomplishing mini-triumphs, they can start to manage their routines again.

Catherine explains: “We explore the impact of physical health, mental health and cognition on people’s ability to do everyday tasks. Working together, we promote independence, safety, risk management and self-management. These make important contributions to the quality of the patient’s assessment, intervention and discharge process, and enable more people to choose where they live.”

OT impact: case studies

Jessica Lang is an Occupational Therapist in the Enhanced Health in Care Homes Service (EHCH) within the South Notts Integrated Care Partnership, and has prepared two reflections on the impact of her work for patients.

“As part of a wider multi-disciplinary team, we will visit new admissions into the care homes we cover and complete holistic assessments. We help people with health challenges to participate in daily life to the fullest.” Jessica Lang, Occupational Therapist, Enhanced Health in Care Homes Service (EHCH)

High anxiety reducing mobility and confidence

“I completed a new resident’s holistic assessment and found that they had ongoing anxiety and were struggling with mobility. Their recent move to a new area had led to delay in being seen by the Community Mental Health Team. Their anxiety was at a high level and they weren’t eating or drinking properly or leaving their room. Their confidence was dropping, which made their anxiety steadily worse. I sat with them to discuss what was going on. I listened to what was important to their quality of life. From this, we were able to set four achievable and graded goals:

  • He would aim to attend all mealtimes.
  • He would refill the drink jug daily.
  • He would go out with carer for a walk to increase confidence.
  • Staff would support him with coping skills such as grounding, mindfulness and a positivity diary.

“I revisited three weeks later and found the resident was now going to every meal, getting coffees and juice and going for walks with staff and friends. We discussed next steps. He wanted to have more confidence to cross the road and get out more, so we set a new goal for a support worker to cross the road first and he would follow, which would help him to build confidence.”

Low mood and suicidal thoughts turned around

“We also work to support the GPs and local community services to provide the best care for the patients in the care homes, as well as giving advice to the care homes themselves.

“I have been visiting a lady in a home who has been experiencing low mood, has dementia, asthma, and knee replacements. From attending weekly home rounds with the care home, it was identified her mood was dipping and she was expressing suicidal thoughts. I was able to talk with the staff and resident to assess mental state, routine and engagement in occupations. The pharmacist was able to review medication and with the GP’s support, increase them.

“From a discussion with the patient and their carers, I was able to set goals:

  • The patient said she felt better when she was sat around people in the lounge, so the carer agreed to prompt and encourage her to get into a new routine where she gets up an hour earlier.
  • We would develop visual aids to support routine and memory.
  • She reported previously enjoying reading but was struggling to maintain attention, so we discussed with the care home and arranged that a carer would sit and read to her and look into audio books.
  • She said she like to sit in the garden, but she needed a chair raiser and there was no suitable seating in the garden for her, so we asked the care home to look into suitable seating outside.

“We’re looking forward to seeing them soon for a follow-up review.”