The Future
Direction of
Occupational
Therapy Post the
General Election.
Suzanne Rastrick
Chief Allied Health
Professions Officer
The College of Occupational Therapists. 30 June 2015
www.england.nhs.uk
How ‘Big
Picture’
Priorities Affect
Occupational
Therapy
www.england.nhs.uk
Government Priorities
www.england.nhs.uk
Government Priorities
•
•
•
•
Obesity
Diabetes
General Practice
Culture of the NHS
Themes from Secretary of State’s recent speeches:
• Leadership values
• Efficiency and performance
• Patient centred care
• Service provision and transparency
www.england.nhs.uk
NHS England Priorities for 2015/16
www.england.nhs.uk
Improving Health
Our first theme focuses on where we need to make greatest progress to deliver improved health outcomes
for patients. While we will be making improvements across many outcome areas, those where we need to
make a big difference this year are:
• cancer – which continues to be a top priority for government and the public
• mental health – to continue the drive towards greater parity with physical healthcare provision
• learning disabilities – to tackle the outstanding issues highlighted at Winterbourne View
• Type 2 Diabetes – to start to address this through a prevention programme.
Overview of our first four priorities
1.
Improving the quality of care and access to cancer treatment: Cancer will affect one out of
every two of us at some point in our lives. Outcomes have been steadily improving but prevention,
earlier diagnosis and better care offer the opportunity of saving many thousands more lives.
2.
Upgrading the quality of care and access to mental health and dementia services: Mental
health problems represent about a quarter of the nation’s ‘illness burden’, but access to services is
worse than for physical health conditions and funding has been lower.
3.
Transforming care for people with learning disabilities: There have been major improvements
in the support and care for people with learning disabilities over several decades but there remains
much more to do.
4.
Tackling obesity and preventing diabetes: Obesity prevention, which will slow
the growth of Type 2 Diabetes, will have a substantial benefit to the health of our
people, and the future sustainability of the NHS.
www.england.nhs.uk
Redesign Care
Our second theme focuses on those service areas we need to redesign to ensure they better
meet patient needs. Our priorities this year are:
• to tackle local configuration and delivery of emergency services, given pressures caused by
rising demand
• access to general practice as the main entry point to NHS service provision
• elective care provision, given the continuing pressure on targets
• specialised services given the need to tackle costs and overspend.
Overview of priorities 5-8
5.
6.
7.
8.
Redesigning urgent and emergency care services: We need to reshape the NHS’
urgent and emergency care services so they respond effectively to the increasing
demands placed on them.
Strengthening primary care services: We need to strengthen primary care as the
foundation for personalised NHS care.
Timely access to high quality elective care: We must ensure elective care
continues to meet service standards and remain accessible for patients.
Ensuring high quality and affordable specialised care: We must
reshape specialised services to improve their quality and future
affordability.
www.england.nhs.uk
Whole system change for future clinical and
financial stability
Our third theme and ninth priority focuses on galvanising the whole system change which
is needed for future clinical and financial stability.
Enabling whole system change
To work towards the vision of the Five Year Forward View we need to get serious about
preventing ill health, empowering patients and engaging communities. This means
involving all our partners to design new local ways of providing care, making better use of
technology and skills. The New Models of Care programme and the 29 vanguard sites will
focus on designing and demonstrating the NHS of the future. We’ll also deliver Integrated
Personal Commissioning demonstrator sites to personalise patient care, and review
maternity services to empower women through more choice and control.
Delivering value and financial sustainability through a step change in efficiency
The Five Year Forward View sets out a £30bn funding gap, and the need for the NHS to
deliver £22bn efficiencies over the next five years to close the gap. Our specific role and
priority is to develop the financial and economic strategy; progress efficiency initiatives
across the system; and take steps to underpin transformation (e.g. development of
payment systems and measurement tools to help us better serve local populations).
www.england.nhs.uk
How Does
Commissioning
Work?
www.england.nhs.uk
NHS Outcomes Framework – 5 Domains
www.england.nhs.uk
NHS Commissioning Assembly…
• “….as clinical commissioners we need to understand
the outcomes that matter most to people in our
communities – these “citizen outcomes” should guide
our decisions….”
Gateway ref 01801
www.england.nhs.uk
Commissioners are sighted on
what “citizens” want.
Adapted from: Legatum Institute (2014) Wellbeing and Policy
www.england.nhs.uk
How should providers respond to
delivering these “citizen
outcomes”?
• Ensure those with Board leadership roles fully understand the
AHP workforce in their accountability
• Approach workforce planning strategically in conjunction with
CCG or Sub Regional NHSE commissioners & LETBs
• Move away from easy stereotypes of just more ‘doctors and
nurses’ to ensure workforce has richness and depth of
competencies that deliver ‘citizen outcomes’
• Using Organisational Development approaches to fully engage
with the existing AHP workforce & their professional bodies to
develop both responsive services & multi professional
leadership
• Share, spread & celebrate AHP innovation
www.england.nhs.uk
The Policy Case for Commissioning OT
Services in England…...
• The NHS Mandate
• The NHS Outcomes Framework
• Patient Choice
• The Five Year Forward View (October 2014)
• The Forward View Into Action: Planning For 2015/16 (Dec.
2014) & Supplementary Information For Commissioner
Planning 2015/16 (Dec. 2014)
• ‘Intelligence’ Based Commissioning Models & Approaches
www.england.nhs.uk
Patient Choice….
www.england.nhs.uk
As a commissioner what would I
want to know about your service?
How much does
the service cost?
Is it worth buying?
What does the
service actually
do? What
difference does
it make?
Can you
evidence what
outcomes you
deliver?
How
safe
and
effective
is your
service?
OT
Service
Can I get this
service cheaper
or more flexibly
from someone
else?
What do you do
that helps me reach
my targets? Eg. To
maintain people at
home
Does it serve the needs
of the local population?
Can you demonstrate that your service is
worth funding amongst others?
Us! Us! Go on,
you need us!
We’re really nice
and we do a
great job!
other
providers
P
Physios
Social
workers
Nurses
www.england.nhs.uk
OT
Influencing Commissioners
Members have access to a range of resources and evidence to enable them to influence
service commissioners
You are best placed to influence service commissioners. BAOT/COT provides resources and
support to help you shape service commissioning in your local area. We can help you respond to
local needs and agendas in a way which will benefit the profession locally and ultimately
nationally.
Saving money for service commissioners
Service commissioners are the budget holders who allocate funds for health and social care. It's
important to demonstrate the value for money of OT services in order to encourage
commissioners to purchase OT services to ensure OT continues to play a vital role in health and
social care delivery.
Materials available for targeting commissioners
Back to health, back to life leaflet
This leaflet can be personalised for your service. Simply insert your organisation details and your
own case studies in the spaces available and use this material when promoting your occupational
therapy service to commissioners, influencers and your senior management.
Occupational therapy evidence fact sheets
The occupational therapy evidence fact sheets provide key facts, examples of cost benefits and
related reference points across a range of key service areas.
NHS Five
Year Forward
View & New
care models
www.england.nhs.uk
NHS Five Year Forward View
•
The NHS Five Year Forward View
was published on 23 October 2014
•
One of its great successes was that it
is a shared vision for the future of the
NHS across six national NHS bodies
•
The challenge is now
implementation; we know:
• It will not be easy
• We need to learn from the past
• We’re going to need a different
approach
• AHPs are up for it!
The future NHS
The core argument made in the Forward View centres around three ‘gaps’:
1
2
3
Health &
wellbeing
gap
Radical
upgrade in
prevention
Care &
quality gap
New
models of
care
Funding
gap
Efficiency &
investment
•
•
•
•
Back national action on major health risks
Targeted prevention initiatives e.g. diabetes
Much greater patient control
Harnessing the ‘renewable energy’ of communities
•
•
•
Neither ‘one size fits all’, nor ‘thousand flowers’
A menu of care models for local areas to consider
Investment and flexibilities to support implementation
of new care models
•
Implementation of these care models and other
actions could deliver significant efficiency gains
However, there remains an additional funding
requirement for the next government
And the need for upfront, pump-priming investment
•
•
Principles of the New Care Models programme
• The programme will be developed with a co-design approach
– built with patients and the health and care system
Clinical
Engagement
Patient
Involvement
• It will seek to identify replicable standards, tool and methods
so that scale can be reached;
• It will use the transformation fund to maximise progress and
pace through centralised support, especially in technical areas
as well as leadership support and development for those local
health and social care systems;
Local
Ownership
National
Support
• The national package of support to prototype sites will be
offered with an agreed Memorandum of Understanding and
mutual commitment to delivery on the ground, and a
commitment to value for local people
• It will establish an evaluation process to support testing and
rapid learning
• It will share early and continuous learning with the whole
national health and care system through a wider community of
support.
New Models of Care
Initially the new models of care programme will focus on:
Multispecialty
Community
Providers
Integrated primary
and acute care
systems
New approaches to
smaller viable
hospitals
Enhanced health in
care homes
• Blending primary care and specialist services in one organisation
• Multidisciplinary teams providing services in the community
• Identifying the patients who will benefit most, across a population of at
least 30,000
• Integrated primary, hospital and mental health services working as a
single integrated network or organisation
• Sharing the risk for the health of a defined population
• Flexible use of workforce and wider community assets
• Coordinated care for patients with long-term conditions
• Targeting specific areas of interest, such as elective surgery
• Considering new organisational forms and joint ventures
• Multi-agency support for people in care homes and to help people stay
at home
• Using new technologies and telemedicine for specialist input
• Support for patients to die in their place of choice
First cohort Vanguard sites
Care model
PACS
PACS
PACS
PACS
PACs
PACS
Wirral University Teaching Hospital NHS Foundation
Trust
Mansfield and Ashfield and Newark and Sherwood
CCGs
Yeovil Hospital
Northumbria Healthcare NHS Trust
Salford Royal Foundation Trust
Lancashire North
Hampshire & Farnham CCG
Harrogate & Rural District CCG
PACS
Isle of Wight
Care model
MCP
Applicant
PACS
PACS
MCP
MCP
MCP
MCP
Care model
Applicant
Care Homes
Care Homes
Care Homes
Care Homes
Care Homes
Care Homes
NHS Wakefield CCG
Newcastle Gateshead Alliance
East and North Hertfordshire CCG
Nottingham City CCG
Sutton CCG
Airedale NHS FT
Applicant
Calderdale Health & Social Care Economy
Derbyshire Community Health Services NHS
Foundation Trust
Fylde Coast Local Health Economy
Vitality
West Wakefield Health and Wellbeing Ltd (new GP
Federation)
MCP
NHS Sunderland CCG and Sunderland City Council
MCP
MCP
MCP
MCP
MCP
MCP
MCP
MCP
NHS Dudley Clinical Commissioning Group
Whitstable Medical Practice
Stockport Together
Tower Hamlets Integrated Provider Partnership
Southern Hampshire
Primary Care Cheshire
Lakeside Surgeries
Principia Partners in Health
So, what are CAHPO team doing?
……Innovating Rehabilitation
• 2012 CAHPO asked by Sir Bruce Keogh to establish if there
was a case of need to improve adult rehabilitation services in
England
• Examples of good innovative practice and service design, but
poor adoption and dissemination
• Clinicians and service users - unsure of services available and
how to access them
• More recent stakeholder engagement told us:
• service not always focused on patient need
• lack of focus on outcomes
• commissioning structures an obstacle to care
www.england.nhs.uk
Plans for Rehab Programme 2015/16
• Publish the economic arguments for rehabilitation
• Take forward recommendations from C&YP scoping
project report
• Publish commissioning frameworks:
• Self referral and early intervention
• Supported self management
• Urgent and emergency care review
• Older people’s programme
• Living with and beyond cancer
• Elective care
• Return to work programme
• Support development of regional networks
www.england.nhs.uk
Rehabilitation Innovation Challenge Prizes
•
“Open Mind Partnership”
Leicestershire Partnership NHS Trust
Leicester Open Mind in partnership with Fit for Work
- GP referral or Open Mind therapists
- Long-term MSK pain
- Cognitive Therapy and Mindfulness techniques
- Addressing physical, social and mental barriers such as depression and
anxiety
•
“Fitness for Work Service”
Derbyshire Community Health Services NHS FT
- Self referral or by managers
- Assessment – physical activity, design of the workplace
- Phased return to work and duties where appropriate
- Service also offers MSK pain education and management, advice on
equipment and educational resources
- ROI - £5 for every £1spent
www.england.nhs.uk
“It’s about
occupation,
stupid….” Why
commissioners
don’t get OT.
(With apologies to James Carville,
1992)
www.england.nhs.uk
Can you demonstrate that your service is
worth funding amongst others?
Us! Us! Go on,
you need us!
We’re really nice
and we do a
great job!
other
providers
P
Physios
Social
workers
Nurses
www.england.nhs.uk
OT
What can be the consequences of
unclear messages?
“OTs avoided using the
word occupation for fear
of misunderstanding”
Wilding & Whiteford 2008
OTs struggled to
maintain their
professional
identity in
multidisciplinary
teams
Robertson & Griffiths
2009
“Because OTs are
concerned with the
normality of everyday
activity … they see it as
taken for granted and
not highly valued”
Clouston & Whiteford
2008
“A profession is not defined by expert
knowledge but through the ability to
demonstrate advanced professional skills,
such …… as carrying out sound and
reasoned judgments.” (p 37).
Hoyle E and John P (1995) Professional knowledge and professional practice. London: Cassell in
Whitcombe SW (2013) Problem-based learning students’ perceptions of knowledge and professional
identity: occupational therapists as ‘knowers’. British Journal of Occupational Therapy, 76(1), 37-42.
It is the skilled process of transferring the
unique knowledge of occupation into
professional action through the use of
reasoning that is the basis of the
profession’s distinct practice
Turner A and Alsop A (2015) Core Skills – Exploring occupational therapist’s hidden assets.
British Journal of Occupational Therapy, Awaiting Publication
The core driver is the concept about
occupation and its impact on health
Concept based profession
Practical skill based profession
Core ideas lack visibility
Core ideas are more tangible
Impact demonstrated through
outcomes which may be
qualitative and long term
Impact demonstrated through
outcomes which may be
quantifiable and short term
Techniques/skills often not
unique
Techniques/skills often unique
Practitioner needs a strong
sense of professional identity
Practitioner less likely to have
issues with identity
www.england.nhs.uk
©annie turner 2015
Hidden core skills versus
the public face of practice
This is
unchanging
and forms
the basis of
all practice
These skills
are
unchanging
though tools
may vary
Splinting
Communication
Analysing &
Evaluating
prioritising
occupational
occupational
outcomes
needs
Identifying and assessing
Enabling occupational
occupational needs
performance
Group work
Wheelchair
assessment
Reflection
Cognitive
behavioural skills
Leadership
Vocational
rehab
Housing
adaptations
Unique core
skills based
on reasoning
Home visits
Context
dependent
practice
skills
Research
Teaching
ADL
Central
philosophy
Professional belief in the impact of
occupation on health and well-being
Business skills
Creative skills
Leisure skills
Mobility
Management
Supervision
skills
Social skills
©annie turner 2015
These practice skills are driven and changed by fashion, research, legislation, context and technological development
The duality of professional practice
in Occupational Therapy
The visible
The hidden
face of
reasoning of
professional
occupational
practice is
therapy is based
based on
on the romantic
rational
concept of the
scientific
positive impact of
thinking that
meaningful
evidences the
occupation on
skills and
health and well
competences
being
used as the
media of
intervention
©annie turner 2015
A Hierarchy of Concepts related to Occupation
Romantic
thinking
Expectations
Environment
Motivation
ROLE
ROLE
Life stage
ROLE
ROLE(mother)
OCCUPATIONAL PERFORM
(Occupational form and
Activity
Activity
Occupational
Balance
Etc..
Activity
(packing school
lunchbox)
Task
Prepare
drink
Performance components
Rational
thinking
Etc..
ROLE
OCCUPATION
“mothering”
Activity
Task
Clean
Lunch
box
Culture
ANCE
function)
Activity
Task
Make
sandwiches
Activity
Occupational
Alienation
Etc…
Occupation
as a “means” and
as an “outcomes”
Skills
Grip flask
Grip lid
Unscrew lid
Occupational
deprivation
Having ingredients ready
Judging amount of concentrate
Etc.
.
©annie turner 2015
You employ us
because……
Yes we have the answers ready!
We know what
difference we make to
our service users.
We’ve got the
evidence
Our practice clearly
demonstrates our
professions’
uniquenesses
We know who to
tell and how to
tell them
We know
how much
our service
costs
We use appropriate,
consistent outcome
measures
We use evidence
informed practice.
We create evidence
Something similar may
be available elsewhere
but it won’t be
delivered by regulated
practitioners
Connect & share…
www.england.nhs.uk
OTs & other AHPs are ideally
placed to deliver many of the
ambitions in the 5YFV
• Two fundamentals AHP’s deliver on:
Innovation
Entrepreneurship
• Some areas to strengthen:
 Economic evaluation
 Consistent outcome data
 Developing networks to spread excellent practice
www.england.nhs.uk
Suzanne Rastrick
Chief Allied Health Professions Officer
…will you join me?
@SuzanneRastrick
www.england.nhs.uk