annual conference 2008
Members arrive at Annual Conference

Occupational Therapy News Journalist Cat Dean and Editor Tracey Samuels, report back from this year's conference....

Maximise new opportunities, members told

Occupational therapists must be prepared to redesign services and move into new areas of practice, delegates were told on the first day of the College of Occupational Therapists 32nd annual conference and exhibition, in Harrogate.

Discussing the College’s newly-launched strategic plan for 2008-2013, Dee Christie, chairman of council, said that it is essential that the profession maximises all the opportunities that are out there. She called on each and every member to read and engage with the three strategic aims and to ‘think about what you can contribute to the profession’.

Turning to the leadership agenda, Dee told delegates that while the College will lobby and be a mechanism for change, members need to take personal responsibility and deliver this at a local level for themselves. ‘I want you to lead the way for health and social care,’ she urged. ‘I want you to be ambassadors for the profession.’

Download the Strategic Plan 2008-2013 (1002 KB pdf*)

Self promotion: are we doing enough?

It is vital that the public knows what occupational therapy is, and what outcomes it can deliver, if the profession is to develop and grow under the latest stage of the government’s reform and transforming services agenda.

Speaking on Wednesday morning, Dee Christie, chairman of council, told delegates: ‘I want the man on the street to know about occupational therapy, so that he can ask for us and he knows what we can achieve.’

This was reinforced by Karen Middleton, chief health professions officer at the Department of Health, who said: ‘The government needs to look at how accessible AHP services are. [It] wants a push on self-referral… the public needs to know what occupational therapy is.’

Health service commissioners' priorities are dominant

OTs must speak the language of health service commissioners if they are to thrive in today’s NHS, according to Karen Middleton, chief health professions officer at the Department of Health. ‘Be in no delusion as to who’s in charge,’ she told delegates at Conference. ‘It’s not you as the provider of services, it’s the commissioner. It’s about their priorities, not your priorities.’

She added that ‘adding life to years and years to life’ should become the mantra of OTs and that they should be able to drop their defensiveness and demonstrate the cost effectiveness of their services in order to compete in the new world of patient choice.

The accessibility of services and the increasing trend for self-referral were also highlighted, resulting in a need for public education in the value and breadth of occupational therapy.

Calling on delegates to work with the other allied health professions in order to make their voice heard, Ms Middleton identified several ‘windows of opportunity’ for OTs to influence and participate in the future of health and social care, including their key roles in prevention, health promotion and the return to work agenda.

Occupational therapy rooted in our shared humanity

OTs are well suited to international development work, thanks to their core values of client-centredness, meaning, occupation and social justice, according to Rachel Thibeault, associate professor of the faculty of health services at the University of Ottowa. In a presentation of her work in countries including Ethiopia, Sierra Leone and Zambia, Dr Thibeault focused on how OTs could make a difference both locally and globally. ‘You may not realise it but the OT discourse is exactly what the UN is looking for,’ she told delegates. ‘OT translates well into other cultures because we remain rooted in what makes us human.’

Highlighting some highs and lows in her work, Dr Thibeault described leaders in a leper colony in Ethiopia signing a business agreement with a specially made stamp as an example of ‘the first time they were treated as free, normal human beings.’ More frustrating was the corruption she encountered within certain political systems and the stark contrast between the lifestyle of those in developing countries and the situation in her native Canada. This she tries to confront by educating her students about the difference they can make by exercising their choice not to consume to excess and to buy products that give the producers a fair deal.

Delegates urged to use blogs and social networking to share skills and experiences

Blogging and commenting on social networking sites offer good evidence for CPD and can help OTs to meet some of the HPC standards for re-registration, conference heard. Angela Hook and Sarah Bodell from the University of Salford showed delegates how sharing their experiences and opinions online, and responding to comments and feedback, would help them hone their skills in writing, reflecting and research.

Blogs provided the perfect forum for creating joint research opportunities, sharing experiences and as a useful marketing tool for OT as a profession, said Angela, who encouraged OTs to come forward and comment on others' blogs. 'People need more confidence and motivation, ' she said. 'The more you are out there and comment, the more people will come to your blog. You just need to have a go.'

Will Wade from Oxford Brookes University demonstrated how to create a blog and urged delegates to join the online OT community. 'This is about more than just adding to your CPD - it's for yourself and the community,' he said. 'OTs are fantastic at enabling people to talk to each other and we need to develop more conversations amongst ourselves.'

'When is an occupational therapist not an occupational therapist?'

Condition case managers for Manchester Primary Care Trust Liz Woof and Sarah Armstrong challenged delegates to answer this question in a roundtable discussion drawing on their own experiences as OTs who have moved into non-traditional roles.They also posed the questions:

One delegate commented that working in a non-traditional setting such as the voluntary sector actually enabled him to feel more like an OT, while another involved in professional governance of a Primary Care Trust said that she continued to do some work in an acute psychiatric setting in order to retain her sense of belonging.

The issue of terminology was also raised and one student expressed concerns that her first position wouldn't include the words 'OT' in the job title. Anne Longmore, head of the OT programme at York St John University said she felt that band 6 and band 7 OTs were able to develop their job roles thanks to their relative seniority, but that 'we really need to make sure the band 5 jobs have the word "occupational therapy" in them' in order to maintain the integrity of their professional identity.

Palliative care referrals occurring too late

Palliative care patients are being referred to OTs too late, according to Baroness Finlay of Llandaff, President of the Royal Society of Medicine and the keynote speaker at the Specialist Section HIV/AIDS, Oncology and Palliative Care Conference. ‘Not only is it a tragic waste of patients’ lives, it is also a waste of resources,’ she said. ‘There are hard economic arguments for being rapidly responsive as opposed to being bound by bureaucracy.’

This was echoed by Professor Jenny Butler, former Chairman of Council and herself a former service user, who added, ‘OTs should be brought in when people are given their diagnosis, as even if things go well you still have a year in which to cope with the treatment process’.

Baroness Finlay was responsible for the Palliative Care Bill, which was introduced in the House of Lords last year, and expressed her objections to the proposed Assisted Dying for the Terminally Ill Bill 2005, which is making a return to parliament. She told delegates: ‘I’ve taken a stand against changing the law, because you have to think about the consequences of that change on the profession and the patients. You have to ask yourself, is it worse that someone ends their life early because of misinformation, or that someone lives days or weeks longer than they wanted to?’

Encouraging conference to do whatever is in their power to restore hope to terminally ill patients, she urged the audience to be ‘agents of change’ through their attitude towards those dying, insisting that OTs were uniquely placed to affect patients’ quality of life. ‘It is always harder to work to improve things than to have somebody dead,’ she said. ‘It’s tough going in the world if you’re really meeting patients’ needs.’

Take the bill by the horns, OTs told

OTs have been urged to engage with the new Mental Health Act, which becomes fully operational in October.

Gail Adams, head of nursing at Unison, in a College-led session on the new career opportunities for OTs afforded by the act, said that the Mental Health Coalition – comprised of Unison, BPS, COT, RCN and Unite – has lobbied long and hard to get the Mental Health Bill through, as it offered a unique way of reflecting multidisciplinary working in legislation. ‘Without it,’ she said, ‘we would have been stuck with outdated laws, which belong in history books, but not modern centred care.’

Calling on OTs to ensure that the bill is implemented fully in their workplaces, and referring specifically to the opportunities the new approved mental health professional and responsible clinician roles offer, Gail said: ‘Ask to see a copy of your employer’s workforce plans for the new roles; get in there and start making some noise as OTs about these roles.’

She pointed out that if employers are doing ‘little or nothing’ towards implementing the bill, OTs should work locally with trade unions and feed back any concerns.’

Her main message to any OTs who would be interested in becoming more engaged with this agenda was: ‘Do not take no for an answer. Take the bill by the horns and make sure that it gets implemented.’

Occupational therapists will work with more HIV+ patients

Health professionals' ignorance around HIV is ‘astonishing' as it has ‘dropped off people's radar', according to Ailsa Springler from the Terrance Higgins Trust.

Speaking to delegates at the College of Occupational Therapists Specialist Section – HIV/Aids, Oncology and Palliative Care keynote address, Ailsa told delegates that there were around 800,000 adults living with HIV in the UK in 2007, and that shockingly 34 per cent of these were unaware of their infection.

‘Stigma is still crucial,' she said. ‘The stigma around HIV is awful. There is still this perception that you only get HIV if you are a bad person.' However, she went on to reassure delegates that HIV is no longer the ‘death sentence' that it was perceived to be in the 1980s and that people have been living with HIV for a long time now – making it a long-term condition.

‘This is not a gay plague,' she stressed. ‘More people will be living – as apposed to dying – with HIV. People living with HIV will age and experience the diseases and infirmities of ageing. That is novel and new as we have not had to cope with that in the past.'

She finished by reminding OTs as health professionals that ‘people living with HIV will also be a larger part of the workforce and OTs will increasingly regularly work with people living with the disease.

Palliative care: a postcode lottery?

Palliative care is a ‘postcode lottery’, according to Sam Turner, development manager for the National Council for Palliative Care (NCPC).

In a keynote address at the College’s annual conference on Wednesday, Sam told delegates that according to a King’s Fund poll, over 50 per cent of people die in acute hospitals, with 20 per cent respectively dying at home or in a care home, and just 4 per cent dying in a hospice – the ‘gold standard’ for care. ‘So we still need to ensure that people experience a good death,’ she said.

Sam also stressed that 95 per cent of specialist palliative care services are accessed by cancer patients, despite cancer deaths only accounting for 25 per cent of all deaths in the UK each year. ‘More people have dementia than cancer,’ she pointed out, ‘yet few receive specialist palliative care. New models of care are urgently needed.’

The big challenge, she said, is to start to provide services based on the person, rather than the medical diagnosis. The NCPC has long campaigned for an end of life strategy, and she was pleased to note that this year, the government will be releasing a comprehensive strategy to deal with this issue, and to coincide with the 60th anniversary of the NHS. Published in July, she urged all OTs to play a major role.  

CPD - your responsibility to stay registered

In a joint Health Professions Council (HPC) and College workshop, Professor Annie Turner, COT’s HPC representative, Zoë Parker, COT education officer – lifelong learning, and Charlotte Owen, HPC policy officer, looked at the crucial issues around re-registration.

In 2009, OTs will have to re-register with the HPC using the new HPC quality audit process. What this essentially means is that a random sample of OT registrants will be selected by the HPC and required to submit written evidence, in the form of a personal portfolio, of continuing professional development (CPD). This can include formal courses, but can also incorporate any activity that helps an individual to learn and develop.

There are five standards that OTs must meet, which are briefly:

For further information and sample CPD profiles visit the HPC website or email registration@HPC-uk.org is you have specific queries. Also, Members can visit the education and learning pages of the COT website.

Is sexuality part of the OT’s role?

In an interactive session, set up to look at some of the issues around sexuality and cancer Karen Butler, senior OT lecturer at the University of Cumbria, and Nicola Evans, head OT in Northern Ireland, facilitated a discussion around the role of occupational therapy in addressing sexuality with clients.

Karen and Nicola, both newly-elected to the College of Occupational Therapists Specialist Section – HIV/AIDS, Oncology and Palliative Care committee, encouraged delegates to vocalise their understanding of ‘sexuality’ and to look at how they approach the subject with their clients, if at all.

‘Is sexuality part of an OTs role?’ delegates were asked. The majority of the audience agreed that ‘yes’, OTs should address sexuality as part of their intervention. But the majority also believed that this is not happening enough, except perhaps in some specialist areas, such as hospices.

‘OTs are so focused on transfers in and out of bed, or on and off the toilet and around the home,’ Karen said, ‘we may want to sit back and think about how we can normalise the topic and get it into routine assessments.’

After much discussion, it was agreed that there are many affects on sexual function as a result of cancer and its treatments and that OTs can provide some specific things, including: information to explain surgical procedures; education, support and referral to others; pharmacological interventions; opportunities for intimacy; practical advice; and the use of occupation to explore concerns such as body image.

Big challenges working abroad — and returning home

OTs who want to work overseas should be willing to adapt to the language, culture and living conditions of their host country, said Rachel Thibeault, associate professor at the University of Ottowa. Sharing her experiences of working both in the developing world and her native Canada, she said that the greatest challenges to OTs working abroad included remaining truly client-centred, keeping their cultural framework in check and adapting to live when back at home. To OTs working in the developing world, she cautioned: ‘you have to know that the work will change you as a person and that even reintegration in your own culture will be difficult.’

This was echoed by Samantha Shann, senior lecturer at Northumbria University and a member of the World Federation of Occupational Therapists (WFOT) executive management team. Speaking about her five years experience in Uganda, Samantha advised people to think about their motivations and expectations of working abroad, and to ‘remember that the experience is not just about you – it also has an impact on your family and friends back home.’ She urged those thinking of working overseas to inform WFOT of their plans in order to exploit existing links and contacts, and signposted delegates to the Occupational Therapy International Outreach Network (OTION) on the WFOT website where they could initiate and join in online discussions about working abroad.

Other presenters included Linda Hansen, director of OT services in Queensland, Australia, who promoted the benefits and challenges of working in a region with a geographically diverse population, and VSO marketing adviser for health Ruth Grearson who, together with OT Fiona Kingsley, described the reality of volunteering in the developing world.

Ritchard Ledgerd, the UK delegate for WFOT, and Beryl Steeden, group head of external affairs at COT, concluded by discussing membership of WFOT and the Council of Occupational Therapists for the European Countries (COTEC) respectively.

OTs should not feel threatened by the introduction of the trusted assessor role and of a retail model for community equipment services, delegates were told.

‘Some OTs fear they’re losing a big part of their role, but that’s rubbish,’ said Susan Heap, Community Equipment Services Manager at Cheshire County Council which piloted a new programme based on a retail model of procurement. ‘What it does is provide opportunities for more complex work and job satisfaction.’

She insisted that within her area, there had been no risk to employment and no contracts actively terminated as a result of the changes. She did, however, acknowledge that in other parts of the country, depending on the role, there might be opportunities for OT assistants and technicians to be redeployed in the retail sector.

Alan Norton, chief executive of Assist UK, the membership organisation for Disability and Independent Living Centres, explained to delegates how the Trusted Assessor (TA) role responded to the government agenda to reduce waiting lists and also addressed the volumes of low level assessments. ‘OTs are the pathways to independent living for disabled people,’ he said. ‘We need to work together to ensure ethics, not profit, are at the forefront of local provision.’

Susan Heap acknowledged that the Cheshire pilot study represented ‘radical change’ and admitted that the transition had not been easy. Issues they had encountered in the process included difficulty in persuading patients to make their own choices about equipment and communicating with the 700-plus potential prescribers from across the county.

Rona Dailey, an OT from Leeds, said she had direct experience of the new system as both OT and as a carer. She called for a better solution to what she found was an unnecessarily complex process, even for a health professional to understand.

Jemima Strydom, an OT from Enfield Social Services, questioned the benefit of moving to the new model, if the service was already running smoothly, and expressed concern about OTs only working on more complex cases. ‘I do see the value of OTs getting involved in lower needs and more technical equipment – that way they are possibly preventing more complicated cases from arising in the first place,’ she said. The move to a retail-based equipment model is non-mandatory but is being considered in other regions across England and adapted according to local need.

OTs suited to case management

OTs are ideally suited to working as case managers in the private sector thanks to their skills in assessment, coordination and identification of a person's functional ability and needs, according to Niccola Hain and Lindsay Wasserfall, OT consultants at Harrison Associates.

Despite the potential for conflict resulting from pressure from insurance companies to save money with the need to remain an advocate for the client's needs, Niccola and Lindsay said they found their work ‘incredibly rewarding.'

The personal qualities needed to be a good case manager included significant experience (around 8 years of practice), and the ability to stand up to insurance companies and solicitors to represent the client's best interests.

Delegates asked how private case managers were able to show evidence of CPD if they were not directly treating patients themselves.

Niccola responded that Harrison Associates provided training days for staff to extend their knowledge and skills, but that ‘if people are interested in hands-on treatment it's probably not the route for them – or they might like to consider combining case management with more traditional OT practice.'

Get Adobe Acrobat Reader

*This document is in 'Portable Document Format' (PDF) which can be read using Adobe Acrobat Reader. If you already have Adobe Acrobat Reader on your machine then the document will open automatically when you click on it. If it doesn't then click on the image to the right to obtain a free copy.

Access Adobe provides tools for converting PDF documents into other formats suitable for disabled users.