Although no single group of professionals holds the key to the future of the health and social care system, it is arguable that one has more influence than most. It is not doctors, not nurses, not even social workers – but occupational therapists, or OTs.

Because of the critical challenges facing the NHS and social care – the ageing population, the need to keep people out of costly hospital beds and care homes, the imperative to integrate services – occupational therapy has the potential to play a decisive part in ensuring the survival of the system deep into the 21st century.

“If you talk about care closer to home, and reducing people’s need for formal health and care services, then OTs are right on the front line,” says Richard Humphries, assistant director at the King’s Fund health and care thinktank. “They may be only a tiny percentage of the health and care workforce, but they punch well above their weight in terms of their impact on people’s lives.”

It is timely that the profession should be emerging into the limelight as the centenary of the first world war is marked. Although occupational therapy’s roots can be traced back as far as mental health care reformers of the late 18th and early 19th centuries, whose “moral treatment” of patients included structured activities, it started to take the form of a distinct discipline in the US in 1917 in response to demand for rehabilitation of wounded soldiers at a time of labour shortage. Pioneer British OTs trained in the US.

It is a common misconception, however, that occupational therapy is concerned solely, or even primarily, with getting people back to work: the term “occupational” in this context means purposeful activity of any kind in daily life, not necessarily employment.

There are more than 30,000 OTs working in the UK, about 60% of them in the health service. Most of the remainder work in some aspect of social care, although these days they are also found in education, housing and the penal system.

“Areas of work have broadened and OTs are now far more autonomous in their practice than when I first qualified,” says Julia Scott, chief executive of the British Association of Occupational Therapists and College of Occupational Therapists. “They are also more confident and less ‘medical model’ in their approach.”

Humphries, whose own 88-year-old father has help from OTs to enable him to continue living independently, observes that they occupy a singular position in the health and care system, making them ideally placed to fulfil the “navigator” role that is increasingly seen as pivotal if people are to access the right support at the right time.

“They’re a very practical, grounded profession,” Humphries says. “Some of the things they have been able to suggest for my dad I didn’t even know existed – and I’m supposed to be an expert.”

The new Care Act and aspects of the new Children and Families Act, offer still more scope for OTs to work with individuals and families who will be entitled to extra support under the legislation. But Scott admits that the profession has more work to do to raise its profile in the UK – it enjoys higher status in North America and some other countries – and to make the case that further investment in what it does would yield multiple returns.

“We’ve been putting much more effort into political and policy engagement and you can see that paying off in the detail of legislation,” Scott says. “On the ground, though, we still need to make the case for what we do.”

One piece of research shows that employing OTs in the A&E departments of the Royal Gwent and Nevill Hall hospitals, respectively in Newport and Abergavenny, South Wales, is preventing the admission of 50% – 60% of referred patients. Another shows that NHS Lothian’s similar use of OTs in A&E departments in the Edinburgh area is preventing 100 admissions a month, saving at least £864,000 a year.

With pressure on A&E a key issue across the UK this winter, such evidence ought to be required reading for hospital managers. “OTs are increasingly loud and proud about how the profession can add value,” says Scott. “We just need others to hear what we are saying.”

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