An increasingly ageing population is putting a strain on the health and social care service which has undoubtedly created a more cost-conscious working environment for all hospital departments. To put the increased demand on the health and social care service into context, over the next 20 years the number of over 85’s will more than double whilst the number of people with dementia is due to rise to 1.5million by 2042. With an increasing demand on the health and social care services as a result of this, there is a focus on the associated rising costs and questioning over the sustainability of our publicly funded health and social care system.
With an increased focus on the economics of the NHS, services are facing increased pressure to evidence their value which in itself creates both challenges and opportunities for our profession. The recent Care Act has provided a shift from a duty to provide particular services to a duty to meet needs. The aim is to make care more responsive and personal for patients by providing care closer to home. As an Occupational Therapist within the hospital setting, I feel that as a profession we are in a prime position to show case our abilities to provide a service that is both cost-effective and able to improve patient experiences and outcomes. Development of a toolkit of outcome measures and patient satisfaction feedback questionnaires has allowed us as a service to provide both quantitative and qualitative evidence of the impact of the OT service on patient outcomes.
One of the biggest challenges we are faced with within the hospital setting is an increasing pressure to facilitate rapid discharges, reduce the length of stay in hospital and the risk of readmission to hospital. A combination of limited resources and the ageing population means that patients have increasingly complex medical histories. Our ability to use activity analysis gives us an understanding of how current and existing occupational performance deficits can make engagement in daily occupations more difficult.
Our skill in breaking activities down into their component parts and the use of creativity allows us to provide thorough assessments within the hospital setting with limited resources. For example, whilst to other members of the MDT it may look like we’re just playing dominoes with a patient, we know that we are looking at an individual’s ability regarding dynamic sitting balance, attention, fine motor skills, sequencing, and self esteem. This skill can be overlooked by other professions and can create a lack of understanding by other members of the MDT about the role of the OT. This in turn can result in an underestimation of the gravity of OT input to assist with formulating appropriate treatment and care plans and facilitating timely discharges. In an environment that is very medical focused, ethical challenges within MDT working are a day to day occurrence to ensure that patients’ needs and wishes are met post discharge.
This being said, the role of the OT within the hospital is not solely aimed at discharge planning. One of our services development projects has been working alongside other members of the MDT to implement and improve the experience and care for those admitted to hospital with more complex cognitive and behavioral needs. This is something that will support individuals whilst in hospital but also assist with longer term management strategies. There needs to be a longer time plan looking at those with complex needs who are at high risk of readmission to hospital or admission to long term facilities with a focus on maintaining people at home.
By using our assessment and intervention tools to understand someone’s needs, which are often multiple and complex, and adopting a client centered approach we are able to understand an individuals short, medium and long term goals. With training in the physical, cognitive and affective domains of human performance, we are in an ideal position to overcome the challenges faced where complex care needs create barriers to effective care.
Whilst there is a danger that the holistic nature in which we claim to see individuals could be lost when focusing on an individuals needs for facilitating a discharge; by utilising community services and referring on and sign posting effectively, we are able to ensure that other elements of occupational performance, which may not necessarily be essential for discharge but are paramount to the individuals well being are still being addressed and in turn help with the management of complex, long term diseases.
It has been well documented that these times of financial austerity and ageing population present a huge challenge to the whole of the health sector. However, we must not lose sight of the unique opportunity that this also presents to our Occupational Therapy profession. We have a key role to play in the management of people living with long term conditions with a focus on maintaining and facilitating independence by providing practical solutions to a range of problems that are both timely and cost effective.