At this time within the Occupational Therapy two year HCPC registration cycle we often revisit documents that instruct us in the way we should conduct ourselves in order to be able to provide relevant evidence if audited.
I am often left feeling somewhat challenged with regards to the term ‘professional integrity’ in the context of statutory services and the level of perceived constraint placed on the ability to fulfil assessment recommendations.
RCOT Code of ethics & professional conduct states that ‘The highest standards of professional integrity are expected of Occupational Therapy personnel ‘ (4.1) and ‘you must act with honesty and integrity at all times…not engaging in any behaviour or activity that is likely to damage the public’s confidence in you or the profession’ (4.3).
This is reinforced within HCPC – Standards of conduct, performance & Ethics, as the profession’s registering body, which states ‘you must behave with honesty and integrity, making sure that your behaviour does not damage the public’s confidence in you or the profession’ (13).
Although we all individually likely have an idea what these statements refer to is important to not simply assume that they are applied, how they are applied or indeed what others perception of ‘integrity is’.
The idea of personal integrity appears more straightforward; treat people with respect, abide by the law (although I know there is more to it than that) and effectively be a good citizen who cares and engages with the community.
However, professional integrity is more complex than this as we are impacted on by a plethora of external factors.
So what does professional integrity mean?
Integrity itself may be best described as ‘person who willingly and consistently acts in accordance with social standards or moral values of society’ with the professional element being ‘one who adopts and consistently applies the knowledge, skills and values of a chosen profession’.
Within Occupational Therapy this means that (amongst other things) we practice in a client centred way, promoting and maximising occupational engagement and independence. We engage and empower our clients to make decisions for themselves, providing them with the relevant feedback and support to ensure the decision is capacitated and informed.
What compromises professional integrity?
On discussion with members of my teams they often feel their professional integrity is compromised when they are aware a patient/client would benefit from provision (equipment/adaptation/care/rehabilitation etc) but falls outside of the local authorities criteria or indeed where there is no statutory service to meet the need based on their imposed referral criteria.
One example of this is identification that involvement with a re-ablement service, which is free at the point of access, would maximise the client’s potential to be functionally independent despite having some long-term needs, being declined on the basis of the long-term need alone.
Another example is the acknowledgement that access to adaptations (such as a stair lift) would maximise independence and support normal daily routines but is not determined as a critical need (using old FAC terminology) by the local authority as basic daily needs can be met without it.
Michael Mandelstam often discusses this debate and indeed will do so again in the Keynote theatre on day 2 of The OT Show 2017. In ‘Occupational Therapy – Law & Good Practice’ (2005) he accepts that ‘the law…places obligations on the therapists employer organisations’ and that it is often ‘organisational pressure…that result in policies and practices’. However, he goes on to state that Occupational Therapists can play a significant role in adhering to good practice and to ‘mitigate the effects of those pressures.’
How is professional integrity therefore maintained?
Occupational Therapists need to know the law and policy drivers so that they can effectively advocate for their clients. Without knowledge and detailed understanding we remain ignorant and therefore unable to provide accurate information/guidance.
Do we allow local policy to impact on our recommendations or do we make accurate Occupational Therapy recommendations and then communicate what can and cannot be met through the statutory service? When those recommendations are made to fall in line with local policy/restrictions (for example, in the second example above simply not recommending re-ablement as you know it’s not available) then integrity could be compromised. In that situation we should be making the right recommendations based on accurate clinical reasoning whilst openly discussing and acknowledging any inability to meet them.
Provide options, including what is available within other sectors. Limitations of statutory services is not necessarily something that should be seen negatively, simply reality. There may be other services within another sector who could meet that demand.
Although this remains a daily challenge, focusing on the professional philosophy and code of conduct rather than external pressures in the first instance allows us to maintain our professional integrity whilst accepting that statutory services has a finite ability to meet anything other than what it terms ‘basic need’.
It is maybe this term ‘basic need’ that causes such a challenge as Occupational Therapists this often covers far more than the physical acts of function.
Author : Adam Ferry