RCOT Annual Conference 2023 – highlights from day one

As part of the Opening Plenary panel discussion, on growing occupational therapy in primary care, the panel focused on leadership and research in such a new area. 

Julia Clifford, Clinical Specialist Occupational and First Contact Practitioner, told delegates how vital it is to evidence our own roles, particularly as this is an emerging role. She talked about evaluating their service and using the evidence to help develop the service and support getting more roles across the city. 

‘In Sheffield we’ve looked at getting a range of qualitative and process data that captures the lived experience of all the stakeholders – GPs, practice staff, patients and their carers,’ she went on. [This] has been really useful in understanding who we see, which pathway they’ve come from and how they benefit from OT.’ 

She urged OTs to ‘recognise that data and evidence helps drive change to practice.’ 

Jennifer Read, University Teacher; Research Fellow and Occupational Therapist, University of Sheffield, then shared four top tips to come out of the experience in Sheffield. The first, she said, which was ‘fundamental’ to their success, is to build collaboration, work in partnership and act as critical friends. ‘Don’t be scared about reaching out to others to build these partnerships,’ she stressed. 

The second is for people to make themselves ‘research ready and research confident’. She added: ‘Take any local and national opportunity as they arise. It’s no coincidence for of us have skilled ourselves up by undertaking a masters in clinical research’. 

Third is to ‘make your research relevant, meaningful and achievable’. And finally, the fourth tip is to ‘think about who you want to influence and inform’. 

She concluded: ‘We wanted to reach GPs, service users, academics, clinicians and commissioners and they all needed to know different things in different ways. So we used lots of different methods to shout about our work and affect change.’ 

Dr Gill Ward was joined by Dr Tanya Rhitman and Dr Sally Payne, Sarah Worth and Amy Beechy, to launch the new evidence-based RCOT ‘Occupational therapy and play’ practice guideline at Annual Conference.  

Tanya, occupational therapy programme lead at Oxford Brookes University and chair of the Play Guideline Development Group, shared the story of the guideline’s development process, saying: ‘It’s such a special milestone to have reached the launch of this truly collaborative endeavour.’  

She added: ‘We are delighted to be able to share with you this guideline, which focuses on play in all its key occupational therapy forms: play is an assessment, play is intervention and play is outcome.’ 

The guideline focus on play for those aged birth to 18 – ‘although play is most certainly a lifetime occupation’ – and Tanya explained that play is considered in the guideline as ‘both a means and end’. She said: ‘While play can be used at various stages of the occupational therapy process, the guideline reminds us of the importance of person-led occupational engagement.’  

Explaining that the overall aim of the guideline is to describe the high level, contemporary evidence regarding the occupation of play and the use of play in OT assessment, intervention and as an outcome to inform practice, she said 13 members of the guideline development group reviewed 1,666 abstracts, undertook 426 critical appraisals, through two rounds of literature searching and integration and ‘hours of debate over the interpretation’. 

Sally, RCOT Professional Adviser, added: ‘As OTs we recognise play as a primary occupation of childhood; something children do for its own sake, but also as a way of learning about themselves and the world around them. 

‘We also see play as a tool we can use throughout the OT process; assessments and interventions have much more meaning for children if they are fun and playful… [but] there is a little bit more to play and OT than just playing, as is evidenced in these guideline.’ 

Sally reiterated that the purpose of the guideline is to provide evidence-based recommendations for the use of play by OTs throughout the OT process, including the recognition that ‘enabling children and young people to play freely and in their own way is a valid and meaningful occupational therapy goal’. 

She added: ‘That means identifying play participation as a therapy outcome, alongside identifying goals for self-care and productivity, which traditionally have been prioritised.’ 

Sally urged OTs to use the ‘robustly developed’ guidelines to support their own practice, saying: ‘Your role now is to consider and apply the evidence to your own practice context, population and environment. Importantly you should use the guidelines to support decision-making and clinical reasoning related to play and OT. They will help you clarify and articulate your rationale for working in a particular way.’ 

Additionally, she outlined, you can use the guidelines as a framework for auditing your service provision and to identify and address professional development needs. ‘Why not start by reviewing them as a team to identify learning and development needs and opportunities to grow as individuals and as a service?’ she urged. 

The guidelines also identify a series of unanswered research questions related to OT and play, and they can be used as evidence to support funding bids to address these research gaps, ‘making sure that the voices of children and young people are incorporated at all stages of the research process’. 

Sally added: You can use the guidelines to make a case for including the costs of co-production and involving children and young people in your research plans. 

Ultimately, the guidelines will enable OTs to ‘provide care that is based on the best available evidence relating to play and occupational therapy’.  

The key message for delegates is to use the guidelines to engage in conversations about play with teams, commissioners and others, to drive service change and ensure our skills and expertise are recognised and used to enable all children and young people to play.  

In a Special Plenary session titled, ‘How do we achieve good health and wellbeing for all?’, Eluned Morgan MS, the Welsh Government Minister for Health and Social Services, told occupational therapists that they are ‘unique’ in understanding people’s health needs, and a vital profession to help deliver the Welsh Government’s vision for health and care services.  

Ms Morgan joined a panel discussion with Dai Davies, RCOT Professional Practice Lead Wales, Ruth Crowder, Chief Allied Health Professions Officer – Wales, and RCOT Chief Executive Steve Ford. 

She began her speech by reflecting on the creation of the NHS and the fundamental tenet that health isn’t just about treatment, it also has to be about prevention. She said that ‘stopping the problem from developing in the first place’ is where Bevan was, and ‘is certainly where I would like to be’. Something, she said, that is firmly set out in the long-term strategy ‘A healthier Wales’. 

Reflecting on the ‘real imbalance’ in the health and care system, with missed opportunities for prevention and early intervention in the community, she said people are being led to feel disadvantaged and that the things that really matter to them, are not being focused on. 

‘So, on 6 June, I announced that in Wales we are going to go further and faster towards delivering on that ‘A healthier Wales’ vision; that shift into the community and as far as possible developing an integrated community care system for Wales.’ 

She told delegates her ambition is to deliver ‘outstanding, whole system, place-based care for the people, ensuring as far as possible we can get them remaining connected in their communities. And go as far as we can – particularly with an ageing population – to prevent avoidable hospital admissions.’ 

Acknowledging the challenges and the need to work on many different fronts to achieve this, Ms Morgan went on to promise that, by seeking a greater use of shared budgets in the future, the Welsh Government will support the existing AHP workforce to ‘drive effectiveness and efficiency’. 

She added that this year, she would ‘really ramp up’ reablement capacity, community nursing and the approach to telehealth and telecare.  

She explained that to establish the longer-term transformation required, the Welsh Government is going to complete a service specification describing what place-based care looks like. It’s also going to continue to support the shift of resources towards preventative action and strengthening community services, to reduce reliance on unnecessary long-term care. 

‘I think that occupational therapists have a really important and unique contribution to make to delivering this change. Your skills, your expertise, enable people to do the things that really matter in their lives. Your interventions increase people’s independence. And it reduces their reliance on unnecessary long-term care services.’ 

She added: ‘If we seriously want to achieve good health and wellbeing, we need to use all the resources in our communities effectively. And I think this includes using the expertise of OTs differently as well.’ 

She recognised this means increasing the proportion of OTs who are directly accessible in people’s own communities. ‘We need to build on the fact you have this dual training,’ she exclaimed. ‘You’ve got mental and physical health abilities that you can call on, and we need to see more seamless working across traditional boundaries.’ 

Talking about the additional money the Welsh Government has already announced to support new recruitment and increasing capacity, and for integration, she said: ‘I think it’s really important we use the skills you have.’ 

Before taking up several questions from Dai, she said: ‘As a profession you are almost unique in understanding that psychological and physical impact of health needs, and we need to deliver a person-centred approach.’ 

And recognising that to achieve these changes, Wales must have a sufficiently skilled workforce, she said the workforce implementation plan in Wales will ‘make sure we deliver’. 

Having pitched to OTs from across the UK to think about working in Wales, she finished her speech by saying: ‘I want to express my appreciation for everything that you do. For your dedication, your expertise, for helping individuals to regain independence, to overcome challenges, to improve their overall wellbeing. Your commitment to understanding each person’s unique needs and empowering them to reach their full potential is genuinely inspiring.’  

Following a short Q&A, led by Dai, Steve Ford, RCOT Chief Executive, closed the session by commenting: ‘A challenge for all of us is to think about how we can develop strategic relationships with politicians at a national and a local level, because isn’t it great when you hear a politician who really gets occupational therapy.  

‘What can we all do to really build that understanding and knowledge and advocacy amongst all of our politicians?’ 

In a session focusing on the theme ‘breaking through’ and helping to make occupational therapy more visible to the public and policy makers, so that we can inform policy and service design, Odeth Richardson, RCOT Chair of Council, introduced inspiring occupational therapist Venus Madden, Clinical Fellow to Chief Allied Health Professions Officer England. 

She told delegates that Venus ‘epitomises the theme of breaking through’; having made the giant leap from Hong Kong to Hampshire [and] from young volunteer to national clinical leader, taking the risk to put herself out there nationally along the way.   

Karin Orman, RCOT’s Director of Practice and Innovation, opened the conversation with Venus about her career and achievements working as an occupationally therapist in the UK and her leadership journey, by congratulating her on her recent Rising Star Award, which members can read all about in the June issue of OTnews. 

Having moved alone to the UK aged 18 to study occupational therapy, supported by her parents, she talked about why she stayed in the UK and that, despite her parents’ pride in her occupation, her mother has only told a handful of close friends what she does. 

The reason being, she explained is due to a lack of understanding of what she does. ‘We need to showcase what we do, who we are and the impact we have on the population,’ she said. ‘[For some] they don’t understand what occupational therapy means and they don’t understand that OTs can make a change in their lives, until they need it.’ 

Venus went on to explain that the motivation for her leadership journey is credited both to her family and her own life experience and, in a very honest account, she reflected on how she turned personal frustration on not being included to talk about her profession at her son’s school – despite people knowing she is an OT - and experience of bereavement around, to kick start her leadership journey. 

Reflecting on what she’s tell her 18-year-old self, from her perspective today, she exclaimed: ‘If I had the chance, I would love to have said, when life gives you lemons, make lemonade!’ 

She added: ‘As a mum with young children it’s very difficult to do different jobs, apply for roles that potentially involve you travelling, and you try to keep that balance. But I think you make the most of the situation you are in [and] what life events are thrown at you.’ 

Venus went on to talk about the newly-launched NHS England’s Equity, Diversity and Inclusion improvement plan, with six high impact actions. One of the actions is around how we can support international recruitment of colleagues, ensuring they have equal access to training and development opportunities. 

‘That’s something that, nationally and strategically, it’s the first time we have had that direction, which is really fantastic,’ she said.  

Venus also touched on the importance of cultural awareness of difference when recruiting from overseas and the need to create a psychologically safe space for everyone.  

She reflected on her own experience as a newly-qualified OT, two decades ago, where one of her patients’ carer made racist and micro aggressive comments about her practice, questioning whether she was qualified to practice on hearing her accent and asking if a colleague would be checking her work. 

Sharing this with her supervisor at the time, who labelled the comments as racist and not right, Venus says it’s ‘something that has stayed with me for quite some time’.  

And while ‘things have changed now’, she says its helpful to think about AHPs Deliver, and the focus on putting people first, when supporting international students or recruits. Ask yourself: ‘What matters to them? Is it the leaning experience? Is it the cultural background? Is it about bringing the whole self to work? And then, how can you harness that? How can you put that individual first?’ 

She added: ‘I wish at the time, my supervisor would have sat down with me and said, do you know what Venus, I found it very uncomfortable, but why don’t we talk about it and reflect together? 

‘We need to be braver… let’s explore why we have these feelings and what actions we need to take together.’ 

Karin’s final question was around ‘imposter syndrome’ and she asked Venus how she manages self-doubt and what strategies or mindsets work for her.  

Using her experience of working for Suzanne Rastrick, Chief Health Professions Officer England, she offered some advice to others, including first acknowledging and embracing negative feelings and questioning where they stem from. 

‘The second step is to think about if someone you love and care dearly about, or even if a patient came to you, to say they are not ready… what would you say to them?’ She suggested people think about self-analysis tools and their strengths, while stressing that ‘we shouldn’t really call it weakness, we should be calling it need’. 

She also said, we need to practise self-compassion: ‘We ask our patients and carers to take time out and give yourself some “me time”. But how many of us really do that and put time aside to look after our own wellbeing to do something meaningful to us?’ 

To read more from the session, including where Venus sees the direction of travel for the profession, look out for the July issue of OTnews.