Service Director, Occupational Therapist
Part 1: So how do Councils support health and wellbeing?
Part 2: Case studies of AHPs working in Local Authority
Part 3: A closer look at the OT role in Local Authority
Part 4: Day in the life of a community OT
Our first article comes from Dr Anita Mottram, Principal Occupational Therapist at Kirklees Council.
There is a famous Monty Python sketch where John Cleese asks of a group, “what have the Romans ever done for us” What Have The Romans… – Monty Python’s Life of Brian – YouTube . In response he received a list of where the Romans had provided interventions to improve sanitation, public health, roads, public safety and education.
Instead of the Romans these now fall under the responsibility of your Local Authority Council. So, for all those students or practitioners who are in the process of seeking out new roles, where better to look than at organisations whose main responsibility is to promote health and wellbeing proactively and where there is so much scope for AHPs to utilise not just their core skills but to develop more wide ranging and holistic ones too.
As a qualified Occupational Therapist for 33 years, I have never worked somewhere that is so proactive in supporting and advancing health and wellbeing than working for a Council.
There are some fantastic opportunities to provide early intervention and prevention, working with individuals and their families to provide therapeutic interventions to enable people to maximise independence, developing relationships with clients and carers over many months, and to see just what a difference that your intervention has made to increase their safety and wellbeing at home as well as increase both the client and carer’s resilience.
In my opinion, this is so much more fulfilling, for practitioners, than reacting or responding to crises or to facilitate a hospital discharge. AHPs can work with individuals in their own homes, co-producing goals, treatment, and support plans to enable them to thrive. This includes working with both adults or children with physical, psychological, and emotional needs.
Councils are funded by the government to provide a range of services at a local level, ensuring that decisions are made that are the right ones for that place. To ensure that there is accountability, to the public for this, each Council is run by elected members – councillors. Councillors represent their local communities and contribute to making decisions about the services that the Council provides.
As a qualified Occupational Therapist for 33 years, I have never worked somewhere that is so proactive in supporting and advancing health and wellbeing than working for a Council
To provide some idea of how AHPs can be involved in the services that Councils offer, I have provided some examples below:
Under the Care Act and Children’s Act legislative frameworks, the Council has a responsibility to assess an individual, and to provide supportive solutions or access to funding to enable the person to source solutions themselves. As AHPs we can contribute to this assessment, identifying the individual’s strengths and needs and putting adaptive solutions in place whether that be various forms of assistive technology (equipment, adaptations, digital options), therapeutic treatment programmes to facilitate enabling, supporting with rehousing, education, accessing employment, social activities, and community groups directly or with the assistance of a Blue Badge – which the OTs assess for.
This is not an area that you would usually expect AHPs to be involved with, but as OTs we were asked to become involved in a redesign of the waste management service as documented in an article in OT news from 2019, “The value of occupational therapy input into service redesign” (Mottram, Anita) 6:40-42.
This identified many people in receipt of a chemical commode service and the opportunity to assess them to provide alternative solutions. Rather than having a chemical commode in their lounge where it would be seen by visitors or at risk of getting tipped over by pets or grandchildren, we enabled them to access their toilet facilities, bringing some normality back into their life, increasing their independence, privacy, and dignity.
Another project involved the redesign of a local social care housing scheme which would affect the resident’s abilities to take their rubbish to the external bins. We worked with the housing department to identify ways of making the routes to the bins safe for people, of all ranges of mobility, to access and considered what types of bins would be safe and easiest for the residents to use, thereby increasing their independence.
My local towns are undergoing a regeneration programme. Part of this work is to ensure that they are inclusive and accessible for individuals with a range of disabilities, using specific design principles.
This involves working with architects to check the proposed plans to ensure that, what they are proposing to build, will meet the needs of our residents and enable them to take full advantage of the new layouts and facilities.
As AHPs we can also work with employers to advise on how to support, those with a disability – including learning disability, in employment making reasonable adjustments in terms of the working environment or supporting the skill set of the person.
Councils are responsible for providing equipment and adaptations solutions to enable people to remain independent in their own home and the input of AHPs are crucial to this. This could range from a simple solution such as bathing equipment right through to building an extension with accessible facilities. We also now have the option of providing smart devices which will allow people to control their home environment more easily.
Where it is not possible to adapt a person’s property then the AHP can produce reports to recommend rehousing and work with our housing colleagues to ensure that an identified property is suitable to meet the person and their families’ needs.
Sometimes individuals have led a challenging life or start to experience cognitive difficulties and may not have the necessary skills to be able to manage their finances or to undertake activities of daily living. There are enabling opportunities to upskill them with living in a domestic setting and, again, AHPs can assist with this.
We have also had situations where individuals were admitted to a care home, usually following a hospital admission or deterioration in their medical condition. Sometimes their medical situation improves, and they would like to return home. As AHPs we have participated in assessing their needs to support this, ensuring their safety within their own home environment but also assessing their ability to access their local community including road safety and shops.
As AHPs we recognise the value of purposeful occupation. It is therefore important to ensure that access to facilities such as libraries and leisure activities are accessible for all and can be utilised as part of therapeutic interventions such as strength and balance training. Many individuals became deconditioned and deskilled due to lockdown and we are currently working with our local leisure and wellness services to improve this.
The roles of AHPs are well recognised and valued in local authority settings and provide the practitioner the opportunities to work in ways that are flexible, creative, fulfilling and where it is possible to see that they have made a positive impact in terms of the individual and their caring networks.
So, if you are asked, “What do Councils actually do for us?”, hopefully this will have provided you with some insight and some encouragement that there is some really positive scope for AHPs to work outside of traditional NHS settings.
Take a look at our inspirational stories to hear about real staff and students experiences of studying and working in Local Authority
In Part 2 of this series we will focus specifically on case studies which provide some additional specific examples of the impact and interventions AHPs can lead on within a Local Authority setting.