Roots of recovery: Occupational therapy at the heart of health equity

Cohesive and systemic planning

It is vital that organisations and services do not plan or work in isolation, but take a joined-up approach to analysing, planning and meeting needs - a universal response. This includes involvement of the voluntary sector. Along with health, consideration needs to be given to the environment, healthy homes, work, education, and healthy occupations. Occupational therapists should be at the table to provide this strategic perspective.

A joined-up approach requires the sharing of information across services and systems, supporting safe and effective service provision, enabling occupational therapists to use resources sustainably, reducing repetition of data gathering, assessments and any overlap of services. Advanced and senior occupational therapists must have scope within their roles to work with their counterparts across sectors to agree actions to minimise duplication and ensure effective use of knowledge and resources.

Designing inclusive services

For healthy and sustainable communities to develop, those communities must be understood and involved. Services and workforces need to reflect and be shaped by the culture of the communities that they serve, with a shared understanding of the desired outcomes for the community and the service.

RCOT are working with the education sector to attract and support people into the profession from a range of backgrounds that reflect diversity within the UK.¹

Advanced and senior occupational therapists must have scope and objectives within their roles to work with public and patient contributors and groups to co-design how services are accessed, delivered and evaluated.

Needs-led and place/localities-based services

Health needs and inequalities are greatest in particular places and in the groups who live there.² Any response needs to be shaped and located accordingly, drawing organisations together with a shared understanding of the needs and wishes of the local population.

Occupational therapy should be targeted where it has the greatest impact; locating occupational therapists with the right knowledge, understanding and skills where they can be accessible and effective:

• Where they can advise at planning and design level – housing and community rehabilitation. 
• Where they can provide early interventions – in primary care and community services.
• Where they can enable and support education in schools, colleges, and universities.
• Where they can support people to be in, stay in and return to work, through primary care, occupational health and rehabilitation services.
• In training and advisory roles, for example, to social prescribers, housing providers, care homes and domiciliary agencies.

Fair access

For people to access occupational therapy expertise on an equitable basis there needs to be a flexibility and fluidity of access.

Access needs to be open, appropriate and fair to population groups who have been known to experience reduced access to, and satisfaction with, health and care services e.g., those in economically deprived communities, BAME groups, LGBTQIA+ groups. This may also include people who find it physically difficult to attend appointments and access local community resources.

Occupational therapy is still predominantly accessed through secondary and tertiary services and tends to focus on individuals, rather than on populations. Access to occupational therapy services needs to be early and easy, across the lifespan, preventing the development of long-term difficulties and addressing some of the wider social determinants of health. Services should be both universal across all aspects of life, and targeted - shaped and placed according to the needs of local population groups.

In some areas people can self-refer to social care, community mental health and rehabilitation services. They can directly access the right expertise when needed, but for this to be inclusive services need to proactively identify local population groups that are not currently reflected on caseloads, then work with them to co-create access points and services that accommodate their requirements and preferences.

Ongoing research

There is a significant amount of anecdotal evidence regarding work done by Allied Health Professionals (AHPs) to reduce health inequalities and influence the social determinants of health. More research is needed to quantify the breadth of impact of AHPs on health inequalities.³ When considering how to re-shape and refocus activity to bring about change, planners and decision-makers need to consider what data would best inform them of service effectiveness and their positive impact.

Data needs to demonstrate when communities that are underserved by health and care services are being reached. National outcome-based data collection (rather than output-based) should evidence the impact services have on addressing access to and remaining in education and work, access to appropriate housing and self-management of health.

1.  Royal College of Occupational Therapists (2021) Equality, diversity and inclusion. London: RCOT. Available at: https://www.rcot.co.uk/equality-diversity-and-inclusion

2.  Marmot M, Allen J, Goldblatt P, Herd E, Morrison J (2020). Build back fairer: the COVID-19 Marmot review. The pandemic, socioeconomic and health inequalities in England. London: Institute of Health Equity. Available at: https://www.health.org.uk/sites/default/files/upload/publications/2020/Build-back-fairer-the-COVID-19-Marmot-review.pdf

3. Public Health England (2017) Reducing health inequalities: system, scale and sustainability. London: PHE. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731682/Reducing_health_inequalities_system_scale_and_sustainability.pdf