1 Introduction

1.1 The purpose of this report is to inform the Policy Review Committee of the developments which have taken place during the past two years in the Occupational Therapy Service and describe current plans to review the service.

1.2 The developments were set out in the Commissioning Plan for Physical Disability, which was presented to PRC on 11 July 2003

1.3 The Occupational Therapy Service (OT Service) in Hampshire Social Services has a well motivated workforce committed to service improvements and interfacing with other organisations to promote independence and achieve positive outcomes for service users.

1.4 The major challenge for the service is balancing the demand from an increasing number of people who have a physical disability with the resources available as well as maintaining a skilled and competent workforce in a climate where there are both national and local shortages of Occupational Therapists.

2 Background

2.1 The Occupational Therapy Service is one of the three field work services within the Physical Disabilities and Sensory Services care group - the others being Sensory Services and Care Management Services for adults with a physical disability. The service plan for Physical disability states that:

`Physical Disability and Sensory Services by working in partnership will ensure consistent quality services, promoting independence, choice, empowerment, skills, rights and participation'

2.2 The Occupational Therapy Service within Hampshire Social Services work with people of all ages who have a disability which affects their ability to live an independent life. Working with service users they identify their needs and potential outcomes, which may include training in different techniques to manage their independence, provision of equipment or adaptations.

2.3 The service supports the Social Model of Disability which defines disability as the disadvantage or restriction of activity caused by society which takes little or no account of people who have impairments and this excludes them from mainstream activity.

2.4 Hampshire County Council Social Services department employs 100 Occupational Therapy staff 76 FTEs working from 8 bases across the county including Social Services Direct - Occupational Therapy (OT Direct).

2.5 Within this resource there are also Occupational Therapy Specialist Advisers who work in the following specialities:

2.5.1 Moving and handling

2.5.2 Children

2.5.3 Equipment Services

2.5.4 Housing

2.5 The overarching aims of the service match the aims of Social Services as a whole and are

2.5.1 Promoting independence and personal development

2.5.2 Protecting vulnerable adults and children

2.5.3 Arranging services which are accessible, convenient and user centred

2.5.4 Striving for best value and greater consistency across Hampshire

2.5.5 Ensuring a workforce is competent and confident

2.5.6 Developing our partnerships with other agencies

2.6 The aims contribute towards the achievement of Hampshire County Councils Corporate Strategy in particular

2.7.1 Aim 1 Maximising life opportunities

Creating opportunities for the whole community.

2.7.2 Aim 5 Improving services

Making sure services continuously improve to meet the changing needs of the whole community.

2.7.3 Aim 6 Developing councillors and staff

Ensuring they have the appropriate training and resources to respond to the needs of the people of Hampshire.

3 The National Context

3.1 Key government guidance, legislation and performance measurement impact on the service - information can be found on the following websites - www.doh.gov.uk and www.odpm.gov.uk

3.2 In the U.K. Occupational Therapists are mainly employed by the NHS or Local Authority Social Services Departments.

3.3 In January 2002 the College of Occupational Therapy launched a strategy to ensure Occupational Therapists work closely together at local level to ensure an integrated seamless service, with positive outcomes for service users regardless of their employing organisation.

3.4 Recruitment and retention of Occupational Therapists across the country is a national issue, which is even more challenging for local Authorities in view of the differential in pay, benefits and post qualification opportunities between Occupational Therapists working for them and those working for the NHS. For example an OT of similar experience and competence employed within Hampshire earns £26,625 for a 37 hour week whereas in the NHS that OT would earn £27,770 with the possibility of a "discretionary" rise to £28,540 plus £753 single allowance for working in the south east for a 36 hour week. A recently developed Winchester City Council housing liaison OT post, comparable to the above Social Services post, is offering £28,173-£33,750 for a 37 hour week. There is a report going to cabinet to address this.

3.5 Waiting times for Occupational Therapy assessments and services delivered especially around the administration and process Disabled Facilities Grants in partnership with District Councils is a national issue.

4 Creating Specialist Teams

4.1 Following a County Treasurers consultancy report in 2002 the management arrangements for care management, OT and Sensory Services were reviewed and restructured into specialist teams.

4.2 There are now 5 teams of Occupational Therapists across the County based in 8 locations including OT Direct, each with their own team manager.

4.3 The specialist OT Team structure has strengthened the service, improved peer support and improved links locally with district councils and health colleagues. The current financial investment in the OT service is £3,860,500 including £73,400 in the OT Direct Service, £646,000 for the Joint Equipment Service and £567,400 in the OT Technician service.

4.4 The role of Senior Practitioner has been developed to assist the Team Manager and to take the lead on more complex cases.

4.5 The Higher Grade Occupational Therapist have a professional Development forum, which focuses on reviewing evidence informed practice and the specialist team structure has facilitated best practice developments to be introduced into operational practice.

4.6 Field work education is offered to OT Students from Southampton University as part of their degree course and other OT education establishments.

4.7 Hampshire and Isle of Wight NHS Workforce Development Confederation awarded their `Mentor of the Year Award' this year to the Senior Practitioner OT in the Havant and Petersfield Social Services OT Team.

4.8 The service continues to work with Hampshire and Isle of Wight NHS workforce confederation as it develops its fieldwork education unit.

5. Social Services Direct - Occupational Therapy (OT Direct)

5.1 There were four principal factors which led to a rethink of the way in which occupational Therapy Services were accessed:

5.1.1 Waiting times for an Occupational Therapy assessments.

5.1.2 Differential access arrangements across the county.

5.1.3 Users indicating that with some pointers they could aid themselves.

5.1.4 Challenge of attracting sufficient qualified OT staff.

5.1 OT Direct was developed following investigation and researching with other local authorities and analysing how referrals were being processed within Hampshire.

5.2 It was felt that by re-engineering the whole way people access the service; offering facilitated telephone assessment with direct referral to Equipment and technician service 40% of referrals to Occupational Therapy Service could be dealt with at that point without the need for an Occupational Therapist visit.

5.3 OT Direct was developed and has now been fully operational for 6 months. It uses service centre technology and is now the first point of contact for OT referrals.

5.4 Service users are empowered to request simple equipment and adaptations through discussion with trained service centre advisers who are supported by the OT Helpdesk within the service centre.

5.5 The service is improving customer service by utilising both service centre technology and web tools to ensure a quicker and more direct service for customers. Additionally, enhanced opening hours (8.00 am - 8.00 pm) as well as standardising referrals, and giving consistent information to customers, service quality and outcomes have improved.

5.6 The use of trained advisers has freed up scarce professional OT resources to focus on reducing waiting lists and working with people with more complex need. 45% of referrals to the OT service are now dealt with by OT Direct.

5.7 Reducing the number of referrals which need a full OT assessment through home visit has produced a 35% reduction in OT waiting lists across Hampshire during the first 6 months of operation, however waiting lists are still too long.

5.8 The priorities within the service are to deal with Hospital discharge and terminal illness cases within a week, along with others classified as critical in the Fair Access to Care (FACS) Criteria.

5.9 The average waiting time for a full OT assessment is 24 weeks with 937 currently waiting. This will include cases who fall in the moderate or low need in the FACS criteria e.g. someone in early stages of disability with other support mechanisms.

5.10 OT Direct is handling 370 referrals per week at the service centre and it has 10,000 referrals for the service since it was introduced at the beginning of the year.

5.11 OT Direct has recently been shortlisted for the 2004 Local Government IT Excellence Awards. The outcome of this is still awaited.

6 Partnership Arrangements

The Occupational Therapy Service users benefit from the close interfaces the service has with many of the organisations that are partners of the County Council. The following lists some of these arrangements.

6.1 District Councils

6.1.1 The O. T. Service interfaces with District Councils and Housing Associations with respect to Disabled Facilities Grants and adaptations to property. This is quite often both practically challenging in terms of the adaptation/building work and complex in terms of the funding arrangements and ongoing maintenance making this time intensive work.

6.2 Health

6.2.1 The OT service works closely with OT colleagues in Health Organisations focussing on positive outcomes for service users. The County Manager for PD and Sensory Services, chairs a forum of OT Team and Service Managers from Hampshire Social Services; Hampshire PCTs and Acute Trusts. The aim is to promote closer working relationships, share good practice, and develop services consistently across the county. The position throughout the county is varied.

6.2.2 OT teams from both Health and Social Services meet regularly; share training events; workshops and ensure local arrangements are in place so that service users are seen by the most appropriate OT with no duplication of effort.

6.2.3 Secondments have been arranged between Health and Social Services OTs so that experience can be gained in the different specialities within the profession.

6.2.4 The joint equipment services and Hampshire County Council technician service support all the Occupational Therapists in both social services and health to undertake their role with service users.

6.2.5 Links with the Hampshire and Isle of Wight NHS Workforce Confederation enable OT Assistants in Social Services to access the part time OT degree course commissioned by the confederation.

7 The Challenges

7.1 There is an increasingly elderly and disabled population which will need access to services.

7.2 Recruitment of qualified Therapists into Hampshire Social Service during the past year has been increasingly challenging and requires further investigation particularly with respect to pay and benefits; opportunities to undertake further professional development qualifications; and whether there is a need to increase the number of OTAs who undertake qualifying training.

7.3 The development of OT Direct has positively impacted on the work in the area teams but there is still need to review the service to achieve a further reduction in waiting times, and to ensure greater consistency across the county.

7.4 There is a need to further explore developmental opportunities with local NHS organisations and with the NHS Workforce Confederation.

8 Service Review

8.1 It is proposed to undertake a review of the service which will investigate the issues and challenges. The review will focus on the following areas.

8.1.1 Referrals and patterns of referral

8.1.2 Fair Access to Care and Caseload Management

8.1.3 Processes and procedures now that OT Direct is established

8.1.4 Management spans of control and team structures

8.1.5 Recruitment and retention

8.1.6 Pay and Benefits/ Terms and conditions including a comparator with NHS

8.1.7 Career Pathways and post graduate opportunities

8.1.8 Fieldwork Education for undergraduate OTs

8.1.9 Opportunities for further integration with Health OTs

8.1.10 External Interfaces with other organisations in particular District Councils; Home Improvement Agencies and NHS Trusts

8.1.11 Internal interfaces with the Equipment and Technician Service

8.1 To support this review, information from the recent PD and Sensory User survey will be used and a consumer audit of the service will be commissioned.

9 Conclusion

9.1 The Occupational Therapy Service in Hampshire Social Services is a strong professional service which has user outcomes and independence at the core of their activity.

9.2 The reconfiguration into specialist OT teams together with the development of OT Direct has achieved improved outcomes for service users and a greater consistency across the county.

9.3 The interface between NHS organisations and district councils is positive.

9.4 The forthcoming review of the service will aim to ensure that it becomes a service which will meet users needs in the future.

10 Recommendations

10.1 PRC note the achievements made to the service since the introducion of OT Direct.

10.2 PRC comment on plans for the service review.

10.3 PRC receives a further report in 6 months time once the review is complete.

Section 100 D - Local Government Act 1972 - Background Documents

The Following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt of confidential information as defined in the Act.