National Assembly for Wales

Name of respondent:

Ruth Crowder

Are you responding on behalf of an organisation?

Yes

If so please give the name

College of Occupational Therapists

Address:

P.O. Box 4156
Cardiff
CF14 ORE

Telephone number:

029 2076 2834

Would you be willing to give oral evidence to the Committee?

Yes, The College would be pleased to provide the expertise of a practitioner in this speciality. Alternatively, the Committee may wish to invite Welsh Therapies Advisory Committee to give evidence.

I am content for my evidence to be published X

This evidence is the view of the Professional Body and has been compiled in partnership with the specialist section for oncology and palliative care (HOPE)

Investment in information technology that is compatible across health and social care would greatly assist. The electronic patient record will facilitate better support for service users as they move across agencies and services, from health to voluntary sector, to social care or vice versa.

ISCO (the Information System for Clinical Organisations) is a valuable resource which enables all staff to access clinical and therapy notes of cancer patients. Complete open access to this system is available to hospitals and voluntary agencies, yet is not fully utilised, partly due to lack of access to IT. This is a real missed benefit to patients resulting in poor sharing of information and the potential of duplication of work, or worse, of areas being missed.

Response

The College of Occupational Therapists specialist section in oncology and palliative care (HOPE) is very active both across the UK, and within Wales. This gives the opportunity to share and disseminate good practice and research activity. Therapists are required to undertake continuing professional development activity in order to retain their registration to practice. Support from employers for attendance at learning and research opportunities needs to extend to ensure this requirement is met.

Research activity outside the medical profession needs to be enhanced and greater finance needs to be made available for therapist, and other research. Occupational therapy research is limited: partly because of the lack of finance/ research funding: partly because of lack of specialists in post, expertise and time. The under-investment in therapist posts means that in most services occupational therapists are employed in small numbers; removing their time and expertise to carry out research denudes the service to a level that impacts on patient care. This can be improved by the funding of specialist, research posts such as consultant therapists and clinical specialists. Currently therapists carry heavy caseloads and where there are only one or two therapists in a service it is extremely difficult to participate in research unless funding is provided for backfill of their posts with new graduate or less experienced therapists.

The Cancer Networks are not receiving adequate involvement from therapists to inform their work. Only one occupational therapist is a member of the Palliative Care Advisory Group, which supports the South East Wales Cancer Network. There needs to be more multi-professional engagement across Wales with communication and ideas flowing between Networks and services.

Response

There is a lack of coherence in commissioning services, with a poor overall picture of what is available. A substantial amount of commissioning is for direct medical diagnosis and treatment with little or no commissioning of the full package of rehabilitation and quality of life enhancing services.

'Living well with cancer’ and the recognition of cancer as a chronic condition are not yet reflected in the service commissioning. There is under-commissioning of therapy rehabilitation services:

For example, Service users attending Velindre Regional Centre can only receive occupational therapy if they are in-patients. Outpatients, day patients and those receiving Radiotherapy or chemotherapy, attending specialist clinics or being cared for at home are not able to access occupational therapy services. This is because only in-patient occupational therapy has been commissioned and there are no resources to offer the whole package of care needed.

Commissioners need better advice on how therapy can be provided. There is a tendency to commission a new project instead of expanding and enhancing the existing services, so too many projects are created. At times, these are "reinventing the wheel" as one member put it, when the skills being developed by other staff groups already exist in the workforce in the therapy service. Where therapist posts have not been commissioned in the new service, other staff groups have to take over those roles. This impacts on quality and raises issues of competence.

Response

The barriers are:

• Lack of time: because therapy services are under-commissioned and staff cannot lift their eyes from the day-to-day load.
• Piecemeal provision of services. For example in Powys, Cancer services are commissioned from England; there are no specialist cancer therapy services and no access to voluntary agency therapy services. Service users are seen, on their return home, by generalist occupational therapists who may not be able to access specialists for support and advice, either generally or about the patient’s specific needs. This does not promote the best practice nor help developing therapies to disseminate

These might be overcome by:

• Better access to therapy advice by the Cancer Networks. There needs to be recognition of the complexity of the needs of cancer patients and of the contribution that therapy services can make. This includes services which support and enhance high quality of life.
• Developing a culture of valuing CPD and professional activity for all staff groups to enhance knowledge and skills. Employers need to invest in staff and support education and development.
• Collaboration across specialist services and the generic services that patients rely on in their own locality. Investment in occupational, and other, therapy consultant posts would mean that these highly skilled staff could then offer an advisory resource and communication network to improve the quality of care across all parts of Wales.

Response

Occupational therapy services have always tried to work effectively together. In South Wales, the occupational therapy service in Velindre is working to set up a collaborative OT team across Velindre and the Marie Curie Hospice to help provide continuity of care. It is hoped the team will reduce duplication, enhance good access to notes enabling information to be shared. Once funding is available, a rotation of staff between the services will develop. Patients can then experience a seamless flow of support irrespective of their location or service provider.

Timely equipment provision can make the difference for whether a person is able to return home. The Welsh Assembly Government investment in integrated equipment stores is welcomed and it is hoped that access will be available for voluntary sector therapists to support integrated care. Clear funding agreements, which recognise the specific difficulties that voluntary agencies have with use of money raised by voluntary contribution, need to be established.

Response

The Integrated Care Pathway is now being used to gather data on last days. Services could be better informed by data gathered across health and social care. This would help identify how and where people are being cared for by social services and whether there is sufficient social care provision to support them.

Therapists provide a key role in keeping people at home. Although general data on waiting times for therapies is not collected, specific data for people with cancer, and other terminal illness could show: whether referrals are made to therapists; waiting times for social care provision; allocation to social workers; meeting times for panels to approve care package finance, for example. This data would better inform service provision for people.

Response

Response