I was asked by the Royal College of Occupational Therapists to present at their Reimagining the Role of Occupational Therapy across inpatient and community settings online event on 24th September 2024.
Below is what I presented.
I’m delighted to have the opportunity to speak with you today. As an occupational therapist and a person with lived experiences of navigating the health and social care system since birth, I bring a unique perspective to this discussion. My journey, shaped by disabilities, neurodiversity, and serious illness, has not only informed my practice but also given me insights into the occupational therapy field from multiple angles.
In my professional roles, I am proud to serve as the Lead Occupational Therapist at Tees, Esk and Wear Valleys Foundation NHS Trust. I am also a Founding Member of AbleOTUK, Chair of the Royal College of Occupational Therapists Northern and Yorkshire Regional Committee, a Public Governor for South Tees NHS Foundation Trust, a Unison Disabled Members Officer, and an OTalk Facilitator. Each of these roles has deepened my commitment to advancing occupational therapy practice, supporting professional development, and promoting equity within health and social care.
Today, I will be challenging some of our current practices and the systems we operate within. I aim to highlight areas where change is necessary to better serve those we deliver services to. Please understand that my critiques are aimed at the systemic barriers faced, not individuals within the system. My goal is to encourage reflection and inspire forward-thinking, so we can evolve our practices together, ensuring they are inclusive and effective.
During my journey through the health and social care system, I found that occupational therapy services often failed to meet my occupational needs. I frequently felt like I was just another part of the system, where practitioners focused on ticking off tasks rather than considering the broader context of my life and what I wanted to achieve. This approach left me feeling frustrated and, at times, almost hopeless.
I was in a privileged position, with access to resources and a certain level of influence, which allowed me to find my own solutions. But what about those who do not have that privilege? How do they navigate a system that does not always see the full scope of their needs?
This experience has deepened my belief in the need for a holistic approach to occupational therapy. We must go beyond the immediate clinical tasks and look at the whole person, ensuring we engage with both personal and systemic barriers. Only then can we provide the support necessary for people to lead fulfilling lives.
Sharing my personal experiences in professional forums has not always been easy. It is challenging and sometimes leads to further difficulties or even exclusion. However, I believe that sharing these insights is essential to the growth of our profession. By opening up these conversations, I hope to foster greater understanding and empathy within the occupational therapy community, leading to more inclusive, supportive environments for all.
My journey as an occupational therapist is intertwined with my personal experiences of disability and illness, making reflective practice a core part of my approach. I was born with cerebral palsy, specifically right hemiplegia, which meant I had healthcare involvement from a young age. Occupational therapy played a significant role in helping me navigate my disability, and it was that experience that inspired me to become an occupational therapist.
In 2020, I faced a major challenge: I contracted COVID-19 and spent over a year in hospital, followed by a lengthy period of home rehabilitation. It was a personal battle, but also a professional reflection point. During this time, I saw firsthand the indispensable role of allied health professionals across the care spectrum, from paramedics to diagnostic radiographers and dietitians. Occupational therapists, speech and language therapists, and physiotherapists were key in enabling me to return to full-time work as an ambulant wheelchair user in 2022.
My professional journey has taken me through acute, rehabilitation, and forensic mental health settings. Currently, I am a Lead Occupational Therapist, but it has not been without challenges. Throughout my career, I have faced ableism and unconscious biases within the profession about my capabilities. These experiences have only strengthened my resolve to advocate for a more inclusive practice environment, for both therapists and the clients we serve.
Slide 4: Gaps in Occupational Therapy Services
Between April 2020 and October 2022, I encountered countless barriers to receiving the support I needed, including several gaps in occupational therapy services.
After 10 months of hospital care that saved my life, it was widely agreed that I was too ill to return home, yet I did not meet the criteria for any rehabilitation services. Accessing a suitable rehabilitation placement became an endless struggle. After one 10-minute assessment, conducted on a day when I had been awake all night due to disturbances on the ward, I was told that I lacked motivation. Other rehabilitation wards rejected me simply because I did not meet their criteria—criteria that focused more on diagnosis than on actual needs.
It took significant advocacy from my mother and my Member of Parliament to secure a place in a neurorehabilitation ward.
In hospital during an initial occupational therapy assessment, the focus was on standardised tasks like putting on socks and making a hot drink. Despite explaining that I do not drink tea or coffee, I was still asked to demonstrate making one. The assessment completely overlooked my actual goals and needs.
When I was assessed for a wheelchair, the focus was on the size and fit of the chair, not on what occupations I might want to do in it. I was only given a self-propelling wheelchair, despite not having the strength in my arms to use it. There was a failure to take into account the fatigue I experience or the energy I need for other meaningful occupations. The decision to limit my access to a suitable wheelchair significantly hindered my ability to engage fully in the occupations I needed and wanted to do.
After three months of daily therapy in the rehabilitation ward, I was discharged home without a proper assessment of my home environment, as that responsibility fell to another team. I was placed on a waiting list for community therapy services, but without ongoing daily support, my mobility began to decline. Carers were provided to meet my basic needs, but I experienced occupational alienation and deprivation, unable to engage in meaningful, purposeful activities.”
One particularly frustrating instance was with a reablement service that informed me they didn’t work with individuals who required hoisting and that I should return when I no longer needed to be hoisted. However, no further support was offered to help me achieve that goal, leaving me feeling trapped and unable to progress.
I was fortunate to have family and friends who came together to personally finance equipment like an electric wheelchair and access to private physiotherapy and hydrotherapy. These made all the difference and are the reason I can speak to you here today. Without that support, I truly believe I would still be reliant on carers for my daily needs.
These experiences underscore the importance of moving beyond a standardised approach in occupational therapy.
Whilst in hospital, I reached out over social media to other occupational therapists with lived experiences. Together, we formed AbleOTUK, a networking and advocacy group for occupational therapy staff and students with lived experiences of disabilities and/or long-term health conditions. We now work alongside the Royal College of Occupational Therapists to challenge and advise them.
We strive to challenge biases and encourage a culture of reflection that acknowledges the unique insights personal experience can bring. This not only enriches our professional practice but also enhances the therapeutic relationships we build with clients.
As we move forward as a profession, we must embrace the diverse perspectives of those with lived experiences. My journey illustrates the need to push beyond traditional expectations and fully realise the transformative potential of occupational therapy.
Reflecting on these experiences and aligning them with the Royal College of Occupational Therapists workforce strategies has deepened my commitment to fostering a reflective practice culture.
Through this approach, we can evolve our profession to be as inclusive and adaptable as possible.
Exploring how the Royal College of Occupational Therapists (RCOT) workforce strategies align with the broader aims of the National Health Service (NHS) long-term plan, the NHS England Community Mental Health Transformation Programme, and the Allied Health Professions (AHP) Deliver Strategy shows an effort toward more personalised, accessible care across different settings.
First, RCOT’s strategies advocate for occupational therapists to use a wide range of assessment tools tailored to individual needs, especially in complex conditions such as mental health. This moves away from the one-size-fits-all approach that often dominates assessments.
Second, RCOT encourages occupational therapists to work outside the traditional diagnostic medical model and towards a holistic, client-centred model. This aligns with Allied Health Professions strategies, where patients are seen as active participants in their therapy, with interventions that reflect their personal goals, environment, and lifestyle.
The Royal College of Occupational Therapists (RCOT) also addresses the fragmentation of care that can occur when multiple occupational therapists are involved without proper coordination. Their strategies promote better collaboration and communication among professionals, ensuring alignment with patient goals and progress. This approach mirrors mental health community transformation efforts, which aim to streamline services for more cohesive care.
RCOT further emphasises needs-based assessments that go beyond rigid criteria, empowering occupational therapists to apply critical thinking and clinical reasoning to meet the diverse needs of patients. This aligns with Allied Health Professions (AHP) strategies, which support flexible service models.
Together, these strategic efforts ensure that care is accessible, personalised, and tailored to individuals’ occupational needs, fostering a more effective and inclusive approach to occupational therapy.
Just imagine if I had been supported by one occupational therapist throughout my health and social care journey, working with me to co-create achievable goals and deliver treatments addressing my occupational needs. My recovery could have been less fraught with the barriers the current system often creates.
Here is a picture of me on my first day back at work, Thank you for your time today. I hope these reflections and personal experiences highlight the necessity of adopting a truly occupation-focused approach. By addressing these gaps in our services, we can empower individuals to live the lives they want to, ultimately enhancing the efficacy and inclusivity of occupational therapy practices. Please feel free to contact me via these platforms.
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