Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence

The debate around workforce shortages in the NHS is often focused on doctors and nurses, the largest and most visible staff groups. However, as made clear by the long-term plan for the NHS, allied health professionals significantly support the demand faced by the NHS and there are studies that demonstrate they improve patient flow.

According to a 2017 study, carried out at Jon Hopkins University in Baltimore, occupational therapists were found to be the only spending category where additional spending had a statistically significant association with lower readmission rates. Sounds good, doesn’t it?

Although this research was done in the US, chief executive of the Royal College of Occupational Therapists Julia Scott believes it also applies to the NHS.

Ms Scott highlights in an interview with HSJ  the transition out of hospital or out of accident and emergency and getting patients back home is a point the long-term plan focuses on.

“We know we can keep people out of hospital and transition them out,” she explains. “There are very good statistics with occupational therapists in emergency departments and with ambulances, there are lots of occupational therapists going out with blue lights.” By going out with paramedics, she explains, they can stop an unnecessary trip to hospital. 

“Long stays in hospitals are difficult for people with mental health problems,” she explains. “There are also statistics showing a 20 per cent reduction in length of stay in mental health units with occupational therapists.”

There are also other ways the profession can add value. The Interim People Plan’s focus on staff wellbeing and retention could surely be an opportunity for OTs to focus on NHS staff, as well as their patients.

“Only a few OTs work in occupational health,” says Ms Scott. “And we believe we should have more of a presence within it. Every NHS occupation health service should have an OT to help the workforce stay healthy and deliver the service people are in great need of.”

She explains NHS staff often present with stress and musculoskeletal problems and adds that getting back to work after weeks signed off can be a “monstrous process”. “I think a lot of trusts would call an OT but that means pulling them off a ward, [so] why not base them in the health service?”

Occupational therapy in adult services is currently facing a 9 per cent vacancy rate, which Ms Scott says impacts on hospital flow as “people are coming in the front door, but not coming out”.

“We know there a significant shortage of occupational therapists in England, particularly in London,” Ms Scott says. “This is related to the cost of living.”

She explains services are really struggling to recruit and it is now more “difficult and expensive” for short-term workers from abroad to work shorter contracts.

“OTs’ joint training in mental and physical health really speaks to the integration agenda we are trying to deliver on right now, but we do not have enough,” she stresses.

The profession was added to the shortage occupation list following recommendations from the Migration Advisory Committee, which was, of course, welcomed by the royal college.

But this alone will not solve the shortages. Ms Scott explains the removal of the bursary for allied health professionals along with nurses impacted the diversity of the profession, as it has prevented those applying who cannot afford to “stop living or working for three or four years”.

“OTs will spend almost a year on placement in work settings and the academic demands are high too,” Ms Scott says. “People really struggle to hold down part-time work or study.”

HSJ has already reported the chief executive of the NHS has said the question of the bursary is “back in play” and it is understood alternative forms of support for students are being considered at some level.

The future for occupational therapists does seem a little brighter following changes to the shortage occupation list, but their full potential is yet to be fully unlocked. Perhaps the final People Plan and spending review could change this?

‘Strategically important’ in whose eyes?

Centre-right think tank The Centre for Social Justice has weighed in on the post-Brexit immigration debate with a new report on the future of immigration and a controversial proposal for a £36,700 wage cap for skilled workers, both EEA and non-EEA.

Although this report is by no means government policy, it said the Home Office should consider a list of occupations that are “strategically important or in high demand, for instance NHS workers” who would be able to migrate to the UK regardless of the cap.

It appears the CSJ is not aware of the shortage occupation list, on which nurses, all medics and many other NHS workers sit, due to severe workforce shortages in the health service for which the UK is reliant on European and international workers to fill.

The Royal College of Nursing’s chief executive Dame Donna Kinnair makes a salient point, which is, even if nurses are not considered to be within the cap, it would act as a barrier for the wider supply for the health and care sector. As Ward Round readers well know, and as illustrated in the former part of this column, the NHS is a multiprofessional organisation, that keeps going thanks to a host of different workers – many of whom are not earning at least £36k.

It would surprise me if the CSJ considered all of these workers to be “strategically important”, but ask any chief executive and they’ll give you a very different answer.