In London, the high cost of living and unaffordable housing means NHS trusts and social care services are struggling to recruit enough occupational therapists.

Occupational therapy services in London are reaching crisis point as they struggle to fill vacancies and retain experienced staff. The first recruitment fair of its kind to attract occupational therapists (OTs) from Europe – specifically Holland, Malta and Ireland – to work in health and social care in the capital took place in late October. At the same time some local authorities are contracting out cases to private companies to help clear the backlog of non-urgent assessments.

Julia Skelton, director of professional operations at the College of Occupational Therapists (COT), admits: “It’s the first time we have ever had to do a jobs fair of any kind – we have never needed it before but it’s a response to help trusts and social care find OTs.”

The vacancy rate for OTs working in social care outside of London is about 8% and it is generally accepted that, nationally, most OTs will find a job within a year of graduating. But the picture is different in London because of the high cost of living and unaffordable housing.

Confidential research, due to be published in the new year, illustrates the scale of the challenge. The figures, which are still being finalised, show that London NHS trusts have a vacancy rate of 15.2% and in social care it rises to 17.5%. The highest number of unfilled NHS posts are in band six and in senior OT practitioner roles in social care where vacancies run at 18.2%.

These provisional statistics are backed up by latest NHS figures. There were 1,016 advertisements for OT jobs in England between March 2014 and the end of February this year – of which 273 were for London alone.

The Health and Social Care Information Centre, which collated the stats, says they should be treated with caution as they are “experimental” and one ad may be recruiting for more than one post. But Skelton says the numbers are significant: “The situation is critical.”

It is a view shared by Rob Gray from the London managers’ OT group, which draws from both health and social services. Lack of NHS OTs means patients – particularly those attending A&E, general medicine and care of older people – are not getting the rehabilitation they need to return home and live independently. “What is happening is that we are pushing people through hospital and discharging them very quickly with lots of equipment which is disabling for the patient,” Gray says.

Traditionally social care OTs work in small teams – usually about 10 staff – so vacancy statistics can sometimes appear alarming. Cathy Kerr, chair of the London branch of the Association of Directors of Adult Social Services, says: “A 20% vacancy rate would account for just two posts in a small team.” But the impact of losing those two posts is significant: “The priority cases will be seen but the less urgent – for example, an older person who needs a level-access shower – will slip down the list.” Kerr is also director of adult and community services at Richmond upon Thames, which like other boroughs is turning to private companies to take a batch of assessments and “blitz the waiting list”, she reveals. “It’s not an ideal solution but it can be quicker than bringing in a locum.”

The recruitment crisis is made worse because in the past trusts and social services have traditionally recruited from Australia, South Africa and the US to fill vacancies. But that route was closed when OTs were taken off the official professional shortages list. An attempt by the COT, supported by the British Medical Association, to get OTs back on to the list in February failed after theMigration Advisory Committee concluded that the recruitment problem was a regional, not a national, one.

For Matt Bourne, deputy head of OT at King’s College hospital NHS foundation trust, the solution is to go to India: “I am currently preparing a business case to recruit OTs from there. The amount we would pay for every relocated OT would be recovered within six weeks because we would not have to pay a locum.”

Stephanie Saenger is a Dutch OT and president of the Council of Occupational Therapists for European Countries. OT vacancies across the Netherlands varies but she believes some, especially young OTs, would be attracted to work in London: “The romance of London will appeal and the language will not be such a barrier. I also think that the Dutch OTs will be able to adapt to UK practice which is very community-based. But where they may find a problem is with the system of an OT hierarchy, which doesn’t exist in the Netherlands.”

Another issue may be the anticipated £400 each will have to pay to become registered to practise in the UK. “In the Netherlands OTs can practise once they are graduated,” she says. “They are not used to having to pay that sort of money to register to practise and it would help if they didn’t have to pay those costs themselves.”

The Guardian

In 2012, NHS England launched the Compassionate Care strategy. At the heart of it are the6 C’s, which are the principles that underpin care with dignity and compassion. Whilst laudable, the realities of applying care, compassion, competence, communication, courage, and commitment to moving and handling can be challenging. We believe this is because the realities of meeting the requirements of moving and handling legislation are at odds with the realism of managing the aspirations of individuals who are having to deal with the realities of living with a long -term conditions. Despite these challenges, let’s take a brief look at how incorporating three of the Cs into moving and handling practice can help workers to deliver care with dignity and respect.

Moving with Dignity

For many people living at home with a long-term condition means having to accept care from health and social care workers. Moving and handling legislation often means this care is delivered in a way that the person would not have chosen, yet they accept it as part of the many daily compromises they make to live a life with meaning and purpose. Through compassionate practice, a worker has the opportunity to undertake moving and handling as an aspect of their role that at least attempts to provide dignity and respect at the core of what they do.

It is hard for a worker, or carer, to develop compassion without first gaining the confidence and competence in using moving and handling techniques. This is because competent workers deliver care that is of the highest quality, and in a way that maintains the individual’s dignity. Therefore, employers have a responsibility in ensuring good quality moving and handling training is provided on a regular basis.

Good quality training will ensure workers understand the role of communication in maintaining an individual’s dignity when being moved and handled. When used well, verbal and non-verbal communication is powerful “dignity” tool because it ensures the individuals receives care that makes them feel safe, respected, and in control of the situation.

Workers and practitioners need to remember that whilst moving and handling is part of their everyday job, for the people they care and work with, it is part of their everyday life they did not choose nor wanted. By “doing” moving and handling techniques in a way that embraces component of the 6 “Cs” we can go a long way in ensuring that we are at least attempting to deliver care in a dignified and respectful way.

Kate Sheehan

OT Service

Mangar will be at the Care Show on the 3^rd and 4^th November, demonstrating the Camel and ELK lifting cushions. The cushions are designed to maintain the dignity of a person who has fallen during a lift.

References

England, N. (2015) NHS England » compassion in practice – our culture of compassionate care. Available at: https://www.england.nhs.uk/nursingvision/compassion/ (Accessed: 30 October 2015).

Ask anyone how to prevent bone fractures and they’re likely to answer, “Get more calcium.” Medical experts have tended to agree. For example, the Institute of Medicine advises a calcium intake of 1,000 to 1,200 milligrams (mg) a day for most adults. But in the last five years, we’ve also learned that calcium — at least, in the form of supplements — isn’t risk-free. An intake of 1,000 mg from supplements has been associated with an increased risk of heart attack, stroke, kidney stones, and gastrointestinal symptoms.

Now an analysis of reams of research concludes that consuming calcium at that level doesn’t even reduce fractures in people over 50. And a related analysis indicates that increasing calcium intake has only a modest effect on bone density in people that age. Both were published online this week in the medical journalBMJ.

These results may seem startling, but they aren’t a surprise to Dr. David Slovik, associate professor of medicine at Harvard Medical School and author of our Special Health Report Osteoporosis: A guide to prevention and treatment. “I don’t believe that we’ve ever thought that calcium per se reduces fractures; it’s one part of a larger picture,” he says. You really can’t say ‘Take enough calcium and you’ll be fine.’”

What the analyses found

The analyses were conducted by a team of New Zealand researchers led by Mark Bolland, who first identified the cardiovascular risk associated with calcium supplements. For the first analysis, they looked at more than 70 studies on the effects of dietary calcium and calcium supplements in preventing fractures. They considered both randomized clinical trials and observational studies, and the studies varied widely in terms of numbers of participants, calcium intake, vitamin D intake, and how fractures were reported. The researchers found that, overall, neither dietary calcium nor calcium supplements were associated with a reduction in fractures.

In the second analysis, the team reviewed 59 randomized controlled clinical trials that evaluated calcium intake and bone density. Fifteen of those studies involved dietary calcium, and 44 looked at calcium supplements. Overall, getting at least 800 mg of calcium a day from the diet or taking at least 1,000 mg of supplemental calcium a day increased bone density. But bone density only increased by about 0.6% to 1.8% — an amount too low to affect fracture risk.

It’s important to note that these studies included very few men. (Many people think that osteoporosis only affects women, but men can develop osteoporosis too.)

The study that started it all?

Bolland and colleagues pointed to one study that they think may be responsible for today’s calcium recommendations. This study was a randomized controlled trial conducted among 3,800 elderly French women (average age 84) in assisted living. The women initially had a low calcium intake (around 500 mg a day), low vitamin D levels, and low bone density. Those who received 1,200 mg of calcium and 800 international units (IU) of vitamin D supplements daily for three years had a 23% lower risk of hip fracture, and a 17% lower risk of fractures overall, than those taking placebos. The women who took calcium also built bone, while those on placebos continued to lose it. Those results — reported in 1992 and 1994 — are often cited by experts when drafting calcium recommendations for the general population. But Bolland argues that healthy, active people who don’t have a calcium or vitamin D deficiency aren’t likely to get the same protection from taking that much calcium.

What to do?

“The takeaway is that you shouldn’t be taking calcium with the idea that it will prevent bone fractures,” Dr. Slovik says. But he notes that adequate calcium and vitamin D intake is still essential for healthy bone. A deficiency of either can increase the risk of diseases like osteomalacia and rickets.

It’s impossible to determine how much calcium each of us, individually, needs. Try to get as much calcium as you can from food. If your doctor advises you to get 1,000 to 1,200 mg of calcium a day, you can safely add a daily calcium supplement of 500 or 600 mg without increasing your risk of heart attack or kidney stones. And don’t forget vitamin D. No one is challenging the recommendation for vitamin D — 600 to 800 IU a day from either food or supplements.

Harvard Health Publications

Frances Leckie, editor of Independent Living, takes a look at the therapeutic benefits of water. Frances is a “DH Guru” who’ll be sharing a monthly column on independent living!

#DHgurus

In the unlikely event that I ever win big on the lottery, or acquire a serious amount of money in some other equally unfeasible manner, I know exactly where the first chunk will go: an indoor swimming pool of my own. Indoor because I am a wimp, and take no pleasure in the idea of a bracing plunge into cold water, however wonderful it might allegedly feel once you get used to it. And privacy is quite a bonus, too. Swimming on your own, without having to dodge lots of other people who travel much faster, or just seem to spread themselves into the same space you’re aiming for, is so much more enjoyable. Leaving my personal daydream to one side, I’d like to look at some of the therapeutic benefits of water therapy, and aids to make it more accessible to all.

The local swimming pool is probably where most of us hit the water, and in addition to swimming sessions, they generally provide aquatic classes – water-based exercises to improve muscle strength, flexibility and balance, or achieve a cardio workout. Exercising in water means that your body weight is supported, relieving stress on the joints. Some people find their range of movement is increased, and mobility impairments that make it very difficult or impossible to walk may well be much less inhibiting in water.

Interesting new aquatic therapies

Ai Chi is a form of aquatic exercise which aims to both relax and strengthen the body, by combining breathing techniques with progressive resistance training. It is usually practiced in warm water up to your shoulders, and was developed in the 1990s using elements of qigong and tai chi chuan. Encouragingly, people with painful conditions who practice Ai Chi have found their pain diminished: a study involving people with MS found reductions in both pain and spasms, well beyond the benefits achieved by those performing similar exercises and breathing techniques in the therapy room.

Watsu or Water Shiatsu is another interesting possibility, combining treatment of acupressure points and shiatsu massage with gentle stretches, using the lightness of the body in water to free the spine, rotate joints and lengthen muscles. Unlike Ai Chi, which can be practiced in classes, Watsu is a one-to-one aquatic therapy.

Access to water-based therapy

Both of these water-based therapies are comparatively new, and are not yet widely available around the country, but if you try a Google search for either term, you will come up with qualified practitioners in various areas – you might be lucky enough to find one near you! Happily, the general concept of aquatic therapy or hydrotherapy is now well established, and there are many physiotherapists who specialise in water-based treatments. You can make a postcode search on the Chartered Society of Physiotherapy website http://www.csp.org.uk/. Unfortunately, as you are probably all too well aware, the chance of an adult obtaining physiotherapy through the NHS, except for a short period of rehabilitation following injury or illness, is extremely slim. So access to aquatic therapy sessions will depend on an individual’s ability to pay: another example of the extra costs of living with a disability. One-to-one sessions lasting half an hour cost an average of £30 – £70. In some areas, you may be lucky enough to find group sessions, which are much more affordable.

Reducing fatigue

Many long-term conditions bring fatigue, which has such a wide-ranging impact on life it’s hard to know where to begin. Nevertheless, studies have shown that regular aerobic exercise, such as swimming, can help to reduce fatigue, boosting the amount of energy you have for other activities, and improving the way you feel psychologically too. It seems counterintuitive, to do something that requires effort when you feel exhausted, but it works!

Swimming pools for wheelchair users

Of course you first need to get into the pool – and this can be quite a challenge for wheelchair users. Sadly, despite the best efforts of the equality legislation – DDA followed by the Equality Act 2010 – you cannot count on there being a hoist at every pool to get you into the water. For interest, I checked on the useful “Poolfinder” website http://www.swimming.org/poolfinder where you can search for pools in your neighbourhood by postcode. There are four public swimming pools within a mile of where I am at the moment, but the nearest one listed with disabled access is more than 40 miles away. Obviously the situation will vary around the country, but that does illustrate one of the problems people may find in embracing water therapy.

Where wheelchair access is provided, you may find that getting into the pool involves transferring from your chair to a poolside hoist to get into the water. If you are lucky enough to be within reach of the London 2012 Aquatic Centre, the Commonwealth Games pool in Glasgow, or a few other strategic locations around the UK, you may be able to benefit from a Poolpod, which provides independent access via a submersible lift platform which takes a wheelchair, or indeed an ambulant user, and lets you lower yourself into the water. You can then call the lift back down when you want to leave the pool, all controlled with an access wristband, so that the process can be managed independently.

Water therapy at home

Does your home boast a stylish modern wet room, or are you fortunate enough to have a bath tub? Many of us have opted for the speed, convenience and easier access possibilities of a shower, but the therapeutic benefits of a soak in the bath have perhaps been overlooked. With tubs that provide for side access from a wheelchair, or have an integrated chair lift to lower you into the water, it is still possible to enjoy some home therapy, relaxing muscles and aching joints, perhaps adding some delicious-smelling essential oils to the water, such as lavender or chamomile, to help promote sleep. A tub with massage jets, like a Jacuzzi, is clearly a luxury facility, but also one that brings considerable therapeutic advantages, for anyone in the fortunate position of being able to afford one.

The other water therapy!

Finally, while I was researching this article, I came across another type of water therapy which certainly deserves a mention, and won’t require any effort or expenditure. Drinking the stuff! Start your day with a large glass of pure water, as the very first item in your morning routine, then make sure that you keep properly hydrated, and I can guarantee you will feel better. I would approach some of the more evangelical websites advocating “Japanese water therapy” with extreme caution. In the first place, they often recommend consuming rather alarming quantities of water – and too much is definitely as bad as too little. Secondly, they claim that it cures all sorts of illnesses, which it obviously doesn’t. What it will do, is help with things like constipation, indigestion and urinary tract infections, and make you feel more energetic. Which seems to me enough reason to give it a go!

By Frances Leckie

Disability Horizons

To see Mangar’s range of bathing equipment click here

Nurses have the highest rates of work-related back pain. Educational interventions can help prevent injury and promote understanding of safe patient handling.

In this article…

Why safe patient handling is important to prevent injury
The principles of safe patient handling
Birmingham City University’s approach to patient handling education
Author

Stephen Wanless is senior lecturer and patient handling lead, Faculty of Health, Birmingham City University; Steve G Wanless (Snr) is moving and handling coordinator, Tameside Hospital Foundation Trust, Manchester.

Abstract

Wanless S, Wanless SG(2011) Improving training and education in patient handling.Nursing Times; 107: 23, early online publication.

Injuries associated with patient handling activities are common in healthcare and cost the NHS more than £80m a year. Improving education and training can help prevent injury, and better communication between education and clinical areas will improve monitoring of poor patient handling practice. This article discusses Birmingham City University’s approach to patient handling education for pre-registration student nurses.

Keywords: Patient handling, Musculoskeletal injuries, Risk assessment

This article has been double-blind peer reviewed

5 key points

Patient handling is a skilled activity combining theoretical knowledge with practical experience. Poor technique can cause musculoskeletal injuries
Healthcare education for safe patient handling is shared between the university and clinical practice. Universities have a legal duty to prepare healthcare students for patient handling activities in practice (HSC, 2004)
Safe patient handling starts with a personal risk assessment. Every time you assist or transfer a patient you are at risk of injury so a handling procedure should only be carried out if it really necessary
Poor posture can be corrected by maintaining a neutral spine, using your legs, never twisting your back and keeping the load close
Promoting good posture and positioning in nurse education will only be beneficial if patient handling is taken seriously in clinical settings
Injuries associated with patient handling have been a problem in healthcare for decades, particularly for nurses, who have the highest rates of work-related back pain among health professionals (Edlich et al, 2004). Patient handling is a skilled activity combining theoretical knowledge with practical experience, and poor technique can lead to herniated discs and other musculoskeletal injuries. However, efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than sound educational theory. Weaknesses have been identified in the educational approaches to improving patient handling practices (Wanless and Page, 2009), and there is a growing body of evidence supporting newer interventions for reducing musculoskeletal injuries to healthcare workers (Wanless and Page, 2009).

This article discusses the methods for educational interventions in patient handling at Birmingham City University and describes how simulation exercises can help prevent injury and promote an understanding of the principles associated with patient handling tasks.

Training and education

Despite strong evidence on its importance, the most commonly used strategy of teaching moving and handling – showing healthcare workers prescriptive techniques required to handle patients – has proved to be ineffective. Healthcare education for safe patient handling is shared between the university and clinical practice. Universities have a legal duty to prepare students for clinical placements and patient handling activities (Health and Safety Commission, 2004). The process begins during pre-registration education with the initial patient and inanimate load training, followed by annual updates; students are then expected to gain further practical experience on clinical placements (Royal College of Nursing, 2000).

As initial teaching is carried out by training and academic, rather than clinical, staff, there is the potential for a gap to develop between taught theory and practice. Felstead and Angave (2005) said teaching patient handling is not always seen as the “true work” of higher education institutions and may not be valued by academics. Health faculties have also failed to take advantage of the opportunities and benefits of interprofessional learning (Kneafsey et al, 2003). Inconsistencies over taught content, mode of delivery and assessment strategies in patient handling also exist (Smith, 2005), as do discrepancies about which set of principles should guide education and training, such as neuromuscular, ergonomic, biomechanical or kinetic (Hignett, 2005). The way patient handling training is designed and delivered has the potential to improve greatly.

Appropriate training

The joint responsibility for training in patient handling led to a lack of clarity over the responsibilities between Birmingham City University and the local NHS trusts. One of the primary aims of the patient handling programme at the university was to make it evolutionary rather than revolutionary. Working with other disciplines within the health faculty and being responsive to their needs, rather than imposing a system of work on them, is vital to establishing ownership of the programme and gaining commitment from other disciplines to teach the subject.

The majority of students who undertake patient handling training at Birmingham City University are pre-registration student nurses. Students are vulnerable to injury because they lack both the technical skills and muscular conditioning developed through patient handling activities (Kier and Macdonell, 2004).

Students at the university are encouraged to be active learners, working towards a set of clear learning outcomes relating to evidence-based patient handling, posture, and positioning. Teaching and learning activities are tailored to the needs of students with different levels of experience.

During patient handling sessions, students often say the practices and techniques promoted bear little resemblance to those undertaken in clinical settings. This raises questions about the relevance of the university’s patient handling training and suggests students are not being adequately supervised or assessed to develop safe patient handling skills. However, the anecdotal nature of students’ comments makes it difficult to determine how widespread these views are.

Students’ experiences are discussed in the training sessions; those who are reluctant to change unsafe practices are encouraged to reflect on their methods and explore the rationale for adopting safe handling postures and an ergonomic approach to risk management. A system is now in place to address the learning needs of students who have difficulty grasping the main principles of safe patient handling, which are:

Risk assessment;
Neutral spine;
Use your legs;
Never twist;
Keep the load close to your body.
Risk assessment

The principles of patient handling start with a personal risk assessment. Patient handling requires a mix of common sense and adaptability to any situation that may arise, and because the load to be moved is unpredictable every patient handling task is unique. Circumstances can change quickly, so a personal risk assessment must be done before each procedure.

The first consideration is always the aim and objective of the patient handling task. It is vital to remember that every time you assist or transfer a patient you are at risk of injury; a handling procedure should only be carried out if there is no other way to achieve the objective. This helps ensure the handler will not be caught unprepared, or put at risk. The following areas should be considered to ensure the patient handling procedure is carried out safely:

Task;
Individual;
Load;
Environment (Wanless and Page, 2010; Smith, 2005).
On completing the assessment, handlers should ask themselves: “Do I need to perform this procedure?” Once the risk assessment has been completed, handlers must concentrate on position and posture to reduce the risk of personal injury.

Maintain a neutral spine

Keeping the spine naturally straight allows it to act like a spring and absorb body weight, assisting the main shock absorbers and the smaller spinal muscles to work to their full potential. Using an anatomical skeleton, students are shown what a neutral spine is (Fig 1) and the facilitator highlights the sloppy “S” shape.

Students are asked to sit in what they consider a neutral spine position; the session facilitator then helps them to achieve the correct position. Students complain how uncomfortable and unnatural this feels but are reminded this is how they were born and that socialisation, as they have grown older, has affected their posture. Students are then asked to adopt the position in which they watch television or sit at a computer; this highlights how they have adopted a “C” position in the way they sit and stand.

Use your legs

The position of the feet is the secret to safe handling. The handler’s feet should be comfortably apart with one foot slightly in front of the other, giving a wider base of support and stability in all directions. Relaxing knees and hips with an offset base can improve balance. The offset feet position also creates a greater surface area as feet are kept in contact with the floor when knees and hips are relaxed.

To demonstrate the importance of this principle, students are paired up and asked to stand toe to toe with their partner. They must then stand on tiptoe, rocking backwards and forwards to see if they are in a stable position. They are then asked how they should position their feet to feel more stable. They are advised to bend their knees and use the quadriceps to aid stability, then practise the same movement but with feet flat on the ground, shoulder-width apart. This position shows stability in a side-to-side rock, but less stability with a forward and backward movement (Fig 2).

Students then perform the same procedure with their feet shoulder-width apart, and with one foot in front of the other. This shows the importance of using the legs when performing a patient or inanimate load handling task.

Never twist

Twisting, or rotating the spine, reduces the effectiveness of the joints and muscles and decreases the body’s capacity to do work; this increases the likelihood of injury (Fig 3). If the spine has to be rotated, handlers need to reposition their feet – not doing so can cause the pelvis and shoulders not to be level.

The facilitator demonstrates this by holding their arms out straight in front and asking one of the students to push their arms from the side, highlighting the twist of the spine. Students are asked how they can stop this from happening. The facilitator then demonstrates two techniques to prevent the spine from twisting – namely, stepping in the direction of the force and swivelling feet and legs on the spot.

Keep the load close

The distance of the person or load from the spine, at waist height, is an important factor in the overall load on the spine and back muscles. Reducing the effect of excessive leverage is best achieved by being as close to the patient as possible. Students are asked to grab a handful of air from in front of them and hold it shoulder’s length distance from their bodies in a cupped hand. The facilitator looks for signs of students starting to tire, such as shoulders rising, and tells them this is how it feels to physically lift during a patient handling exercise.

Students then bring their hands in front of them at their waist and the facilitator asks if this is releasing the strain on their back and shoulder muscles, highlighting the importance of keeping the load close.

After being shown and practising the principles, students are asked to lift a 5kg box. Their peers watch to ensure they maintain posture and positioning using the four main principles. All students must participate in the task.

Communication

When applying the principles of practical patient handling, students are asked to choose a leader for the task. It is the leader’s role to communicate with the team. Once the patient is prepared, the handlers prepare the equipment and environment, carefully removing all hazards from the handling area and route if transferring a patient.

Students are told movement should commence on a predetermined signal, such as “ready, steady, stand”.

Training staff

Two patient handling coordinators were appointed to lead the team of trainers at Birmingham City University, providing a central point of contact for staff and students. The coordinators are members of the National Back Exchange, an organisation that supports health professionals in reducing occupational back pain in healthcare (www.nationalbackexchange.org). One of the aims of the National Back Exchange is to develop and promote common standards of training in safer handling (Williams et al, 2002). All trainers attend yearly updates to share their knowledge and experience with the training team. This helps ensure all trainers are kept up to date with any developments in moving and handling.

Conclusion

Communication between education and clinical placement areas, and monitoring of poor patient handling practice has improved in the West Midlands. Patient handling training has also improved corporate commitment, and the faculty has ensured compliance with legislation and best practice. This will help improve student and patient experiences in this important area of practice.

University education, using the promotion of good posture and positioning, will only be beneficial if students learn to take patient handling seriously in clinical settings, and where a culture of safety exists throughout the organisation.

Box 1. Back injuries: the facts

Work-related musculoskeletal disorders, including manual handling injuries, are the most common type of occupational ill health in the UK (Health and Safety Executive, 2007)
NHS sickness absence due to musculoskeletal disorders accounts for 40% of all sickness absence (NHS Employers, 2009)
Work-related back pain has an annual prevalence of 40-50% for nurses, and a lifetime prevalence of 35-80% (Edlich et al, 2004)
Unison has estimated that around 3,600 nurses are forced to retire every year due to back injuries (NHS Employers, 2009)
Sickness absence related to patient handling injuries costs the NHS over £80m a year (HSE, 2007)

Nursing Times

Care Act, Social Services, Housing and Promoting Wellbeing

The Care Act has been hailed as the biggest change in health and social care since its origins 60 years ago.  It will do this this by replacing numerous outdated pieces of social care legislation, Fair Access to Care (FAC’s), the Chronically Sick and Disabled Person Act 1970 are two such pieces of legislation which have been repealed for adults, which has been at the forefront of Occupational Therapy professiona within social care.  This article will look at,

• Key principles and legislative changes
• Housing – suitability of living accommodation
• The impact on Occupational Therapy practice

The Care Act is attempting to address the confusion and often-conflicting piecemeal Social Care legislation by empowering and trusting people to take responsibility for their own health and social care needs.  The Care Act is also making a bold statement by making well-being the focus of social care provision, yet does not give Occupational Therapists a clear definition on which to work with. Though the guidance does not define wellbeing as such, it does provide what commentators are calling the wellbeing principles as set out in Act under Clause 1(2) and the guidance states clearly that Local Authorities MUST promote wellbeing.

Independent living is not one of the key principles but is a crucial part of the Act and covers the key components expressed in the UN Convention on the Rights of People with Disabilities Article 19, supporting everyone to ‘live as independently as possible, for as long as possible’.  The Act also affirms the need for the outcomes to be focused on what truly matters to the end user. Suitable housing is key to independent living as is a client centred approach and a core part of a community OT’s practice.

Whilst some people have criticised the Care Act for not providing a definition of wellbeing, it could be argued that principles are more useful to professionals who implement it, as it allows us to put the client at the centre of the process and clearly defines the needs around one or more of the 9 principles. The guidance lists the nine wellbeing criteria and one the key ones for those working in housing is point ‘h’ Suitability of living accommodation.  The guidance is also clear that point ‘h’ is just as important as the other 8 principles

Housing is mentioned throughout the Act and its guidance. It is seen as a crucial health- related service. The key areas of note for any OT working in Social care are:

• The Act places a duty on a LA to carry out care and support functions that promote integration, including housing (4.88 in the guidance)
• LA must provide or arrange services which prevent delay or reduce individuals needs for care and gives as an example home adaptations (2.2.3 in the guidance)
• Home adaptations are an example of prevention as stated in 2.8 of the guidance.
• There is a legal duty to cooperate with external partners including housing providers (15.21 in the guidance)
• Clearly states that the Housing Grants, Construction and Regeneration Act 1996 still stands as a provider of housing grants to adapt service users homes via a disabled facilities grant.
• Funding up to £1,000 is still available for minor adaptions (and equipment) and is free of charge (8.14 in the guidance)
• Re-ablement and adaptations are seen as an effective route to prevention of deterioration of the clients condition or admission into hospital’ (15.62 in the guidance)

The World federation of Occupational Therapy defines OT as a ‘client-centered health profession concerned with promoting health and wellbeing through occupation,’ – wellbeing is at the heart of what we do and the Act supports our professional role.

The new Care Act will enable OT’s in Housing to

• Empower the service user to define their own housing needs and goals
• To promote independent living in a way that is focused on the client not the services or resources available.
• Look at more innovative ways to achieve the client’s goal.

The OT Profession needs to understand the legislation and be able to clinically reason occupation based assessment of need of the individual clients we are working with.

As a profession we need to embrace change and look at ways of promoting our services, which will put the client at the centre and promote true wellbeing as defined by our users. The Care Act should enable us to achieve this outcome.

Kate Sheehan

The OT Service

Occupational therapists are key professionals in a variety of settings, including care homes, according to the latest report.

The National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) has highlighted the importance of having such expertise when looking after elderly and vulnerable patients. It comes as part of an initiative across England to urge councils to ensure they are providing meaningful and person-centred activities in care homes. This, according to the body, will guarantee that each local authority is meeting its safeguarding responsibilities.

The latest announcement is part of a briefing to local government from NICE, which emphasised the importance of involving occupational therapists when trying to improve the general health of people living in care homes. It also stated that a lack of meaningful activity can suggest a wider pattern of neglect.

As well as improving the standard of care, and safeguarding the health of people in care homes, NICE states that providing more meaningful and person-centred activities could also reduce the cost of care. In addition, it would also potentially help people keep their independence for as long possible, and support councils in their duty of providing care to residents.

College of Occupational Therapists

Karin Tancock, a professional adviser at the College of Occupational Therapists (COT), said: “These recommendations from NICE leave no doubt about the necessity for meaningful activity in care homes. We welcome the clear action points for Councils which includes embedding occupational therapy in their strategy to deliver good standards of care for residents.”

She said keeping mentally and physically occupied is “a human need” and unless this is supported by care home residents their health is at serious risk.

“We call on our partners in social care to work with occupational therapists in their area to give people in care homes fair access to meaningful and person centred activities,” Ms Tancock added.

The College of Occupational Therapists has produced a free Living Well Through Activity for Care Homes Toolkit providing practical steps and advice to increase activity in care homes. It includes specific guides for care home inspectors, owners, managers and staff and resources for residents and their families.

JustOT

More and more occupational therapists are coming from New Zealand, Australia and other destinations to work in the UK. There are many reasons to come to work and live in the UK as a locum occupational therapist, with the location offering a lot opportunities for people in the industry.

For those looking to expand their skill set or develop their expertise, the UK is one of the world’s top destinations and can offer plenty of incentives for people at all stages of their career.

More location opportunities

One of the biggest advantages the UK has is that you can get from one end of the country to the other within a day. This allows locum occupational therapists to have a high level of flexibility in the positions they commit to. Even if you are located in the north of England, where the property prices are considerably cheaper, you can get to the capital in just over two hours. This means locum workers can really make the most of the opportunities on offer in the UK as location doesn’t need to be a boundary if you don’t want it to be.

This enables professionals to focus their efforts entirely on the area they want to expand to or develop their skills in, rather than being restricted to a certain location. It also means that seeing friends and family members across the UK is achievable within a weekend.

World-leading research and experts

With its high calibre of universities including Oxford, Cambridge and other ‘Red Brick’ institutions, the UK is a world leader in terms of research and development, and offers plenty of opportunities for locum occupational therapists who want to expand their skills at this level. Regardless of whether or not you want first-hand experience in cutting-edge research in your field, this has a knock-on effect on the number of roles and positions available.

As far as occupational therapy is concerned, reports suggest that stroke services in the UK are developing quickly and have the potential to be world-leading within a few years. This offers a unique chance to be significantly involved with the development of something that could dramatically change the level of service patients can receive.

Beautiful location

Although New Zealand and Australia are beautiful places with stunning coastlines, there really is no place like the UK. From the rolling moors of Yorkshire to the cultural heritage of Wiltshire, there is so much to see across the country. The best thing is you can be living and working in the heart of London, Leeds or another vibrant city, but be in the rich countryside within a few hours. This can really help people strike a positive work-life balance, and make the most of their free time.

England, Scotland and Wales also benefit from an impressive amount of museums and other institutions that celebrate the nations’ history.

Click here for original article Just OT

See how Mangar works with Occupational Therapists

‘Arthritis is a common condition that causes pain and inflammation in the joints’*, it affects around 10 million people in the UK and Osteoarthritis is set to reach 17 million by 2030 according to research conducted by the charity Arthritis Care¹ and most of people diagnosed with the condition are over the age of 65, not only does it affect you physically it can have a huge affect on someone’s mental health as well.

* According to the NHS choices website (http://www.nhs.uk/Conditions/Arthritis/Pages/Introduction.aspx)
There are approximately 120 different types arthritis, the two most common are, Osteoarthritis and Rheumatoid arthritis.  The type and severity of the symptoms varies and it is essential to have a clear diagnosis prior to any form of therapeutic intervention.

This article will,

• Review the clinical presentation of the two common types, Osteoarthritis and rheumatoid arthritis
• Discuss how a hot bath can improve pain and swelling, which can lead to improved occupational performance, if used as part of a holistic treatment programme.

Osteoarthritis (OA)

OA was historically thought to be a normal consequence of aging, leading to the term “degenerative joint disease.” However, it is now known that OA results from the interaction of multiple influences, including joint integrity, genetics, local inflammation, mechanical forces, and cellular and biochemical processes.  This leads to

• Joint pain and tenderness
• Swelling of the joints causing reduced range of movement
• Boney deformities
• Joint instability and muscle wasting around affected joint
• Reduced ability to carry out day to day activities

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterised by progressive damage of synovial-lined joint. RA can affect any joint, but it is most commonly found in metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints. Symptoms following diagnosis can be but not limited to,

• Joint inflammation and pain
• Morning joint stiffness
• Fatigue
• Muscle wasting
• Rheumatoid Nodules
• Eyes: secondary Sjögren’s syndrome.http://www.nhs.uk/conditions/Sjogrens-syndrome/Pages/Introduction.aspx
• Reduced ability to carry out day to day activities

Early diagnosis and treatment is critical to ongoing management of the RA according to the National Institute for Health and Care Excellence (NICE)² as this allows for the degeneration of the joints to be reduced and protected.

There is significant evidence that all forms of Arthritis impact on a person’s mental health and studies have shown that there is a 13-20% increased likelihood of depression due to the excruciating pain and loss of functional ability³

Therefore pain management and strategies to maintain Occupational performance are key in developing effective therapeutic interventions.

What are the benefits of a hot bath?

There is good reason why hot baths or hydrotherapy pools are routinely used by physiotherapists and pain management experts in the ongoing treatment of people with a diagnosis of OA and RA, as immersion in hot water stimulates the release of endorphins, these are naturally occurring neurotransmitters released from the pituitary gland in the brain that reduce pain and improve mood, thus having a positive affect on two of the most debilitating symptoms of the condition.

So why is this the case, immersion in warm water raises your body temperature, causing your blood vessels to dilate and increasing circulation, this results in less swelling and pain, and increases mobility. The soothing warmth and buoyancy of warm water makes it a safe and an ideal environment for relieving arthritis pain, stiffness and enables its user to carry out a range of movement in a supportive environment.

The additional benefit of a hot bath is that hot water prompts relaxation and the increase in body temperature helps you fall asleep faster and sleep more soundly, this then allows for a deeper sleep pattern and thus reduces the effect of fatigue.

The warm bath can therefore be used as part of a treatment progrmme to reduce the affects of pain prior to purposeful activity, e.g. social event, cooking, gardening or a round of golf or to aid sleep prior to a significant occasion which would have historically been to difficult to attend due to fatigue.

The healthcare professional involved with a client with RA or OA should look at creating clearly defined client centred goals which look at self-management, engagement in therapeutic activities and exercise programs that are essential to increase functional abilities, improve sleep, decrease depression and enhance overall health and well being.

1. OA Nation 2004. Arthritis Carehttp://www.arthritiscare.org.uk/PublicationsandResources/Forhealthprofessionals/OANation
2. Rheumatoid Arthritis NICE CKS, August 2013 (UK access only)
3. Creed F. Psychological disorders in rheumatoid arthritis: a growing consensus.