The LGA Standards for Employers of Occupational Therapists in England 2022

This standard is a clear statement on the principles that constitute good occupational therapy practice, and how those principles function across the full range of settings.

It outlines the ways in which each organisation can achieve and maintain the theories, skills, research, and evidence that underpin good occupational therapy practice at strategic and operational levels (RCOT, 2021a).

Employers should have a strong, clear accountability and assurance framework that promotes safe and effective occupational therapy practice, delivering positive and for filling outcomes for people; flexible, safe, effective, caring, responsive and well-led (ADASS, 2022). The framework should demonstrate that risk and resource are managed, leadership is accountable, and communication, feedback and information processes are available. It should include reflection, learning from experience, evidence and research of outcome-focused occupational therapy practice, and the voices of children, adults, and families should be evidence throughout.

Occupational therapy is a difficult and challenging activity that involves unpredictable, uncertain, and complex situations. Occupational therapists need a supportive environment in which to work, where learning and reflection on practice are fundamental (RCOT,2021c).

Occupational therapy is one of 14 professions that are allied health professions (AHPs). The AHP workforce strategy is system-wide, including health and social care occupational therapists (NHS England, 2022).

Occupational therapists are regulated by the Health and Care Professions Council. The protected title ‘Occupational Therapist’ can only be used by an accredited and HCPC-registered professional (HCPC, 2013).

1.1 Strategic accountability

All employers should:

1.1 ensure there is a Principal Occupational Therapist or similar senior occupational therapist leader to develop, maintain, and regularly review a statement setting out the purpose, vision, values, and outcomes sought for members of the occupational therapy profession in the organisation.

1.2 establish and communicate an appropriate evidenced based model of practice, setting out how the organisation will operate.   

1.3 ensure the model takes into consideration issues such as balancing strengths, needs and uncertainty, and how occupational therapists can be supported to exercise professional judgement and creativity.

1.4 develop, and review this approach regularly with their workforce and with those who use the service.

1.5 ensure the approach is shared, discussed, and understood by partner organisations, and by people who use the service.

1.6 Leaders and senior managers must be held to account for ensuring that the right conditions exist in the organisation to support and allow the delivery of excellent practice, in line with the agreed approach.

1.2 Operational accountability

All employers should:

1.2 ensure that the culture of the organisation promotes learning and accountability through “high support and high challenge” that creates a safe place for reflection and continual improvement. 

1.3 put in place a system to gather, collate, analyse, and act on the views of adults, children, families, formal and informal carers who experience occupational therapy interventions, so that learning and feedback about impact and outcomes inform continuous development, refinement, and improvement of practice and services.

1.4 ensure that mechanisms are in place to listen and respond to the views of occupational therapy practitioners on a regular basis, including an annual health check to ensure the organisation remains a place where the right environment and conditions exist to support best practice.

1.5 ensure that there is a Principal Occupational Therapist or similar senior occupational therapist leader who promotes and develops best practice, to give certainty that the employer standards are maintained and enhanced, and who can report concerns or barriers to good occupational therapy practice direct to the Service Directors or senior leadership team.

1.6 ensure that there is a strong focus on occupational therapy recruitment, retention, workforce planning and development so that they seek the necessary occupational therapy skills, capacity, and expertise to meet the needs of those they serve.

1.7 ensure that systems and governance are in place to allow senior occupational therapy leaders to influence action required to act on regular qualitative and quantitative performance data, learning from case audit, peer review and inspection, research and best practice as well as the voices of those using the service and practitioners. 

1.8 ensure that there are effective opportunities for occupational therapists to learn and develop, including bespoke support for newly qualified occupational therapists in their first year in practice, and a career progression scheme based on evidenced good practice.

1.9 promote understanding about the unique and complex role of occupational therapy to partners, politicians, the public and practitioners in all public services, such as schools, the NHS, district council housing and grants departments, and the police.

1.10 support occupational therapists to access courses and development opportunities, including allowing them time to undertake continued professional development (CPD) (Standard 6), and supporting them to engage with professional bodies and trade unions

1.11 provide planned professional support programmes for occupational therapists to help them return to work after a long absence.

This standard is about using effective workforce planning systems to make sure that the right number of occupational therapists, with the right level of skills and experience, are available to meet current and future service demands (Skills for Care, 2022). Employers should have a strategy to promote and take concrete steps to improve diversity across all levels throughout the organisation.

Employers should be able to show that they have appropriate workforce planning systems in place to meet the needs of local communities now and in the future.

Effective workforce planning systems should determine immediate staffing requirements and help to ensure that enough occupational therapists are trained to meet future demand. These should be based on an understanding of the factors that influence need and demand, including the size and specific circumstances of the local population. Workforce planning procedures should be regularly monitored and reviewed.

All employers should:

2.1 undertake an assessment of current and future need, and feed this data into local, regional, and national workforce planning.

2.2 ensure that workforce planning systems involve strategic partnerships with higher education institutions and other agencies e.g. AHP faculties

2.3 ensure that occupational therapists have the right knowledge and skills at entry, experienced, advanced practice, operational management, and strategic leadership levels. 

2.4 build a clear practice methodology, based on an up-to-date understanding of the required knowledge and skills base for occupational therapists

2.5 provide good quality practice placements and practice educators, as well as other types of practice learning experience. 

2.6 complete workforce data assessment and share analysis regionally and nationally to ensure that the right numbers of new occupational therapists of the right calibre are trained.

2.7 engage with the occupational therapy education sector to facilitate exchanges of personnel and expertise

2.8 facilitate further learning and development and collaborative opportunities across partner agencies to encourage OT placement capacity expansion, e.g. AHP faculty.

This standard is about ensuring employees do not experience excessive workloads, resulting in unallocated cases and long waiting times for the people accessing the service (RCOT, 2020)

All employers should:

3.1 use a system that has been agreed jointly with occupational therapy practitioners and line managers to set transparent, safe working levels in each service area that enhances a more direct relationship-based practice.

3.2 ensure workload is regularly assessed with each occupational therapist taking into consideration work complexity, individual worker capacity, time needed for supervision (Standard 5), and CPD (Standard 6).

3.3 ensure that occupational therapy cases are allocated transparently and effectively, following discussion with the individual occupational therapist, and with consideration given to experience and existing caseloads.

3.4 ensure that an occupational therapist`s professional judgment about workload capacity issues is respected, in line with the requirements of their professional standards of proficiency for HCPC registration, which refer to the requirement for an occupational therapist to declare to the appropriate authority anything that might affect their ability to carry out their role competently, or that might affect their fitness to practise.

3.5 take contingency action when workload demand exceeds staffing capacity, and report regularly to strategic leaders about workload and capacity issues within services.

3.6 publish information about average caseloads (and their complexity) for occupational therapy within the organisation, as part of the occupational therapy health check (Standard 1).

This standard is about promoting a positive culture for employee wellbeing and supporting occupational therapists to have the practical tools, resources, and organisational environment they need to practice effectively and safely (LGA, 2022).

Employers should create and encourage a culture of wellbeing and self-care that is available for all occupational therapists, to empower and enable them to actively participate in managing their own health including, engagement with occupational health, immunisation requirements, preventative strategies, information about the range of wellbeing tools, and the work-based wellbeing activities available to them (RCOT, 2021 d). 

Induction, team meetings and organisational communication sources should be used to raise awareness of the support available to help occupational therapist thrive in the organisation. 

Employers should be committed to breaking down mental health stigma in the workplace, and managers should use wellness action plans or similar that enable discussions about what helps people keep well, what supports their wellbeing and resilience at work, and where to get help (HSE, 2022).

Employers need to be consciously aware of the emotional demands inherent in occupational therapy, and how they can affect wellbeing. Employers need to understand the ways in which work-related stress can impact on employees’ emotional resilience when working within complex systems and with people, children, families, and carers at times of crisis (HSE, 2022; RCOT, 2021 d).

Reflective supervision can enable staff to process the complex emotional demands that they may experience and can be used to understand which cases or circumstances may be impacting on their wellbeing (HCPC, 2017). Supervision should be used to encourage open conversations with to include action, appropriate adjustments, and an offer of support (RCOT, 2015).

Employers need to champion wellbeing in the workplace, develop a culture where open discussion about the emotional demands of the work is normalised and peer-to-peer support activities are facilitated (LGA, 2022). Employers should develop policies that support those with mental health problems, encourage employees to come forward and seek appropriate support. Initiatives such as the introduction of wellbeing champions and peer support groups in the workplace have been used in other sectors to great effect.

4.1 Strategic accountability

All employers should:

4.11 foster a culture of openness and inclusion in the organisation, which empowers occupational therapists to make appropriate professional judgements within a supportive environment (Standard 5).

4.12 recognise occupational therapists' identities and cultural needs within the organisation, allowing time to engage with staff-led equalities groups, and promote recruitment from diverse backgrounds so that the workforce is reflective of the local population.

4.13 be responsive to workforce needs, be proactive and creative by working with occupational therapists in the organisation to develop a wellbeing framework that supports occupational therapists to thrive at work.

4.14 enable occupational therapists and managers to raise concerns about inadequate resources, operational difficulties, workload issues or their own skills and capacity for direct work with children, adults, family, and carers without fear of recrimination.

4.15 enable occupational therapists to engage with their professional association, regulator, and if they are members, their trade union.

4.16 put in place and support flexible working arrangements.

4.17 promote learning and development opportunities, including secondments with relevant partner organisations.

4.2 Work environment

All employers should:

4.21 make quality time and a suitable environment available, for telephone and video conferencing calls, informal professional discussions between colleagues, break-out areas, formal supervision, and team meetings.

4.22 have a suitable space for confidential interviews, with adequate safety measures to protect practitioners.

4.23 have in place caring and effective systems for reporting and responding to concerns raised by occupational therapists and managers, so that risks are assessed, and preventative and protective measures are taken, to ensure the occupational therapist is kept safe and well.

4.3 Safety

Employers should provide a safe and effective working environment for occupational therapists where their welfare needs are met (HSE, 2022a). This means all equipment that they use, for example hoists for moving and handling people, are serviced and maintained in line with the Health and Safety at Work Act (HSE, 2018a; HSE, 2018b). It also means occupational therapists must have access to moving and handling training, including an annual refresher (HSE, 2016; HSE, 2022 b).

Employers should have policies on violence, aggression, and lone working, and guidance to ensure that employees can do their jobs safely (Unison, 2018). Employers and managers, along with occupational therapists, should ensure that the risks of violence, harassment and bullying are assessed, minimised and where possible prevented. Where such instances do occur, there should be clear procedures in place to address, monitor, resolve and review the situation so that occupational therapists are aware of how to raise and report concerns. (HCPC, 2013) 

All employers should ensure:

4.31 occupational therapists complete regular moving and handling training, even when in roles that are advisory.

4.32 any moving and handling equipment that occupational therapists use is serviced and maintained.

4.33  that any occupational therapists involved in delivering direct personal care have an awareness of policy, guidance, and access to preventative measures such as immunisations and protective personal equipment (PPE) and occupational health advice.

4.34 awareness of the risks of violence and aggression when working alone and that occupational therapists know the local policy and steps needed for employers to protect employees from exposure to foreseeable violence and aggression at work, and other risks arising from lone working.

4.35 that support services, such as occupational health, employee assistance programmes and human resources are available and that occupational therapists who experience violence and aggression at work are actively signposted to these services, recognising that the extent of that support will depend on the circumstances of the individual case.

4.4 Tools and support to do the job

All employers should:

4.41 provide occupational therapists with appropriate practical tools to do their job, including effective case recording systems, business support, access to ICT and ensure that occupational therapists are trained to use them effectively.

4.42 work with occupational therapists to identify ways in which they can deliver better support to people using digital services, like assistive technology and technology enabled care, to adopt new digital technologies, and provide relevant training. 

4.43 ensure occupational therapists have safe means of transport for visiting people in the community.

4.44 ensure occupational therapist are aware of safe social media policies and encouraged to use social media to network professionally.

4.45 provide administrative support to occupational therapists to help to maximise the time they can spend working directly with the children, adults and families who use the services.

4.46 provide occupational therapists with access to fellow professionals, including legal advisors, translators, and interpreters.

This standard is about making sure occupational therapy students and qualified occupational therapy practitioners can reflect critically on their practice through high-quality, regular supervision as an integral part of occupational therapy practice (HCPC, 2013; HCPC 2017b). Supervision should challenge and foster an inquisitive approach to occupational therapy and its application in a social care community setting (RCOT, 2015). This starts with the occupational therapy student on placement (HCPC 2017a; RCOT, 2019), continues with the Newly Qualified Occupational Therapist in their first year of practice (Skills for Care, 2019), and then extends throughout the occupational therapist’s career (RCOT, 2015; RCOT, 2021 c). 

Supervisors’ practice and skills should adhere to post-qualifying competency frameworks (RCOT, 2021b; Skills for Care, 2019). Practice educators supervising student social care occupational therapists should be accredited by the local Higher Education Institute and adhere to the local university Practice Educator Standards (RCOT, 2019).

5.1 Frequency of supervision

All employers should:

5.11 ensure that supervision takes place regularly, consistently is uninterrupted, in line with organisational requirements and guidance, and:

• newly qualified occupational therapists: at least weekly for the first six weeks of employment, then at least fortnightly for the remainder of the first six months, and a minimum of monthly thereafter
• occupational therapy students on placement: as agreed with students and programme providers
• occupational therapy apprentices: at least weekly for the first six weeks of employment, then at least fortnightly for the remainder of the first six months, and a minimum of monthly thereafter.
• occupational therapists who have demonstrated capability at Newly Qualified Supported Year in Practice and above: in line with identified needs, and at least monthly.

5.12 ensure that they have a policy in place that governs supervision, and which:

• locates responsibility for that policy with the Principal Occupational Therapist or other appropriate senior occupational therapy manager.
• requires the actual frequency and quality of supervision to be monitored against clear expectations.

5.2 Quality of supervision

All employers should:

5.21 ensure that occupational therapy supervision is not treated as an isolated activity, and that it is recorded and incorporated into the organisation’s occupational therapy accountability framework and workers’ annual appraisal.

5.22 promote continuous learning and knowledge sharing through which occupational therapists are encouraged to draw out learning points by reflecting on their own practice in the light of the experiences of peers (RCOT, 2021c)

5.23 promote the use of supervision as an opportunity for occupational therapists to critically reflect on and identify their learning needs, using evidence, research, and other occupational therapy frameworks where appropriate.

5.24 actively use the Occupational Therapy Professional Standards and Code of Ethics (RCOT, 2021c) to inform supervision, evaluate capability, identify development needs, and ensure that occupational therapists can draw on and use additional resources, such as The Learning and Development Framework for Occupational Therapists (Skills for care, 2018) to develop their day-to-day practice and skills base.

5.25 ensure that supervision supports students and qualified occupational therapists to meet the HCPC Occupational Therapy Standards of Proficiency (HCPC, 2013).

5.26 encourage occupational therapists to plan and reflect on learning and development activity, evidencing the benefits of learning and development for the people they serve, and making improvements to their practice to meet the HCPC CPD standards.

5.27 ensure that coaching and action learning opportunities are core components of the supervision offer to occupational therapists.

5.28 provide regular supervision training for occupational therapy supervisors.

5.29 assign explicit responsibility for the oversight of appropriate supervision and for issues that arise through supervision.

5.30 provide additional professional supervision by a registered occupational therapist for practitioners whose line manager is not an occupational therapist.

This standard is about occupational therapists being provided with the time and opportunity to learn, keep their knowledge and skills up to date, and critically reflect on the impact this has on their occupational therapy practice. They are required to demonstrate this learning as part of their regulatory requirement (HCPC; 2013; RCOT 2021c). Employers should provide opportunities for regular and effective CPD.

CPD is the reflection and learning activity that occupational therapists undertake throughout their careers to maintain and improve their practice. It is an important part of an occupational therapist`s professional standards (RCOT 2021c). By undertaking and recording CPD, an occupational therapist demonstrates to the public, their regulator, and their employer that they uphold those professional standards.

It is important that employers provide their occupational therapists with time and opportunities to carry out regular and effective CPD, fostering an open learning culture where they are supported through supervision to carry out learning activities that they feel benefit them and their practice.

6.1 Supporting staff development

All employers should:

6.11 have effective induction systems for all occupational therapists in place.

6.12 tailored support for newly qualified occupational therapists through an occupational therapy Supported Year in Employment programme, protected development time, a managed workload, tailored supervision and personal development plans.

6.13 have an appraisal or performance review system, which assesses how well professional practice is delivered, that includes the feedback of people with lived experience of the occupational therapist’s practice and identifies a learning and development plan to support the achievement of objectives.

6.14 provide dedicated time, resources, opportunities, and support for occupational therapists to carry out CPD, and record their learning, in line with HCPC regulatory requirements.

6.15 have fair and transparent systems to enable occupational therapists to develop their professional skills and knowledge throughout their careers through an entitlement to formal and informal CPD, specialist training and development as appropriate.

6.16 provide support and information to enable occupational therapists to progress through post-qualifying specialist training and access nationally funded development and support programmes that will allow them to develop their knowledge, skills, and practice and, in some cases, annotate their registration to reflect a specialism.

6.17 all occupational therapy employers will have a clearly defined career pathway from work experience, student to senior professional lead. 

6.18 encourage occupational therapists to work towards and maintain professional accreditation, where it is available.

6.19 encourage occupational therapists to think creatively about their CPD activity, consider learning they already undertake and online resources, and to draw from their work towards, post-qualifying career development frameworks and accreditations.

6.20 encourage occupational therapists to consider their ethics and values in relation to their practice and emphasise the importance of reflecting on the impact of their learning.

This standard is about supporting an occupational therapist to maintain their professional registration with their regulating body (HCPC; 2013) so that they can continue to practice as an occupational therapist.

All employers should:

7.1 be familiar with occupational therapy professional standards for safe and effective practice and understand the HCPC regulatory requirements for professional registration.

7.2 recognise that carrying out and recording CPD is a condition of registration renewal with the HCPC for occupational therapists.

7.3 support occupational therapists in upholding the HCPC professional standards, which are specific to occupational therapists, ensuring effective CPD opportunities and supervision are provided.

7.4 if there are concerns about an employee’s fitness to practice, take appropriate steps to inform the regulator, co-operate with investigations and hearings carried out by the regulator, and respond appropriately to its findings and decisions.

7.5 be clear about the circumstances in which occupational therapists should be referred to the regulator, and when they shouldn’t.

Promote and encourage ethical practice so that occupational therapists have the support and confidence to challenge unsafe practice and report concerns, in accordance with the HCPC professional standards.

 

This standard is about creating strong partnerships, system leadership and encouraging collaboration between employers, ICS stakeholders, Higher Education Institutions, training providers, and promoting the degree apprenticeship for occupational therapy workforce development (Institute for Apprenticeships and Technical Education, 2021).

System partnership working is an asset to the community, social care occupational therapists work across the Integrated Care System with a wide range of stakeholders, as part of a multi-disciplinary team supporting Community Health Service, advising on housing and adaptation work, social prescribing, voluntary sector, and facilitating hospital discharge.

Strong partnership working will continue to support the training of high-quality occupational therapists, resulting in improved services for children, young people, adults, families, and local communities. Linking with Higher Education Institutions who run post graduate training opportunities, will enable growth in clinical academics (NIHR, 2022), and promote multi professional collaboration for service improvement and evidence-based research (HRA, 2020)

8.1 Developing strategic leadership and existing staff

All employers should:

8.11 engage with local, regional, and national partners, including regional alliances, ICS stakeholders, safeguarding partners, Ofsted, the Care Quality Commission, and RCOT the national occupational therapy professional body, to encourage and implement continuous improvement across the organisation.

8.12 ensure that the Principal Occupational Therapist or appointed strategic occupational therapy lead, understands, and manages the organisational responsibility for this standard.

8.13 ensure that occupational therapy is represented at system level, partnership forums, e.g. AHP council and AHP faculty, clinical and professional cabinet. (NHS England and NHS Improvement 2021) 

8.14 implement formal partnership arrangements with Higher Education Institutes that provide occupational therapy courses, to promote and enable effective joint planning for the provision of occupational therapy placements in a statutory setting, shared communication, and activities to further the delivery of occupational therapy education (Standard 6).

8.15 engage with networks to promote and share best practice and develop opportunities for joint research and evaluation, which enable occupational therapists to participate in research-based activity, grounded in the principles of the UK Policy Framework for Health and Social Care Research (HRA,2020).

8.16 have a clear policy for recruiting, training, and supporting occupational therapy Practice Educators and Practice Supervisors.

8.17 support staff to access post qualifying occupational therapy programmes.

8.18 provide support to newly qualified occupational therapists, ensuring their Supported Year in Employment programme is subject to robust quality assurance processes.

8.2 Developing future occupational therapists

All employers should:

8.21 provide high-quality placements, and support for occupational therapy students on those placements.

8.22 contribute to the recruitment and retention of occupational therapy students.

work collaboratively with partner organisations to develop the skills and knowledge required to deliver high-quality occupational therapy education. 

ADASS(2022) Quality Matters (www.adass.org.uk)

Available at: www.adass.org.uk/media/6021/quality-matters-final.pdf

HCPC (2013) Standards of Proficiency- Occupational Therapist (www.hcpc-uk.org)

Available at: www.hcpc-uk.org/globalassets/resources/standards/standards-of-proficiency---occupational-therapists.pdf

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Available at: www.instituteforapprenticeships.org/apprenticeship-standards/occupational-therapist-integrated-degree-v1-1

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