40th COT Annual Conference

Last week saw the 40^th COT Annual Conference in Harrogate and as always it was a great conference, making people excited by what occupational therapy has to offer, and with lots of sustainability highlights.  There was a buzz about the place with over 1500 attendees, the highest number for a COT conference yet.

I usually enjoy being at the whole conference but was only able to make it up for the final day this year.  I met with Nick Pollard and Samantha Shann, who are members of the WFOT sustainability working group, to discuss the poster about the forthcoming WFOT document ‘Sustainability Matters: Guiding Principles on Sustainable Development’.  This document will be in the same vein as WFOT’s previous ‘Guiding Principles on Diversity and Culture’. Rather than providing definite answers, ‘Sustainability Matters’ will encourage thinking, discussion and awareness of sustainability issues, their effect on occupational performance, health and wellbeing, and consideration of new sustainable approaches that will need to be developed. 

In the afternoon, I facilitated a workshop titled ‘Future proofing occupational therapy in mental health through sustainable commissioning’.  The workshop was designed with Daniel Maughan, who was lead author of the Joint Commissioning Panel for Mental Health ‘Guidance for commissioners of financially, environmentally, and socially sustainable mental health services (future proofing services)’.  The workshop aimed to get people think critically and differently about service design so that they could discuss this with their Clinical Commissioning Groups.  

‘Future proofing’ has been referred to by Simon Stevens (Chief Executive of NHS England) as a key challenge for the entire NHS.  It requires applying the triple bottom line of the economic, environmental and social impacts that our services are having and thinking more clearly about the resources we are using in each of these areas.  Mental health services have been commissioned in terms of financial costs, but government legislation requires acknowledging the environmental and social costs too. 

Global climate change will have consequences on the health of all populations.  The environmental impacts of our unsustainable healthcare system are contributing to this global problem and there is both a moral and legal obligation to address this issue.  Mental health impacts of climate change in the UK include the include increased distress, for example, at times of flooding or during heat waves.  One study that I was unaware of prior to doing this workshop is that during the 1995 heat wave in England suicide increased by 46.9%.  

The area of social impacts is one that occupational therapists are excellent at addressing.  Social sustainability is about restoring social capital for service users, such as through vocational rehabilitation, and developing relationships and a sense of connection to community.  Working with people on their social capital is a core part of occupational therapy and is enabled through key tenets of hope, empowerment and engagement in meaningful activity.  Social sustainability is the hardest of the triple bottom line to define and to measure, but we as a profession are very used to measuring it through social outcomes for people.  As a result, I think that OT outcome measures could be used to help audit social sustainability for services that are evaluated using a triple bottom line approach.

Sustainable commissioning is not about commissioning one particular type of service.  Instead it requires commissioners to apply the four key principles of sustainable healthcare to all their decisions to bring about widespread system change:

1. reduce use of health care through preventative strategies

2. empower service users, carers and others to develop healthy, independent lifestyles

3. deliver high value care by providing the right care at the right time (ensuring the best care is delivered for the minimum resource use)

4. reduce the carbon cost of care (by considering carbon in every decision).

The first two are integral to occupational therapy practice, and show how occupational therapists are already adopting a sustainable approach.  But we need to think hard about these principles and how they’re embedded.  We need to look critically at everything we do.  Could we make things more preventative, more empowering, of higher value, more sustainable?

In relation to point 3 above, there was a discussion in the workshop about the unsustainability of both undertreatment (e.g. premature discharge from services leading to people sometimes returning to services in a worse state) and overtreatment (sometimes leading to dependence on services).  The importance of maximising independent living as much as possible was agreed upon. 

There were some great ideas in the workshop, not all of which I was able to capture, but some of which I hope will be shared on this site soon.   These included developing coping strategies in schools to improve wellbeing, the possibilities of exploring the model of creative ability, managing ‘boom and bust’ in mental health treatment, and concerns about the amount of money wasted on food in a low secure unit when the money could be better spent on service user’s engaging in preparing their own food.  Another consideration was the difficulty of bringing our environmental awareness into the workplace, when we can be far more environmentally sensitive at home.

The Sustainable Development Unit strategy suggested components of sustainable care models that health and social care should adopt to transform services.   These components were: living well, prevention and early intervention, enablement and support, self-management, acute and specialist rehabilitation, and dying well, which are descriptive of occupational therapy practices.  So occupational therapists are already leading the way on practicing within sustainable care models, without possibly realising that we are doing so.  

Exploring sustainable commissioning of mental health services leads to discussions about commissioning sustainable occupational therapy approaches, and the benefits that this could have for the health of our service and the future proofing of our profession and mental healthcare system.