Realising the benefit of occupational therapy in prevention and enablement: Hertfordshire

Evidence suggests that occupational therapists (OTs) deployed to work with reablement home care providers will maximise the efficacy of reablement interventions. On this basis, Hertfordshire County Council created a small number of occupational therapy roles, in generic teams largely managed by social work qualified managers. In practice, however, the expected benefits did not materialise. 

In the new service model, OTs in a stand-alone Enablement Team triage reablement referrals to identify those who would benefit from an occupational therapy intervention where this has not been identified by the main teams undertaking Care Act assessments. The team also works with health providers to ensure the service works in an integrated way, with health OTs covering some discharge to assess beds, and others covered by the local authority OTs. 

The service supports Hertfordshire in delivering the Care Act statutory duties of prevention and enablement, achieving better outcomes and promoting wellbeing. Leadership by the Principal Occupational Therapist ensures practice is of a high quality, and the service developed utilising the full potential of occupational therapy, based on professional confidence of the impact rather than waiting for performance data and evidence that can be difficult to collect. 

Subsequently, the redesign of the front door to Hertfordshire Adult Care Services under the leadership of an occupational therapist in a senior management role, has focused on prevention and enablement opportunities, and included a significant investment in further occupational therapy and assistant roles. 

In the first year (2017-18) the Enablement Team saved £800,000 or 40,490 home care hours, in addition to savings related to people returning home from short stay residential beds.