Academic journal article British Journal of Occupational Therapy

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Academic journal article British Journal of Occupational Therapy

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Article excerpt


Social care services for older people are a part of local authority adult social care services in England, social work services in Scotland, and social services in Wales. In Northern Ireland, health and social care is integrated into one structure (College of Occupational Therapists [COT] 2010). Occupational therapists are employed in all of these services. However, in view of Northern Ireland's organizational differences, which inevitably impact on service delivery, this critical review of the literature relating to occupational therapy for older people in local authority social services focused on England, Scotland, and Wales (Great Britain).

Older people are the main users of health and social services (Department of Health [DH] 2001) and the number of older people in the United Kingdom (UK) as a whole is expected to rise, with the fastest projected increase in those over the age of 85 years (Office for National Statistics 2012). This growth in a potentially frail population will place further pressures on social care services, including occupational therapy, at a time of increasingly scarce resources. Such pressures place an onus on the profession to demonstrate the effectiveness of its services for older people in social care settings.

Across Great Britain, National Service Frameworks and strategies for older people emphasize the need for services, such as occupational therapy, that help people to manage and maintain independence in their own homes and communities for as long as possible, and prevent the need for hospital admission or long-term care (DH 2001, Welsh Assembly Government [WAG] 2008, Scottish Executive 2007a). Government policies relating specifically to local authority social care services in England, Scotland and Wales (DH 2008, Scottish Executive 2006, WAG 2007) state that this is achievable through a preventative and enabling approach to social service provision that reduces the need for complex and costly packages of care. A review of the literature on occupational therapy in local authority social services prior to 2000 identified the importance of occupational therapy interventions in maintaining older people's independence (Mountain 2000). Since then, occupational therapists have continued to play a key role in promoting individuals' self-reliance and resourcefulness (COT 2008).

Occupational therapists in adult social care services make up approximately 2% of the social care workforce in all three countries (Information Centre for Health and Social Care 2011, Scottish Government 2011, Welsh Government 2011) Despite their small numbers, occupational therapists are reported as handling over 35% of adult social care services' referrals and their skills have been identified as key to the delivery of Government policies in England, Scotland, and Wales. Since Mountain's (2000) review of the literature, no systematic reviews of evidence relating to occupational therapy for older people have concentrated specifically on social care services within Great Britain.

Policy context

Each country has, since devolution in Scotland and Wales in 1997, developed its own social care policy drivers and directives, which impact on the delivery of occupational therapy services. At the time of the review these were: Changing Lives in Scotland (Scottish Executive 2006), Fulfilled Lives, Supportive Communities in Wales (WAG 2007) and Putting People First in England (DH 2008). Scotland also introduced a rehabilitation framework (Scottish Executive 2007b) and all three countries have developed strategies for older people (DH 2001, Scottish Executive 2007a, WAG 2008) and frameworks for action. Whilst there are discrete differences, and services are broadly addressed, all emphasize a person-centred approach, and promotion of self-reliance and resourcefulness for service users, principles which are central to occupational therapy in social care services. Taking into account the changes in policy and organizational drivers that have had an impact on social care services since 2000, this review aimed to critically appraise and synthesize the post 2000 evidence on the effectiveness of occupational therapy interventions for older people in preventing the need for complex packages of care in social care services in Great Britain. …

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