Linda Hindle, Lead Allied Health professional for Public Health England, writes about her visit to the Children’s Occupational Therapy Service in Birmingham City Council as part of the week of action.
Speaking to Allied Health Professionals (AHPS) over the last few months it has become clear to me that, while most are doing health improvement as part of their day-to-day job, they don't see themselves as health promoting practitioners. A lot of AHP’s think public health tends to focus on community development or health promotion work done by teams or individuals with a specific public health remit. However, public health encapsulates so much more than this; it is something we all have the potential to do. Fundamentally, it is about taking the opportunities that arise to help individuals and communities to make the most of their health. How often does a patient say ‘I wish I could lose weight’ or ‘I really ought to stop smoking’? This is a perfect opportunity to ask if they would like some help and, if so, to offer to refer them to a service established to do that. If the answer is 'no', we can let them know help is there when the time is right, and a seed is sown.
Yesterday I had the pleasure of visiting the children's occupational therapy team in Birmingham City Council. I heard about some great examples of how occupational therapists are taking opportunities to improve the health of their clients and their carers.
Birmingham has a population of over 1.1 million; it has a lot of young people with over 280,000 children. The council has significant financial savings to make and therefore the children’s occupational therapy service, like others, is striving to become more efficient and do more with less. How does a service like this, with high levels of demand, still find time for health improvement? The answer is by working in partnership with others and developing an integrated service focusing on the needs of the family.
Two particular examples I discussed with the team this morning were their work on appropriate seating for children with disabilities and how the team prepare parents and carers for the challenges of looking after a child with a disability.
Choice of seating for disabled children is not an issue that would traditionally be considered a public health intervention. However, appropriate seating improves posture and maximises function. This minimises the formation of deformities which unmanaged could require surgery as well as improving the quality of life of the child.
Supporting a child with a disability, is incredibly rewarding, but at times can also be challenging. Carers have multiple pressures to cope with and are more prone to back problems due to the level of lifting and handling required. The children's occupational therapy team has started to work with the charity Mencap to develop a range of introductory information for families helping them to navigate the complex care system and understand the support available. Families are supported to develop coping skills, plan early for problems that may arise and the best way to handle and lift the child. By doing this, families feel well equipped to cope and have higher levels of resilience; their emotional and physical health is improved and the risks of health problems are reduced. This type of early intervention is extremely cost effective.
There are of course many more opportunities, one of which is obesity prevention. Children with disabilities are at an increased risk of developing obesity partly because of their limited mobility but also because of the tendency of carers to use food as a treat or a way of showing love, especially when there is a perception that the child is missing out on other treats. Services such as the children’s occupational therapy team have an opportunity to raise awareness of these risks and provide early referrals to weight management service if a child’s weight is becoming a concern.
Colin Jones is the manager of the children's occupational therapy service and I asked him about the opportunities and challenges of integrating public health into current models of care:
‘’Relationships and partnerships provide our best opportunity, we can’t do all of this ourselves but we can make a real difference if we work with others. We need to identify how we can help colleagues to hit their priorities and trust that they will do the same for us’’
‘’Our main challenge is finding the headspace in busy schedules to look at services and identify where the opportunities are and then being able to make a business case for change if the innovation requires initial investment before savings are realised’’
This visit reinforced to me that any service can provide opportunities for health improvement the critical things are the will to make it happen, the relationships to make it happen, developing trust among colleagues including commissioners and developing capacity to innovate. As Lead AHP at Public Health England, I am working with colleagues in professional bodies and other agencies to develop tools to support local services, such as Colin’s, to identify the best opportunities to intervene, measure the impact of interventions and develop partnerships and relationships with public health colleagues.