Beyond adaptations: why social care needs to unlock the full potential of occupational therapy

As adult social care looks to shift from crisis to prevention, occupational therapists have a vital role to play. Dr Anita Mottram, Principal Occupational Therapist for Kirklees Council, discusses why unlocking that potential requires not just funding, but time, trust and investment in the occupational therapy workforce.

When people think about occupational therapists (OTs) in adult social care, the first thing that often comes to mind is equipment and adaptations. Grab rails, stairlifts, level access showers. These are important and valuable interventions, but they are only a small part of what we are trained to do, and nowhere near the full contribution OTs can make. 

Across England, there are around 3,400 occupational therapists working in adult social care. As part of the National Principal OT Network, what we consistently see is a workforce that is under-resourced, under-utilised and, too often, pigeonholed. Many OTs are primarily deployed to respond to crisis, focusing on equipment and adaptations, rather than being enabled to work upstream in early intervention and prevention. This is a missed opportunity. 

OTs are clinicians. We complete health degrees and are trained in diagnostics, long-term conditions, medication and lifestyle management. We work across physical health, mental health, learning disabilities, autism and dementia. We are uniquely placed to support people and their carers to prevent, reduce or delay deterioration, as well as building resilience and promoting independence long before needs escalate into crisis. 

That kind of work takes time. A strength-based, person-centred assessment is not a quick conversation. It involves co-production: understanding what matters to someone, working alongside them to set meaningful goals, and supporting positive risk-taking so people can live their lives in the way they choose. With some individuals, particularly those with learning disabilities or complex mental health needs, it may take several visits just to build trust before the real work can begin. 

Yet too often, OTs are expected to operate within rigid, time-limited models that simply don’t reflect the reality of good practice. If we are serious about prevention, we need to invest in sufficient staffing, realistic workload management and professional autonomy. We also need clarity about what only an OT can do, and where tasks can appropriately be delegated, so that this skilled workforce is positioned in the right place, at the right time. 

The recent focus on the Disabled Facilities Grant (DFG) highlights another challenge. On paper, a £30k threshold sounds substantial. In reality, it no longer goes very far. For example, essential adaptations such as level-access showers, stair lifts, ramps and specialist equipment have all increased significantly in cost. A level-access shower that could be installed for around £3k a few years ago now costs closer to £4-5k. For someone with multiple needs, requiring adaptations such as a level-access shower, a stair lift, a ceiling track hoist, a ramp and kitchen alterations, the costs quickly add up. £30k will not stretch to a single-storey extension, let alone a package of adaptations. More funding alone will not deliver better outcomes if there is not also investment in the workforce required to assess, plan and deliver those adaptations effectively. 

Strong OT leadership matters too. CQC reports consistently show that where occupational therapy leadership is visible and influential, services achieve better outcomes. OTs work across health, social care and housing, and are well placed to contribute to system-wide transformation and integrated working, if we are invited to the table. 

Finally, there is an issue of consistency. The Care Act explicitly recognises both social workers and occupational therapists, and most local authorities enable OTs to practise to the full extent of their training. In some areas, however, OTs are not able to complete Care Act assessments, creating an unnecessary variation in practice. 

Occupational therapists do far more than equipment and adaptations. To support sustainable adult social care, better outcomes for people, and better value across the system, we should ensure OTs are able to work to the full scope of their training. 

Dr Anita Mottram is also the Chair of the Yorkshire and Humber Principal Occupational Therapy Network and Co-Chair of the National Principal Occupational Therapy Task Force.