What Next? Learning from the findings of the Royal College of Occupational Therapists workforce survey 2022–2023

Why are we feeling the strain?

The reasons for the increase in demand are multiple. Over three-quarters of survey respondents said the complexity of people’s needs had increased, and the same number felt that a lack of capacity elsewhere in the health and care system was contributing to increased referrals to occupational therapy. The COVID-19 pandemic was felt to have some influence on the rise in complexity, but with around one in four adults in England currently living with two or more health conditions, and the number living with four or more conditions expected to double by 2035 (National Institute for Health and Care Research, 2021), it is reasonable to expect that the need for occupational therapy will only continue to rise.

Unsurprisingly, these challenges are affecting occupational therapists’ capacity to deliver effective, occupation-focused interventions. This in turn is impacting their wellbeing and resilience. One survey respondent captured the sentiments of many, saying ‘being told not to work to gold standard due to capacity issues provides a huge amount of stress’. Worryingly, the pressure created by a lack of staff risks becoming a self-fulfilling cycle. Over a third of respondents said they intended to leave their current role within the next 2 years, and almost a quarter of respondents said they intend to leave the profession entirely within the next 5 years. Work-related stress was the most common reason for this, other than retirement.

How do we tackle the challenge?

Occupational therapy workforce shortages are not unique to the UK. The World Federation of Occupational Therapists (WFOT) has recorded shortages in 62 countries and territories, equating to 65% of WFOT member countries/territories worldwide (WFOT, 2022). Evidence suggests that more research is needed to fully understand and address occupational therapy workforce challenges globally, noting that existing research is scarce, inequitably distributed, poorly funded and of limited quality, especially in comparison to workforce research on other health professions (Jesus et al., 2023).

To address the workforce challenges in the UK, RCOT is creating a workforce strategy to help plan and develop an occupational therapy workforce that is fit and ready for the future. This will focus on recruiting greater numbers into the profession as well as retaining and making the best use of the current workforce. While the approaches to achieving this may be unique to the UK context, the principles are arguably universal. More (and more diverse) people need to be attracted and enabled to train as occupational therapists, to create a robust, inclusive workforce that is representative of the populations and communities that they serve (American Occupational Therapy Association, 2020). The existing workforce must be nurtured and supported so that practitioners thrive and choose to remain within the profession. Evidence suggests that this requires consideration of ‘push, pull and stay’ factors (Mak et al., 2023). For example, the RCOT workforce survey shows that, in the UK, work-related stress is ‘pushing’ people from the profession, while a desire for a better work life balance is ‘pulling’ them away. Conversely, a sense of pride in the profession is a factor encouraging them to ‘stay’.

A recurring theme in the qualitative data captured in the RCOT workforce survey was a sense of feeling under-utilised and unable to practice in a truly person-centred, occupation-focused way. This was typically due to services being over-stretched and was another factor ‘pushing’ people from the profession. To address this, services may need to think differently about when, where and how occupational therapists intervene, so that they make the best use of their skills, and effective interventions are available for those in greatest need. Enabling occupational therapists to optimise and utilise their unique competencies is associated with increased job satisfaction and service delivery, which in turn impacts retention (Mertala et al., 2022).

Reasons to feel hopeful

Despite the undeniable challenges within the occupational therapy workforce, there is also cause for optimism. 93% of respondents to the RCOT workforce survey said that occupational therapy is a rewarding career, and 86% would recommend it as a career to others. Occupational therapists are proud of their profession and passionate about the impact that occupational therapy has on people’s lives. Increased investment in understanding and addressing the current workforce challenges will empower occupational therapists to continue delivering life-changing interventions that benefit individuals and society – now and in years to come.