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Recovery is our business

They're getting out of hospitals and into schools and other community centres. Martin Whittaker reports

There are more than 28,000 qualified occupational therapists in the UK, working in hospitals, residential homes and other settings. A lesser-known role is their work in schools - an area likely to grow as they try to move beyond the traditional bounds of the health service.

The College of Occupational Therapists, the professional body, wants universities to give trainees practice placements in the community, including special and mainstream schools.

"We believe occupational therapists are best served helping people in the community, rather then helping people in the health services, where sometimes they just end up being discharge therapists," said Anna Wood, the college's education policy officer.

There is a chronic shortage of people to do the job. The NHS has no figures, but in local authority social services departments, nearly one vacancy in five in England and Wales is going unfilled; in London, the rate is nearly one in three.

There is also a high turnover rate - most occupational therapists are women, many of whom leave or go part-time because of family commitments.

Another problem is that the job lacks recognition. The college complains that politicians frequently refer to doctors and nurses when talking about the health profession, but ignore the valuable contribution of the occupational therapist.

"I think it's partly because it's difficult to explain what an occupational therapist does succinctly," says Anna Wood. "It's about rehabilitation and it's about enabling people to live their lives as effectively as they can.

It's encouraging people to live independently through a range of activities that are tailored to the individual."

The work covers all sorts of people: those with physical disabilities, older people with Alzheimer's disease or arthritis, people with mental health problems, alcoholics or drug addicts, or patients recovering from an operation.

The list of practice areas and specialisms really is exhaustive - they include helping people recovering from burns or plastic surgery, those with eating disorders, stroke rehabilitation, helping someone to get back to work, or recovering from a heart attack or brain injury.

When people lose the ability to carry out the everyday activities that most of us take for granted, an occupational therapist can help them regain some or all of those lost skills.

They work alongside a team of other professionals, including doctors, nurses, psychologists, speech and language therapists, social workers and teachers.

Two-thirds of qualified occupational therapists work in the NHS, while a proportion are in social services. A small number also work in schools, liaising with teachers, learning support assistants and other staff to help children gain the skills they need to function successfully. They could be helping a pupil with handwriting, for example, looking at how they hold a pencil, or helping them to use a computer. The work covers looking at how pupils can get themselves dressed and ready for the day, to how they function in the playground.

Given the national shortage of occupational therapists, the job prospects are excellent. You can be a practitioner, researcher, manager lecturer or consultant. The usual way in is by studying for a degree in occupational therapy, but there are also training routes for those with degrees in other disciplines.

Trainees spend a third of their time - about 1,000 hours - on practice placements, gaining experience in the main areas of the job, usually in physical rehabilitation, learning disabilities, mental health or social care.

Some enter the profession as support workers, whose only entry requirement is a good standard of education. They earn around pound;10,050, rising to Pounds 14,500 after a few years.

The average starting salary for a state registered occupational therapist working in the NHS is around pound;19,000, depending on where you work.

More experienced therapists can earn around pound;35,000, and consultants around pound;50,000. Local government salaries tend to be pitched around the same level, although they are set by individual employers so they can vary significantly.

"There are great job opportunities," says David Cocke of the College of Occupational Therapists. "It's one of the few professions where you can work in health and social care, you can work in schools or charities, a variety of different settings and taking up a variety of different roles with people of all ages."

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Judy Tjan is a 32-year-old occupational therapist working for Lambeth Primary Care Trust. Her job takes her into schools.

A typical week is very varied. You will be going into either mainstream or special needs schools and the children on your caseload might have co-ordination problems, such as difficulties with handwriting. The teachers may have tried lots of strategies, but they just need a bit more from someone with a health background.

That's where we come in. It could be just a little bit of a boost where you could provide some input and do a block of sessions with the learning support assistant or with the teacher.

You can also find yourself working with children who have more physical difficulties, for example, a child with cerebral palsy. We'd be looking at how the curriculum can meet their needs, and looking at practical things such as equipment: how the furniture can be adapted, whether they need more time for writing, or perhaps they can't write and they'll need to learn how to use a keyboard.

Not all the work is in school - it depends on the child. You might decide to work at the centre because of the equipment and resources we have here.

Or you might be working at home with children, helping the parents.

It could be children from nursery up to secondary school, so it's that huge spectrum of development, a huge range of needs.

I find it most challenging but also most rewarding in that it keeps you motivated, because you're looking at development from when they're babies, up until their secondary school before they go into adult services, and from mild to very complex special needs. And it's not only that they have complex physical and cognitive disabilities, but also social problems as well.

The nice thing about working in the community is that you see children in their natural settings: at school, you can see first hand what they have to contend with.

It feels as though the demands on teachers are getting higher and higher, so to be able to co-ordinate your time to meet them and work jointly, I think that's a big challenge.

One of the most rewarding experiences I had was helping a child learn to tie his shoelaces - he was nine years old. It was just great to be able to let him get on with playing in the playground with the other children more independently.

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