Moving to Trust Status: The Experiences of Staff of Occupational Therapy Departments

Abstract

There has been much discussion of the NHS and Community Care Act 1990 and the changes it has brought to the delivery of health and social care. The introduction of self-governing trust status for hospitals as part of an internal market for the NHS has played a significant role both in the lives of occupational therapy staff and in the services that they provide. This article describes a qualitative research study into how occupational therapy staff (n=15) from both a trust and a non-trust unit have perceived and experienced these developments. The findings are considered under four key themes: the need to justify and market the role of occupational therapy; how trust status has affected staffs roles and relationships; how staff understood trust status to have affected the departmental identity, and concepts of leadership, power and autonomy; and in what ways trust status has shaped staff attitudes and opinions. The findings highlight the important role played by departmental leadership during moves to trust status and the interest now shown in measures of outcome to demonstrate the effectiveness of interventions. A range of perspectives on trust status is then discussed.

Occupational Therapy in Mental Health: Managing Stress and Burnout

“…In the community setting, occupational therapists often work as lone practitioners within multidisciplinary teams and generic work is integral to most posts (Gaitskell 1998). Various issues have been raised about this new way of working, including professional isolation, a lowering of standards of practice, no clear career structure and a lowering of the professional profile (Lloyd-Smith 1997, Craik et al 1999. It has also been found that occupational therapists are spending less time on professionally oriented work (Harries 1998) because there has been pressure to become increasingly generic and less specialised (Craik et al 1998).…”

Organisational Change and Occupational Therapy

“…Changes in the workplace that were affecting professional freedom were also having an impact on the level of job satisfaction and the morale of the staff. Lloyd-Smith (1997) conducted a qualitative research study with 15 British occupational therapy staff to examine how they had experienced the introduction of trust status in their hospitals. The need to justify and market the role of occupational therapy was a dominant theme in this study.…”

“…There will be a greater focus on ensuring that services are of high quality and effective in terms of outcome and that resources are deployed in the most cost-effective and efficient way (Atkinson 1993). A key impact of the reforms has been to ask occupational therapists (and all other professional groups) to demonstrate that the services that they offer are cost-effective, hence the drive to establish an evidence-based approach to professional practice (Lloyd-Smith 1997). East (2000) emphasised the desirability of pursuing academic excellence and rigorous research to enable therapists to make a successful transition within the changing health care environment.…”

“…Professional staff are, therefore, faced with both organisational and work role redefinition. They often feel powerless in response to changes in procedures, values, the reporting hierarchy and the nature of their work (Callan 1993, Lloyd-Smith 1997.…”

Occupational therapy in mental health: challenges and opportunities

“…It has been suggested that work role insecurities have increased and that there is conflict between increased accountability and decreased autonomy and control over the nature of the work (Gaitskell, 1998). Occupational therapists have also raised concerns about the lowering of their professional profile, professional isolation, loss of positions and lack of supervision (Lloyd-Smith, 1997). Another major issue facing occupational therapists is that they are often seen as performing tasks that may appear to be unskilled and common sense (Thorner, 1991;Munday, 1997) and they may not be considered to have the skills required to be included in the staffing for new positions and services.…”