In this blog, we explore what it means to ‘future-proof’ adaptations and the challenges and opportunities this brings to everyday practice. We start by getting under the bonnet of what we mean by the term future-proofing.
In health and social care, the purpose of future-proofing has been described as the approach to delivering services that ensure better outcomes are achieved for people both now and in the future, despite increasing resource constraints. For occupational therapists, this approach mirrors the responsibility to practice in a sustainable way, described in the Royal College of Occupational Therapists Professional Standards as working:
…as effectively and efficiently as possible to make best use of and sustain environmental, physical, financial, human and personal resources, whilst seeking to meet the needs of those who access the service. This means using resources to deliver services in a way that does not compromise the health of present or future generations for ensuring practice.
There are two common challenges to achieving future proofing in practice. Firstly, there is the ‘professional reasoning’ challenge of predicting the person’s future needs and translating this information into a solution or the design of an adaptation that accommodates the person’s needs as they change.
While predicting future needs will always be a challenge, when it comes to adaptations, there is an opportunity for occupational therapists to use their knowledge of inclusive design principles, such as those described by the Centre for Excellence in Universal Design. Using these principles as part of the professional reasoning process, occupational therapists and others involved in the design of adaptations have a better chance of recommending or designing adaptations that naturally accommodate a wider range of needs or needs as they change.
The second challenge is the blanket use of the incremental approach to meeting health and social care needs. This approach is often thought to be cost-effective because the simplest, often the cheapest, solution is provided to solve the immediate and presenting need. However, while this approach has its place, it often fails to provide future-proof solutions as the outcomes are often short-lived. For example, while a bath board and seat might initially help an older person with their difficulties with bathing, further assessment and provision of alternative equipment and eventually adaptations or care are often required as the older person’s needs change as a result of the ageing process.
The Centre for Sustainable Healthcare would also argue that the incremental approach has hidden financial and environmental costs to society. First are the health and social care costs associated with repeated assessments as the person’s needs change. Second is the environmental cost of disposing of the low-level equipment no longer required by the person.
We often hear practitioners’ frustrations with the incremental approach. They want to provide future-proof solutions but feel unable to do so due to local policies surrounding the provision adaptations, where the person has to have tried equipment in the first instance. However, these policies are short-sighted because providing future-proof solutions, such as a wet room rather than a bath lifter, is an excellent way of achieving long-term sustainable outcomes – as demonstrated in the BATH-OUT pilot. These local policies also seem at odds with central and devolved Governments’ agenda of preventing, delaying, and reducing health and social care needs.
Occupational therapists have an incredible opportunity to use their skills and knowledge, such as using inclusive design principles, to recommend and design future-proof solutions. And there is growing evidence that this approach genuinely contributes to the prevent, reduce, and delay agenda discussed above. But this opportunity relies on practitioners becoming much more vocal and articulate in explaining why a more costly solution will often provide a more cost-effective and future-proof solution in the long term – so are you up to this challenge?