Inequality starts early for many children in Wales. Before birth, before their first birthday and before their first day school.

It’s not controversial to state that many children from poorer areas such as the Queensway in Wrexham, the Gurnos in Merthyr Tydfil and Townhill in Swansea will not have long or healthy lives. That’s the stark reality of the systematic inequalities that have persisted in areas of our communities for decades.

Children learn through doing. The health and development of children and young people is significantly affected by the conditions in which they are born, live, learn and play.

The pandemic has drastically affected all children’s lives in Wales and has significantly impacted the opportunities they have to flourish and develop. In a recent survey of children’s occupational therapists, 93% reported an increase in demand. This is against a backdrop in which almost half report that their services are still not fully staffed.

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The Royal College of Occupational Therapists (RCOT) represents about 1,900 occupational therapists in Wales who support citizens from the cradle to the grave through the NHS and social care.

As part of Occupational Therapy Week 2021, RCOT is publishing a new report, Roots to Recovery. It offers practical steps to highlight where occupational therapists can be deployed to maximum effect to help build health equity. Nowhere is that more important than during the formative years of life.

Inequalities experienced during school years have lifelong impacts – in terms of income, quality of work and a range of other social and economic outcomes including physical and mental health.

For example, a waiting list existed for children and young people’s occupational therapy in one area of Wales. Occupational therapists redesigned serviced practices across local authorities to have a single method of working: this included training clinicians with new skills and changing systems to create a more flexible workforce and manage waiting lists. Members developed training and groups for teachers and parents to equip them with skills to support children. An occupational therapist was available to teachers and parents post-training to support them with their knowledge. This reduced waiting times from 45 weeks to seven weeks. Referrals to the service have also decreased because of the ability to carry out preventative work.

Our report strongly recommends that therapists should be working across traditional service boundaries to address physical, social and mental health needs that impact on learning. They should support the early years workforce to embed opportunities to develop foundation skills and resilience for learning into children’s routines and activities, and support the capacity of school staff to identify and address physical and mental health needs early. And they should identify the barriers and supports that prevent or enable children to access full-time education.

Wales does have a strong policy and legislative background in working towards equality. The Well-being of Future Generations Act requires public bodies in Wales to think about the long-term impact of their decisions, to work better with people, communities, and each other, and to prevent persistent problems such as poverty and health inequalities. However, our members worry the operational realities have yet to catch up with the legislative rhetoric. Does the complexity of tackling these societal issues and the range of organizations required to work together to do so mean that health inequalities gets put in the ‘too difficult pile’ by too many organization in Wales?

Solutions should be shaped by drawing organisations together with a shared understanding of the needs and wishes of the local children and their careers. Welsh services and workforces need to reflect the culture of the communities that they serve and have a shared understanding of the desired outcomes for the community and the service.

Our occupational therapists want to ‘build back better therapy services’ in Wales. They want their services to be targeted where it has the greatest impact. This would help address the needs of children who have missed developmental opportunities before the gap widens and their needs escalate requiring specialist intervention and support. We have the chance to use what we’ve learned to create a healthier, more resilient society. This can be achieved only through tackling the root causes of poor health and health inequality. In short, we need to work towards health equity - a fairer distribution of health. Occupational therapists have a duty and the skills to play a key role in making this happen.

Dai Davies is professional practice lead for the RCOT and Amanda Atkinson is vice chair of the RCOT Wales Board and a children’s occupational therapist.

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