Understanding the current available workforce planning data for Occupational Therapists: A scoping review to support collaboration workforce planning in the Leeds Health and Care System

Abstract

Introduction:

Strategic workforce planning is a priority for health and social care, and the city of Leeds is focused on localised planning to balance supply and demand and develop this based on changing needs of the system. There are gaps in data required for Occupational Therapy (OT) workforce modelling; therefore, we need to find out whether proxy data exist that can support this activity in Leeds.

Method:

This scoping review appraised existing OT workforce literature from five academic databases using a three-staged approach, capturing any degree of data relating to OT workforce from the last 10 years; evidence-based workforce data to be applied to workforce planning where actual workforce data is unavailable.

Results:

We included nine papers in this scoping review, organising available data under three headings: current capacity of OT workforce, OT workforce entering the health and care system and returning to practice OTs and outflows reflecting turnover data.

Conclusion:

Findings demonstrated significant gaps in available workforce data for Occupational Therapists to support collaborative workforce planning in the Leeds Health and Care System. The available data vary hugely limiting opportunities for proxy data utilisation. Improved consistency and quality of OT data are crucial to support future workforce planning.

Keywords

Workforce planning turnover recruitment workforce capacity health occupations Occupational Therapy

Introduction

The NHS Long-Term Workforce Plan (NHS England, 2023) reports 112,000 vacancies in the NHS in 2023, with 152,000 vacant posts in the social care sector (Skills for Care, 2023b). Many of these roles require years of training and as such need long-term, strategic workforce planning to address. The importance of strategic workforce planning in health and social care for the next 5–20 years was identified by Sutton et al. (2023) as essential to balancing supply and demand of healthcare workers. They advocated a whole-system needs-based approach, identifying the benefits of predictive modelling but noting a lack of integration between health and social care, beyond policy ambitions.

Workforce shortages are a global concern, affecting countries around the world and influencing the need for collaborative, forward-thinking workforce strategies. For instance, the United States has reported critical shortages of healthcare professionals, including Occupational Therapists, with an ageing population and increasing demand for rehabilitative services (American Occupational Therapy Association, 2022). Similarly, in Australia, a national strategy for Allied Health Workforce Planning highlights workforce imbalances exacerbated by geographic disparities and changing service delivery models (Australian Government Department of Health, 2022). These challenges underscore the shared need for data-driven workforce planning across diverse health systems internationally.

The Leeds Health and Care Academy (LHCA) was developed in recognition that a step change was needed to tackle workforce challenges and maximise the opportunities that a joined-up approach across health and care partners in Leeds could bring (LHCA, 2024). The Academy is an organisation funded by statutory health and care organisations in Leeds but one that works with and supports all health and care providing organisations across the city. In order to deliver this change, a city-wide Leeds One Workforce Strategy (LHCA, 2021) was developed. This contains the strategic workforce priorities which underpin the city’s Health and Wellbeing Strategy (Leeds City Council, 2023) and Healthy Leeds Plan (Leeds Health & Care Partnership, 2023), in response to notable workforce gaps and in recognition that the future workforce will require different roles and skills. Workforce planning is a shared strategic priority, with city-wide workforce planning expected to deliver the shared workforce priorities and allowing a focus on long-term strategic needs of a changing health and care system.

Internationally, cities and regions are adopting similar strategies to address workforce challenges. For example, Canada has undertaken regional workforce planning initiatives in provinces like Ontario, where coordinated efforts aim to address growing demand for health services, including allied health professionals like Occupational Therapists. These efforts focus on increasing recruitment, training and retention to alleviate workforce gaps that are expected to grow in the coming decades (Canadian Occupational Therapy Association, 2022). Learning from these global initiatives may provide valuable insights into the implementation of similar approaches in Leeds, helping to inform the design of workforce planning processes.

The LHCA has developed a bespoke approach to collaborative workforce planning for the Leeds Health and Care System which includes a Tactical Workforce Planning process (Tissiman et al., 2024). This is a predictive model designed to identify current workforce capacity and future workforce need across the whole health and care system, by year for the following 5 years (Figure 1). The Tactical Workforce Planning process has been designed to provide unique insights into the whole health and care system’s workforce.

As a newly developed process, Tactical Workforce Planning required staged implementation, which allowed the sophistication of the process to be developed along with the conditions required for successful collaborative workforce planning. These include system leadership, data and workforce planning maturity.

The NHS Long-Term Workforce Plan (NHS England, 2023) identifies an estimated workforce shortfall across the NHS of approximately 150,000 full-time equivalents (FTEs), growing to between 260,000 and 360,000 FTEs by 2036/37 without the interventions contained in the plan. The Plan specifically identifies Occupational Therapists as a workforce group where shortfalls are modelled to increase most among the wider Allied Health Professional (AHP) workforce, attributed to limited supply growth due to education and training pipelines not keeping pace with expected demand.

As part of the development of the Tactical Workforce Planning simulation process, the LHCA identified the need for a relatively small but important, cross-system workforce of registered professionals to test the process in a live but manageable data environment. Due diligence showed the Occupational Therapist workforce as a single professional group of approximately 400 people working across multiple partners in the Leeds Health and Care System in October 2023. Furthermore, the LHCA’s workforce planning team was somewhat familiar with the Occupational Therapist workforce due to previous collaborative workforce planning activity through the Citywide Workforce Planning for Allied Health Professionals Project (Hornby, 2023).

In developing and testing the Tactical Workforce Planning process, the LHCA identified data maturity as a condition for success, meaning the data need to be reliable, robust, accessible and comparable. Due diligence of the data environment identified that some areas of the system would not be able to provide the data specified by the model and there were likely to be issues concerning the robustness and reliability of some data where it was available. These known limitations of the data environment created a need to seek potential sources of proxy data, alongside evidence and insights which could be used as a source of triangulation for data inputs. Proxy data are evidence-based workforce data to be applied to workforce planning where actual workforce data are unavailable.

Relevant proxy data may be available in existing literature, such as academic articles or government reports, and international reports in countries where Occupational Therapy is practiced and defined similarly to the UK health and care system. Therefore, this scoping review aimed to locate published workforce planning data, as this will provide vital context and insights from the relevant settings. This will influence recommendations to the Leeds Health and Care System on how to utilise data to support workforce planning. Insights drawn from international workforce planning initiatives will offer a broader context and may inform more globally aligned strategies for the development of the Occupational Therapy workforce.

Method

Design

To locate relevant published OT workforce data, we chose to do a scoping review of the literature. This is a method which will allow us to quickly and efficiently summarise the evidence in our area of focus and understand the gaps in knowledge surrounding international Occupational Therapy workforce planning (Arksey and O’Malley, 2005; Colquhoun et al., 2014).

Expertise of our team in workforce planning and conversations with expert stakeholders within OT across the Leeds H&C partnership led us to develop the following research question:

What workforce data are available to support workforce planning for Occupational Therapists in the H&C system in Leeds, and nationally in the UK?

Finding evidence in response to this question will help us to determine the implications of these findings for supporting workforce planning in Leeds H&C system.

To answer our research question, the search strategy consisted of three stages, according to the process outlined by members of the Joanna Briggs Institute (Peters et al., 2015). This recommends carrying out an initial database search to enable familiarisation with the literature base and selection of keywords, before conducting a systemic database search utilising relevant terms, academic databases and sources of grey literature, and finally hand searching the reference lists of relevant articles to identify any further sources.

We carried out a search of the literature in January 2024. We limited our search to include studies from the last 10 years (2014 onwards). Literature published in the last 10 years was deemed relevant as it is not expected that there have been any significant workforce changes in this period and it is expected that national reporting for the health and care workforce has remained the same. We carried out electronic searches of the following databases: Scopus, Academic Search Complete, Business Source Premier, MEDLINE and CINAHL Ultimate. Our search terms included variations of keywords describing the Occupational Therapy workforce (occupational therap*), the settings in which OTs work (i.e. health care, social care, community) and terms relevant to workforce planning matters (i.e. retention, turnover). These terms were combined using Boolean operators to form search strings for each of our selected databases. During the hand-searching process we also searched the webpages of known government and third-sector organisations (such as NHS England, the Kings Fund) for relevant published reports as these were expected sources of relevant, up-to-date workforce data for many parts of the sector. The initial search was global, but the hand-search for grey literature was limited to United Kingdom only. This was due to parameters of our professional insight and the extent to which relevance to the UK OT workforce could be determined in applicable practice-based reports.

Study selection

The search results for each database were uploaded to Zotero (Corporation for Digital Scholarship, 2024) to enable collaborative screening. Duplicate results were removed at this stage. We screened the full set of articles, first by title and abstract and then by reviewing the full-text articles, applying the following inclusion/exclusion criteria at each step:

Inclusion criteria

Relating to the registered Occupational Therapy workforce in health or social care settings.

Published in the last 10 years.

Reporting any type of quantitative, qualitative or mixed-methods data about the OT workforce deemed relevant to be used as proxy data and inform workforce planning.

Published in peer-reviewed journals or grey literature (i.e. Government, statutory bodies).

Exclusion criteria

Where the study sample solely perform voluntary or unpaid roles and are therefore not part of the registered OT workforce.

Not presenting original research or data, except for systematic reviews/meta analyses of relevant data (i.e. news articles, editorials).

Not available in English.

Article selection was conducted following a reliability check of the selection criteria involving three co-authors. During this stage, all three individuals screened 10% of the articles before comparing and discussing the results to reach an agreement of the process and appropriateness of the criteria. After the criteria had been agreed, two members of the research team with expertise in workforce planning continued with the complete set of results. We also conducted hand-searching of the reference lists of included studies to identify any further relevant articles that had been missed from the original searches. Any queries, challenges and potential conflicts were discussed and a consensus reached.

Interpreting data

Based on discussions with sector partners around the availability of evidence in this area prior to undertaking this review, we expected a limited amount of insight in this area. The broad aim of the study warranted a pragmatic approach to exploring and interpreting available data to support OT workforce planning. We developed a process of data extraction which enabled us to determine extent of knowledge relevant to operational workforce planning, that is, to understand the capacity, inflows and outflows of a defined section of the OT workforce. There is much variation in the forms of data collected, status of OT staff participants (i.e. registered, apprentices/trainees) and the setting in which they work; therefore, we will explore the scope of available evidence, present this data thematically using a workforce planning lens and discuss the implications of the available evidence for future efforts to carry out operational workforce planning for Occupational Therapy across the Leeds Health and Care System.

Results

Our search of the literature identified 2392 papers. Once duplicates had been removed, we reviewed the titles and abstracts of 2374 articles. This resulted in 91 articles which met the inclusion criteria at this stage. We obtained and reviewed full texts for those that remained, retaining a total of nine papers after reading these articles in full. See Figure 2 for a diagram of this process according to PRISMA guidelines (McGowan et al., 2020).

Despite our inclusion criteria covering literature published since 2014, the majority of the literature originated from the last 5 years with the oldest report produced in 2018. This not only reflected our assumptions around the prevalence and availability of OT workforce data but also suggests what is available is reasonably up to date for our intended purpose. Full details of the included articles are included in Table 1.

Table 1.

Studies included in the review.

Author name(s) (surname, initial)	Year of publicat ion	Title	Article typ e	Journal/Public ation/Host organisation	Location of study	Roles (if not exclusively OT)/service area	Aim(s) of study/report	What are the research question(s) to address?	Conceptual frame work if applicable	Hypothesis if applicable	Study methodology (quantitative, qualitative, mixed)	Research methods used (interviews, surveys etc.)	Description of findings
Ghela, P., Govender, P., Ogunlana, M.O.	2022	A review of occupational therapy services within an acute public tertiary hospital in KwaZulu-Natal, South Africa	Journal Article	South African Journal of Occupational Therapy	South Africa	OT only	To review the occupational therapy services in an acute, public tertiary hospital from 2015 to 2019 and to compare this with the expectations of these services in a tertiary hospital to identify potential gaps in service delivery	This study aims to review the services rendered in the occupational therapy department of a designated acute public tertiary hospital from 2015 to 2019 and to identify potential gaps in service delivery	n/a	n/a	Quantitative	Single site, retrospective quantitative audit utilising unit service records: (i) time spent on patients, meetings, and ward rounds, (ii) number of patient consults and (iii) intervention rendered	Findings indicated a consistent decline in the mean values of, the number of therapists attending to patients, number of patients, assistive devices issued, total time of patient units and consultations, total time spent on ward rounds, clinics, and meeting attendance. The number of student therapists attending to patients, splints, pressure garments and issued wheelchairs showed an increase in trend across the reviewed years
Health Education England	2018	Allied Health Professions at the forefront of improving care – a year in review 2017/2018	Report	Health Education England	England	Allied Health Professionals	There is still some way to travel before the goal of an integrated, team based system is reached, where cooperation not competition drive progress and improvement. This is the first update on HEE’s work with the AHPs towards this goal, providing a snapshot of the achievements to date and work in progress	n/a	n/a	n/a	Mixed	Not stated	Return to Practice Current data from the National Programme for AHPs 114 OTs enquired about returning to practice (RTP), 47 started the RTP process, 24 completed RTP
Skills for Care	2023	Apprenticeships in adult social care 2021/22 Skills for Care analysis of Education and Skills Funding Agency data	Report	Skills for Care	England	Health and social care roles – Apprenticeships included in this report are the Health and Social Care framework	This report describes the number of adult social care apprenticeships which were started or achieved during the 2021/22 academic year (August 2021 to July 2022)	This report covers factors such as apprenticeship level, demographics, regional make-up, trend analysis and comparisons to other frameworks to provide context	n/a	n/a	Quantitative	Not stated	Retention rate – 53.5% – this is 44.1% for health and social care apprenticeships (including OTs)
Hemmings, N., Buckingham, H., Oung, C., Palmer, B.	2021	Attracting, supporting and retaining a diverse NHS workforce	Report	Nuffield Trust	England		To ensure a sustainable workforce, both now and in the future, the NHS needs to ensure that it attracts, recruits and retains a diverse staff reflective of the local community it serves. This report we set out to build on this existing work to develop some practical policy recommendations that can improve the current situation	n/a	n/a	n/a	Mixed	A manual, non-comprehensive literature review of academic, grey and policy papers, alongside six stakeholder scoping calls with national and local organisations	Number of unpaid additional hours working over contracted hours although this figure is not separated by service area/discipline
NHS England	2023	NHS Long Term Workforce Plan	Report/Policy	NHS England	England	NHS workforce	A strategic direction for the long term, as well as concrete and pragmatic action to be taken locally, regionally and nationally in the short to medium term to address current workforce challenges	n/a	n/a	n/a	Not stated	Not stated	There will be an estimated 3.4%–3.7% growth in occupational therapists by 2036/37. The proportion of entrants joining the occupational therapy workforce via an apprenticeship route will be 25%–50% by 2031/32
Skills for Care	2022	Headline Occupational Therapist Information	Presentation (Online)	Skills for Care	England	OT only	n/a	n/a	n/a	n/a	Quantitative	Not stated	Number of filled OT posts in 2022 and percentage change since 2012. Vacancy and turnover rates
Rolewicz, L., Palmer, B., Lobont, C.	2024	The NHS workforce in numbers. Facts on staffing and staff shortages in England	Report	Nuffield Trust	England	NHS workforce	Size and structure of the current NHS workforce. Highlights the extent of current shortages and their effect, and outline some of the workforce pressures that lie ahead	n/a	n/a	n/a	Quantitative	Not stated	OT growth of 21% between 2010 and 2023
Skills for Care	2023	The state of the adult social care sector and workforce in England	Report	Skills for Care	England	Adult Social Care workforce	This report provides information about the adult social care sector, including its size and structure, employment information, recruitment and retention issues, workforce demographics, pay, qualification rates, and future workforce projections	n/a	n/a	n/a	Quantitative	Survey: Adult Social Care Workforce Data Set (ASC-WDS), a mandatory return for local authorities (non-mandatory for the independent sector) with estimates created to account for the whole workforce	National OT data: filled posts, employment type, vacancy and turnover figures (discussed in detail in results section)
Palmer, W., Rolewicz, L., Dodsworth, E.	2023	Waste not, want not: Strategies to improve the supply of clinical staff to the NHS	Report	Nuffield Trust	UK	NHS Workforce	Uses bespoke data to explore the nature of domestic training pipeline across a range of professions – nursing, midwifery, occupational therapy, physiotherapy, radiography (both diagnostic and therapeutic) and medicine – to highlight where there is potential scope for addressing leakages	n/a	n/a	n/a	Quantitative	Calculation of attrition rates and analysis of national survey data, using categorisation to scale up estimates of graduate population figures	One in seven occupational therapy graduates (15%) do not immediately join their respective profession. Occupational therapists (21%) have left NHS hospital and community settings within 2 years. On average, around twice as many graduating in occupational therapy (15%) do not end up starting employment as an occupational therapist. Among occupational therapy graduates, there are higher proportions going into nonhealth-related employment (such as welfare or teaching work) as well as more graduates taking time to travel or care for someone instead of taking up employment, relative to other clinical graduates

AHP: Allied Health Professional.

All but one article reported workforce data from the UK-based Occupational Therapy services. The exception to this was a peer-reviewed article based on the OT workforce in South Africa (Ghela et al., 2022). The UK-based literature originated from non-peer reviewed sources. These consisted of policy/strategy documents and commissioned reports from statutory bodies and charity organisations, reporting on primary data sources from within the health and care sector. Aside from NHS-commissioned reports, three are published by a leading source of high-quality data for the sector in the United Kingdom (Skills for Care, 2022, 2023a, 2023b) and the remainder are published by the Nuffield Trust, an independent health charity who have analysed data from the NHS (NHS England, 2018; Hemmings et al., 2021; Nuffield Trust, 2024; Palmer et al., 2023).

The majority of the available data had been gathered in NHS settings (Ghela et al., 2022; NHS England, 2018; Hemmings et al., 2021; Nuffield Trust, 2024; Palmer et al., 2023), specifically acute and community settings only. The next largest data source was from the adult social care sector (Skills for Care, 2022, 2023a, 2023b). All available data were national with no specific detail relating to region; therefore, we cannot make any inferences relating to Leeds health and care settings. Furthermore, detailed data collection methods were seldom reported, and where mentioned most articles accessed and analysed data gathered from Electronic Staff Records (ESRs). The types of workforce data identified varies but can be grouped into data related to OT workforce capacity and the inflows and outflows of OTs into and from the health and care system.

Current capacity

A key finding in the literature was data related to the current capacity of the health and care sector workforce; however, this was inconsistent and did not present a cohesive picture within any service area or across the health and care sector as a whole. Findings provide details of the size of the OT workforce in particular settings at specific time periods, and vacancies can help to identify current gaps in capacity, but without breakdown of hours worked, number of people in roles, staff grades/level, etc., they lack the detail required for sufficient scrutiny and comparison.

One report provided vacancy data and FTE growth for OTs nationally in the NHS between 2 years; 2010 and 2024 (Nuffield Trust, 2024). The article demonstrated the increase in the OT workforce size in the NHS of 21% since 2010, totalling 2867 full-time equivalent employees in 2024. This data were provided similarly for the Social Care sector in England (Skills for Care, 2022), including trends in workforce size between 2012 and 2022; showing a 11.6% increase. However, this only relates to Local Authority, excluding the independent adult social care sector. This data presented capacity as ‘the number of OT filled posts’, which can be assumed to be capacity as headcount. Whilst growth can be identified between these two pieces of literature, the difference in the way these capacity figures are represented mean that comparisons between the two sectors cannot be accurate.

Another aspect of capacity data available in the adult social care sector was national average vacancy rates from the ‘State of the Social Care Sector’ report for OTs (Skills for Care, 2023b) which stated a vacancy rate of 11.4%. This article also presented trend data from previous years and is representative of both local authority and independent organisations, making it more reflective of the whole sector. This report also breaks down the employment status of the OT workforce in the adult social care sector, most of which were in permanent employment (90%), some were indirectly employed (those on bank, pool, agency and/or other contracts) (7%) and others had temporary contracts (3%). Whilst this data were helpful to understand the breakdown of OT workforce capacity, this is not translated to headcount or FTE, or variation in employment status over time.

Approaches to calculating capacity are further complicated by additional unpaid hours reported within healthcare, with one report containing data for the overall NHS workforce broken down by demographic category (Hemmings et al., 2021). Another report presented capacity for OTs broken down into patient-facing, and non-patient-facing hours (Ghela et al., 2022), enabling more detailed assessment of patient care versus time for other roles such as staff development.

OT workforce entering the health and care system

Another key theme in the literature was the availability of OT workforce data related to OTs entering the health and care system, including data related to graduate and apprenticeship trainee retention, and return to practice.

The NHS Long-Term Workforce Plan discussed the expansion of apprenticeships in providing trainees for the OT workforce (NHS England, 2023). Degree-level apprenticeships are a route for aspiring OTs to become registered Occupational Therapists; they are employed in a paid job while studying at degree-level to gain their professional registration (Royal College of Occupational Therapists, 2025). By 2031/32 the pool of AHPs would need to expand to become a third of the supply, equating to at least a 25% increase in OT apprenticeships. The OT workforce within the NHS would also need to expand by 3.4%–3.7% per year to meet the expansion targets. One adult social care report provides a retention rate for apprentice OTs in 2021/22 of 58.8%, along with a pass rate of 98.1% (Skills for Care, 2023a). Similarly, the Nuffield report demonstrated retention rates for OT degree students during study from 86% in 2014/16 to excess of 90% in 2019/20 cohort, but also stated that 15% of OT graduates do not go on to work in care-related roles following completing their degree (Nuffield Trust, 2024). These collective findings are helpful in understanding trainee numbers required to ensure that retention rates will not impact the NHS Long-Term Workforce Plan targets for OT apprenticeships.

Another report presented national return-to-practice statistics for OTs, separated by expressions of interest, those who have begun the process and those who have returned (NHS England, 2018). A total of 21% of those who expressed an interest in returning completed returning to practice, and this was the largest number of expressions of interest to return of all AHP workforce groups. However, some of these other roles under the AHP descriptor are smaller in workforce size than OT which may count for their lower relative numbers. Overall inferences from this data are limited, as the reporting period is not given.

Outflows

A final key aspect of OT workforce data related to the outflow of OTs from the health and care system, including permanent leavers, only represented by two included articles. A report of national NHS turnover trend data presented a 21% turnover rate for new starters leaving their role within their first 2 years. This rate flattens in the 3 years after this point, reducing to 5% turnover for OTs 5 years post-qualification (Palmer et al., 2023). The state of the social care sector reports presented current national turnover rates for OTs of 14.1% (Skills for Care, 2023b). However, this figure does not consider those changing roles within the sector so it is not directly comparable to other turnover figures.

Discussion

The findings of our scoping review have demonstrated significant gaps in available workforce data related to inflows, outflows and capacity for Occupational Therapists to support collaborative workforce planning in the Leeds Health and Care System. This complexity is discussed in the following section.

Opportunities to support workforce planning in Leeds

The key finding of this scoping review is that it is possible to utilise existing trainee retention data to project onto the Leeds health and care workforce, to improve our understanding of expected trainee figures to support workforce planning. The Leeds H&C system has the opportunity to utilise this data to support collaborative workforce planning. The Nuffield report findings present data to support understanding of the inflows and outflows of OTs into and out of the NHS within a specific time period (Palmer et al., 2023). This report highlights data findings related to the inflow of OT graduate trainees into the UK healthcare system. The report states that 10% of OT students are not expected to finish their OT undergraduate degree course, and a further 15% of the students who do graduate do not go on to work in healthcare-related roles. This means that of the students who start an undergraduate course, 23.5% of them will not go on to work as an OT in the UK healthcare system. Furthermore, this report highlights the NHS turnover rates of first-time UK trained OTs, stating that 21% of UK-employed OTs in entry-level roles leave their registered profession within 2 years of starting. Combined, this indicates that the OT trainees flowing into the health system could reduce by 40% within the first 2 years or training and employment. Whilst this research is specific to OT trainees, the scope of this research is limited to NHS acute and community healthcare settings only, and it does not account for other training routes such as apprenticeship trainees that contribute significantly to the inflow of OTs. There is currently no available data for trainee attrition in Leeds, so trainee inflow figures could currently be overestimated without considering retention rates. Therefore, it is important to utilise the available data to improve the reliability of trainee inflow figures to support workforce planning. As a result workforce planners in Leeds can understand the loss in investment in trainees in Leeds and focus on retention of the newly qualified OT workforce.

Implications for workforce planning in Leeds

Findings also highlighted a gap in available OT workforce data for both the health and social care sectors in national and local terms. National data focuses predominantly on UK-based NHS and adult social care settings. Whilst this data are consistently collected and reported, making it accessible and timely for workforce planners, it is limited in scope; NHS data covers only some NHS services, and not all adult social care data covers both local authority and the independent parts of the sector. There is no data available for other parts of the H&C system such as primary care or the charity or voluntary sector, and furthermore, no available data were identified from the H&C system in Leeds as part of this review. As a result, there is no comprehensive list of national, or Leeds-specific proxy data to create a whole-system view that is required for workforce planning in healthcare (Sutton et al., 2023) and support workforce planning in Leeds.

Findings identified a lack of research data focused specifically on Occupational Therapists in the national or local context. Sources were predominantly general workforce or AHP specific publications and OT data formed part of this, suggesting that OTs were not a priority for research. However, the NHS Workforce Long-term Plan specifically highlights ambitions for the OT workforce (NHS England, 2023), suggesting there is a need for OT specific workforce planning data to support planning for these targets. Literature refers to the wide variety of roles that OTs undertake, and there is often a lack of understanding around scope of practice of OTs (Ghela et al., 2022). This suggests that even OT specific data may only be applicable to specific OT roles and contexts. Primary research undertaken with the OT workforce in Leeds would support workforce planning in the Leeds context.

The types of workforce planning data varied across the literature. Data related to the capacity and inflows were of higher prevalence than outflow data for OTs; however, there were significant gaps across all types, suggesting no area was a priority for data capture or research in any H&C setting. From expert experience in workforce planning within the H&C sector, reasons for prevalence in different types of data could be that data are available for NHS and social care sectors due to the large scale of their sectors and their levels of data availability and reporting, as well as government interest in workforce capacity and inflows. This type of data is captured at a national level and often forms a significant role within operational planning and delivery across the health and care sectors, whereas data relating to those leaving the H&C workforce is less mature across all of the H&C system sectors.

OT Workforce current capacity data was primarily annual trend data for the substantive core workforce and vacancy rates (Nuffield Trust, 2024; Skills for Care, 2022, 2023b), enabling workforce planners to make comparisons for levels of OTs over different yearly periods. For example, the annual provision of some adult social care sector capacity data (Skills for Care, 2022, 2023b) reveals that the local authority OT workforce has increased by 11.6% between 2012 and 2022, in comparison to a decreasing local authority workforce overall in this period. However, methodologies differ between publications, and the same data are not available consistently across sectors, limiting useful comparisons. No data were available for other elements of capacity such as contingency staffing, temporary absence or training capacity, meaning that a full picture of OT current workforce capacity cannot be generated. Therefore, the current needs of the system in terms of required capacity is unavailable for the purposes of OT workforce planning in Leeds.

In the included studies, several data items and applications of said data were deemed inappropriate to apply to a Leeds health and social care context. One paper presents OT capacity split into patient-facing and non-patient-facing hours with the aim of optimising efficiency of the OT workforce (Ghela et al., 2022). However, this study is limited to an acute public tertiary hospital setting only in South Africa, suggesting this split of capacity data may not be reasonable to project onto the United Kingdom or Leeds context. Findings from a point-in-time 2020 NHS staff survey (Hemmings et al., 2021) shows the range of average additional unpaid hours undertaken in addition to contracted hours by the general NHS workforce which is not specific to OT, and could be misinterpreted because working environments for these staff could vary significantly from that of OTs across the Leeds H&C system. However, the availability of this data could support workforce planners to understand the likelihood of unpaid additional hours for OTs in Leeds, as this is a key element to understanding current and required capacity. As a result of these findings, workforce planners are unable to fully map current OT capacity nationally or locally, or identify suitable proxies to implement the model.

Outflow data for Occupational Therapists only included turnover figures for OTs. This data were only available for NHS and adult social care settings nationally (Nuffield Trust, 2024; Skills for Care, 2022, 2023b) and were obtained using varying methodologies, making direct comparisons difficult. As a result workforce planners have no understanding of OT data related to the full H&C system, and no breakdown of other factors that contribute to outflows such as retirement, and therefore they are unable to predict the scale of OT outflows nationally or locally. This means that there is a lack of comprehensive data to support required recruitment activity or retention support to ensure OT supply and demand are balanced.

OT inflow data included details on national NHS workforce targets, trainee retention figures and return to practice data for OTs, but it did not include data to provide a full view of OT inflows into the H&C system. Whilst the NHS Long-Term Plan provided targets for expanding the NHS OT workforce (NHS England, 2023), there was no direct information related to expected numbers of OT trainees within Leeds (Palmer et al., 2023; Skills for Care, 2023a), and this provides no basis for workforce planners in Leeds to apply the trainee retention figures. Furthermore, the apprenticeship retention figure only focuses on retention during the OT course (Skills for Care, 2023a), and does not take into consideration the retention of these apprenticeship into the employed OT workforce in the health and care system. The return to practice figures identified are from an unknown source and time period (NHS England, 2018), and are again only NHS specific, and as a result these cannot be projected reputably onto the Leeds system. As a result, workforce planners are unable to understand wholly current or predicted inflow of trainees, graduates and apprentices expected to fill OT roles within the Leeds H&C system, and therefore, there is a lack of evidence to support recruitment or development activity.

Strengths and limitations

This scoping review has some limitations, owing to our reliance on published or publicly available workforce planning data which are held within the organisations who collect the data and not routinely made available. Many of the reports accessed for this review will have utilised data only available on internal systems and data libraries such as ESR or Model Health System that require permission to access, thus limiting the inferences we are able to make from this data.

We know from professional experience that the day-to-day OT role, delivery and services can vary significantly within Leeds, across the United Kingdom and internationally, and therefore, it is acknowledged that projecting data across the workforce is a limitation. Additionally, we were unable to consider papers not written in English, and may have been unable to access unpublished smaller reports that might have applied to our study and provided localised context.

Despite these limitations, we were strengthened by expert knowledge of system partners who are aware of relevant sources and publications to support this review, a thorough process for locating data and wide inclusion criteria. Furthermore, by taking a narrative and pragmatic approach to interpreting the data, we are attenuated to the key considerations for future OT workforce planning operations.

Conclusion

In conclusion, this scoping review has identified that there is a lack of available national and Leeds-specific workforce data for Occupational Therapists across all parts of the health and care system. The available data vary hugely by type of workforce data; however, the Nuffield report data on retention of trainees nationally can be used to support workforce planning in Leeds (Palmer et al., 2023).

The implications of these findings is that there is very limited ability to project available, national data onto the Leeds context to provide a whole-system view that is required for workforce planning in healthcare. As a result, there is no comprehensive list of national Leeds-specific proxy data to create a whole-system view and support workforce planning in Leeds. Whilst there is no data specifically available for Leeds OT context, the Nuffield trainee and retention data can be used as a proxy and be projected onto the Leeds system to support workforce planning. This scoping review could support workforce planning for the OT workforce beyond the Leeds context (UK or internationally) having identified findings that can be utilised for the wider OT workforce.

Recommendations

Consistent, specific workforce data relating to OT services is crucial to fill gaps in recruitment and future-proof these services. Methods and tools to support the gathering, open sharing and utilisation of this data in a timely and consistent way would provide a comprehensive picture of the workforce and should be explored by service providers and those involved in workforce planning.

Despite a distinct lack of recent, comprehensive data specific to the OT workforce, this scoping review has located one source of valid and useful data for the purposes of workforce planning in the Leeds Health and Care System. We can utilise this OT graduate retention figure to support understanding on inflows into the OT workforce across the full Leeds H&C system. This will also open opportunities for the wider discipline, both UK-wide and internationally when taking contextual factors into account.

To support the filling of current workforce data gaps via primary research of OT workforce data to improve the quality and standardisation of data collection and reporting both locally and nationally. This improved data can be applied to the Leeds-specific Tactical Workforce Planning model.

Key findings

National data on OT workforce is inconsistent and lacks detail for local planning.

OT trainee retention data offer useful proxy indicators for workforce inflow.

Significant data gaps hinder whole-system workforce planning in Leeds.

What the study has added

This review has identified usable proxy data and critical workforce data gaps, providing direction for improved Occupational Therapy workforce planning within Leeds and potentially other UK health systems.

Footnotes

Author’s note

Cara Gates is now affiliated to School of Medicine and Population Health, University of Sheffield, UK.

Research ethics

Not applicable.

Consent

Not applicable.

Patient and public involvement data

During the development, progress and reporting of the submitted research, Patient and Public Involvement in the research was not included at any stage of the research.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) declared no financial support for the research, authorship and/or publication of this article.

Contributorship

CT and KM developed the aims and research questions and conceived the study. They developed the search strategy supported by CG, and carried out the full paper screen. KM and CT wrote the first draft of the manuscript. CG devised the screening and analysis procedure, wrote the methods section of the manuscript and contributed to drafting and refinement of the full paper. JL extracted the data and contributed to the analysis of results. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

ORCID iD

Cara Gates

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