Working with people with MS is an honour and privilege – and winning recognition for that is just the icing on the cake.

That’s according to Susan Hourihan, lead neuro-sciences occupational therapist at London’s National Hospital for Neurology and Neurosurgery.

Susan, who took the Outstanding MS occupational therapist title at the QuDoS recognition event in November, said: “I feel I can do a huge amount to help people with their everyday lives, to make their quality of life better.

“In MS, you can develop longer term relationships with patients that lead to richer possibilities in terms of the interventions you can offer. It’s a total privilege to work with these people throughout their journey.”

Susan was nominated for QuDoS thanks, in part, to the huge amount of work she has done to set up a range of clinics and services designed to help people with complex needs.

These include fatigue management, vocational rehabilitation, spasticity splinting, seating, and the transition from relapsing to progressive disease.

“In this job, you find yourself in the most incredible situations in terms of being able to help people to work their way through complex scenarios, whether that be managing the adjustment to disability, staying in work, or successfully leaving work – whatever it is that they need to do,” she said.

“I quite often look in on myself and think, ‘wow’. Not many people in life have an opportunity to help people like this, and I feel really lucky that the patients trust me enough to let me.”

Outstanding challenges

That’s not to say the job is easy, or that she is able to provide absolutely everything she feels her caseload could benefit from.

The biggest challenge Susan faces is one that most of her colleagues around the country would probably relate to – competing interests in terms of time and resources.

“There are a lot of things I’d like to be able to do for people with MS, but I have to balance those against whether it would be the best way to allocate resources. To do that, I look at the evidence that is available, something the MS Trust really helps me with,” said Susan.

“Whether it’s the best research evidence or the best consensus evidence in the field, I try to use a scientific approach to balancing resources. If you are going to put your energies into something, you want to make sure that it’s really giving your service and your patients the best value for money.”

This balancing act is set to worsen as demand increases and austerity continues to bite, forcing teams up and down the country to do more with less.

The Department of Health’s recent emphasis on advanced clinical practice and developing the role of consultant allied health professionals (AHPs) could alleviate pressures across the healthcare ecosystem – but only if implemented in the right way.

“I think therapists are well placed to holistically assess patients. Annual reviews, for example, can take a significant amount of time, but a neurologist may only have 10 to 15 minutes with a patient.

“It may be better for the patient to speak to an advanced practitioner who can do an overview, and then refer onto the individual therapists and disciplines that the person needs.”

For this to work, however, these new roles must be in addition to, rather than instead of, existing AHPs, Susan believes.

“My worry, particularly about the advanced clinical practitioner roles, is that they take you out of your disciplinary area and you become more of an interdisciplinary team member. That can be really important, but you still need the expert OTs and physiotherapists to refer on to,” she said.

Outstanding networks

As a multidisciplinary network of MS experts, the more evidence we have, and knowledge we share, the better care we can provide, Susan told the QuDoS team.

She said: “Using evidence-based practice and sharing best practice is so important in terms of the best allocation of NHS resources, particularly when budgets are being squeezed.

“We are lucky to have NICE guidelines to guide us, and we need to really focus in on that evidence as well as learn from colleagues and respond to new information as it becomes available.”

Asked how it felt to be named 2019’s Outstanding MS occupational therapist, Susan said she was incredibly flattered – and also name checked her team.

“Sometimes, you can get a bit of imposter syndrome, and I think the main thing the QuDoS recognition did was give me confidence that I am on the right track: that what I am doing is in the best interests of people with MS.

“It also made me reflect on all the advantages I have within my role. I work with an amazing team that spans across disciplines, and that is what gives me the opportunity to offer patients the best interventions.”

She added: “I just feel really lucky to be part of a service that has given me a platform to work on to meet the best possible interests of people with MS.”