Deborah Harrison, founder of A1 Risk Solutions, explores the positive impact of single-handed care
What is it?
Single-handed care is a person-centred assessment of an individual’s moving and handling needs.
Ensuring they receive the right amount of care, treatment and in the correct environment, whilst creating capacity across the whole system (Harrison, 2022).
Does it matter what we call it?
The negative connotation associated with the name single-handed care may make you decide to call it something else, such as proportionate care, moving with dignity, smarter care, right size care, optimal handling, optimised handling and reduced carer handling. It all means the same thing. For this article we will refer to it as single-handed care. In your systems don’t get hung up on a name, call it what feels right for you.
Be mindful that trying to hide what you are doing by calling it something else may not demonstrate transparency. If you are calling it by another name, ensure that they are aware of what the concept is. It’s about a person-centred approach, whilst optimising everything across a whole system and ensuring the care is proportionate to meet the individual’s needs.
Why is it important?
We need to ensure care is not over prescribed and is proportionate to a person’s needs. For the person being discharged from hospital, cared for at home, or in a care home, it is vital that we do not foster dependency as this has numerous negative consequences on the person.
THE KEY DRIVERS FOR CHANGE
Workforce Challenges
There are workforce challenges across health and social care. Over 50% of social care providers in England report challenges recruiting care workers, with 31% of them reporting difficulty retaining them (CQC, 2023). Staff shortages within the home care sector have made it difficult for them to accept new packages of care, such as those being discharged from hospital.
Capacity
There is a significant lack of workforce capacity within the system, causing considerable pinch points across the totality of the health and social care sectors. This has resulted in seriously ill and injured people not receiving treatment in a timely manner.
Improved patient flow in the hospital
As capacity in social care is increased and more hours are released into the system, evidence demonstrates the number of bed days lost are radically reduced (Harrison, 2018).
Meeting unmet need in the community
There were approximately 246,000 people awaiting assessment in the community in England (ADASS, 2023). Hours released using single-handed care will prevent people from remaining in hospital or going into long term care unnecessarily and enable them to remain in their own homes.
It is an enabling approach
By enabling people to do as much for themselves as possible in the community and in the hospital, we reduce the likelihood of harm associated with deconditioning and people being readmitted. After all, it should be about the person we care for, the whole approach is person-centred.
Less invasive and person-centred
With fewer carers and a real opportunity to build relationships, people have reported feeling part of the care support as opposed “being done to”. Fewer carers were considered an optimal way of working during COVID, and organisations who were already carrying out single-handed care benefited from this.
Is it safe?
Absolutely. With the correct systems and processes in place, the right training, equipment and risk assessments, even the most complex cases may be safely carried out with one carer. Many organisations have reduced the number of care packages requiring two carers by upwards of 40% (Harrison 2020).
There will always be instances when two or more care workers will be required.
Is it against the law?
No, it is not against the law, it embraces the Care Act 2014, ensuring a robust and holistic approach is used.
All complex moving and handling assessments require an assessment and a robust review process is put in place.
Is it just cost saving?
No, this is a frequent misconception. In fact, it is a means of creating efficiencies and capacity across the system. Many organisations record cost savings as opposed to hours created, which is where this misunderstanding comes from.
This approach is a spend-to-save model, monies are reinvested into the workforce, with training and provision of safe equipment.
Many organisations have reported cost savings these have included:
· Hackney in 2021 making cost savings of over £500,000 in six months
· Tower Hamlets in 2021 reported a saving of £1million in a 4-year period
· Cambridge in 2019 reported cost savings of £1.2 million
Many others have made savings and reported them as hours created, conversion rates of double to single-handed care. Ultimately, the financial saving is substantial.
How do we engage the workforce?
Across the social care and NHS workforce there are entrenched beliefs that every patient requires two people to move them safely. To overcome these barriers we suggest meaningful engagement, training, creation of forums, continued support, as well as ensuring supportive provider contracts are in place.
What is defined as meaningful engagement?
An engagement day works well and starts to engage with the frontline staff across the whole system.
What does an engagement day involve?
1. Bringing together key stakeholders
2. Host a presentation explaining the concept
3. Survey stakeholders prior to the event to establish concerns
4. Address concerns within the presentation
5. Physical demonstration of equipment and how it can be used
6. Answer questions
What should supportive contracts involve?
They should outline what is required:
· Need for the care workforce to attend training in SHC
· To work in co-production with service-users, NHS and social services
· How the care providers are going to be supported with an equipped training room or loan of equipment
· How else the care providers are going to be supported, examples being SHC forums
· Accountability also requires addressing.
Will we have to buy any equipment?
As this is a spend-to-save model, it is expected the purchase of some equipment for assessment and continued use will be required. Some of the equipment you currently have may be suitable. Examine what is required to mirror what is being used in the community.
Consider what type of equipment will be required in different areas, for assessment purposes and training.
What are the key takeaway messages?
· Engagement is vital across all sectors
· Use a whole system ergonomic approach
· Learn from others and exchange ideas
· Be open and receptive to change
· Ensure systems and processes are in place
· Seek continual improvement
· Supportive contracts with care providers
· Training of key personnel
· Creation of a supportive forum
· Ensure staff realise they are part of the solution.
Case Studies
This approach has been used successfully introduced by A1 Risk Solutions to over 100 organisations. It has been adopted by several local authorities as a means of reducing dependency upon a system.
The acute NHS organisations that have now adopted this approach has gathered momentum.
The success of these programs varied between 40-80% of packages being reduced.
Organisations that used a whole system approach found the greatest success. Examples are below:
· Dudley Council: Their project has been successful, reported 84% of total conversions from double to single-handed care (2018). It is now considered business as usual.
· Lancashire Council: Their project reported 87% of total conversions from double to single-handed care (2018).
· Southampton as a whole system have introduced SHC across the therapists in acute and community and in house reablement services. This has proven successful. Within the first three months of the programme the results below have been achieved. Foxley (2024)
159 Patients reviewed for SHC
72 Patients deemed appropriate to be on the SHC pathway
63 Patients discharged home with SHC
9 patients discharged home with 72-hour review to implement SHC
100% of patients discharged to their preferred destination
So far 579.6 bed days saved
Length of stay reduced for those on the SHC pathway by 9.2 days
· Medway intermediate care have adopted single-handed care into their successful home first model. This has now been adopted by the NHS acute discharging hospital. This has reportedly resulted in a successful reduction in the number of beds that are occupied by patients no longer meeting the criteria to reside.
· Forth Valley region in Scotland, brought several boroughs and organisations together. They have changed processes and pathways, trained 200 therapists and care providers across the region. The benefits realisation work has commenced. This involved work across three councils, one NHS acute and one NHS community organisation.
· Nightingale Hammerson: Nursing Home in London. Early adoption of the single-handed care approach has begun in the home. Headed up by head occupational therapist Rosalind Grey and Nuno Lopes Transformation Director. They have purchased some standing products and started assessments. We are now exploring the use of in-bed sheets for care in bed.
There is lots of potential for how the SHC approach can be implemented in the care home sector.
Each organisation has taken a slightly different approach. Harrison has established what works and published this in 2020. Subsequently improving and refining the diagnostics pathway, solutions approach and what delivery processes should be used.
Key Considerations
1. Start with a working party.
2. Establish and carryout diagnostics, this is a spend to save model, use a tool to assist with this.
3. Develop a fluid strategy and establish workstreams and barriers.
4. An equipment evaluation to establish that the correct equipment and support is in place.
5. Define the solutions local to your own systems.
6. Establish processes that require refining within the discharge pathway.
7. Decide what tools you are going to use, such as a video or safe online system. This is to act as an aid memoir after training, to support efficiencies when writing handling plans.
A1 Risk Solutions online system has an evidence-base that demonstrates its use improves competence, confidence and improves safety when used (Webb et al, 2022).
Spend to save assessment tool This to be used prior as part of your business planning, this will give your evidence of what savings you could make.
Risk Assessment tool specific to SHC A risk assessment tool that was specific to single-handed care has been developed (Webb et al, 2023)
Data Collection tool
Data analysis tool A data collection and data analysis tool is vital to record all your KPI’s. Harrison and Webb, (2022a) developed this tool, this has demonstrated to be invaluable in collecting data and analysing it.
Mobility assessment tool, to aid with equipment choice Harrison and Webb (2022b) developed a tool that allows both qualified and unqualified health care professionals to choose appropriate equipment. This is particularly important if you have a service user with variable ability.
8. An engagement day, this would involve all stakeholders.
9. Delivery of effective training across all organisations.
10. Ongoing sustainability and support for those who you are trying to engage. This is to be supplemented with how to guides, tools, individual as well as organisational case studies, webinars, and podcasts.
If you are exploring implementing single-handed care across your system. Consider what the implications are “if you do not follow what works”, or “if we sit back and do nothing”.
Many have carried out small pilots and then it never moves past the stage of a small pilot. Some do not invest in the equipment, are then limited by what they can deliver. Some limit who attends the training, when the key people move on, the system reverts to old practices. Some do not provide ongoing support, this can be via forums, practice days, access to a training room and the equipment. A lack of support results in poor engagement and adoption by the care providers.
What does the future hold?
Tomorrow due to vision, innovation, technology and enforced budgetary constraints may look very different to today.
Moving and handling should not be looked at in isolation from the environment and system that individuals are cared for. These systems are complex and actions that are changed within the system can start a ripple effect. It is like a drop on the surface of a lake: as its falls, it starts a ripple effect that affects the entire system.
We need to be prepared for the changes which are inevitable that lead to improvements.
For advice and guidance contact:
Deborah Harrison A1 Risk Solutions Managing Director deborah@a1risksolutions.co.uk.
Further Reading and Evidence Base
ADASS (Association of Directors of Adult Social Services) (2023). Time to Act Available at https:// adass-time-to-act-april-2023.pdf Accessed 19th March 2024
CQC (2023) The Health and care workforce. Available at https://www.cqc.org.uk/publications/major-report/state-care/2022-2023/workforce Accessed 16th March 2024
Foxley, H. (2024) Linkedin SHC first 12 weeks results of Pilot. Available https://www.linkedin.com
Accessed 22nd March 2024
Harrison, D. (2018) Single-handed care: it is a vision or a reality. Parts 2. Column, Volume 30, Issue 1, 2018
Harrison, D. (2020) Single-Handed Care what works: A discussion paper. 17th December 2020 Accessed 23rd January 2022 at https://www.inclusion.me.uk/news/single_handed_carewhat_works
Harrison, D. (2022) Single Handed Care workshop, presented at NHS Improvement ECIST Oval London 7th June 2022.
Harrison, D. and Richardson, J. (2022) Leap of Faith, plenary presented at NBE Conference Harrogate 26th September 2022.
Harrison, D and Webb, J. (2022a) Moving with Dignity: The development of a data collection and data analysis tool for use across all systems of health and social care. Column 34.2
Harrison, D. and Webb, J. (2022b) Mobility Assessment Tool: The development of a mobility assessment tool when assessing for single-handed care across all systems of health and social care Column 34.3
Outhwaite, C., Harrison, D. (2018) The development of a community assessment tool. Conference proceeding. March 18th 2018. Accessed 15th September 16th 2020 at https://issuu.com/prysmgroupltd/docs/naidex_pro_highlight-showguide_
Sefton Council (2019) Sefton Council holding free workshop on new care approach. 22nd January 2019 Accessed September 15th 2020. athttps://mysefton.co.uk/2019/01/22/seftoncouncil-holding-free-workshop-on-new-care-approach/
Webb, J., Hogg, P., Twiste, M. and Correa, E. (2022) Improving Competency in Safe Patient Handling Through Online Learning Beyond the Classroom: A Longitudinal Study. The American Journal of Occupational Therapy, 2022, Vol. 76(2), 7602205160. https://doi.org/10.5014/ajot.2022.044388
Webb, J., O’Donoghue, A., MacDonald, A., and Harrison, D. (2023). Moving with Dignity: The Development of a Moving and Handling Risk Assessment tool for the prescription of single-handed care across all sectors. Column 35(1):8-13