Single-handed care Part One: The winning formula

Single-handed care (SHC) has been around for many years, however, many authorities have not yet adopted this working methodology.

This will be the first in a series of three articles concerning SHC designed to help anyone interested in implementing such a policy. Each article is based on extensive research and real-life studies carried out by A1 Risk Solutions.

• Part One: Exploring barriers, who you should engage with and potential benefits.
• Part Two: Examining more of the barriers, learning what an engagement day is and how you can set this up, and learning about the implementation of your strategy.
• Part Three: Evaluating a different way of implementing SHC across health and social care.

The aim of this three-part series is to: assess the impact that adopting SHC has had on local authorities and NHS organisations, evaluate the success stories, and explore what lessons can be learned and how the future may look.

Part One: Exploring barriers, who you should engage with and potential benefits

Knowing what the barriers are to SHC is the only way to create sustainable solutions.

The main barriers to the implementation of SHC are:

1. Lack of collaboration and engagement of the relevant stakeholders
2. Lack of education and awareness
3. Limited training in SHC and availability of equipment
4. Limited ongoing support and tools

During 2016, A1 Risk Solutions conducted an extensive review of 4,586 stakeholders. This unexpectedly identified that the source of the barriers came principally from occupational therapists, care workers and moving & handling professionals. Further investigative clarification in 2017 and 2018 confirmed these findings.

The disparity of the barriers presented by these groups was particularly apparent and what was needed was a strategy that took an integrated approach. This required all stakeholders to recognise, understand and accept the barriers presented by other groups in order to concentrate on moving forward cohesively.

“Knowing what the barriers are to single-handed care is the only way to create sustainable solutions.” Deborah Harrison

Given this information, A1 Risk Solutions developed the initial Change Management Programme. This involved a full day of change management, exploring organisational, team and individual barriers and how these could be overcome. This was then followed by two days of practical skills and problem-solving focusing solely on SHC moving & handling techniques in both common and complex situations.

This programme has been refined and developed over the last three years and now exists as a three-day Level 4 accredited qualification. It has been adopted by over 40 councils across the UK (England, Scotland, Wales and the Channel Islands). The councils that have adopted this way of working have seen extraordinary successes above and beyond what the original study demonstrated in 2016. The original study found that the majority of councils were converting approximately 40 percent of cases from double-handed to single-handed care (Harrison 2017, 2018). Where the A1 Risk Solutions approach has been introduced, this has increased to 60-89 percent.

What is a single-handed care approach?

Many organisations have been naming their projects “moving with dignity” due to the negative association with the term “single-handed care”.

How would you describe this?

A1 Risk Solutions collated the description below from 750 delegates over three years to describe SHC:

“A person-centred review of an individual’s care needs, allowing effective use of resources in a safe and dignified manner. Freeing up carers reduces the level of unmet need and improves patient flow throughout the acute hospitals, enabling a timely hospital admission and discharge resulting in more people to be cared for in their own homes.”

It does not always mean reducing care packages down to one person, it can mean reducing the package from four to two, one to none or even an increase in care time. It may mean reducing the number of carers at some – but not all – of the calls and it may increase the time required at the call for the remaining carer.

This will free up carers, who will then be able to attend to those service users with unmet needs in the community.

SHC in an acute hospital setting for discharge is a relatively new concept. Using the same equipment available in the community on the wards has several benefits. One simple example is the patient on discharge is no longer asked to use an unfamiliar piece of equipment at home. This will reduce anxiety, increase cooperation and has the potential to improve safety and reduce failed discharges.

The future vision

If the therapist in the hospital can confidently assess for SHC and access equipment, they will create a system that facilitates a timely discharge process into the community. No longer will the community OT be required to reassess when the patient gets home, it will merely require a review. This will save time and resources for the community OT.

“It does not always mean reducing care packages down to one person, it can mean reducing the package from four to two, one to none or even an increase in care time.” Deborah Harrison

Despite the obvious advantages, this is not mainstream and there are only a few hospital trusts where this is implemented. This will be discussed further in Part 3 in later publications of AT Today.

Collaboration and engagement

One of main themes identified as being a barrier was effective engagement. Engaging with people on a meaningful level that addresses their concerns, allows them to have a voice, explores their fears and resistance without fear of retribution is critical.

An effective strategy must outline the engagement plan, identify who to collaborate with and take into consideration how to approach each group or individual. Spending time identifying who the key parties are and securing their involvement early on is critical. This allows for an intensive exchange of ideas which leads to creative solutions. Who you do involve will depend on your vision.

“Engaging with people on a meaningful level that addresses their concerns, allows them to have a voice, explores their fears and resistance without fear of retribution is critical.” Deborah Harrison

A1 Risk Solutions considers it vital to include your NHS health colleagues at the beginning of the process, even if they push you away. Persistence is part of the course.

There are distinct benefits in involving the following people and organisations:

1. A board representative such as an assistant director of services or a transformation director
2. Commissioners of adult services
3. Legal department
4. CCG (Clinical Commissioning Group)
5. Care providers
6. Heads of services from the following groups:
   Occupational therapy
   Physiotherapy
   Moving & handling professionals
   District nursing
   Social workers
   Hospital discharge team
   Intermediate care
   Rehabilitation
   Equipment stores
7. Service users and their families

A board representative

Ideally, they will be your sponsor and support your project at board level, ensuring it gets the airtime it deserves. They can often bring together a range of people that you will not even be aware existed. They may find a route for funding for your projects. Most projects have been initially funded from the Better Care Fund in England. There are similar funding routes for projects that integrate health and social care in Scotland and Wales.

Commissioners

These are the people who will assist you in realising your potential. They will open doors that you did not know were there. They can help redirect your focus and have a distinct knack of cutting through the barriers. They have the ability to influence the care agencies via policy changes and contract amendments. They will be able to assist you with building business cases if you are not experienced in this.

Legal department

There are several common blocks that will require legal input. It makes perfect sense that the organisation is prepared for these blocks and for any difficult questions as less time will be wasted in developing solutions.

Care providers

These can be the most resistant group initially. If you do not have the care agency on board, it is 100 percent certain it will be a fight all the way. The care providers will have no incentive to adopt this change in practice without training and support from the local council.

The care agency managers have a difficult job on their hands convincing the staff to work differently. However, there are many ways to support the agencies.

“Recording of your data is vital; if it has not been recorded correctly, who is going to believe it actually happened?” Deborah Harrison

Here are a few examples: provision of training for the care agency trainers and risk assessors, provision of a free-of-charge training room with the correct equipment in place, loan of equipment, the occupational therapist to meet with the carers and demonstrate and guide the risk assessor and available carers, an online system such as that provided by A1 Risk Solutions, regular update sessions, and the creation of a network of SHC practitioners across all sectors.

If you use all of the techniques, you are more likely to ensure the adoption of the approach is smoother for all parties.

Therapists and moving & handling professionals

These groups frequently demonstrate signs of anxiety which can come across as resistance. “Why should I change?” “It will never work.” “How am I supposed to carry out single handed care assessment when I am unsure myself?”

Once they have attended training and received support, they see it as tool to change their practice for the good of the community and realise how they can positively effect change themselves.

Equipment loan stores

Loan stores managers should be involved from the beginning as they are crucial to ensuring the required SHC equipment is purchased. To ensure buy in of these managers, you need to outline where the money will be coming from for the initial and continued spend. The SHC equipment needs to be segregated from the general equipment for ordering.

Planning and preparation

A great deal of both is required by an organisation prior to training delivery. Funding needs to be agreed, knowing how much money you think you will need and what you require the funds for is essential. It is a spend to save model. A1 Risk Solutions has a calculator that takes into account projected hours, money saved and money spent throughout the course of the project.

Recording of your data is vital; if it has not been recorded correctly, who is going to believe it actually happened? A1 Risk Solutions has developed a separate tool that helps you record 36 Key Performance Indicators (KPIs). This enables you to instantly see the following:

• Assessment time spent on each case
• Assessment time spent on the project
• Time spent sourcing products and other tasks
• Time it takes to recoup the spend on individual cases on equipment and therapists’ time
• What time of the day you are making your savings, useful for workforce planning
• Numbers of equipment types ordered
• Cost of equipment spend
• Savings in care hours
• Saving in money
• Complaints and why
• Well-being KPIs
• Cost of therapist time
• Conversion rate
• Non conversion and reason why not

There are plenty of other things to be considered as part of your strategy. Here is an overview of some them:

1. A pilot first and then a dedicated team
2. An in-depth equipment evaluation to determine which pieces of SHC equipment will become part of your core stock
3. Implementation of a funding stream to come from money saved to replenish the equipment stores budget
4. An engagement event quickly followed by the training for the therapists, moving & handling team, care agency risk assessors and trainers

Next time in Part Two, we will explore more of the barriers, what an engagement day is, how you can set this up and implementation of your strategy.