The growth of manual handling packages designed for just one carer
After the Second World War, when the welfare state was founded, the care and special needs sectors faced very different challenges to those they face today. People’s lives were considerably shorter; a boy born in 1948 could expect to live to 66; a boy born in England today, however, can expect to live to 79. Consequently, the healthcare, social care and special needs establishments operated very differently. There were far fewer special schools (or children receiving specific education to cater for their SEN) and complex care packages for very sick and disabled children were rarely delivered at home. Conditions such as cerebral palsy often meant a much reduced life sentence in 1948 and a much higher proportion of sick and disabled children died young.
Times have changed and the improvements in health care which have taken place over the decades have bequeathed us, not only an ageing population, but also a population that is far more likely to survive profound disability and episodes of serious ill health. But how is this impacting on today’s healthcare, social care and SEN sectors? There are certainly concerns about how care will be funded in the years to come with recent media reports citing plans for serious funding cuts for disabled people over the next four years. One area under consideration is the minimum number of care or support staff required to deliver safe and effective care in the home. This is particularly relevant to manual handling tasks, as costs inevitably increase proportionately to the number of care or support workers required.
Does it always take two?
In recent decades, a common misconception about complex moving and handling cases has emerged, that two care or support workers are always needed, as opposed to one. This is particularly the case where hoisting is required, often based on health and safety considerations. How did this misconception arise? The now superseded National Minimum Standards for Domiciliary Care (2003), standard 12.8, stated that, “Two people fully trained in current handling techniques and the equipment to be used are always involved in the provision of care when the need is identified from the manual handling risk assessment”. This seemed to cause some care managers to conclude that two care/support workers are a legal requirement. Indeed, many care organisations wrote this into their manual handling and health and safety policies at the time. For many, this approach still stands today. In fact, the document says two handlers are only required when “the need is identified from the manual handling risk assessment.”
Consequently, with thorough risk assessing and care planning, a care package, even a complex one requiring hoisting, may well be managed safely and effectively with one care or support worker, resulting in significant cost savings to the local authority.
Over the past five years or so, manual handling equipment manufacturers have improved greatly on existing handling aids and developed new products specifically for the single-carer market. Some examples include in-bed sliding systems which work on a basis similar to slide sheets, in that they enable you to slide the person up and down the bed as well as turn them for personal care and/or pressure care. Unlike slide sheets, they do not need to be inserted or removed – they lie behind the person the whole time and are more like bed sheets in their material type. However, they differ from traditional bed sheets because they are designed to slide.
In-situ hoist slings are another really useful product that negates the need to insert and remove slings prior to hoisting. As with the in-bed sliding systems, they are designed to be in position behind the person the whole time (whether they are in a chair or bed) meaning that all the handler needs to do is attach the hoist to the already-in-place sling to enable a transfer. Flexible application boards for inserting and removing hoist slings are designed to replace slide sheets for the same task and are easily operated with one person, making inserting and removing hoist slings (if an in-situ sling is inappropriate) much quicker and easier to accomplish.
Electronic patient-turning bed-systems and fully profiling beds are both excellent examples of ensuring movement in the bed is possible with fewer staff. The electronic patient turning bed is a relatively new invention and is very innovative, utilising two rollers fixed to the edges of the bed enabling movement to occur on a large canvas sheet that is moved between the rollers. As with all handling aids, a thorough risk assessment will be required to ensure their appropriate selection and use and not all products will work for all children and young people. However, these pieces of equipment have all served well to date to meet this growing need.
Some of this equipment is not particularly well known now but with awareness training sessions and the opportunity to try equipment, as well as effective workplace supervision programmes, many of these products will be invaluable in future care packages relying on one care or support worker.
Freeing up budgets
The significant cost savings, and potential to re-deploy domiciliary care/support workers to where they are most needed, have been proven via a number of local authority case studies within adult services. These projects have utilised occupational therapists and specialist manual handling advisors to re-assess some of the double-handed community care packages being delivered. For example, Somerset County Council’s project between September 2011 and February 2012 found that 25 per cent of assessed adult clients had been reduced to single care worker management, whilst a further 31 per cent were identified as having potential for conversion at a later stage. Essex Council established a similar project in July 2011, under which around 500 client cases were reviewed and within six months 44 per cent had had packages reduced. These Councils invested significantly in handling aids designed to be operated safely with one person. Specific training programmes were designed by the manual handling training teams and rolled out initially to care managers and then onto the front-line care and support workers who were supporting the clients in question. The resulting savings continue to this day in these and other authorities across England and Wales. It is expected to be only a matter of time before these authorities look closely at achieving similar results within their children’s services.
Adapting to change
It seems clear that at a time of national government budgets cuts and efficiency savings, local authorities and social services will need to be more certain than ever that they are using their resources wisely. An increasing number are likely to look again at two-handed care packages to see if there is potential for savings. Care providers will need to be alert to changes, as new and innovative moving and handling equipment makes single-handed care packages more feasible across both adult and children services. However, the overriding need is for accurate risk assessing, effective staff training and staff supervision, as well as the investment in new equipment. There should also be absolutely no compromise on the safety of the moving and handling of disabled children and young adults, whatever the financial pressures.
Kate Lovett is a Director of EDGE Services, which supplies training courses including manual handling events designed specifically for children services: