Community equipment and housing adaptations: draft guidance

Moving & Handling

Equipment plays a critical role in supporting the effective moving & handling of people who are frail or unable to transfer independently. Where an unpaid carer is assisting the person, the correct equipment plays an equally critical role in enabling them to do so safely. The Health & Safety section in this guidance confirms the obligations in relation maintenance, inspection and testing requirements, clearly outlining the responsibilities that agencies hold, as employers of staff, to ensure that equipment is safe for their staff to use. It also highlights the employers responsibilities related to the training of staff, and good practice recommendations for unpaid carers.

It is equally important that the assessment process to determine appropriate equipment provision, evidences clearly the views of the person who requires to be moved and handled, and a person-centred approach is promoted.

• Services need to evidence a minimum intervention ethos, which aims to maximise a person's ability to utilise functional performance, and avoids practice which over prescribes equipment requirements, and 'disables' the person and impacts negatively on their potential wellbeing.
• Risk assessment should promote this ethos, and health & social care partners and care agencies should ensure they work jointly to develop person-centred approaches.

For 'end of life' it is essential that services act in line with good practice/policy for those with palliative needs, and ensure the service users wishes are central to the decision making for any required equipment provision e.g. often a person in 'end of life' stages would prefer to be allowed home to their own bed, with more discreet personal care, rather than be cared for in a hospital bed.

It is also important that equipment categorised as 'moving & handling', in line with the previous recommendations from the 2009 Guidance, should not be viewed, as only the responsibility of certain professions to provide. Often a multidisciplinary approach is vital to secure the best outcomes for the service user, and to ensure all aspects of the person's needs have been fully considered. A wide range of professionals including physiotherapists, nurses, occupational therapists, and social care staff, should be able to assess for and provide moving and handling equipment as required, as part of the service they are providing, and health and social care services should ensure that they avoid arrangements which encourage duplication in the assessment pathways, and inappropriate onward referrals.

Increasingly services have considered the application of 'single-handed care' initiatives whereby they embark on a review and reduction of care packages to require fewer care workers per person, without putting that person's health and wellbeing in harm's way.

This approach recognises concerns about the adoption of generalised practice, which assumes double-handed care as the standard response and default position in all circumstances. The Health & Safety Executive (HSE) are clear in their guidance that blanket solutions should not be applied, and their helpful guide Getting to Grips with Hoisting provides information which highlights the importance of the individual assessment in determining the appropriate number of care workers required to safely move and handle the person.

Unnecessary use of additional care workers has implications, not just in terms of costs, and best use of valuable resources, but more importantly, can be more intrusive for the person who requires moving and handling support, and can prevent them from being encouraged or supported to maximise or regain any functional potential they may have.

Effective and robust individual risk assessments and care plans, produced with the full involvement of the service user, their family, any unpaid carers, and all relevant professionals, are essential to ensure risks are fully understood from the service user and unpaid carers perspective, and minimised for all involved. A number of equipment solutions can effectively support single-handed care strategy, and these should be considered as appropriate as part of the local equipment service core stock provision.

With the publication of the Scottish Manual Handling Passport in 2016, health and social care services have recognised the importance of a strategic, partnership approach to the effective provision of manual handling interventions, ensuring safety, and competence, in the workforce, whilst promoting person-centered approaches which maximise independence and choice. Further work is required to encourage more widespread uptake of the tool and partnerships should review their arrangements to encourage standardisation and consistency that this promotes.

Key Actions

• Assessments should evidence the views of the person who requires to be moved and handled and a person-centred approach should be promoted.
• Services should apply a minimum intervention ethos, which aims to maximise a person's ability to utilise functional performance and avoids practice which 'disables' the person and impacts negatively on their potential wellbeing.
• For 'end of life' ensure that services act in line with good practice/policy for those with palliative needs and ensure the service users wishes are central to the decision making, avoiding unnecessary equipment provision.
• Ensure that a wide range of professionals are able to assess for and provide moving and handling equipment as required, either to support hospital discharge and/or as part of the service they are providing.
• Services should ensure they avoid arrangements which encourage duplication in the assessment pathways and inappropriate onward referrals.
• Blanket solutions to moving and handling should not be applied and individual assessment is used to determine the number of care workers required to safely move and handle the person, encouraging the use of single-handed care where appropriate.
• Partnerships should review arrangements to encourage good practice recommendations from the Scottish Manual Handling Passport which aim to help standardise good practice across Scotland.