Case Study: Cambridge HIA

Background

Cambridge Home Improvement Agency (HIA) is a forward thinking organisation that looks to ensure its customers receive the highest quality care.

In early 2019 they were working with the County Council on a new pathway for simple adaptions that would enable their staff to complete basis assessments following the principles of the RCOT’s paper on “Adaptations with Delay”. This would result in more timely adaptions for the customers and help manage busy Occupational Therapy workloads.

The HIA team comprises of caseworkers and surveyors who work closely with the adaptations officer at Cambridge City Council and specialist housing advisors that sit within the Council’s Adult and Children’s Early Help / OT teams: their primary role is to ensure the suitability of existing housing and support broader wellbeing.

The Solution

The Cambridge HIA chose to work with the Disabled Living Foundation after meeting them at an OTAC conference. They were impressed with the DLF’s approach to practical activity-based training.

They opted to train 12 caseworkers, surveyors and other learners from the county council at both Trusted Assessor Levels 3 and 4. The training took place in a DLF training venue in London over two days in March and April 2019.

The learners thought the training was challenging but “very good”. They found that the Level 4 course was most relevant to their work they do. They felt the trainers were very knowledgeable and enabled them to think outside of the box as well as to know when to refer onto occupational therapists in more complex cases.

The Results

As a result of the training, the new Trusted Assessors are now able to assess for and order minor adaptions and equipment as well as being able to feel more confident when completing adaptations. They have a greater awareness of how certain conditions impact on mobility and how to measure when choosing adaptations.

Cambridge HIA are in the process of implementing this new way of working, however at the time of writing their occupational therapy waiting times were 9–20 weeks. The case workers that attended the training are visiting within seven days. The HIA predict that when fully up to speed, they will be able to reduce their customers’ waiting times by up to 15 weeks or more by having case workers complete more simple assessments. This in turn will increase customer satisfaction and reduce risk.

Case Study: Sandwell Council

Background

Sandwell Council has an in-house equipment store which at the time of the training had re-designed their service to enable them to complete some assessments via a triage and telephone based system or in a centre / hospital meaning that some of their clients were not seen in their own home. This enabled Sandwell to get some low level equipment out to clients in need without the delay of waiting for a home assessment. They also noticed that the waiting times for assessment were increased by the need for an assessor to review the equipment once delivered.

Sandwell recognised they needed to update their technicians’ skills as they would now need to deliver, set up and demonstrate equipment in clients’ homes. They also wanted to ensure the technicians were able to recognise risk in other areas within the home.

The Solution

After discussions and a full tender, Sandwell decided to work with the DLF to deliver our then-new course: Trusted Assessor: Installing and Demonstrating Minor Adaptations to all the staff [please note that the equivalent course is now known as Trusted Installer]. DLF met with managers and occupational therapy staff to ensure the course met their needs and delivered six courses at their own venue.

Sandwell chose DLF Training as DLF “came out on top on both quality and price which made them the obvious choice”. They also “liked the way DLF offered different tiers / levels of Trusted Assessor training that fitted different job types”.

The training taught the technicians about the equipment they would be installing, covering how to measure clients to ensure the equipment fitted, to check the environment was safe for equipment to be installed, how to ensure the client would use the equipment safely and be sure that it solved the client’s difficulties. They were also taught demonstration skills and what to do when the equipment did not meet the need.

Technicians were also tested on their learning to ensure the knowledge was embedded and so that they could receive the Trusted Assessor accreditation.

The Results

As a result of training Sandwell staff achieved Trusted Assessor status. Although staff had some concerns initially about the changes to their roles, “all those that undertook the course were pleased with the content and learning” and further “are happy and confident with the new duties of demonstrating equipment”.

Sandwell are now within the top five equipment stores for equipment provision, reducing risk and increasing customer satisfaction. The training has “reduced re-visits being made by Prevention Assessors, this creates greater assessment capacity within their Therapy Service.’’

During the training it was highlighted that some of the equipment available may not have been the most current model on the market. As a result of the training, the equipment stores manager engaged with suppliers to visit and show new product ranges and uses. This enabled the service to expand their provision.

The training also highlighted areas of uncertainty around some equipment and the assessment factors relating to it, resulting in updating some policies to make processes clearer. DLF continues to work with Sandwell to support their on-going work to provide excellent customer service and quality provision.

Case Study: Royal British Legion

Background

The Royal British Legion (RBL) is the country’s largest armed forces charity. It aims to help members of the Royal Navy, British Army, Royal Air Force, veterans and their families to find solutions to a wide range of issues during and after their time in the armed forces. Founded in 1921, it has an impressive 235,000 members, 110,000 volunteers and a network of partners and charities.

As well as offering financial, emotional and mental wellbeing support, they also provide services with a focus on care and independent living. It was the Independent Living Service that commissioned the Disabled Living Foundation (DLF) to undertake a range of Trusted Assessor training for their UK-wide service.

One of the RBL’s important services is their Handy Vans Service which helps veterans and their families with small household repairs and minor adaptations to their homes. There is a dedicated and trusted team of experienced handy-people who are fully trained to carry out low-level maintenance works including:
• changing light bulbs and tap washers
• putting up shelves, curtain rails and grab rails
• fitting smoke alarms and carbon monoxide detectors
• fitting and changing door locks and other security features
• building access ramps and storage sheds to house Legion-provided Electrically Powered Vehicles
• installing care phones.

They currently run handy vans in 21 counties, along with partnerships with other organisations such as Age UK.

The Solution

RBL wanted to improve their service provision and ensure they provided a robust assessment so that they could continue to meet the needs of their beneficiaries. They also wanted to be able to confidently signpost on and understand what to do and who to refer to when an issue outside of their remit was identified.

RBL had previously used DLF’s services for equipment-related training and was keen to work together again.

DLF trained 45 staff members including Independent Living Advisors, Independent Living Regional Leads and Handy Vans Fitters. The course taught learners how to recognise a need for equipment and how it might enable independent living, measure for it and fit it into the environment. This could be installing equipment for minor adaptations such as a grab rail, or an aid such as perching stool.

RBL staff have also since attended refresher courses to ensure they are continuing to provide an up-to-date and high quality service.

The Results

The general feedback from the RBL learners was that the course was very good. They liked the training venue and felt that it improved the quality of the sessions.

Since attending the training courses, the Independent Living teams feel more knowledgeable and confident and this in turn has led to more accurate and up-to-date advice, support and guidance being given to RBL beneficiaries. They have also reported feeling more able to communicate with external services such as local councils.
The charity believes that they are now undertaking a more comprehensive and robust approach towards tackling the increasing demands and case work within the Independent Living Service.

Case Study: Dorset County Council

Background

Dorset County Council is home to the Adult and Community Services Team.
The area is also administered by six smaller authorities that have their own District Councils.
The team comprises of both social workers and occupational therapists (OTs) who work very closely together. The core work carried out by the OT service involves assessments for care packages, carers assessments but the main aim, as supported by the Care Act 2014, is to ensure service users can stay as independent in their own homes for as long as possible. The team therefore focus on ways to reduce dependency on complex care packages that might not be needed or may be counter- productive. Each year they handle thousands of cases with up to 15 new cases each week including housing needs assessments.

With rising demand the team roles are both multi-faceted and often specialist in nature. Work involves reporting to courts on the support required for an individual to be able to return home such as for DoLS (The Deprivation of Liberty Safeguards) appeals, relocating service users from residential care into other types of accommodation and assessments for hospital discharge. A specialist OT works and educates hospital-based OTs to ensure appropriate equipment is prescribed, that risk is assessed and that care is not “doubled up” where single-handed care approaches can be used.

Increasing pressure led to the creation of a new role: The Assessment and Support Co-ordinator (ASC) which combined the duties of an OT Assistant with a Social Worker Assistant and one of the first initiatives was to train their 48 newly-appointed ASCs as Trusted Assessors. This training would ensure that they were able to provide a better service to users and provide a good grounding in the basic elements of OT skills and assessment. The aim was to help them to become more confident in carrying out basic assessments, to be able to measure for equipment including grab rails and understand minor adaptations and daily living aids.

The Solution

The Council chose to work with the Disabled Living Foundation, as leaders in the field of Trusted Assessors. They also felt that DLF provided best value in terms of course content and affordability.

They chose Trusted Assessor training at Level 3 for their staff so that they could conduct assessments within the client’s home and measure for and then prescribe minor equipment and adaptations. They were keen to use clinical reasoning and adopt a best practice approach which would further enable them to reflect and adapt future practice.

The course was carried out over 4 sessions with groups of 12 learners in each and was carried out at their own training centre.

The Results

As a result of training their staff to become accredited Trusted Assessors, the ASCs now have a better understanding of practical assessments and how to use those assessments to improve the lives of the older and disabled residents that they visit. Confidence has increased in both understanding and measuring for appropriate equipment and ASCs are able to identify risk and report it accurately to seniors. Learners appreciated the practical nature of the training and now find that small aids are often the solution.

Dorset are now able to focus on ensuring care is appropriately prescribed and OTs are able to concentrate their efforts on more complex cases, confident that they have staff that can assess minor needs and refer to them when needed.

The challenges for Local Authorities mean they have to make the best and most efficient use of the resources they have available. For Dorset this has meant developing their staff to provide a more professional, holistic provision to service users.

Dorset is very focused on helping residents to have a good quality of life. By helping them to maintain independence and ensuring that they are safe and able to stay in their own homes for as long as possible they are achieving this.

Case Study: Surrey County Council

Background

In 2016 Surrey County Council on behalf of itself and 11 district and borough councils commissioned Foundations**, the national body for Home Improvement Agencies (HIAs), to investigate ways in which there could be a more standardised way of working between the eleven councils in the county. Foundations produced a number of recommendations following which Surrey created a temporary Programme Manager post. Alyson Smith was appointed in 2017 and she was then responsible for overseeing the work to implement the recommendations.

Surrey began by exploring the customer’s typical journey and timelines for accessing services for vulnerable residents with the goal of understanding what “good” looked like. They wanted to improve hospital discharge provision and also the links between the multidisciplinary teams involved in the care of vulnerable residents.

When professionals and service users were interviewed a number of areas for improvement emerged. One major area was the need to better integrate the work amongst OTs and the HIA in providing assessments. Waiting lists varied amongst the localities but demand for social care assessments was generally high. Foundations recommended that trusted assessors could be used to reduce the demand by training a range of staff to carry out basic assessments.

Surrey CC highly values its handyperson services: not only in providing improvements to the homes of vulnerable people but that they also represent a clear link between housing, health and social care. The work that they do day-to-day enables and encourages partnership working between the three disciplines and the positive outcomes have a huge impact on the service users’ lives. “Medical professionals can be daunting. Handyperson services are a friendly face and people let their guard down and more information can be gathered about the issues they face and how we can help them” Alyson explained, “It made great sense for them to be trained as trusted assessors”.

The Solution

The handypeople undertook Level 3 Trusted Assessor training which enabled them to have a good understanding about the equipment they would be installing, how to measure service users to ensure equipment fitted correctly, how to check the environment was safe for equipment to be installed, to verify that the person could use the equipment safely and that it solved their difficulties. They were also taught demonstration skills and most importantly when to refer the service user on to an OT.

Alyson reported that the process of organising the bookings with DLF was “Smooth, easy, very flexible and accommodating to our needs; I wouldn’t have changed anything.”

The Results

Learners were said to be happy to be trained and that following the course they are more confident in identifying needs and are happy to be in a position to do something about the issues that they come across on a daily basis. “The handyperson services now see the bigger picture and have a deeper understanding of risk and issues that clients face. They know what to do now when they see a risk. They are more confident in taking measurements and prescribing equipment for residents which has been beneficial and appreciated by the wider teams. “

Surrey plans to broaden the reach of the training to more learners within the home improvement agency and adult social care teams so that service users with low to moderate needs can have quick access to an assessment by a confident and competent member of staff meaning that they can continue to live safely and independently within their own homes.

Note: There is a two tier system of local government in Surrey, the county council and the 11 district and borough councils.:

o Elmbridge Borough Council
o Epsom and Ewell Borough Council
o Guildford Borough Council
o Mole Valley District Council
o Reigate and Banstead Borough Council
o Runnymede Borough Council
o Spelthorne Borough Council
o Surrey Heath Borough Council
o Tandridge District Council
o Waverley Borough Council
o Woking Borough Council

** For more information about Foundations, visit Foundations