1. + Producing the evidence-base for complex assessment Sheenagh Orchard Registered member of National Back Exchange RGN, RNT, CertEd, DN(London) 06/06/2014SRO/HSP

2. + Meeting complex need Patients and Clients are presenting with a need for increasingly complex care management Therapists and Risk Assessors decisions are being challenged particularly on the cost of complex managements Imperative that meeting the individuals need is not compromised How do we ensure the individuals need is central to the decision and demonstrate to clinicians and budget holders that our assessment is valid? 06/06/2014SRO/HSP 1

3. + Competent Assessor R equired by Law Management of Health & Safety at Work Regulations 1999 (UK) Every employer shall: “appoint one or more competent persons…” A person shall be regarded as competent where: “they have sufficient training and experience or knowledge and other qualities to enable them properly to undertake the measures …” 06/06/2014SRO/HSP 2

4. + Complex case assessment Requires a wider knowledge and understanding of how to apply that knowledge effectively Need to understand the law and its interpretation so as not to be swayed by ‘myth’ or ‘opinion’ Need to ensure managements are evidence-based demonstrating sound knowledge of: Best practice Biomechanics and normal movement Ergonomics and Equipment 06/06/2014SRO/HSP 3

5. + Analysis and Evidence Must be confident of our competency Must be able to source and use evidence to support our decisions Must be able to produce our own evidence to support our decisions e.g. use ergonomic assessment tools such as Borg, REBA. Must be able to undertake analysis e.g. of equipment 06/06/2014SRO/HSP 4

6. + Positive Risk Taking This is nothing new – discussed in Health Care in Later life 1996 Need to empower staff to think this way Hayes (1992) suggests ‘ the notion of risk as a wager – assessing both losses and gains – would seem a more appropriate conception of risk’ Risk taking is a normal part of daily living at all stages of life In order to experience maximum fulfilment in life and reach one’s potential it is necessary to take risks 06/06/2014SRO/HSP 5

7. + Benefits For the individual include: Increased emotional and physical independence Greater ability to make choices Increased confidence Regain and retain control over their lives within the limits imposed by their physical and mental capacity For Social Care the benefit is mostly on cost 06/06/2014SRO/HSP 6 Negative Outcomes  Possibility of injury must not be ignored  Each case must be considered individually and agreement reached on the levels of risk, possible outcomes and possible injury

8. + Best Practice How do you develop and evidence your own ‘Best Practice’? The guides to the Handling of People are just that – Guides – Adaptation of standard practices is required if we are to meet some specific client need How do you develop ‘variance practice’ and evidence it? 06/06/2014SRO/HSP 7

9. + An Example Use of REBA – postural analysis Borg – perceived exertion of carer Comfort Likert scale Activity Likert scale Benner – skill level of carer E.g. to comply with MHOR 4(3)..” the physical suitability of the employee to carry out the operations – their knowledge and skills …” Use of FIM to identify individuals ability 06/06/2014SRO/HSP 8

10. + Assessment must take account of Security & stability of individual Body Mass Index ratio Avoiding 2 tasks at once The handling management can use 2 carers OR Ergonomically ‘design out’ the issue to allow a single carer to safely undertake the management 06/06/2014SRO/HSP 9

11. + Equipment Require sufficient depth and breadth of knowledge to be able to consider the ‘pros’ and ‘cons’ of every piece of equipment to be able to make sound choices for specific managements and individuals Ability to analyse for ourselves not just accepting manufacturers claims Make sound business case to demonstrate that cost of equipment can be off-set (e.g. reduced re-assessment, cost- effective use of carers Does the equipment - Utilise function and promote some independence Reduce effort for the carer Enable a single carer to complete a task 06/06/2014SRO/HSP 10

12. + Cost benefits of correct equipment Time Cost Cost profile when using 2 carers to assist Service User Cost profile when using 1 carer to assist Service User Initial investment in equipment Potential Benefit The breakeven point will move dependant on whether new or second user equipment is used 06/06/2014SRO/HSP 11

13. + Managements using a single carer This is one of the most topical complex case management situations The framework just described can be used to ‘evidence’ the decision to use a single carer. Benefits to the individual - Improved dignity Less stressful and invasive, physically and socially. Improved flexibility in care routine. Empowering 06/06/2014SRO/HSP 12

14. + What ‘evidence’ supports the decision BIOMECHANICAL – REBA Borg Considering Body Mass Index match ERGONOMIC Training/Skill level/competence Risk Assessment Design 06/06/2014SRO/HSP 13

15. + The Framework Aiming to improve functional ability and confidence The outcomes for the individual are key and a balanced-decision making process must be used Keep a ‘broad vision’ on equipment provision – providing even relatively high cost equipment has a cost benefit over provision of care Involve all ‘interested parties’ but the individuals needs and opinions are central 06/06/2014SRO/HSP 14

16. + The Process Identify Broad Goals and the Desired Outcome Undertake an Activity Analysis – may use ergonomic assessment tools such as FIM and identify what the ‘normal movement patterns’ are Undertake a Task Analysis Identify the current difficulties for the individual in achieving the task Set staged goals for the individual to progress towards the Desired Outcome 06/06/2014SRO/HSP 15

17. + Task Analysis Task analysis is the systematic analysis and recording of human work activity: Identify risk elements/factors/exposure Investigate usability and effectiveness of procedures Develop instructions/job aids Ensure the system will work and can be maintained Determine whether assistance required to meet care/enablement needs 06/06/2014SRO/HSP 16

18. + Competent Assessors Does your knowledge/skill/experience match the level of Risk Assessment you are undertaking? Could you benefit from learning how to develop and apply evidence to support decisions? Can you apply specific legislation to support your decisions? 06/06/2014SRO/HSP 17

19. + An Ergonomic systems approach to complex risk assessment in Health and Social Care 1 day Introduction workshop - Ethos 5 day Advanced practitioner course Facilitators Jacqui Smith – Editor Sheenagh Orchard – Contributing author of The Guide to the Handling of People 5 th & 6 th editions www.angelbeck.co.ukwww.angelbeck.co.uk or www.work-fit.co.ukwww.work-fit.co.uk 06/06/2014SRO/HSP 18

20. + References Michael V Hayes (1992) On the epistemology of risk: Language, logic and social science Frances Heywood & Lynn Taylor (2007). Better Outcomes, Lower costs. Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. Office for Disability Issues. Jennifer Hurstfield, Urvashi Parashar and Kerry Schofield (2007). The Costs and Benefits of Independent Living. Office for Disability Issues HSE (1999) Management of Health & Safety at Work Regulations 1999, (2 nd edition) Norwich: HMSO. HSE (2004) Manual Handling Operations Regulations 1992 (as amended) (3 rd edition) Norwich: HMSO Smith, J (ed) (2005) The Guide to the Handling of People 5 th ed 2005, BackCare Smith, J (ed) (2011) The Guide to the Handling of People 6 th ed 2011, BackCare 06/06/2014SRO/HSP 19