Moving & Handling: It Takes Two?
Is double handed care always necessary?
Some interesting research came my way, on the subject of safe moving and handling. Undertaken by the University of Salford, the remit of the report was to challenge the widely received wisdom that two people are required in a situation where someone needs manual handling, i.e. double handed care.
Safe manual handling is one of those topics that comes up a lot on Independent Living; we get emails from family carers who are struggling to move their loved ones from bed to chair or loo unaided, quite frequently contrasting this with care workers refusing to help with transfers unless there are two of them – and not always even then, as in this account:
“What I find difficult to comprehend is the attitude of professional district nurses who refuse to use my mother’s Ergolet stand aid in order to change her sacrum dressings. .. I informed them that training was available for them and I could give them the phone number only to be told that they didn’t want it as they would then be expected to use the equipment! They would visit, find that either I or a carer was not present to use the stand aid and go away again… Even if they arrived in pairs!… The irony is that the carers use this aid safely and efficiently, single handed. I use it, as does my mother’s hairdresser, all of whom are less qualified and significantly less financially rewarded. The latest reason for not using it was that although trained in its use, they didn’t use it sufficiently often to be up to date. If I dropped mother on the floor, that was ok but it wasn’t a risk that they were willing to take!”
Update September 2018
Although this article was written a few years ago, the myth about requiring two people for every transfer still persists.
We have an interesting contribution from Declan Barry, moving and handling trainer, who shares his experience of why this might be. Do please add your own thoughts after reading!
Poor quality training in moving and handling
From the other side of the fence, people coming into employment in the care industry are sometimes dismayed at the sketchy nature of the moving and handling training they are provided with, as in this case:
“I have been working as a Social Care worker for one month, in a large, well-known organisation, and frankly I’m appalled at the ‘Moving & Handling’ training, or rather lack of it. An hour or so at best, of formal practical training with a ‘qualified’ trainer. It’s all very well saying, “this is the hoist, this is how it works”, and an arbitrary demo using a co-worker as a ‘dummy service user’. What I really needed to know was… how do we hoist someone into a bath, onto a commode, onto a toilet, onto a shower trolley? What happens if a service user slips through a sling? etc etc.”
Compulsory training, but no quality standards specified
Manual handling training is compulsory for care workers, but the content and quality of the training is left to the professional judgement of the organisation involved, leading to some very dubious courses, which may provide incorrect or misleading information, or just not enough time and practical sessions to enable the trainees to feel confident in their abilities.
Given all the noise around “Health and Safety”, we should perhaps not be surprised that many care providers simply introduce a blanket “no lifting” rule, effectively depriving thousands of people of support; rather than undertaking a proper risk assessment.
Origin of the double handed care myth?
So to this new research, which identifies a possible source for the “two people for every lift” misconception, in the National Minimum Standards Regulations for Domiciliary Care 2003, which state:
“12.8 Two people fully trained in current safe 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.”
Note the final third of that statement, when the need is identified from the manual handling risk assessment.
What managers should take from this is that a moving and handling risk assessment is necessary, not that two carers should be involved in every lift.
Transfer aids often designed for safe single-handed use
Another factor which is very often not taken into account, is the many developments in transfer aids in recent years: frequently, when I receive information about a new hoist or stand aid, somewhere in the description will be words to the effect that it has been designed for safe use by a single carer. As is so often the case, practice doesn’t always keep up with technology, and what might have been prudent with previous generations of products is just carried over without question.
Today we have perhaps reached some sort of tipping point, where finances are so tightly squeezed, and demands on care providers so great, that attention really has to be given to any sort of waste: and insisting on double handed care in all circumstances, whether necessary or not, means that costs of care are higher than they need to be; many people may miss out on necessary support altogether; coordinating care visits is harder; and those on the receiving end have twice as many people invading their space as is really necessary.
Research shows benefits of assessing whether or not two carers are needed
The research from the University of Salford makes a strong financial case for challenging the notion of double handed care for every lift.
I would love to know what you think on this subject, whether you are a professional involved in moving and handling; an equipment supplier; a family carer; or client receiving care services. You can post your comments at the bottom of this page.
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Further reading and resources
You can access information on a wide range of hoists and transfer aids in our Moving and Handling People area
November 2019: Matthew Box and Linda Agnew, independent occupational therapists, have reviewed double-handed care packages in Thurrock, with positive results.
The M&H debate will trundle on for the rest of time. In my experience domiciliary care providers are cash-strapped by their local authorities demanding the cheapest care possible. This is translated by the care providers into accessing the cheapest, shortest and legally flimsy M&H training courses or DVD’s, it is also translated into very low pay for domiciliary care-workers who feel de-valued and de-motivated by their circumstances. Why should people on minimum wage and very long hours become well trained professionals? Until care-workers are valued by society, employers and local authorities nothing will change!
As authors of the HfH report “It Takes Two? Exploring the Manual Handling Myth”, we read with interest the comments the report has stimulated and are pleased to have generated such a debate. Having trawled through years of legislation, guidelines and court proceedings we agree that safe assessment and provision of moving and handling equipment and the training of techniques is a multifaceted combination of skills. This debate should continue and include service users perspectives to ensure that the application of blanket policies is continually challenged. In addition to this, it is imperative to ensure all caregivers are supported through regular quality training from competent providers, allowing sufficient time for practical techniques (and not just watching a video!), regular updates on innovations in equipment developments to meet service user needs and involving the client / advocate at the centre of their risk assessment to identify the most appropriate moving and handling techniques and equipment to meet their individual needs.
I absolutely agree with the authors comments, could we not explore taking it a step further spreading the word to Local Authority leaders surely in their cash conscious minds they can see the benefits to those in need of and those providing manual handling support.
I subscribe to the risk assessment argument. The conclusion of the assessment will depend on the type of hoist, the type of sling, the assessed condition of the person being transfered, the ability/competency of the carer, the task being conducted and the working environment. In my experience, a well trained, competent carer with the right equipment will be able to safely conduct about 90% of hoisting tasks single handed. However, there are definately situations where two or more carers are required. I would also like to add that I believe that the training and competency of carers is a far more serious issue that the number of carers and that is where the focus should be if safety is the true issue behind the debate. Decent training and good equipment is also likely to be more cost effective.
A very pertinent comment – thank you. The quality of training is certainly a key issue: two poorly trained carers are no safer than one! It would be good to have some sort of enforceable standards for training…
As a private domiciliary physio I see all kinds of manual handling some good some not.
The training provided by some home care agencies seems woefully inadequate, in many cases carers have said they have not been shown the equipment they are expected to use. Most of them are under the impression that 2 people are always needed for hoisting or using transfer equipment. Many report they have had no hands on training and if they have had anything it is often theoretical on-line training. This in my opinion you cannot train a practical skill without demonstrating and practising it.
How many carers are needed should be dictated by a comprehensive risk assessment. Someone may need more than 2 carers for many different reasons for other people one carer is more appropriate.The issue here is that often the people carrying out the risk assessment do not have adequate knowledge or expertise to do a comprehensive assessment using the 5 steps identified by the HSE and mentioned by athenacare above.
It is about time that there were standards in place about who can carry out risk assessment and what training is appropriate. The National Back Exchange has some good advice on this and offers training guidelines and attributes a trainer needs to poses. http://www.nationalbackexchange.org/index.php/resources/free-resources.html
Hi,
I was interested in the Judgement made in the East Sussex case in 2003, it seems that the blanket “no lift policy” is still used, although it was stated as being unlawful. As things stand and a disabled person who needs to be hoisted has 2 carers, if for any reason only one carer turns up, they are told that they must not lift on their own. Not very good for the disabled person who requires to toilet. I can understand that there is a correct way, and an incorrect way to lift a person, but the carers should be shown both ways, lifting with one or two. Also are the people who are showing how it is done themselves know how to do it, there are many cases where the person teaching the job are not fully conversant with the way to lift without harm to the carer or the person they are lifting. The last statement in this article is very true that someone will become too expensive, this is happening now in certain drugs are not being available on the NHS. This idea could snowball.
wife’s carer
Hi. My first thought on reading this was what about the East Sussex judgement (2003)? As far as I am aware this precedent still stands. For those unfamiliar with the judgement it was a legal case that challenged a blanket ‘no lift policy’ and the judge ruled that blanket ‘no lift’ policies were unlawful. She emphasised the need to balance the rights of the disabled person with the rights of workers. Any lift needs to be individually risk assessed.
My experience as a carer goes back to when my daughter started receive direct payments and the local authority stipulated that we needed two carers to use the hoist because that was their practice in their services, which meant that one of us always needed to be at home to work with the paid carers. I challenged this on the basis that we were the employers not them and therefore the decision rested with us. I requested a risk assessment in our home as we operated both the ceiling tracking and mobile hoist on our own as frequently one of us may not be around (that is life). Once a risk assessment was done it was agreed that one person could lift using the hoists.
Perhaps a ‘blanket ban’ needs to be challenged again through the courts – if someone has the time and money or we could land up in a situation where the most severely disabled people become ‘too expensive’ to enjoy an ordinary life in their community. That situation would run counter to the rights of disabled people under the Equalities Act!
I do get frustrated with the insistence by some providers that there must be two carers, we have always adopted the approach of “subject to assessment” if it can be managed by one “safely” then that option should be available, but it should be reviewed on a regular basis. In my opinion charging a service user for two care staff when the task can be done by one is tantamount to fraud. I was told by the CCG that i had to put two staff in for a job that when assessed only required one.
it does not help when contracting packages the commissioners and O.Ts etc have this single minded attitude, NHS and Local authority policy state “minimum of two” when using equipment.
Hi,
I was interested in reading about manual handling, as I see it a lot of the problem is one, the government is hell bent on cuts to the medical professions, and two the health and safety rules are made by people who don’t understand the situations they put the rules in place for. It seems that common sense has gone out of the window, I am a carer for my wife, she needs to be hoisted, and I do not think enough training is given to the people involved. My wife’s carers are very good, but regarding all the types of slings used, they are not shown all the types, so they may be needed to use a sling they have not seen before. In many cases costs are the main reason certain equipment is available. A lot of the people sitting on committees have no idea what a disabled person’s needs are, all comittees should have disabled people on them so they know what is needed. A friend of mine is on a committee and they were very surprised when he stated things would not work, because the people making the rules were not disabled. He is in a wheelchair, and a simple thing like using a cash point is not possible, in fact he is invited to sit in on different committees. Politicians take note.
I can just about remember some research I found over 10 years ago that showed over 3,500 people were being denied any support at all, as care providers would not risk assess and insisted on adopting a blanket no lifting policy.
We risk assess each person and take the approach of:
1) looking for & recording the hazards
2) deciding who may be harmed
3) evaluating the risks
4) recording our findings
5) reviewing our findings as a minimum every six months
6) developing an action plan and if required detailed guidance to be followed by the supporting staff.
This approach though has not always worked in our favour and we have several recordings to prove it. For some health professionals, the risk assessment process isn’t good enough and they insist we provide two persons regardless.
The problem with some providers is they do not train their assessors to risk assess correctly nor do they train care staff properly. We know this because out of 50 persons who attend an interview to work, only 10% or so can demonstrate their competence with manual handling training; some have never had a practical hands-on training session – which is appalling considering they have been care workers for over 5 years.