Case for change: A system wide imperative for Optimal Handed Care

However, despite its potential, OHC faces significant barriers to widespread and consistent implementation, demanding a radical shift of emphasis and a unified, system-wide transformation driven by strong leadership and accountability.

1. The compelling need:

As of September 2025, daily average number of patients remaining in hospital who no longer meet the criteria to reside was 13,032, representing around 12 percent of total general and acute hospital beds in England. Reflecting this trend, University hospital Southampton (UHS) undertook two OHC pilots, reviewing 651 patients in the first 12 months, resulting in reduction of care needs for 52 percent of patients and release of 3,039 bed days.

The implementation of Proportionate Care (or Optimal Handling Care) at University Hospital Southampton

The ADASS Spring 2024 survey highlights significant financial pressures, with widespread overspends and a growing number of clients with complex needs, threatening councils’ ability to meet statutory duties (ADASS 2024). Directors of Adult Social Care have expressed a lack of confidence in sustaining care markets and delivering legally required services, especially as local authorities are now subject to Care Quality Commission (CQC) quality assurance under the Care Act 2014 (CQC 2025).

Operationally, the impact is clear: waiting lists for OT services have risen by around 139 per cent since 2019 (Ames 2024), resulting in longer waiting lists, delayed assessments, and increased risk of hospital admissions and long-term care dependency. Addressing these challenges, Kirklees Council has been leading the implementation of OHC in local community since 2017, with 50 percent of all referrals assessed to be Optimal Handed Care, releasing an average of 56,487 care hours annually (2017 to 2024), with an estimated annual cost avoidance of £1.1M.

The implementation of Optimal Handed Care in Kirklees Council

Across England, continuous efforts have made to embed Optimal Handed Care approach but have often failed to achieve lasting success due to fragmented existing processes, limited collaboration between therapy and social work teams, misconceptions around safety and lack of senior leadership. Manchester City Council is an example of such area, where Optimal Handed Care is now being implemented with senior management support and have started to see a culture shift across the system – from one of caution and dependency to one focused on empowerment, rehabilitation and independence.

The implementation of Optimal Handed Care across Manchester City Council

Hospital Acquired Deconditioning (HAD) is one of the reasons for overuse of double handed care at discharge from hospital. This happens due to long stays in the hospital, multiple comorbidities, lack of focus on function and mobility in the hospital resulting in people having low confidence in their own physical abilities. North Cambridgeshire hospital has implemented a rehabilitation model to mitigate against HAD. The model focuses on patient engagement and empowerment, ensuring that patients take an active role in their own recovery and progress towards independence every day.

Organisation of function and mobility in hospital ward at North Cambridgeshire Hospital

Providers in some areas are also responding to the challenging needs of population and resource constraints by finding innovative solutions. British Red Cross identified a clear need for a more responsive and sustainable approach to ensure all staff received timely and effective moving and handling training. The resulting project has resulted in OHC training now embedded in service delivery and improved consistency and quality in moving and handling practice with greater responsiveness when new staff join or equipment changes occur.

The British Red Cross: optimisation of function and mobility in hospital ward at North Cambridgeshire Hospital

2. Consequences of inaction:

Failure to adopt and embed Optimal Handed Care (OHC) practices across health and social care systems leads to significant adverse consequences for individuals, staff, and organisations. Inaction perpetuates inefficient care models, harms to independence, increases workforce risk, and undermines system sustainability.

Impact on people receiving care: Lack of comprehensive risk assessment and adherence to moving and handling principles exposes people to avoidable harm and dependency. Research analysing clinical incident reports found that some staff failed to follow recommended moving and handling policies, particularly around risk assessment and choice of assistance methods (Cornish, Jocelyn, and Anne Jones. “Moving and handling and patient safety: analysis of clinical incidents.” British journal of nursing (Mark Allen Publishing) vol. 21,3 (2012): 166-70. doi:10.12968/bjon.2012.21.3.166)

The overuse of double-handed care: often driven by misconceptions, lack of awareness of specialist equipment, and rigid adherence to outdated practices — contributes to loss of independence, deconditioning, and psychological harm (Phillips, Jeremy et al. “It takes two? exploring the manual handling myth.” (2017).). Such over-reliance on double-handed care also infringes upon personal dignity and privacy.

Inadequate moving and handling practices directly reduce mobility, function and independence, which are essential for preventing long-term physical and psychological effects (Warren, Gemma. “Moving and handling: reducing risk through assessment.” Nursing standard (Royal College of Nursing (Great Britain): 1987) 30 40 (2016): 49-58.)

Furthermore, poor moving and handling practices exacerbate hospital acquired deconditioning (HAD) leading to physiological change that can affect multiple body systems and often results in functional decline. The risk can be further increased by people’s fear of falling and healthcare staff prioritising a person’s safety, which may cause the person to limit their activity (Dr Sarah Hanson, Prof. Andy Jones, Dr Kathleen Lane and Bridget Penhale, University of East Anglia (2019))

Impact on workforce safety and capability: Unsafe handling practices place health and social care staff at higher risk of musculoskeletal injury. Studies show that 26 percent of student nurses experience musculoskeletal injuries during clinical placements due to unsafe handling, insufficient supervision, or inadequate training (Kneafsey, Rosie, and Carol Haigh. “Learning safe patient handling skills: student nurse experiences of university and practice-based education.” Nurse education today vol. 27,8 (2007): 832-9. Doi: 10.1016/j.nedt.2006.11.005). These gaps undermine workforce confidence, increase sickness absence, and contribute to high attrition rates among frontline care workers.

Without a system-wide approach to competency and continuous professional development in OHC, variability in skill and risk perception persists, perpetuating unsafe practice.

Systemic and operational strain: At system level, overuse of double-handed care packages consumes a disproportionate share of workforce capacity, reducing availability for new referrals and creating bottlenecks in hospital discharge pathways. In community settings, duplication of assessments and inconsistent care planning between health and social care providers cause delays and inefficiencies.

This fragmentation contributes to avoidable delayed transfers of care, inconsistent quality standards, and limited flow across the continuum of hospital, community, and domiciliary settings.

Dignity, proportionality and rights: Delivering more assistance than needed erodes dignity, autonomy, and person-centred care. It may conflict with legal expectations of proportionate care under the Care Act 2014, Equality Act 2010, and human rights principles.

Financial and sustainability risks: Maintaining double-handed care where a safe, single-handed approach is feasible leads to significant and unnecessary expenditure. Analyses show that over-prescription of two-carer packages inflates budgets and prevents reinvestment in preventative and reablement services.

The opportunity cost of inaction is substantial: funds that could enhance workforce training, digital systems, or community rehabilitation are absorbed by inefficient care models. Over time, this undermines the sustainability of both NHS and local authority budgets. 

4. A call to action:

Embedding OHC across the health and care system is a critical enabler for the 10 Year Health Plan for England: fit for the future. It will help deliver better outcomes for people – including improved independence, dignified end of life care, and more meaningful interactions for those living with dementia, learning disabilities or long-term conditions – while ensuring a more efficient, equitable and sustainable system. 

OHC is not an isolated practice change; it represents a cultural transformation in how we view care, risk, and independence. It shifts the narrative from “what we do for people” to “what people can do for themselves, with the right support.” This reframing moves beyond “reablement” towards enablement — empowering people to build on their strengths, regain confidence, and live with purpose and dignity.

Aligning with national policy and good practice

Implementing OHC at scale supports and complements existing national frameworks and statutory duties, including:

Delivering OHC is not just about efficiency — it is about doing the right thing. Every unnecessary double-handed task represents an opportunity missed: for independence, for dignity, for value. The case for change is clear, the evidence is strong, and the tools now exist. What is needed is collective will, accountable leadership, and sustained action