Driving system change

The presentation

This presentation highlighted the transformative work of occupational therapists leading optimised handling (also called right-sized or single-handed care) initiatives across different healthcare systems. The panel featured Lauren Walker (RCOT Professional Advisor), Suzy England (OT and Service Innovation Manager at RCOT), Alex Hadayah (Directorate  Lead Therapist in Tower Hamlets), Hannah Foxley (Single-Handed Care Project Lead at University Hospital Southampton), Emily Corrigan (Head of Improvement for Therapies, Emergency Care Improvement Support Team at NHS England), and Nigel Pluckrose (from Somerset Council). 

Lauren Walker opened by noting that optimised handling initiatives have emerged as a key theme in submissions to RCOT's Innovation Hub. These projects demonstrate that system-wide changes can be approached in multiple ways depending on local contexts, while yielding similar positive outcomes. 

Alex Hadayah described how her team initially focused on optimising care packages in social care, starting with simple interventions like providing hot water flasks so clients could make their own drinks rather than requiring carer visits. This approach saved approximately £1 million in care package costs while improving client independence. Her team later expanded the initiative upstream to acute services, working across organisational boundaries. 

Hannah Foxley shared her experience implementing optimised handling in an acute hospital setting. Her team secured initial funding for a 12-month pilot but gained substantive funding after demonstrating benefits at the six-month review. The project created positive impacts on patient choice, discharge destination preferences, care capacity, and length of stay. Hannah emphasised the importance of collaboration with community partners and developing a shared moving and handling plan across the system. 

Emily Corrigan offered a national perspective, highlighting that OTs are uniquely positioned to lead optimised handling initiatives because they: 

• Possess the technical expertise as part of their core skills 
• Work comfortably across health, community and social care 
• Know the right stakeholders who will be impacted by the change 

Nigel Pluckrose (via video) stressed several critical factors for success: 

• Securing operational influence within both operations and commissioning 
• Obtaining dedicated funding (he utilised Better Care Fund) 
• Considering partnerships with external training providers for objectivity 
• Executing a strong launch with broad participation 
• Engaging healthcare colleagues and domiciliary care providers 

All speakers emphasised that the data-driven approach was crucial for garnering support. Hannah's team collected data on patient choice and discharge destination preferences, demonstrating that optimised handling improved patients' ability to go to their preferred place of care. Alex's team measured pre- and post-intervention care costs, showing significant savings while maintaining quality care. 

Emily highlighted that various data sources are already available to OTs who might not realise it, including: 

• Acute discharge situation reports 
• Community discharge situation reports 
• Discharge delay codes 
• Length of stay metrics 
• Criteria to reside metrics 

She encouraged OTs to learn this ‘language’ of data to better communicate with senior leaders and commissioners. 

The panel agreed that collaboration is the cornerstone of successful system change. Hannah established a steering group to provide feedback loops and identify service gaps. Her team brought together acute and community OTs to develop a shared moving and handling plan used across the system. Alex described how chance conversations and networking opportunities led to productive partnerships across organisational boundaries. 

Regarding patient experience, the panel confirmed that optimised handling isn't about reducing care but promoting independence and active participation. Hannah's team collected patient voice data showing improved satisfaction when patients could be discharged to their preferred destination. Alex shared an example of a couple who preferred going out for dinner rather than having carers visit at mealtime, illustrating how optimised care can enhance quality of life. 

When asked about resources and training, panellists acknowledged more work is needed in this area. Hannah mentioned that her team is developing a training programme with potential for national sharing through a Virtual Learning Environment platform. Alex offered to consider creating webinars or case studies to share their experience. Emily suggested gathering input from OTs about what specific topics would be most helpful. 

For professional development, the speakers recommended quality improvement training, coaching, and networking. Alex noted how OTs can combine their strengths with others to become a ‘powerhouse’ for change. Emily added that OTs already possess many essential skills for improvement work—they are natural problem-solvers, networkers and collaborators—but additional training can help demystify improvement science and build confidence. 

The session concluded with Suzy England highlighting how the RCOT Innovation Hub serves as a virtual networking space where members can access a searchable service improvement database. The Hub helps OTs make cases for their projects, identify appropriate measures, and connect with others doing similar work. RCOT also analyses the data to identify trends and gaps, which has led to initiatives like a pilot seed innovation fund offering up to £5,000 to help members initiate change projects. 

Throughout the presentation, the speakers emphasised that OTs are ideally positioned to lead system change due to their ability to work across boundaries, understand multiple perspectives, and develop practical solutions that benefit both patients and systems.