The implementation of Optimal Handed Care across Manchester City Council

Manchester had previously trialled a single-handed care initiative, but it had not achieved lasting success and eventually lost momentum. The challenge was to reignite the concept under a new, sustainable framework that would embed single-handed care as standard practice across the city.

The primary issue lay in the fragmentation of existing processes. Care providers were inconsistent in their approach, there was limited collaboration between therapy and social work teams, and misconceptions persisted about safety, particularly around hoisting and manual handling. A national shortage of Occupational Therapists also posed a significant barrier to establishing a dedicated team. Additionally, the absence of clear clinical governance and system-wide leadership meant there was no consistent direction for embedding this model across hospital and community settings.

The need was realised to re-establish optimal handed care as part of a wider transformation programme, bringing together social care, health, commissioning, and data partners under a single, coherent approach focused on improving independence, efficiency, and care quality.

The programme was relaunched as part of the Better Outcomes, Better Lives transformation work in Manchester. A new multidisciplinary structure was designed to ensure sustainability. 

The team was composed of a dedicated manager, a combination of occupational therapists and physiotherapists, two assessment officers, and a senior social worker. This collaborative model enabled clinical leadership to work hand in hand with operational delivery, ensuring that each perspective – clinical, social, and practical – informed decision-making.

Implementation began with three care providers identified by the commissioning team as having a large number of double-handed care packages and a willingness to engage in service redesign. The team worked closely with these providers to review care packages, carry out joint assessments, and test new single-handed approaches using specialist equipment. The team led on the development of operational processes within Liquid Logic, created referral and assessment pathways, and established business rules to ensure consistency.

Over time, the initiative expanded in phases, engaging additional providers and building a network of trained professionals across the city. Recognising that sustained success depended on capability-building, the team designed a practical training programme for care staff, delivered both in-person and online. Using the Manchester. Equipment and Adaptations Partnership (MEAP) Smart Suite, carers received hands-on training in the use of specialist equipment such as Molift stand aids, in-bed satin sheets, and gantry hoists.

Collaboration with hospital therapy teams became an important next step. The team worked with Manchester Royal Infirmary and North Manchester Hospital to align practice and ensure continuity between hospital discharge and community care. This alignment aimed to prevent unnecessary double-handed care packages being established at discharge and to encourage early functional reassessment of individuals returning home

The journey was not without challenges. Initially, there was scepticism from some care providers who were accustomed to traditional double-handed approaches and uncertain about the safety of single-handed care. Misunderstandings about policy and risk assessment created resistance, while the limited availability of OTs made it difficult to maintain staffing stability. Hospital colleagues also faced cultural and practical barriers, including inconsistent equipment use and competing discharge pressures. Finally, uncertainty around where the clinical governance for single-handed care should sit within the system created delays and confusion during the early stages of implementation.

Progress was achieved through clear leadership, flexibility, and persistence. The senior management’s visible support gave the project credibility, while the inclusion of physiotherapists alongside OTs expanded the team’s capacity and enriched its skill mix. Continuous communication and engagement were key: The team held regular meetings with care providers, developed strong relationships with commissioning colleagues, and introduced a “train-the-trainer” approach to empower providers to maintain competence internally.

Developing the in-house training programme was a turning point. By creating accessible, hands-on learning sessions within the MEAP Smart Suite, care staff were able to build both confidence and competence in using equipment safely. The team also worked closely with data specialists to establish a live dashboard for monitoring referrals, outcomes, and cost avoidance, providing the evidence needed to sustain senior-level support. Over time, collaboration with hospital therapists helped bridge the gap between acute and community settings, allowing for a more consistent and efficient approach to single-handed care across Manchester.

The project required a blend of human, financial, and infrastructure resources. Dedicated clinical leadership and project management were essential, supported by investment in temporary locum staff during the pilot phase and funding to transition to a permanent workforce. The support of commissioning, finance, and data teams was critical in ensuring alignment and accountability, while the MEAP Smart Suite provided a purpose-built training environment that enhanced the learning experience. Continued investment in equipment, training materials, and staff development underpinned the programme’s sustainability.

The programme evolved over several years, beginning with the pilot phase under Better Outcomes, Better Lives. Within the first 12 months, the team successfully implemented the model with three care providers. Over the following two years, engagement expanded to 13 providers, while the team matured from a small, pilot project to an established, integrated service. Today, the Optimal Handed Care team operates as business as usual within Manchester City Council, continuing to refine and embed the approach across the system.

The optimal handed care model has transformed the way care is delivered across Manchester. A stable, multidisciplinary team is now embedded within the council, supported by strong partnerships with commissioning, finance, and health colleagues. Over 13 care providers are now engaged in the approach, and the model is being factored into the city’s care provider re-tendering process, ensuring its continuation and growth.

The initiative has delivered measurable efficiencies through reduced double-handed care packages and avoided increases in support hours. It has also improved quality and independence outcomes for citizens, with carers reporting greater confidence and satisfaction through the new training model. The partnership with hospital therapy teams has created a shared understanding of optimal care, and the council’s performance data now clearly demonstrates both financial and operational benefits.

Perhaps most importantly, the initiative has shifted the culture across the system—from one of caution and dependency to one focused on empowerment, rehabilitation, and independence. What began as a pilot project has evolved into a sustainable, city-wide model of best practice, demonstrating how collaboration, leadership, and innovation can deliver real change in adult social care.

• Manchester City Council – Better Outcomes, Better Lives Programme
• Manchester Equipment and Adaptations Partnership (MEAP) Smart Suite 

Sarah Piercey 

Email: [email protected]