Introduction

North East London NHS Foundation Trust (NELFT)  https://www.nelft.nhs.uk/  provides an extensive range of integrated community and mental health services for people living in the London boroughs of Barking & Dagenham, Havering, Redbridge and Waltham Forest and community health services for people living in the south west Essex areas of Basildon, Brentwood, and Thurrock. They provide an Emotional Wellbeing Mental Health Service for children and young people across the whole of Essex and are the provider of all age eating disorder services and child and adolescent mental health services across Kent and Medway.

With an annual budget of £490 million, they provide care and treatment for a population of circa 4.3 million. They employ approximately 7,500 staff who work across 210 bases in London, Essex, Kent, and Medway.

Background

IN 2023 the AHP Directorate at NELFT identified a need to improve skills in advising and prescribing equipment solutions for patients across several teams.

NELFT wanted to improve confidence in prescribing equipment and establish a standard in this area anchored on a competency-based national qualification. The training needed to be practical to ensure that learners would know how to measure, assess and prescribe and to cover the range of equipment typically available through community equipment provision.

Learners would want to be able to handle simple cases confidently, using an Occupational Therapy model and to know when to refer complex cases to an OT colleague.

The solution

Starting in late 2023 and running through to early 2025, TACT provided accredited Trusted Assessor training courses to several cohorts of learners from a range of teams within NELFT. The learners attended our two-day face-to-face versions of the level three course at venues local to them where there was a good range of equipment for the practical sessions. The courses were led by TACT’s OT Trainers who led both classroom and hands-on practical sessions with a range of equipment. Afterwards, learners completed an assignment as homework and were supported in this when needed by our OT Trainers; accreditation was via OCN London.

Trusted Assessor: Assessing for Minor Adaptations is a national qualification that teaches a range of roles to be able to handle simple assessments for equipment and to know when to refer more complex cases to an OT. As a result, qualified Trusted Assessors grow those roles able to safely prescribe equipment solutions and this reduces delays in providing suitable equipment to older and disabled people.

NELFT’s learners came from a variety of roles including inpatient care, occupational therapy, physiotherapy, rehabilitation, nursing, support, and specialist therapies and were based in a range of teams including mental health, wellness, paediatrics, and older people. Teams also included discharge and support at home and both community and at home treatment. Several staff were based in discharge to assess teams and teams specialising in falls prevention.

What NELFT found

Learners were asked to complete a survey asking them about their roles, they were asked to report on what they would do differently because of the training and what they would have done without it. We asked for examples and asked them to suggest any changes needed to support Trusted Assessors.

Participants reported several benefits from the training, including:

  • Increased confidence in prescribing and measuring for equipment and adaptations.
  • Improved understanding of available equipment and assessment criteria, particularly for international practitioners unfamiliar with local standards.
  • The ability to conduct assessments with fewer errors and greater autonomy.
  • Enhanced decision-making in patient care, reducing reliance on senior colleagues and specialist occupational therapists (OTs).
  • A more holistic approach to patient assessments and equipment prescriptions.

As a result, many respondents noted that they had previously relied on OTs or senior colleagues for support. After completing the training, they reported the following changes:

  • More independent decision-making in prescribing equipment and adaptations.
  • The ability to measure for and recommend grab rails, chair and bed raisers, and bathroom adaptations.
  • More confidence in assessing patient needs and providing solutions without needing OT referrals.
  • Improved efficiency in handling cases, leading to a reduced burden on specialist teams.
  • A better understanding of the social model of care and its application in practice.

Several participants shared examples of how they applied their training and the impact on practice:

  • One participant, previously unsure about measuring for stair rails, now feels equipped to take correct measurements and prescribe suitable adaptations.
  • A practitioner in mental health settings reported increased confidence in recommending equipment to support independence for older adults.
  • Another respondent noted that the training enabled them to convince families of necessary equipment changes for improved safety.
  • A participant working with adults with learning disabilities was able to integrate assessment for mobility aids alongside dementia screenings, streamlining patient care.

One learner, an OT based in an in-patient rehabilitation service who often carries out home visits explained her situation to TACT:

‘I qualified as an OT in Sri Lanka, and this is my first post in the UK. I was used to prescribing wheelchairs and some mobility aids but not the wider range of equipment available here. Some of the equipment I tried out in the course I had not seen before, and it was important for me to understand the risks and benefits of them. Since training I have prescribed a wide range of equipment including mobility aids, items for self-care such as bathing equipment, chair raisers and lots of rails! Home visits often include social workers and physiotherapists, and they have also improved their knowledge. The main thing for me was gaining confidence in equipment and this came at a good time for me.’

Participants reflecting on the Trusted Assessor model offered various suggestions for improving procedures and service pathways:

  • Expanding the competencies of Assistant Practitioners through the Trusted Assessor model to enhance service efficiency.
  • Establishing a structured pathway for Trusted Assessors to handle minor equipment assessments post-hospital discharge, potentially rotating them within hospital wards to improve discharge planning.
  • Encouraging other healthcare professionals, such as support workers, to attend training to expand the workforce capable of assessing and prescribing equipment.
  • Ensuring that service adjustments align with the skills acquired in training to fully implement the Trusted Assessor model.

The project lead at NELFT concluded:

‘Our learners’ feedback indicates that the training has been highly beneficial in increasing autonomy and confidence among practitioners, improving patient outcomes, and streamlining service delivery. While some services may already be optimized, further refinements to pathways and procedures could enhance the impact of the Trusted Assessor model. Continued support and possible expansions in competencies for relevant professionals may further alleviate pressure on OT services while maintaining high standards of care.’

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