Health and safety in the NHS Richard Griffith
Accidents at work cost the NHS some billion pounds every year. Over half of these accidents are due to avoidable slips and falls—the most common cause of claim for compensation faced by the NHS. Under the Management of Health and Safety at Work Regulations 1999, the NHS as an employer and nurses as employees have a legal obligation to manage health and safety and to ensure that others are not put at risk by work-related activities. The first of a series, this article on health and safety law sets out the duties imposed on NHS organisations and their employees. Key words: Health and safety ■ Risk assessment ■ Reporting of incidents
E
nsuring the health and safety of employees and patients is essential to the delivery of health care in the NHS. The Health and Safety Executive (HSE) estimates that staff absence in the NHS costs a billion pounds each year. The four main causes are (HSE, 2007): ■■ Musculoskeletal disorders: along with stress, these are the biggest cause (40%) of sick leave in the NHS. For example, a quarter of all nurses have at some time taken time off as a result of a back injury sustained at work. ■■ Stress: a major cause of work-related ill health and sick leave among healthcare employees. Work-related stress accounts for over a third of all new incidences of ill health. Each case leads to an average of 30 lost working days. ■■ Violence: NHS staff are four times more likely to experience work-related violence and aggression than other workers. ■■ Slips and trips: these result in two-thirds of major injuries to NHS employees. Patients are also placed at risk of injury if appropriate safety measures are not taken. The NHS Litigation Authority (NHS LA) (2007) estimates that £500 million is paid every year by the health service in compensation claims and fines for breaches of health and safety law. The human cost can also be high: mistakes and errors can put lives at risk and even
Richard Griffith is Lecturer in Health Law, College of Human and Health Sciences, Swansea University
112
cause fatalities. The Mid Staffordshire Inquiry identified 1200 avoidable deaths arising from health and safety breaches (Francis, 2013).
Health and safety law To prevent the avoidable loss of life and minimise the days lost to injury, the NHS has a legal duty to comply with the requirements of the Health and Safety at Work etc Act 1974. The Act is the basis of health and safety law in the UK and sets out general duties that: ■■ Employers have towards employees and members of the public using their service ■■ Employees, including nurses, have to themselves and to each other. Breaching or failing to comply with these duties are criminal offences. The employer’s general duty is set out in section 2 of the Act and states that an employer has a: ■■ Duty to ensure so far as is reasonably practicable, the health, safety and welfare at work of employees and any others who may be affected by the undertaking. The legal standard imposed by the Act is ‘reasonably practicable’ or ‘so far as is reasonably practicable’. The standard implies a weighing up of the risk against the cost in terms of time, money or trouble of preventing or controlling the risk. The duty of nurses as employees at work, set out in section 7 of the Act, states that it shall be the duty of every employee while at work: ■■ To take reasonable care of their own health and safety and of any other person who may be affected by their acts or omissions ■■ To cooperate with their employer so far as is necessary to enable that employer to
meet their requirements with regards to any statutory provisions.
Health and safety regulations The Act is supplemented by a wide range of secondary legislation in the form of regulations. The main regulations that affect the health service and nurses as employees are set out in Table 1. Nurses and their employers must work together to ensure implementation of health and safety measures. Involving staff in workplace health and safety is a legal requirement under the Safety Representatives and Safety Committee Regulations 1977 and the Health and Safety (Consultation with Employees) Regulations 1996, which require staff representatives to: ■■ Consult with and be consulted by employers ■■ Investigate hazards, accidents and complaints. ■■ Make representation to the employer ■■ Perform workplace inspections ■■ Be given time off to perform their duties and undertake health and safety training.
Managing health and safety The HSE (2006) requires workplace health and safety to be managed methodically to ensure risks are minimised. This includes: ■■ Establishing a health and safety policy to provide information on the management of work-related risks ■■ Demonstrating that health and safety management is organised and functioning by reference to the four Cs: cooperation, communication, control and competence ■ Assessment and monitoring of risks ■ Review and audit.
Workplace risk assessments A risk assessment is the identification of hazards present in the workplace and an estimate of the risk associated with performing a task. A hazard is something that has the potential to cause harm and a risk is the likelihood of that hazard causing an accident or incident. There is a legal duty to perform risk assessments under the provisions of the Management of Health and Safety at Work Regulations 1999.
© 2014 MA Healthcare Ltd
Abstract
British Journal of Nursing, 2014, Vol 23, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
LEGAL Table 1. Regulations relating to health and safety in the NHS Management of Health and Safety at Work Regulations 1999
Sets out how employers are required to risk-assess all work activities; implement control measures if required; provide information; and train and appoint competent persons
Manual Handling Operations Regulations 1992
Cover the moving and handling of objects either by hand or by bodily force
Control of Substances Hazardous to Health Regulations 2002
Relates to the assessment of hazardous substances and biological agents, and the implementation of appropriate precautions
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
Requires employers to notify certain types of injury, disease and dangerous occurrences to the HSE
Personal Protective Equipment at Work Regulations 1992
Covers the provision of suitable and sufficient protective clothing and equipment, such as uniforms and gloves
Workplace (Health, Safety and Welfare) Regulations 1992
Covers issues such as ventilation, temperature, flooring and workstations
Health & Safety (Display Screen Equipment) Regulations 1992
Sets out requirements for the use of visual display units, workstations, seating and so on
Provision and Use of Work Equipment Regulations 1998
Covers the safe use and maintenance of equipment, such as hoists, at work
Health and Safety (First Aid) Regulations 1981
Concerns first-aid requirements such as the contents of first-aid boxes and the number of trained first-aid personnel
Health and Safety (Safety Signs and Signals) Regulations 1996
Specifies the minimal requirements for safety signs at work
Fire Precautions (Workplaces) Regulations 1997
Requires employers to assess the risk of fire in the workplace
Hazardous Waste (England and Wales) Regulations 2005
Specifies the requirements for the classification, segregation and disposal of waste, including infectious and hazardous waste
Health and Safety (Sharps Instruments in Healthcare) Regulations 2013
Sets out the requirements for minimising needlestick (sharps) injury in health services
Once a hazard has been identified, the likelihood of the risk occurring and the severity of the harm must be considered. The law requires that risks be reduced as far as is reasonably practicable. The Control of Substances Hazardous to Health Regulations 2002 seek to control exposure to hazardous substances which arise out of work under an employer’s control. They require that exposure of employees to such substances be either prevented or, where not reasonably practicable, adequately controlled (Regulation 7(1)). Employers must, where reasonably practicable, eliminate completely the use or production of substances hazardous to health in the workplace by changing the method of work, modifying the process or substituting with a non-hazardous substance. Where prevention of exposure to substances hazardous to health is not reasonably practicable, employers must adequately control exposure (Dugmore v Swansea NHS Trust [2002]).
© 2014 MA Healthcare Ltd
Reporting of accidents and incidents Reporting accidents and incidents at work is an essential component of monitoring the effectiveness of health and safety measures and preventing recurrence of an incident. In addition to local NHS trust accident-reporting procedures, there is a legal requirement to report certain categories of accident that occur in the workplace to the HSE under the
British Journal of Nursing, 2014, Vol 23, No 2
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. Accidents at work are only reportable if they arise out of, or in connection with, work. There are different categories of accidents, which include: ■■ Death or major injuries ■■ Over three day injuries ■■ Diseases and infections specified in the regulations, such as occupational dermatitis.
Dangerous occurrences Dangerous occurrences or near misses must also be reported. These are events that may not result in a reportable injury, but have the potential to do significant harm. In NHS, such events would include: ■■ Failure of lifting equipment such as a hoist ■■ Bursting of any closed vessel (e.g. an autoclave) ■■ Electrical short-circuit or overload, causing fire or explosion ■■ Explosion or fire, causing suspension of normal work for over 24 hours ■■ Accidental release of any substance that may damage health.
Conclusion The Health and Safety at work etc Act 1974 and its regulations require nurses to cooperate with their employers to manage health and safety at work. Nurses must be methodical in identifying hazards through risk assessments and in reporting incidents that have resulted
in injury to themselves or their patients. It is essential that nurses fulfil their duties as employees to ensure that they and others are not put at risk by work-related activities. BJN Conflict of interest: none Control of Substances Hazardous to Health Regulations 2002 (SI 2002/2677) Dugmore v Swansea NHS Trust (2002) EWCA Civ 1689 Fire Precautions (Workplaces) Regulations 1997 (1997/1840) Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. TSO, London Hazardous Waste (England and Wales) Regulations 2005 (SI 2005/894) Health and Safety (Consultation with Employees) Regulations 1996 (1996/1513) Health and Safety (Display Screen Equipment) Regulations 1992 (1992/2792) Health and Safety (First Aid) Regulations 1981 (1981/917) Health and Safety (Safety Signs and Signals) Regulations 1996 (1996/0341) Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 Health and Safety Executive (HSE) (2006) Five steps to risk assessment. HSE, London HSE (2007) Health and safety in health and social care services. HSE, London Management of Health and Safety at Work Regulations 1999 (SI 1999/3242) Manual Handling Operations Regulations 1992 (1992/2793) (NHS LA) (2007) Annual Report and Accounts 2007. NHSLA, London Personal Protective Equipment at Work Regulations 1992 (1992/2966) Provision and Use of Work Equipment Regulations 1998 (1998/2306) Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (1995/3163) Safety Representatives and Safety Committee Regulations 1977 (1997/500) Workplace (Health, Safety and Welfare) Regulations 1992 (1992/3004)
113
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
Accidents at work cost the NHS some billion pounds every year. Over half of these accidents are due to avoidable slips and falls—the most common cause of claim for compensation faced by the NHS. Under the Management of Health and Safety at Work Regulations 1999, the NHS as an employer and nurses as employees have a legal obligation to manage health and safety and to ensure that others are not put at risk by work-related activities. The first of a series, this article on health and safety law sets out the duties imposed on NHS organisations and their employees. Key words: Health and safety ■ Risk assessment ■ Reporting of incidents
E
nsuring the health and safety of employees and patients is essential to the delivery of health care in the NHS. The Health and Safety Executive (HSE) estimates that staff absence in the NHS costs a billion pounds each year. The four main causes are (HSE, 2007): ■■ Musculoskeletal disorders: along with stress, these are the biggest cause (40%) of sick leave in the NHS. For example, a quarter of all nurses have at some time taken time off as a result of a back injury sustained at work. ■■ Stress: a major cause of work-related ill health and sick leave among healthcare employees. Work-related stress accounts for over a third of all new incidences of ill health. Each case leads to an average of 30 lost working days. ■■ Violence: NHS staff are four times more likely to experience work-related violence and aggression than other workers. ■■ Slips and trips: these result in two-thirds of major injuries to NHS employees. Patients are also placed at risk of injury if appropriate safety measures are not taken. The NHS Litigation Authority (NHS LA) (2007) estimates that £500 million is paid every year by the health service in compensation claims and fines for breaches of health and safety law. The human cost can also be high: mistakes and errors can put lives at risk and even
Richard Griffith is Lecturer in Health Law, College of Human and Health Sciences, Swansea University
112
cause fatalities. The Mid Staffordshire Inquiry identified 1200 avoidable deaths arising from health and safety breaches (Francis, 2013).
Health and safety law To prevent the avoidable loss of life and minimise the days lost to injury, the NHS has a legal duty to comply with the requirements of the Health and Safety at Work etc Act 1974. The Act is the basis of health and safety law in the UK and sets out general duties that: ■■ Employers have towards employees and members of the public using their service ■■ Employees, including nurses, have to themselves and to each other. Breaching or failing to comply with these duties are criminal offences. The employer’s general duty is set out in section 2 of the Act and states that an employer has a: ■■ Duty to ensure so far as is reasonably practicable, the health, safety and welfare at work of employees and any others who may be affected by the undertaking. The legal standard imposed by the Act is ‘reasonably practicable’ or ‘so far as is reasonably practicable’. The standard implies a weighing up of the risk against the cost in terms of time, money or trouble of preventing or controlling the risk. The duty of nurses as employees at work, set out in section 7 of the Act, states that it shall be the duty of every employee while at work: ■■ To take reasonable care of their own health and safety and of any other person who may be affected by their acts or omissions ■■ To cooperate with their employer so far as is necessary to enable that employer to
meet their requirements with regards to any statutory provisions.
Health and safety regulations The Act is supplemented by a wide range of secondary legislation in the form of regulations. The main regulations that affect the health service and nurses as employees are set out in Table 1. Nurses and their employers must work together to ensure implementation of health and safety measures. Involving staff in workplace health and safety is a legal requirement under the Safety Representatives and Safety Committee Regulations 1977 and the Health and Safety (Consultation with Employees) Regulations 1996, which require staff representatives to: ■■ Consult with and be consulted by employers ■■ Investigate hazards, accidents and complaints. ■■ Make representation to the employer ■■ Perform workplace inspections ■■ Be given time off to perform their duties and undertake health and safety training.
Managing health and safety The HSE (2006) requires workplace health and safety to be managed methodically to ensure risks are minimised. This includes: ■■ Establishing a health and safety policy to provide information on the management of work-related risks ■■ Demonstrating that health and safety management is organised and functioning by reference to the four Cs: cooperation, communication, control and competence ■ Assessment and monitoring of risks ■ Review and audit.
Workplace risk assessments A risk assessment is the identification of hazards present in the workplace and an estimate of the risk associated with performing a task. A hazard is something that has the potential to cause harm and a risk is the likelihood of that hazard causing an accident or incident. There is a legal duty to perform risk assessments under the provisions of the Management of Health and Safety at Work Regulations 1999.
© 2014 MA Healthcare Ltd
Abstract
British Journal of Nursing, 2014, Vol 23, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
LEGAL Table 1. Regulations relating to health and safety in the NHS Management of Health and Safety at Work Regulations 1999
Sets out how employers are required to risk-assess all work activities; implement control measures if required; provide information; and train and appoint competent persons
Manual Handling Operations Regulations 1992
Cover the moving and handling of objects either by hand or by bodily force
Control of Substances Hazardous to Health Regulations 2002
Relates to the assessment of hazardous substances and biological agents, and the implementation of appropriate precautions
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
Requires employers to notify certain types of injury, disease and dangerous occurrences to the HSE
Personal Protective Equipment at Work Regulations 1992
Covers the provision of suitable and sufficient protective clothing and equipment, such as uniforms and gloves
Workplace (Health, Safety and Welfare) Regulations 1992
Covers issues such as ventilation, temperature, flooring and workstations
Health & Safety (Display Screen Equipment) Regulations 1992
Sets out requirements for the use of visual display units, workstations, seating and so on
Provision and Use of Work Equipment Regulations 1998
Covers the safe use and maintenance of equipment, such as hoists, at work
Health and Safety (First Aid) Regulations 1981
Concerns first-aid requirements such as the contents of first-aid boxes and the number of trained first-aid personnel
Health and Safety (Safety Signs and Signals) Regulations 1996
Specifies the minimal requirements for safety signs at work
Fire Precautions (Workplaces) Regulations 1997
Requires employers to assess the risk of fire in the workplace
Hazardous Waste (England and Wales) Regulations 2005
Specifies the requirements for the classification, segregation and disposal of waste, including infectious and hazardous waste
Health and Safety (Sharps Instruments in Healthcare) Regulations 2013
Sets out the requirements for minimising needlestick (sharps) injury in health services
Once a hazard has been identified, the likelihood of the risk occurring and the severity of the harm must be considered. The law requires that risks be reduced as far as is reasonably practicable. The Control of Substances Hazardous to Health Regulations 2002 seek to control exposure to hazardous substances which arise out of work under an employer’s control. They require that exposure of employees to such substances be either prevented or, where not reasonably practicable, adequately controlled (Regulation 7(1)). Employers must, where reasonably practicable, eliminate completely the use or production of substances hazardous to health in the workplace by changing the method of work, modifying the process or substituting with a non-hazardous substance. Where prevention of exposure to substances hazardous to health is not reasonably practicable, employers must adequately control exposure (Dugmore v Swansea NHS Trust [2002]).
© 2014 MA Healthcare Ltd
Reporting of accidents and incidents Reporting accidents and incidents at work is an essential component of monitoring the effectiveness of health and safety measures and preventing recurrence of an incident. In addition to local NHS trust accident-reporting procedures, there is a legal requirement to report certain categories of accident that occur in the workplace to the HSE under the
British Journal of Nursing, 2014, Vol 23, No 2
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. Accidents at work are only reportable if they arise out of, or in connection with, work. There are different categories of accidents, which include: ■■ Death or major injuries ■■ Over three day injuries ■■ Diseases and infections specified in the regulations, such as occupational dermatitis.
Dangerous occurrences Dangerous occurrences or near misses must also be reported. These are events that may not result in a reportable injury, but have the potential to do significant harm. In NHS, such events would include: ■■ Failure of lifting equipment such as a hoist ■■ Bursting of any closed vessel (e.g. an autoclave) ■■ Electrical short-circuit or overload, causing fire or explosion ■■ Explosion or fire, causing suspension of normal work for over 24 hours ■■ Accidental release of any substance that may damage health.
Conclusion The Health and Safety at work etc Act 1974 and its regulations require nurses to cooperate with their employers to manage health and safety at work. Nurses must be methodical in identifying hazards through risk assessments and in reporting incidents that have resulted
in injury to themselves or their patients. It is essential that nurses fulfil their duties as employees to ensure that they and others are not put at risk by work-related activities. BJN Conflict of interest: none Control of Substances Hazardous to Health Regulations 2002 (SI 2002/2677) Dugmore v Swansea NHS Trust (2002) EWCA Civ 1689 Fire Precautions (Workplaces) Regulations 1997 (1997/1840) Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. TSO, London Hazardous Waste (England and Wales) Regulations 2005 (SI 2005/894) Health and Safety (Consultation with Employees) Regulations 1996 (1996/1513) Health and Safety (Display Screen Equipment) Regulations 1992 (1992/2792) Health and Safety (First Aid) Regulations 1981 (1981/917) Health and Safety (Safety Signs and Signals) Regulations 1996 (1996/0341) Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 Health and Safety Executive (HSE) (2006) Five steps to risk assessment. HSE, London HSE (2007) Health and safety in health and social care services. HSE, London Management of Health and Safety at Work Regulations 1999 (SI 1999/3242) Manual Handling Operations Regulations 1992 (1992/2793) (NHS LA) (2007) Annual Report and Accounts 2007. NHSLA, London Personal Protective Equipment at Work Regulations 1992 (1992/2966) Provision and Use of Work Equipment Regulations 1998 (1998/2306) Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (1995/3163) Safety Representatives and Safety Committee Regulations 1977 (1997/500) Workplace (Health, Safety and Welfare) Regulations 1992 (1992/3004)
113
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
