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To: Health and Safety Enforcing Authorities

For the attention of: Local Authority Health and Safety Enforcement Managers, Health and Safety Regulators and others

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Introduction

This circular gives advice to local authority enforcement officers and  addresses national arrangements for liaison and coordination of large independent corporate care providers in England, Wales and Scotland as described in Public Services Sector SIM 07/2008/02.

Background

Over the last few years, a small number of corporate social care providers have significantly grown in size and now have many premises located throughout the UK.   With the exception of BUPA, no central approaches have been made.    In order to engage more effectively with these providers, FOD is being asked to establish lead PI/Inspector arrangements with a selection of them.  

Nature of the problem

Several large corporate social care providers have had interventions by HSE and or LAs simultaneously across the UK.  In the absence of formal national lead PI arrangements, it has been difficult to monitor and coordinate ongoing enforcement activities and take forward issues with national significance.  Moreover, it has been difficult to assess and measure the corporate health and safety management arrangements of these large corporate social care providers. 

Due to the diversity of the corporate providers it has not been possible to extract accurate RIDDOR data.  Therefore the table below details the number of injuries to members of the public and employees involved in all care home activities as reported by RIDDOR to all enforcing authorities:

	2005/06				2006/07
	Fatal	Major	Over 3 day	Total	Fatal	Major	Over 3 day	Total
Employee	-	713	3571	4284	-	715	3692	4407
Member of Public	27	1138	-	1165	23	979	-	1002

In 2006/07 the most prevalent causes of injury to employees were attributable to handling (34%), physical assault (24%) and slips and trip (21%).  The most prevalent major injury to the public arose from slips, and trips and falls. The causes of the 23 fatal injuries were varied and arose from slips, trips and falls, drowning, asphyxiation, and contact with harmful substances.

Each year a number of investigations are undertaken and several result in prosecutions, for example:

BUPA Care Homes (CFC Homes) Ltd were fined £23,000 and ordered to pay costs of £12,607 for failing  to implement their national bed rail policy, resulting in poor risk assessments, inadequate staff training and unsuitable bed rails being used at one of their care homes (February 2007);

Southern Cross Care Homes Ltd were fined £70,000 and ordered to pay costs of £10,103 in following the death of a service user who was left unattended and was subsequently strangulated by the lap belt restraint on a reclining chair (November 2007).

Lead PI approach

• Annex A provides a list of the largest corporate providers of social care in the UK with information on; the number of employees, the services provided and contact details (broken down into HSE divisions and based on information current at the time of production).   The headquarters of the largest providers are all located in England, but for completeness, the largest providers have been included for Scotland and Wales.
• Each FOD division in England is asked to nominate a Lead PI for 6 of the largest providers highlighted in Annex A (FOI qualified exemption under section 30).   Approaches to other providers would be welcome where resources permit (including Scotland and Wales).
• The arrangements for establishing the lead PI role are within the discretion of the divisions but should be focused on delivering the following outcomes:
• the company has the opportunity to meet the lead PI and understands the scope of that role with relation to their own company;
• HSE and LA Inspectors have a point of contact to exchange information about their respective interventions.   This will encourage and facilitate better communications where there may be simultaneous interventions with a provider.
• dialogue is initiated with the CSCI Provider Relationship Manager (PRM) (through the local CSCI contact) with responsibility for the corporate care provider to allow for the exchange of information as necessary.    A Working Arrangements Protocol between CSCI, HSE and LACORS is currently being written and will provide details of the PRM responsibilities.   In the meantime please refer to SIM 07/2006/14:  Better Regulation - regulatory bodies inspecting social care [82KB].  Each PRM publishes an annual performance report for their respective corporate care providers.  These are available on CSCI website.
• Divisions may also decide to undertake a programme of local inspections to establish how well the company is currently managing health and safety and in particular the risks arising from, MSD, slips and trips and challenging behaviour.  Key risks affecting service users continue to be falls from windows, hot water, hot surfaces and bed rails.  Guidance on these issues can be found in the references at paragraph 14.   Strategic Partnership managers should be notified of any local intervention plan as many premises owned by the company will be LA enforced for the purposes of HSWA.

Action for lead PI’s

• For this approach to be effective, the lead PI arrangements will need to be communicated to FOD and LA inspectors.  In order to facilitate this Lead PIs are asked to complete the proforma attached at Annex B at the earliest opportunity or by the 30th June 2008 and return to the publicservicessector@hse.gsi.gov.uk email account.  
• The completed proformas will then be published on the Public Sector on-line Community Site and the extranet (for LAs) along with a revised Annex A which will include contact details of the lead PI.

Action FOR HSE and LA Inspectors

• All inspectors are asked to provide the lead PI with:
• early notice of any significant intervention activity.  In particular fatal, major  accident investigation, or intended prosecution with updates as appropriate;
• outcome of any prosecutions/and or inquests;
• copies of enforcement notices, letters etc;
• issues arising from an intervention which may have national implications eg. poor manual handling training, lack of equipment maintenance etc.

Feedback

• The sector would welcome any feedback about this approach.  Please email the publicservicessector@hse.gsi.gov.uk with the details.

Further information

Guidance on the key causes of accidents to service users can be found in:

• SIM 07/2007/09 – Burning risks from hot surfaced in health and social care; [45KB]
• SIM 07/2007/08 – Scalding risks from hot water in health and social care; [68KB]
• SIM 07/2007/07 – Falls from windows in health and social care; [49KB]
• SIM 07/2007/06 – Bed rail risk management. [121KB]
• Guidance on these and other health and safety risks can be found in the HSE publication ‘Health and Safety in Care Homes (HSG 220).

Annex A

Corporate Social Care Provider List (FOI qualified exemption under section 30)    This document can be viewed by enforcement officers on the Extranet.

Annex B

• National leads for corporate care providers proforma [85KB]

Please return by email to publicservicessector@hse.gsi.gov.uk