Moving and handling in health and social care

These pages are for employers and employees in the health and social care sectors involved in moving and handling, particularly those who assess moving and handling needs and carry out handling activities.

What you need to know

In health and social care services, moving and handling injuries account for 40% of work-related sickness absence. Around 5000 moving and handling injuries are reported each year in health services and around 2000 in social care.

Moving and handling is a key part of the working day for most employees; from moving of equipment, laundry, catering, supplies or waste to assisting residents in moving. Over 50% of injuries arise from the moving and handling of people.

Poor moving and handling practice can lead to:

• back pain and musculoskeletal disorders, which can lead to inability to work
• moving and handling accidents – which can injure both the person being moved and the employee
• discomfort and a lack of dignity for the person being moved

You must take action to prevent or minimise the risk of injury. See what you need to do.

For general information on factors that can lead to injury, visit the musculoskeletal disorder web pages.

As more than 50% of moving and handling injuries in health and social care involve the handling of people these web pages concentrate on reducing the risk from people handling. For further information on risk assessments for inanimate/object handling please see the manual handling web pages.

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What the law says

The following legislation may be relevant for assessing moving and handling risks:

• Health and Safety at Work etc Act 1974 (HSWA)
• Manual Handling Operations Regulations 1992 (MHOR) (as amended 2002)
• Management of Health and Safety at Work Regulations 1999
• Provision and Use of Work Equipment Regulations 1998 (PUWER)
• Lifting Operations and Lifting Equipment Regulations 1998 (LOLER)

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What you need to do

If risks from moving and handling are to be managed successfully, there must be support from those at the top of the organisation, whatever its size. This can be expressed in a clear statement of policy – supported by organisational arrangements – to ensure that the statement is implemented. Key elements include:

• recognition of the risks
• commitment to introducing precautions to reduce that risk
• a statement of clear roles and responsibilities
• an explanation of what is expected from individual employees
• arrangements for training and providing / maintaining equipment
• arrangements for monitoring compliance
• a commitment to supporting people who have been injured in connection with their work

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What are your duties?

Employers must reduce the risk of injury to staff and people using care services by:

• avoiding those manual handling tasks that could result in injury, where reasonably practicable
• assessing the risks from moving and handling that cannot be avoided
• putting measures in place to reduce the risk, where reasonably practicable

Employees must:

• follow appropriate systems of work and use the equipment provided
• co-operate with their employer and let them know of any problems
• take reasonable care to ensure that their actions do not put themselves or others at risk

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Carrying out a risk assessment

Moving and handling risk assessments help identify where injuries could occur and what to do to prevent them. It should be possible to complete the majority of assessments in-house as no-one knows your business better. The person carrying out the assessments must be competent to identify and address the risks from the most complex handling activities you undertake.  This usually requires specific training.

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Identifying the risk

Activities that may increase the risk include, for example:

• assisting in person transfers
• aiding treatment
• assisting in carrying out daily activities (such as bathing) with individuals who will have specific needs

Assessments, care needs, competence and equipment provision are some of the factors that need to be addressed but handling people is not the only risk. Ancillary staff, porters, maintenance and support staff may also be expected to undertake handling activities which put them at risk and their activities will also need assessment and controls to manage the risk.

Some staff may have to adopt and hold awkward postures as part of their work, for example, nursing staff, sonographers and theatre staff. Stresses and strains arising from adopting awkward or static postures when caring for and treating people need to be addressed.

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Two types of risk assessment are usually needed:

Generic assessments to consider the overall needs of the setting, looking at:

• the type and frequency of moving and handling tasks
• overall equipment needs
• staffing
• the environment
• what moving and handling would be required in emergencies such as fire evacuations or residents’ falls

Individual assessments which consider the specific moving and handling needs of care service users and form part of the care planning process.

Generic risk assessments

Care providers should balance the safety of employees with the needs, safety and rights of the people using care services. Manual handling policies and practice should not place unreasonable restrictions on residents’ rights to autonomy, privacy or dignity. 

Risk assessment should be part of a wider needs assessment process to achieve the best outcome. Health and safety issues will then be identified and built into the complete care package.

Individual risk assessments

The assessment should be person-centred and, where possible, involve the service user or their family in decisions about how their needs are met. This can reassure them about the safety and comfort of the equipment, and how it and the methods used will ensure their safety and the safety of staff.

Record the risk assessment and care plan. Include detail on the individual’s moving and handling needs, day and night, specifying:

• what the user of the care service is able/unable to do independently
• the extent of the individual’s ability to support their own weight and any other relevant factors, for example pain, disability, spasm, fatigue, tissue viability or tendency to fall
• the extent to which the individual can participate in/co-operate with transfers
• whether the individual needs assistance to reposition themselves/sit up when in their bed/chair and how this will be achieved, eg provision of an electric profiling bed
• the specific equipment needed – including bariatric where necessary – and, if applicable, type of bed, bath and chair, as well as specific handling equipment, type of hoist and sling; sling size and attachments
• the assistance needed for different types of transfer, including the number of staff needed – although hoists can be operated by one person, hoisting tasks often require two staff to ensure safe transfer
• the arrangements for reducing the risk and for dealing with falls, if the individual is at risk

The Guide to the handling of people contains detailed guidance on people handling assessments and may be helpful.

An example of a person-based manual handling risk assessment can be found in the All Wales NHS manual handling passport scheme and Scotland NHS manual handling passport scheme.

An individual’s needs and abilities can change over the course of a day. Staff should understand the impact this may have on moving and handling practices.

Individuals may become upset or agitated when being moved. Others, though willing to assist at the start of a manoeuvre, may find themselves unable to continue.

Training may prevent injury arising in such circumstances. A natural reaction, while helping with walking, for example, is to try to prevent a fall. Injuries have occurred to both staff and the service user in such circumstances. Properly positioned, the helper may prevent a fall or allow a controlled slide. Having made the individual comfortable, they can determine how to move them safely – often with a mechanical aid.

Specialist advice on how to help some users with specific moving and handling needs will also be useful. Sources of advice include:

• occupational therapists
• physiotherapists
• manual handling advisers
• ergonomists with experience in health and social care
• professional bodies
• organisations such as the National Back Exchange or Chartered Society for Physiotherapists

It is a legal requirement to record the findings of your risk assessment if you have five or more staff.  However, it is good practice to keep a record of risk assessments to help you manage the risks. You must communicate the findings of your assessment to all relevant staff.

Monitoring and review

Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current.

There should also be arrangements in place to ensure that moving and handling activities are monitored to ensure that correct procedures, techniques and equipment is being used.

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Do I need a manual handling policy?

Health and social care providers carrying out a wide variety of moving and handling activities may need to develop a moving and handling policy.

Key elements should include:

• a statement of the organisation’s commitment to managing the risks associated with moving and handling people and loads
• details of who is responsible for doing what
• details of your risk assessment and action planning processes
• a commitment to introduce measures to reduce the risk
• arrangements for training
• arrangements for providing and maintaining handling equipment
• details of your systems for monitoring compliance with the policy and for regular review
• information for staff on reporting pain and injuries

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Types of moving and handling equipment

The type and amount of equipment needed will vary according to the specific needs of care service users. When providing equipment, providers should consider:

• the needs of the individual – helping to maintain, wherever possible, independence
• the safety of the individual and staff 

Necessary equipment may include:

• a selection of hoists – eg hoists to raise fallen individuals from the floor, standing hoists, mobile hoists etc
• bath hoists or bath lifts and/or adjustable height baths
• a sufficient number of slings of different types and sizes
• slide sheets
• transfer boards
• turntables
• electric profiling beds – for dependent/immobile residents
• wheelchairs
• handling belts to assist weight-bearing residents (not for lifting)
• lifting cushions
• bed levers, support rails/poles
• emergency evacuation equipment
• suitable walking aids, hand rails etc for people needing minor assistance
• bariatric equipment (ie for use with very heavy people)

Introduce equipment only after assessment and use in accordance with the care plan and manufacturer’s instructions. 

Moving and handling equipment used for health and social care may be classified as medical devices. The supply and design of such devices or equipment is regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA). Find guidance on managing medical devices and information on how to report defects, adverse incidents or problems with equipment on the MHRA web pages.

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Using hoists safely

It is important that safe working procedures are followed during hoisting to avoid accidents that can result in serious or fatal injuries.

Problems include:

• selection of the wrong size sling – resulting in discomfort if the sling is too small and the person slipping through if it is too large. Staff should be aware that sling sizes and coding vary between manufacturers
• wrong type of hoist or sling for the individual, or task – resulting in inadequate support and a risk of falling. For example, toileting slings give a great degree of access, but little support
• incompatibility of hoist and sling can result in insecure attachment between the two. Follow the manufacturer’s advice and refer any concerns about sling/hoist design, supply, manufacturer’s instructions or compatibility to MHRA website, the regulator for medical devices
• failure of equipment due to lack of maintenance/inspection
• leaving a vulnerable person unattended in a hoist; or in a position where they might be at risk of falling
• hoist overturning due to difficult surfaces, transporting an individual over a long distance on a hoist, or not following manufacturer’s instructions
• failure to use a safety harness, belt or attachment appropriately. Some slings come with different length loops for attachment to the hoist to increase comfort or the range of positions. You must choose the correct loops so that an individual is not at risk of slipping from the sling. Use the same loop configuration on both sides to reduce the risk of sideways falling

The individual’s risk assessment and care plan for hoisting should specify:

• which hoist to use for which task
• type and size of sling and any configurations of loops or leg attachments
• use of any additional safety devices such as safety belts
• number of carers needed to carry out the task
• any other relevant information specific to the person being hoisted

You must communicate this information to staff and keep it accessible for easy reference. It is common practice to include assessments in individual care plans or profiles and provide an additional quick reference guide in a convenient place, eg on the inside of the resident’s wardrobe door.

• Guidance on hoisting people - HSIS3

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Maintenance of lifting equipment

Where lifting equipment, including hoists and slings, is used by people who are at work, the Lifting Operations and Lifting Equipment Regulations (LOLER) apply. In addition to routine maintenance and servicing, LOLER requires employers to make sure that lifting equipment is inspected and thoroughly examined. ‘Thorough examination’ by a ‘competent person’ is required either at six-month intervals or in accordance with a written scheme of examination.

A competent person is someone with the relevant technical knowledge and practical experience of lifting equipment to enable them to detect defects or weaknesses and to assess their importance in relation to the safety and continued use of the equipment. 

The health or social care setting should:

• check  for obvious defects
• keep records of hoist and sling thorough examinations
• check that equipment is within date of examination before use – this is usually achieved by labelling the individual equipment with the date last examined or due

More detail on safe hoisting and maintaining lifting equipment can be found at:

• Getting to grips with hoisting and hoisting checklists

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Case studies and research

These case studies look at manual handling in a health and social care context.

• Risk assessment and process planning for bariatric patient handling pathways (RR573)
  The obese population in the UK is growing and this group are considerably over-represented in their use of health and social care services. This project aimed to identify and explore the manual handling risks and process planning for bariatric patients.
• Mobile patient hoists in hospitals
  A newly built hospital had received reports from the nurses that the carpets made the mobile patient hoist far too difficult to manoeuvre. This case study explores the solutions proposed to reduce the risk when moving the hoist.  
• The ambulance service
  Ambulance crews sustain very high levels of reported handling injuries or disorders, particularly from patient retrieval and moving/handling
• Electric profiling beds in hospitals: Case studies
  Electric profiling beds can reduce risks from manual handling as well as having other benefits. These case studies show how they benefit health and social care services
• Musculoskeletal disorders in podiatry and chiropody professionals (RR647)
  Podiatrists have an above average incidence of MSDs. The main objective of this project was to introduce some portable equipment for podiatrists to use on domiciliary visits and highlight any improvements that the equipment has on their working postures.