Health and Safety Executive/Local Authorities Enforcement Liaison Committee (HELA)

To: Local Authority Health and Safety Enforcement Managers, Health and Safety Regulators, Regulators of Health and Social Care Services and Others

This circular  provides advice to Health and Safety Regulators (for clarity and convenience referred to as Inspectors) who are involved in the regulation of health and social care activities. The circular addresses the number of serious burning incidents to people who use care service from hot surfaces in health and social care premises.

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Burning risks from hot surfaces in health and social care

Background

1. This circular SIM addresses the specific risk of burns to service users from hot surfaces in health and social care premises.   For consistency, the term ‘people who use care services’ is used to describe patients, residents, and any other clients in health and social care establishments.

2. Those at risk from burning include children, the elderly, those with reduced mental health capacity, and anyone with mobility and/or sensory impairments. who cannot react appropriately, or quickly enough, to prevent injury.  They may be in hospitals, nursing homes, social services premises, special schools or residential care homes (ie. health and social care establishments).  The risk should also be assessed in community facilities such as hostels, staffed and sheltered housing for the elderly, the mentally ill, and those with learning difficulties.

3. For the period April 2001 to March 2006 RIDDOR statistics identified 2 fatal incidents and at least 5 major injuries attributable to burns from hot surfaces in health and social care premises.

Nature of the problem

4. Individuals who cannot move away from a heat source (ie. hot water pipes, radiators or other forms of space heating devices) quickly enough can sustain serious burns.  This often occurs because they have fallen and are physically unable to move due to their mobility or are trapped by the furniture arrangement.  Incidents often occur in areas where there is not a regular flow of staff or others to raise the alarm, eg in bedrooms (especially during the night), bathrooms, and some lounges. 

Legal considerations

5. The health and safety of people who use care services is covered by the general requirements of Section 3 of the Health and Safety at Work Etc Act 1974, (HSW s.3) and by the risk assessment requirements of the Management of Health and Safety at Work Regulations (Reg 3) (MHSWR reg.3). HSE and LA Inspectors enforce these requirements.

6. Regulation 3 of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) requires that where a person not at work suffers a major injury (as defined in schedule 1 to the regulations ) or fatal injury out of or in connection with work must be reported to the relevant enforcing authority. Guidance on understanding the meaning of the phrase “Arising out of or in connection with work” is given in regulation 2(2)(c) of RIDDOR. Accidents involving service users and hot surfaces will generally be classed as ‘arising out of or in connection with work’ and will be reportable if they meet the above criteria.

Role of intermediaries

7. CSCI is the single, independent inspectorate for all social care services in England.  Further information on their role with regard to health and safety of people who use care services can be found in SIM 07/2006/14 [155kb] . Better Regulation:  Regulatory Bodies Inspecting Social Care.  

8.  In Scotland, the Scottish Commission for the Regulation of Care (the Care Commission) was set up under the Regulation of Care (Scotland) Act 2001 to establish a unified system of registration and regulation for social care services in Scotland including early education and independent and private health care. The Care Commission (CC) carries out regular inspections (at least twice a year for 24-hour care providers and annually, as a minimum, for others) to make sure that services meet the required minimum standards. Both HSE and CC have legitimate interest in matters concerning regulation in the care sector. However, because workplace health and safety is a reserved matter, HSE/LA inspectors in Scotland remain responsible for the regulation of risks to people who use care services arising out of or connected with work. A protocol, which will clarify the roles and responsibilities of HSE and CC is being developed.

9. In Wales the Care Standards Act 2000 and The Children Act 1989 (as amended) provide the National Assembly for Wales with the authority to register and inspect establishments and agencies in Wales that provide social care. The Care Standards Inspectorate Wales (CSIW), an operationally independent part of the Assembly regulates social care, early years and private and voluntary health care services. CSIW conduct regular (usually annual) inspections measuring services against National Minimum Standards produced by the Welsh Assembly Government. The National Minimum Standards address patient safety issues as well as the health and safety of care staff. A memorandum of understanding between HSE, LA’s and CSIW is being developed.   CSIW will take the lead in enforcement in relation to any issue relating to the safety of people who use care services within the Care Standards Act and associated regulations; this will include the management of risks from hot water.  Social Services Inspectorate for Wales will merge with CSIW to create the Care and Social Services Inspectorate (CSSIW) in April 2007.

Risk management system

10. Inspectors should look at the following elements of the risk management systems:

Risk assessment

11.   A risk assessment should be carried out to identify potential risks of burning from hot surfaces and to assess the vulnerability of those who may be at risk.  Questions to be asked may include:

1. Can the person using the care service get in/out of bed, sit up and move about unaided?
2. Is the person using the care service sensitivity to temperature impaired in any way?
3. Is the care service user’s mental state such that they can recognise hot surface temperatures?
4. Is the person using the care service capable of summoning assistance if needed?
5. Are there any potential trapping risks, eg bed rails, furniture?

12.   The results of the risk assessment may be recorded on individual care plans of those using the care service, which should include an assessment of capabilities and needs.

Control measures

13.   The maximum surface temperature of space heating devices should not      exceed 43oC, when the system is operating at the maximum design output.  Other design solutions with ensure that the maximum surface temperature does not exceed 43oC are also acceptable.

14.   The risk of burns from hot surfaces may be reduced by:

1. Providing low surface temperature heat emitters, eg cool wall;
2. Locating sources of heat out of reach, eg at high-level;
3. Guarding the heated areas, eg providing radiator covers, covering exposed pipework;
4. Reducing the flow temperatures (although usually not practicable in existing heating systems without sacrificing their effectiveness).

Maintenance

15. Suitable arrangements should be in place to ensure control measures are in place and functioning properly.

Training

16. Adequate training and supervision should be provided to ensure that staff understand the risks, precautions to be taken, and the need to report any difficulties to a responsible person.

Determining the risk gap

17. Determining appropriate enforcement action requires HSE inspectors to reference the HSE Enforcement Management Model (EMM) [133kb] ., Version 3.0. This is a fully open government document available at the HSE website.

Actual risk

18. A judgement of actual risk will need to be made based on the vulnerability of the population and the control measures in place.

19. In a worst-case scenario of vulnerable people being able to come into contact with a heat source (para 2 refers), there is a risk of serious personal injury with likelihood probable to single casualties.

20. Where there are vulnerable people and control measures are incomplete or inadequate (ie furniture placement), there will always be a risk of serious personal injury from burns if heat source surfaces exceed 43oC with likelihood possible to single casualties.

Benchmark

21.   Where all elements of the risk control system are in place, the permitted level of risks of injury is nil or negligible.

22.   The risk gap should be determined using Table 2.1 of the EMM.

Established standards

23. The following standards have been identified as ‘Established’ using the criteria set out in Table 3 of the EMM:

24. NHS Estates Health Guidance Note ‘Safe’ hot water and surface temperatures 1998 edition (file 357 – electronic copies also available via the NHS Knowledge Information Portal (details of access already provided to Services B2s)) (Scottish version is Scottish Health Guidance Note (1999) recommends how to meet the employer’s legal duty in respect of the risk of scalding and burning from hot water and hot surfaces.  It applies to all healthcare premises and those premises registered under the Registered Homes Act 1984 (Registered Establishments (Scotland) Act 1987). The guidance sets out that the maximum surface temperature of space heating devices should not exceed 43°c.

25. HS(G) 220 Health and safety in care homes - issued 2/01  (file 357) describes      the main risks found in care homes, including burns from hot surfaces, and what should be done to safeguard both workers and people who use care services.

Initial enforcement expectation

26. Initial enforcement expectation is derived from Table 5.1 using the risk gap and standards criteria.

Local factors

27. Inspectors should take into account previous advice, including any from the relevant intermediaries (paras 7 to 9 refer).

Strategic factors

28. The potential risks to vulnerable service users from hot surfaces are well known and publicised.  There are public interest implications to consider when determining appropriate action.  The Health and Social Care Services Unit promotes strong enforcement action where failings of risk management systems give rise to significant risk to vulnerable service users.  Inspectors should also consider that enforcement action will have a positive impact on dutyholders in the industry in general.

29.   A relevant example of successful enforcement action against a County Council demonstrates the potential serious natures of burns incidents.  The county council pleaded guilty to contravening HSW Act s.3 and were fined £12000 plus £7240 costs.  The council admitted that it had failed to take necessary precautions to protect vulnerable service users after an investigation into a number of burns injuries found that surface radiator temperatures were between 70oC and 80oC, and that the only protective measures in place were the use of furniture being placed in front of the radiator.  No risk assessments had been carried out and many of the council care managers were unaware of the HSE and NHS Estates guidance.

30. The case above highlights the need for caring organisations to manage the risks to service users properly.  Most care homes maintain an incident register, which could also provide useful information on non-reportable incidents involving contact with hot surfaces.

Feedback

31. The Health and Social Care Services Unit would welcome information about any incidents, campaigns or initiates on this issue.  Contact should be made using the general Health Services Communities email account:  hscsu@communities.hse.gov.uk

Further information

32. See also SIM 07/2007/10   - “Balanced decision making for people who use care services” (Due to be published shortly).

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