HSE/NW/134/07 26 November 2007

HSE warns hospitals that they have a duty to ensure the safety of patients from falls from windows

The Health and Safety Executive (HSE) has warned hospitals and other care providers that they have a duty to ensure the safety of their patients, especially from the dangers of open windows. The warning follows HSE’s prosecution of Stockport NHS Foundation Trust after a patient was injured when he climbed out of a window.

The Trust pleaded guilty to breaching Section 3(1) of the Health and Safety at Work etc Act 1974 and Regulation 3(1) b of the Management of Health and Safety at Work Regulations 1999 at Trafford Magistrates Court on 22 November 2007 and was fined £5000 and ordered to pay £1965.58 costs

Between 28-31 October 2006, a male patient was admitted onto a first floor ward at Stepping Hill Hospital, Stockport, for treatment for alcohol use. He opened an unsecured window, climbed onto the sill and dropped to the ground, fracturing his ankle.

HSE Inspector Thomas Merry said: “This case graphically illustrates that hospitals need to ensure that vulnerable patients in their care are not put at risk.  This patient’s injuries were entirely avoidable. The hospital had not assessed the risk of someone getting out of an unsecured window. They had no system in place to ensure that, where fitted, window restrictors were properly applied or in use.

“This is a well known risk in the care sector with a number of prosecutions being taken every year in relation to people falling from windows. Hospitals deliver important services to some of the most vulnerable members of society. This makes it essential that effective assessment of the risks to health and safety are undertaken in order to ensure the necessary preventive measures are put in place.”

Notes to editors

1. Section 3(1) of the Health and Safety at Work etc Act 1974 states: “It shall be the duty of every employer to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected thereby are not thereby exposed to risks to their health or safety.”
2. Regulation 3(1)(b) of the Management of Health and Safety at Work Regulations 1999 states: “Every employer shall make a suitable and sufficient assessment of – the risks to the health and safety of persons not in his employment arising out of or in connection with the conduct by him of his undertaking.”
3. Nature of the problem
   

   The HSE have identified that there are three broad categories of falls on hospital premises::

   1. Accidental falls
   2. Falls arising out of a confused mental state
   3. Deliberate self-harm.

   Accidental falls are a minority, but can occur where a person is sitting on a window
   sill, or where the sill height is low and acts as a pivot, allowing them to fall out.

   A significant number of reports refer to the mental state of the patient. Senility,
   dementia, mental handicap or illness, the effect of drink and drugs (both prescribed and illegal) can all cause anxiety and confusion. Patients are inclined to try to escape from a perceived hostile environment, or to use a window believing it to be a door, possibly unaware that they are not at ground level. Other influencing factors include patients being unfamiliar with new surroundings, often exasperated by uncomfortable temperatures, anxiety, broken sleep and medication effects.

   Deliberate self-harm is a recognised risk for patients with certain medical conditions. Suicides can be a matter for HSE, although they are not reportable under RIDDOR. The propensity to self-harm should be considered as part of the initial clinical assessment, particularly for psychiatric patients, and actioned as appropriate. In this and other cases, falls from windows are reasonably foreseeable

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