Health and Social Care - Frequently asked questions
These FAQs help illustrate the nature of some of the issues that HSE routinely gives advice on. The list is not exhaustive and further questions and answers may be added at a later date.
Please note if you are a provider registered with CQC, and with premises located in England, CQC is the relevant regulatory body for patient safety matters
Fire and electrical safety
How do I make sure that the fixed electrical installation in my care home is safe?
In care homes the main electrical risks are:
- Contact with live parts causing shock and burns;
- Faults that could cause fires.
The fixed electrical installation includes the incoming supply cables, switchgear, distribution boards, socket outlets, etc. To reduce risks from the electrical installation it is essential that it is properly installed and maintained.
The most widely used standard in the UK covering installation and maintenance is BS 7671:2008 (2011) Requirements for electrical installations, (also known as the 17th Edition of the IET Wiring Regulations). Following BS 7671 is not a legal requirement, but it is the widely accepted standard in the UK and compliance with it is likely to achieve compliance with the Electricity at Work Regulations 1989.
There is no legal requirement for inspection and testing at set intervals. The legal requirement is simply to maintain the installation in a safe condition. However, guidance on BS 7671, published by the IET, recommends that the fixed electrical installations in residential premises such as care homes should be inspected and tested every 5 years, although the interval can be varied on the advice of a competent person. A competent person, normally an electrician, should carry out the inspection and testing.
In addition to the 5-year inspection and testing, regular visual checks of the installation are an essential part of any preventive maintenance programme. Checks can be carried out by staff trained in what to look for, eg broken socket covers, but they should not dismantle or attempt to repair equipment, unless they are competent to do so. You can decide on the frequency of these checks, based on risk and results from previous inspections.
Are fire precautions in care homes enforced by HSE?
General Fire Precautions (GFPs), for example ensuring adequate means of escape from a building, are enforced by individual Fire and Rescue Services (FRS) in England, Wales and Scotland.
HSE deals with process fire risk, for example using flammable liquids and LPG or electrical faults, which can cause fires.
Although serious fires in care homes are fairly rare, when they do occur they can be catastrophic. On 31 January 2004, a fire occurred at Rosepark Care Home in Uddingston, Scotland, in which 14 elderly residents lost their lives.
Valuable lessons that other care home owners can learn from this tragic incident can be found in the guidance below along with other useful information about fire safety for care homes.
- Rosepark 'Dear colleague letter' issued by Department of Health
- DCLG guide 'Fire Safety risk assessment – residential care premises' 2006
- Additional guidance for application to DCLG guide March 2011
- Health and safety in care homes - HSE booklet HSG 220
- HSE Fire and Explosion website topic pages
- Practical Fire Safety Guidance for Care Homes issued by the Scottish Government
Should magazines and toys be banned from waiting rooms, because of infection control or other health and safety risks?
Magazines can help reduce the stress sometimes suffered by patients waiting for an appointment and there are no current infection control or health and safety reasons for banning them. Similar considerations apply to the provision of toys that can be easily cleaned.
Magazines that are visibly soiled should be removed. Toys should be selected with ease of cleaning in mind ie they should have hard surfaces that can be washed or disinfected, as per the healthcare facility's decontamination policy. They should be cleaned on a regular basis, and should be decontaminated if visibly soiled with blood or other body fluid. Soft toys should not be used, because of the difficulty of decontamination.
This overall approach should be reviewed, in exceptional circumstances, in line with national guidance (for example specific advice should be sought and followed in the event of a pandemic influenza outbreak).
HSE recognises that other regulators, including the Care Quality Commission, Healthcare Inspectorate Wales and the Healthcare Environment Inspectorate, have an important role in patient care and safety. We are grateful for their help and support in providing this answer.
- Department of Health guidance - provides advice about special measures required during the 2009 H1N1 pandemic influenza outbreak, including the removal of magazines.
- Who regulates health and social care
Should flowers be banned from hospital wards because of health and safety or infection control risks?
Flowers can be a source of comfort to patients and there are no infection control or health and safety reasons for a 'blanket ban' on cut flowers in wards.
There may be valid reasons, including infection control or health and safety concerns, to restrict cut flowers for certain patients or in some areas. These may include patients with an impaired immune system; or who require augmented care (eg adult critical care) where, because of their high dependence on electrical equipment, open vases might present electrical risks, or impede emergency access.
The work that might be involved for staff in maintaining flowers, and any electrical risks, can be reduced by using sealed containers, rather than open, water-filled, vases.
Space around the bedside is generally quite limited. To facilitate cleaning of all surfaces in the near patient environment, patients and visitors are often asked to limit the number of vases or arrangements.
HSE recognises the role of other regulators, including the Care Quality Commission, Healthcare Inspectorate Wales and the Healthcare Environment Inspectorate, in patient care and safety and is grateful for their help and support in providing this answer.
- The Welsh Assembly Government report - 'free to lead, free to care' gives information about cut flowers, particularly on pages 23, 26 and 27.
- Who regulates health and social care
How do I prevent my staff and residents developing Legionnaires' disease?
Legionella bacteria can grow where water temperatures are between 20 and 45°C. If you run a care home or healthcare premises, it is likely that you will have residents or patients that are at higher risk of contracting the disease.
The potential risk from Legionella bacteria is likely to come from hot and cold water systems or evaporative cooling towers. To reduce the risk of contracting the disease you will need to carry out a risk assessment identifying who is at risk, the risk from your systems and any necessary controls.
To control the risk you will need to ensure that hot and cold water storage tanks, distribution pipe work and outlets remain clean. Where temperature is used to control the risk, hot water should be stored above 60°C, hot water distribution should be above 50°C and cold water storage and distribution should be below 20°C. Infrequently used outlets should be flushed out regularly and showerheads de-scaled and cleaned.
Why is legionella a risk to patients and users of care services?
Users of health and social care services are likely to be at higher risk of contracting Legionnaires disease, which is a form of pneumonia that can be fatal. Legionella bacteria can grow in hot and cold water systems where the conditions are suitable for bacteria growth. The disease can be contracted by breathing in tiny droplets of water, for example, when using showers, taps or fine sprays etc.
Bacteria is likely to grow where, for example;
- water temperatures are between 20°C and 45°C,
- water contains debris or nutrients which promote bacteria growth
- water is stagnant or infrequently used
Lifting equipment and manual handling
My care agency used to provide two carers to move me in a hoist and sling, but they have recently reduced this to one. How many should they provide?
The number of carers required for hoisting can vary depending on the needs of the individual service user and the specific hoisting transfers required. Some individuals can safely use a hoist in their own home without assistance; others may need assistance from a number of carers.
The employer responsible for delivering the care must ensure that a suitable and sufficient risk assessment has been undertaken. It must consider:
- the individual being assisted and their needs;
- the environment;
- the specific hoisting transfers;
- the equipment provided;
- how the sling is to be applied; and
- the individuals who are carrying out the moving and handling tasks.
In some cases assessment will show that at least two carers are needed; one to operate the hoist; and the other to help keep the individual in a safe position whilst moving, to maintain co-operation and provide direct reassurance.
If you have concerns about moving and handling you should ask your care agency to provide a copy of their risk assessment and discuss your concerns with them.
Getting to grips with hoisting (HSE Information Sheet HSIS3)
Is lifting an individual without a hoist banned?
The Manual Handling Operations Regulations 1992 require employers to avoid hazardous manual handling tasks so far as is reasonably practicable. The regulations do not prohibit workers from assisting people without a hoist, but do require them to put measures in place to carry out moving and handling tasks safely.
An across the board 'no lifting' policy, whilst eliminating some handling risks, overlooks the needs of the individual and the benefits to them from receiving appropriate assistance with mobility. Such assistance can enable rehabilitation and help people to enjoy more active and independent lives.
Where individuals need moving and handling assistance, the care provider must ensure that a suitable and sufficient risk assessment has been undertaken. Carers and those they care for should not be put at risk from unsafe handling practices. A diverse range of handling aids and techniques are available which, when used by appropriately trained carers, can assist people to move safely.
I am employed to carry out care within a person's own home. Do the Lifting Operations and Lifting Equipment Regulations (LOLER) apply to lifting equipment owned by the person receiving care?
If you visit someone's home, and are required to use the service user's own equipment, this equipment is not considered to be supplied for use at work. Therefore, the service user has no duties under LOLER.
However, if you are required to use this equipment, the duty to ensure your safety, so far as is reasonably practicable, rests with your employer. In this situation, your employer may have no control over the condition of the equipment. They therefore need to decide whether to provide suitable alternative equipment, or take adequate steps to ensure that the service user's equipment is properly maintained and safe to use. The responsibilities of all parties involved should be clearly set out in the care provision contract.
I work for a community equipment service, and we loan equipment for people to use in their own home. Do the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) apply to this equipment?
Where equipment has been loaned by an employer or community equipment provider for private use, ie solely to be used by individuals, family or unpaid carers, LOLER will not apply as it is not defined as work equipment during the loan period.
However in practice, LOLER will apply to the majority of loan equipment provisions, as you may not be able to determine whether it is being used solely for private use. Also, the loan period for private use may only be for a few weeks, before the equipment is loaned to another individual who has paid carers, therefore bringing it under the definition of work equipment.
If you decide it is not work equipment as the owner and provider of the equipment you will still have a general duty under the Health and Safety at Work etc Act 1974, Section 3, to provide and maintain safe equipment. This can usually be satisfied by following the principles of LOLER and the Provision and use of work equipment Regulations 1998 (PUWER).
How can I ensure slings for lifting people are uniquely identifiable for maintenance and inspection?
Under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) anyone using lifting equipment should be able to check that it has been thoroughly examined and is safe to use. This means that lifting equipment and accessories such as slings need to be uniquely identifiable.
Manufacturers often label slings with a serial number, although these can fade over time or during laundering. Some also provide space on the sling label for recording thorough examination dates.
Whilst it is fine to write on the label, there is a potential problem with using some permanent markers on the fabric and load bearing webbing of slings. Most permanent markers do not state their chemical composition. If they contain solvents, such as Xylene, this can weaken the fabric. Attaching some other identifying label (for example by using a robust cable tie) is acceptable. Users should avoid sewing labels onto the sling fabric or attachments as this can also weaken the fabric. If in doubt, contact your supplier / manufacturer.
If a patient arrives in hospital in a wheel chair, with their own lifting sling, can we use this sling or do we have to replace it with one which has been LOLER tested?
The organisation must balance the risks of using the patient's own sling with the risks to their well being or recovery.
If a patient is taken into care with an unverified sling of their own then the employer should make a decision about the risks of using the sling.
If the risks to the patient in changing the sling, ie the delays in urgent treatment, discomfort or disturbance etc outweigh the risks of using the sling, it would be appropriate to use it until it can be changed at the earliest opportunity. Before making this decision, an experienced person should check the sling for obvious damage.
Getting to grips with hoisting people – HSE information Sheet HSIS3
Where can I get information about handling heavy (bariatric) people?
Employers should ensure bariatric handling activities have been adequately assessed by a competent person. It is likely that specialist training in appropriate techniques will be required. Specialist equipment may also be needed which should be regularly checked and maintained.
Organisations such as Backcare, National Back Exchange and the Royal College of Nursing provide information and guidance on appropriate techniques for handling people.
Skin at work
I'm a healthcare professional working at a hospital, can I use latex gloves?
Yes, however your employer should carefully consider the risks when selecting gloves in the workplace, because of the importance of latex gloves as a source of exposure to natural rubber latex (NRL) proteins.
When considering glove use in the workplace (latex or otherwise), employers should follow HSE's glove selection guidance. Your employer must be able to demonstrate that they have carried out an assessment to select which (if any) type of gloves they should provide. They must also be able to demonstrate that they have an effective glove use policy in place that, for example, takes account of those employees or others (such as members of the public), who may have a latex allergy.
HSE has provided specific information and guidance for employers relating to dermatitis and latex allergies in health and social care.
How do I identify the appropriate level of health surveillance for occupational contact dermatitis (OCD)?
Employers should carry out suitable and sufficient risk assessments considering the risks from:
- irritant contact dermatitis (ICD) caused by wet work, chemicals, and physical and biological agents;
- allergic contact dermatitis (ACD) caused by sensitising chemicals; and,
- occupational contact urticaria (OCU) caused by proteins in food or latex
If appropriate, identify suitable health surveillance, which should be based on risk and form part of your overall system for managing occupational health (OH) risks. You may wish to involve a health professional (OH doctor or nurse) in your health surveillance programme. Their competent advice will help develop your scheme, train a 'responsible person', and/or manage the programme as a whole.
A responsible person is someone who is given the responsibility to help deliver a system of occupational health surveillance. They will have received training or coaching on what they need to do in order to perform this role effectively. This may involve training from a health professional, management, health and safety professional or other, as appropriate. This person may be a supervisor, first-aider, safety representative or the employer and the role will be clearly defined. They will be someone trusted by the workforce with good communication and interpersonal skills.
Health surveillance for occupational contact dermatitis (OCD) could include the following elements:
- Regular visual skin inspections by a 'responsible person' (frequency as advised by a health professional)
- Annual employee questionnaires
- General training of employees on likely exposures and symptoms
- General training of employees on how (and to whom) to report such symptoms
- Assessing workers' skin condition as soon as possible after they start a relevant job to provide a baseline (eg within six weeks).
To identify a suitable level of health surveillance you need to consider a number of factors including:
- The individual's work activities
- Type of hazard
- Degree of risk
- Length of exposure
- Type of PPE/gloves
- Likely health affects (irritation or allergy)
- History of other affected employees.
It is important to consider all activities that may present a risk of OCD and provide a level of health surveillance that will help manage the highest risk of exposure. For example, healthcare employees may be at risk of exposure from more than one hazard, frequent hand washing, glove use and other hazardous agents.
The following examples are provided to help organisations identify a suitable level of health surveillance. However, HSE expects all of the above factors to be considered; therefore, the level of surveillance may vary between individuals doing similar work.
A higher level of health surveillance is appropriate
This is appropriate when the evidence for a hazard is clear and/or there is potential for significant exposure. For example;
- An employer has identified that a chemical he uses can cause severe OCD, they know that despite risk reduction measures being in place, exposure can happen, and that OCD is not uncommon in their industry.
- For hygiene reasons, a worker cannot avoid frequent hand washing. The worker's employer knows that as a rule of thumb, a worker is at risk of developing OCD, if they wash their hands more than 20 times a day.
HSE would expect all of the above elements of health surveillance to be included.
A lower level of health surveillance is appropriate
This is appropriate when there is weak evidence of a hazard and/or there is limited potential for significant exposure. For example;
- Workers are required to wear low protein powder-free latex gloves intermittently at work. There are many different types of protective glove available and HSE does not have the evidence to identity the appropriate level of health surveillance for all glove materials. However, for powder-free, low protein, single-use latex gloves, the evidence suggests the risks of developing occupational contact dermatitis are low.
- A worker uses an irritant substance but exposure is controlled effectively without reliance on personal protective equipment.
HSE accepts that a lower level of health surveillance is likely to be sufficient. Skin inspections by a responsible person may not be necessary, but employee questionnaires and providing appropriate information, instruction and training so they know when and how to report their own skin problems would be required.
Health surveillance programmes must include keeping a health record for each individual. This should include:
- the activity that can cause dermatitis;
- worker's name, address and National Insurance number;
- products or process they work on, and how often;
- protective measures provided;
- date of starting work with the product or process; and
- the result of skin inspections.
Slips, trips and falls from height
Does slip-resistant flooring make it harder to hygienically clean floors?
Some health and social care providers are concerned that smooth floors are required to enable hygienic cleaning to reduce the risk of infection. Many providers make extensive use of smooth vinyl, which can lead to an increased risk of slip and trip accidents.
HSE has commissioned research to explore whether slip resistant flooring installed in hospitals can be cleaned to a hygienic standard using standard cleaning practices.
The research concluded that the ability to clean a typical hospital floor to a hygienic standard is not influenced by the slip resistance of the flooring.
Are window restrictors legally required?
Under health and safety legislation, window restrictors are required where people who are vulnerable to the risk of falling, have access to the windows, and the windows are at a height, which is likely to cause them harm.
Is it safe to allow residents with dementia to have access to balconies?
Many factors need to be considered, including the rights and freedoms of individuals. However, if people using the care service are assessed as being at risk from falling, restricted access may be appropriate.
If the balcony is at a height likely to cause injury, you will need to consider whether the design and height of balustrades provide sufficient protection to prevent people falling or climbing over. You will also need to ensure that furniture or other footholds do not allow easy access.
Should heat packs or other heat treatment equipment be banned in care homes because of health and safety risks?
Heat packs or other heat treatment equipment, such as electric heating pads, heated gel packs, heat wraps or hot water bottles, can be used to reduce pain or discomfort for patients and users of care services. Often this equipment is provided by friends or relatives, and in some cases their use has been banned by the care provider citing 'health and safety'.
Health and safety legislation does not ban their use, but there can be risks associated with their use (eg. discomfort or burns) and it may not always be a suitable treatment where there are contra indications to their use. For example, where individuals have impaired circulation or skin sensitivity (eg. following surgery), or have open wounds etc.
In considering the use of heat packs or heat treatment you should always follow the manufacturer's instructions and carry out checks prior to use to ensure that the equipment is in good condition.
Things to consider include:
- Individual assessment of the need / purpose / outcome of using the heat pack and suitability for the person.
- Arrangements for monitoring the use of the heat pack
- Initial and ongoing assessment of the safety of the specific heat pack used. For example, heat packs should have some form of insulation to reduce the risk of discomfort or burns.
- Over-heating of packs, inadequate insulation or too long a duration can cause burning of the skin. Particular care should be taken to ensure that such equipment does not reach too high a temperature.
- How to explain to friends and relatives the reasons for your decisions.
Should my employees be paid to attend health and safety training?
The Health and Safety at Work etc Act 1974 (HSWA) requires you to provide whatever information, instruction and training is necessary to ensure, so far as is reasonably practicable, the health and safety at work of your employees.
If training is identified as part of a control measure and relates to safety (for example moving and handling, dealing with challenging behaviour, or fire training) attendance must be treated as work time and should take place during working hours. If it is necessary to arrange training outside an employee's normal hours, this should be treated as an extension of time at work. Special arrangements may be needed for part-timers or shift workers.
Section 9 of HSWA prohibits employers from charging employees for anything they have to do in respect of carrying out specific requirements of the relevant statutory provisions. The requirement to provide health and safety training is such a provision and employees should not therefore be required to pay for their own training.
Health and safety training: A brief guide (HSE leaflet INDG345)
Are tooth whitening practices HSE enforced?
Tooth whitening is a way of lightening the natural colour of teeth using bleaching methods.
It is the view of the General Dental Council (GDC) that the actual procedure of tooth whitening is the practice of dentistry, regardless of the products used. All dental practitioners in the UK are required by law to be registered with the GDC. Tooth whitening can only therefore be carried out lawfully by registered dentists. Registered dental hygienists and dental therapists are also permitted to carry out this type of work, but only on the prescription of a dentist.
The GDC has successfully prosecuted a non-registrant for performing tooth whitening. See their press releases for further information.
The Health and Safety (Enforcement Authority) Regulations 1998 state that cosmetic services and therapeutic treatments carried out under supervision or control of a dentist are enforced by HSE. This includes work within retail outlets and offices. Any work-related health and safety matters associated with this type of work are therefore enforced by HSE.
If the work carried out at the premises is not undertaken by or under the supervision of a dental practitioner registered with the GDC then, it is likely they are operating illegally and this should be reported to the GDC.
Complaints about the standard of work carried out by dentists, including the way tooth whitening is performed, should also be referred to the GDC. Information about how to make a complaint can be found on their website.
Considering tooth whitening? - Leaflet produced by the GDC
What is the EU Directive on the prevention of sharps injuries in hospitals and the healthcare sector?
An EU Directive was introduced on 10th May 2010 to prevent injuries and blood borne infections to hospital and healthcare workers from sharps instruments such as needles. In summary, the Directive aims to;
- achieve the safest possible working environment;
- prevent injuries to workers caused by all medical sharps;
- protect workers at risk;
- set up an integrated approach establishing policies in risk assessment, risk prevention, training, information, awareness-raising and monitoring; and,
- put in place response and follow up procedures.
The Directive requires that all provisions are transposed into UK legislation by 11th May 2013.
As an employer, am I required to provide personal communication devices for lone workers?
There may be situations where employees are working alone, at risk of violence and aggression, and may need to contact someone for assistance. For example, community-based staff such as midwives, district nurses, and social workers; and site-based staff working in isolated areas of premises.
In these cases, employers should have arrangements in place to ensure that lone workers are safe. The provision of personal communication devices may be one of a number of reasonably practicable control measures to help manage the risk. Examples of devices include; telephones, mobile phones, radios, automatic warning devices and emergency alarms.
It is important to recognise that personal communication devices will not prevent incidents from occurring. However, if used correctly in conjunction with robust procedures, they will improve the protection of lone workers.
If employers provide personal communication devices, they must train employees to use them appropriately. Employees must be aware of and follow supporting procedures and arrangements. The employer must maintain the equipment and have appropriate response arrangements in place.
If the employer has identified the need for personal communication devices as a control measure, then removal of the devices based on cost alone is unacceptable, unless additional equivalent control measures are put in place.
The care home I manage has bedrooms with en-suite facilities. How do I manage the risk of scalding?
You should develop safe bathing procedures if people you care for are assessed as being vulnerable to scalding. Where storage and distribution temperatures are being used to control Legionella (ie above 60ºC and 50ºC respectively), or high temperatures might otherwise be achieved, baths and showers should be fitted with thermostatic mixer valves (TMVs) to ensure water temperatures do not exceed 44ºC. Outlet temperatures and TMVs should be monitored and maintained to ensure the controls are effective.
Where electric showers are fitted, the potential output temperatures should be checked under fluctuating local conditions (ie different pressure / flow) to ensure that temperatures above 44ºC (max 41ºC required in NHS) are not achievable. Where electric shower temperatures have the potential to exceed 44ºC you will need to install healthcare standard electric showers unless your assessment indicates adequate control of the risk by other means.
Whilst the risk from basins is much lower, owing to there being no full body immersion, if someone is assessed as being vulnerable to the risk of scalding at basins, adequate controls on output temperature (eg TMVs) should be in place.
How do the Health and Safety (First-Aid) Regulations 1981 (FAW) relate to first-aid provision in care homes?
Under the regulations, employers are responsible for providing appropriate first-aid equipment, facilities and ensuring an adequate number of first-aiders. However, these requirements only relate to first aid provision for employees. The regulations do not require employers to provide first aid for non-employees (eg users of care services, patients etc.). However, HSE strongly encourages employers to consider non-employees when carrying out their first-aid needs assessment and to make provision for them.
If your assessment identifies that training in emergency techniques might help control the risk, then such training may be required under the Health and Safety at Work Act (HSWA), rather than FAW. An example might be a resident of a care home who is known to be at serious risk of choking, where training in emergency techniques may be appropriate.
I employ carers within my own home - do I have any health and safety responsibilities?
When you ask people to carry out work within your own home you will have a general responsibility for them under civil law.
If you live in a private domestic household and you employ someone to carry out solely domestic activities (eg cleaning, gardening or general personal care), it is unlikely that you will have any responsibilities under the Health and Safety at Work Act 1974 (HSWA) (see section 51).
However, if you employ carers to carry out tasks that go beyond what may be considered to be ordinary domestic service, for example, hoisting a person, dealing with challenging behaviour or using complex medical equipment, then you may have responsibilities under HSWA.
Under HSWA you would need to consider the carer's and your own safety. For example, there may be a need for suitable training and equipment for 'higher risk' activities.
Does HSE regulate foster care?
Other bodies regulate fostering. Carers are subject to a thorough assessment process to ensure their suitability to foster children and receive training, monitoring and supervision. For this reason, HSE would not generally regulate foster care.
Further information on regulation of foster care, can be found in the fostering service regulations and Department of Health minimum standards.
Should bedrails always be provided in care homes?
No. Many factors need to be considered, including the rights and freedoms of individuals. Fatalities have occurred where people using care services have become trapped in bedrails or fallen from beds.
Even where people are vulnerable to injury, because of falling from their bed, bedrails may not always be a suitable option. You will need to assess the risk of falling, and, whether bedrails are suitable. Where provided, bedrails must be properly fitted and maintained.
What advice is there for staff who may be exposed to second-hand tobacco smoke in client homes?
Employers have a duty under the Health and Safety at Work etc Act 1974 (HSWA), to protect, so far as is reasonably practicable, the health and safety of their employees, including from risks arising from exposure to environmental tobacco smoke (ETS).
Employees carrying out work in clients' homes
Below are some ideas, which may be helpful. However, it is for the employer to decide how they tackle the problem of second-hand smoke, based on the findings of their risk assessment.
- Consult the HSE Guidance. Look for sensible solutions and compromises that protect the well-being of carers, but respect the rights of those being cared for.
- Ensure exposure to second-hand smoke is considered as part of the workplace risk assessment. Prioritise those most at risk (eg those with respiratory complaints, or those subjected to greatest exposure).
- Evaluate whether smokers are happy to stop smoking when carers are present or how carers might persuade them to do so.
Examine possibilities of:
- asking smokers to warn carers before lighting-up, so they may leave the room
- opening doors and / or windows or use of extractor fans
- smoking next to an open door / window
- designating smoking areas, eg the kitchen
Consider educating those being cared for. Smokers may be prepared to risk their own lives, but be more concerned about the damage they might cause others.
Employees carrying out work in care homes / premises
Employers should consider drawing up a policy to limit ETS at work. There is the added complication of the care home not only being a workplace, but also where users of the service should have certain freedoms, as if in their own home. Full consultation with users of the care service is highly desirable. Employees and service users are more likely to accept a policy if they feel they have been properly consulted.
(Note: There is no legal obligation for care homes to offer designated smoking rooms if they do not wish to do so, and many care homes may not permit smoking in residents' own rooms for safety reasons. You should also consider the impact of second-hand smoke on non-smoking residents and staff.)
An effective policy on smoking may include:
- allocating smokers and non-smokers separate rooms, where possible
- designating separate smoking and non-smoking common rooms
- banning smoking in all common areas such as corridors, lifts and dining rooms
- improving ventilation / extraction systems so that smoke is more effectively removed from the working environment. However, such systems may not remove all harmful carcinogens from the air and would not be as effective as going smoke-free
Some users of the service may wish to smoke in their bedrooms. Fire safety is important and many fires are caused by smoking in bed. Complete individual risk assessments before seeking the views of the Fire Prevention Officer.
Responsibility for enforcing the legislation, including judgements about its application, is a matter for local authorities. If you have queries about applying the Regulations to your particular situation, you may wish to contact your local authority's department of environmental health or public protection.
The issue of exposing health and social care workers to second-hand smoke is addressed in supplementary guidance developed by the Welsh Assembly Government for the NHS, local authority and care service providers. Although aimed at Wales, the guidance will be useful across the UK.
HSE's guidance is consistent with the British Government's ongoing commitment to reduce people's exposure to tobacco smoke, and recognition that introducing smoke-free workplaces advances that policy.
Following the total ban on smoking in enclosed public places and workplaces under public health legislation, HSE remains responsible for the consistent application of health and safety law across Britain, including ensuring the appropriate management of any risks arising from exposure to ETS in the workplace.
- HSE Guidance – Smoking in the workplace
- HSL research report – Second hand tobacco smoke exposure in residential care homes: Controlling the risk
- HSE Guidance – Health and safety in care homes HSG220
- Welsh Assembly – Guidance on second hand smoke
What can I do to control the risk from surgical smoke?
Diathermy is a surgical technique which uses heat from an electric current to cut tissue or seal bleeding vessels. Diathermy emissions, sometimes known as surgical smoke, can contain numerous toxic gases, particles and vapours and are usually invisible to the naked eye. Their inhalation can adversely affect surgeons' and theatre staff's respiratory system. The risks vary according to individual circumstances, such as the procedure, equipment, environment, technique and patient.
The Control of Substances Hazardous to Health Regulations (COSHH) require employers to carry out an assessment of the risks from hazardous substances and to always try to prevent exposure at source. If you cannot prevent exposure to diathermy emissions then you should control it adequately.
This is usually achieved by effective local exhaust ventilation (LEV). Typically, this takes the form of extraction incorporated into the electrosurgery system to remove emissions at source, known as 'on-tip' extraction.
Is my incident reportable under RIDDOR?
RIDDOR is the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. These Regulations require employers, the self-employed and those in control of premises to report specified workplace incidents.
In the health and social care sector there is often uncertainty over whether incidents are reportable, particularly when they involve members of the public (eg patients in a hospital or residents in a care home), or when employees receive sharps injuries or suffer from work-related stress.
Some incidents are not reportable under RIDDOR. However, this does not mean that the general provisions of the Health and Safety at Work etc Act 1974 (HSWA) do not apply.
To help explain what should be reported, HSE has produced a new information sheet. This provides clear guidance on how RIDDOR applies to the health and social care sector. It gives a number of examples to help you decide whether an incident is reportable or not.
For general guidance on the requirements of RIDDOR, such as who should report, how to report and when to report, please visit the HSE RIDDOR pages.
Why has the Memorandum of Understanding 'Investigating patient safety incidents involving unexpected death or serious untoward harm: a protocol for liaison and effective communications between the NHS, Association of Chief Police Officers (ACPO) and HSE' been withdrawn?
The MoU was published in 2006 largely in response to Operation Orcadian, a wide ranging investigation into a number of incidents arising from the blockage of patient breathing circuits. Its purpose was to encourage consistent and well-coordinated joint working between the police, NHS, HSE and others.
Much has changed since the MoU was first launched, and consequently HSE with the support of NHS England and ACPO have withdrawn the MoU. Concerns included references to organisations that no longer exist, or whose responsibilities have radically changed. For example NHS England, rather than the Department of Health, now have responsibility for patient safety and the document does not refer to the Care Quality Commission – the lead regulator for patient safety and quality of care.
Much of the content of the MoU has been incorporated into Police guidance and the Police, HSE and others work closely together in accordance with the Work Related Deaths Protocol. Also, CQC, HSE and Local Authorities in England have a Memorandum of Understanding which addresses how they work together on investigations with effect from April 2015.