This is the report of the Forum for Safety and Health held in Chester on 15th May 2019.
“Lets be Crystal Clear”
Following the opening of the day the first session was from the HSE.
The session started by explaining the HSE’s work plan 2019/20 and the focus it will have on health and social care. The HSE aims to carry out proactive inspections in relation to occupational lung diseases (OLDs), musculoskeletal disorders (MSDs) and work-related stress. These three areas are the focus of the HSE’s “Go Home Healthy” campaign (originally launched in September 2017), which continues to drive a significant part of its inspection operations.
On top of the issues raised as part of the “Go Home Healthy” initiative, the HSE also aims to complete a further programme of targeted proactive inspections during the early part of 2019. Such visits will be aimed at specifically addressing priority issues within certain high-risk industries.
Inspections focused in health care are related around MSD’s and Violence. There have also been a number of visits focusing on the Management of Asbestos and compliance with the ionising regulations 2017. The message was that the focus on these topics will be mainly in the health care setting rather than social care.
The HSE work closely with Local Authorities (LA) and the inspection activities they undertake as part of their enforcement responsibilities will focus on the moving and handling of persons in residential care. This has been identified as a focused inspection topic owing to a lack of effective management of MSD’s.
Emmie then gave an explanation to a list of findings from HSE visits in health and social care setting in 2018. The list was as a result of 20 visits, and contained the following:
- Lack of K P I’s;
- Low trade union and worker consultation;
- Time factors – not allowing enough time to work safely;
- Poor monitoring and review – identifying risks;
- Poor training needs analysis;
- Poor maintenance of equipment.
The session moved on to another topic, as we shine a light on work-related stress. Last reported by the HSE as the cause of 12.5 million working days lost each year, stress is now the leading cause of sickness absence in the UK. 526,000 people in the UK are reported to be suffering from work-related stress, anxiety and depression.
As an employer it is your duty to protect your employees from stress at work and consider their work design. One of the main ways of doing this is to complete a stress risk assessment, and then following up on any findings. The HSE’s Management Standards are a useful tool in ensuing you follow good practice and promote a healthy working environment.
Emmie finished the session with two case studies related to COSHH and fall risks. The COSHH related to contact dermatitis and an improvement notice was issued as a result of failures to risk assess; reg 6. The other related to a hospital patient 81 years of age who fell and died as a result of their injuries.
Session Notes Nigel Lawrence NE.
Linda Drew, Advanced Public Health Practitioner – Health Protection, Public Health, Derbyshire County and City Councils.
When two worlds collide, what can be learnt?
Linda works with the Infection Prevention & Control (I P & C) team at Derby County Council, Linda’s interesting and informative presentation introduced us to how, using her nursing background and working with the health & safety officer (two worlds colliding) were able to implement significant changes to address I P & C with care providers within their remit.
We were taken through how the changes in demographics and knowledge on infection control over the last 20 years have impacted on the care providers and with the benefit of horizon scanning we can predict some alarming issues which need addressing.
Linda made the chain of infection attention-grabbing – with her infectious (forgive the pun!) enthusiasm and sense of humour.
An excellent case was made for the encouragement of service users, residents and key workers to not make assumptions, clearly define standards in job roles along with an audit tool which supports actual ‘looking’ and ensure equipment is fit for purpose to tackle the constantly metamorphosing task of infection control.
Session Notes Rebecca Brooks NE.
A refreshment break was held with the opportunity for networking with colleagues
Julie Rayner, Care Quality, Governance & Compliance
The presentation delivered by Julie centred on the advantages and disadvantages of electronic auditing; covering a number of aspects, explaining Hallmark Care’s experience of implementing this system. The presentation was extremely engaging and gave a clear overview of the pitfalls that could be experienced by organisations when trying to put such a system into place. Julie was very knowledgeable and delivered a very structured and thought provoking presentation.
Aneurin also from Hallmark Care then delivered his presentation entitled ‘How safe is safe enough’, discussing positive risk and how it can be beneficial in the workplace. He also discussed the dynamics of safety within the care home environment and the tie in with the Care Quality Commission (CQC) and the Care Act.
Aneurin also talked about the journey Hallmark Care had taken implementing the Montessori approach, how this was received and what impacts this had on the environment for both staff and residents. This was very well presented and gave a practical and rounded view of a sometimes difficult subject area to tackle; very energising.
Session notes Brett Edwards NE
After the lunch break and the opportunity for networking with colleagues
“How Safe is Safe Enough?” – Part 2 Engagement and Debate
Conducted by Julie and Aneurin
An Open Forum on current and emerging Health and Safety risks for the social care sector.
Anna provided a legal update titled “getting ahead of the curve” which included a review of recent case law and sentencing trends.
Anna explained that as the CQC now have the powers to prosecute, there is a new era of regulatory scrutiny and approach to enforcement.
There is an emerging trend in which providers have been prosecuted by CQC for breaching regulation 12 – Safe care and treatment.
Common areas for investigation include ligature incidents in mental health facilities, failing to protect patients, medication errors, falls from height or bed, burns, choking and entrapment in bed rails.
Session notes Lisa Harris NE
Emmie Galilee – Health and Social Care Services Sector
Emmie completed the day with a presentation on the Ionising Radiations Regulations 2017 (IRR17) with a focus on radioactive patients in care facilities.
Emmie explained this was an area where she had asked colleagues to assist in developing the presentation and to bear with her as she had notes to assist in its delivery.
The topic was selected from requests from previous NASHiCS event where delegates were asked to suggest titles for future presentations.
The IRR17 replaces IRR99. It came into force on the 1st January 2018. Its focus is to regulate occupational and public exposures arising from work activities. In addition the Ionising Radiation (Medical Exposure) Regulations 2017 regulate medical exposures. In England CQC enforce and in Scotland and Wales it is Scottish Government and Healthcare Inspectorate Wales.
The presentation looked into the various aspects of the regulations. Regulation 3 of IRR 17 sets out the application of the regulations. This applies to “any practice” which means the production, processing, handling, disposal, use, storage, holding or transport of radioactive substances” which can increase the exposure of individuals to ionising radiation.
Just because the radioactive substance is within a human body does not alter the fact that radioactive substances are being handled, disposed, used, stored, and transported. Care facility or a nursing home with patients who have been administered with radioactive material will be considered to be an employer undertaking work with ionising radiation.
There is a requirement to notify, register or gain consent for work with IR. There was a requirement under IRR99 to notify to HSE any relevant work at least 28 days in advance of that work beginning. It was pointed out that that the notification under IRR17 uses different activity concentration and quantity levels than notification under IRR99. Diagnostic and therapeutic treatment will require registration. Any previous notifications under IRR 99 are no longer valid.
Under the Ionising Radiation Regulations 2017, employers must apply to the Health and Safety Executive (HSE) before they start certain new work with ionising radiation. This is known as the ‘graded approach’ as what you apply for depends on the size and likelihood of exposure. Depending on the level of risk of the ionising radiation work you do you may need to apply to:
Reg 5: Notification;
Reg 6 Registration;
Reg 7 Consent.
The thresholds for registering in the regulations are very low. They are based on quantities and concentrations of radioactive materials. However it still may be only for a period of a few days that the radioactivity is above the thresholds. In reality it is likely that where high doses are given, the patient will remain in hospital.
There is also a guidance booklet available online “ Ionising Radiations Regulations 2017 – guidance for notifications, registrations and consents.
Session Notes Nigel Lawrence NE.
NASHiCS members then attended the Annual General meeting.