Care is often provided within people's homes by personal assistants (PAs), care agency staff or local authority homecare services. This is known as ‘domiciliary care’.
The risks to both those being cared for, and those providing the care, will vary greatly according to the individual's needs, the environment where care is provided, the type of care being provided and the competence of the carer.
This page covers:
- when HSE will become involved following a serious incident
- duties of those providing care in people’s own homes
- the main risks to workers and how to control them
- local authority health and safety duties and those towards people receiving direct payments for care
Does the Health and Safety at Work Act (HSWA) apply to care provided in people's homes?
The HSWA does not apply to activities classed exclusively as 'domestic services' carried out in 'private households’.
Personal care provided within someone's own home may be 'domestic service' and therefore may fall within this disapplication.
Whether the HSWA disapplication applies in specific circumstances will need to be considered on a case-by-case basis (and be subject to careful legal interpretation). However, as an indicative guide:
- if the carers work for the NHS, local authorities or employment agencies then they are unlikely to be employed exclusively as domestic workers and HSWA may apply
- if the care involves complex healthcare activities (such as operation of life support or palliative care equipment) then the HSWA is likely to apply
- if delivery of the care requires specialist training (for example, people handling and dealing with challenging behaviour) then the HSWA is likely to apply
HSE has guidance on the application of the HSWA to domestic service.
Will HSE become involved if a serious incident occurs?
If a serious incident occurs, HSE's involvement will be decided in line with its policies and procedures, on a case-by-case basis. HSE will have no involvement where the HSWA is disapplied.
Where equipment is provided by external employers or third party organisations, the HSWA duties are likely to apply. Civil or other duties of care might apply, even if the HSWA does not.
What are the main health and safety risks?
The most common causes of injury and ill health to carers arise from moving and handling, and dealing with challenging behaviour.
Where the HSWA applies, any significant risks to both the carer and service user must be adequately assessed. So far as is reasonably practicable, safe working procedures and appropriate equipment should be provided, and carers should be suitably competent/appropriately trained to carry out the tasks safely.
The health and safety of carers working in Great Britain from overseas may need particular attention. You can find guidance on how to ensure the safety of migrant workers.
Responsibilities of those who employ carers in their own home
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 (such as cleaning, gardening or general personal care), it is unlikely that you will have any responsibilities under the Health and Safety at Work Act (HSWA) – 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.
Duties of a care provider in a person’s home when lifting equipment is owned by the service user
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 the Lifting Operations and Lifting Equipment Regulations (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 those involved should be clearly set out in the care provision contract.
You can find more guidance on work equipment in health and social care.
Local authorities’ duties under health and safety legislation
Local authorities have duties under Section 3 of the Health and Safety at Work Act.
They are also required to assess risks. Guidance is provided on sensible risk assessment.
Health and safety legislation may apply where the local authority:
- has duties to assess care needs and provide care, or makes payments to allow the individual to employ their own carers or services
- has control over how the funding is used, and what level of care is provided or purchased by the individual
The main duties of care, both criminal and civil, will rest with the employer. Where this is the person in receipt of payments, the local authority may still retain duties.
Example – If specialised equipment is required for complex handling and the funding does not cover these needs, it could be argued that the decision by the local authority not to provide enough funding to cover appropriate equipment, or provide someone sufficiently competent to operate it, is likely to expose non-employees to risk.
The risk (or possibility of danger) might be said to have originated from the way the local authority conducted its undertaking. Each case would depend on the particular facts, including the terms of the particular agreements with service users, and how reasonably practicable it was to do otherwise.
What should individuals do?
- Tell the local authority about any change of circumstances, living arrangements or medical requirements so that needs can be reassessed
- Tell the local authority about any issues with obtaining the correct and safe delivery of care
- Understand that they have a responsibility for their own health and safety and for those they employ
- Share the assessments and care plan with the care agency or the employee who is to deliver the care
What is HSE's involvement?
Other organisations lead in health and social care regulation, as set out in our Who regulates health and social care page. This page also describes the circumstances under which HSE may investigate health and social care incidents.
Local authority duties towards people receiving direct payments
What are direct payments?
If you or someone you care for receives help from social services, you can apply for direct payments. These let you choose and buy the services you need yourself, instead of getting them from your local authority.
Direct payments are cash payments which are only made to individuals who have been assessed by social services as needing care and support services.
You can find more guidance from the NHS on personal budgets and direct payments - social care and support.
Summary of local authority duties regarding care needs
Local authorities must assess the individual person's care needs.
Where people qualify in needing certain services, local authorities should either provide:
- the services required to qualifying individuals, or
- direct payment to enable an individual to obtain their own services
Individuals may employ carers directly or through an agency.
Local authorities should:
- adequately assess care needs and how safe care should be delivered
- ensure arrangements are in place to review assessments to help ensure safe delivery of care
- share any relevant risk assessments, which form part of the care assessment, with direct payment recipients. This will help recipients to take health and safety into account when employing carers
- ensure that there is good ongoing communication between the person in receipt of payments and the local authority, so far as is reasonably practicable
- consider what health and safety advice recipients might need
- explain the safeguards needed in the employment of workers
- review the level of direct payments to help ensure the right services to provide a safe level of care are secured