Health and social care - Frequently asked questions

The fixed electrical installation includes the incoming supply cables, switchgear, distribution boards and socket outlets. 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 Requirements for electrical installations (also known as the 17th Edition of the IET Wiring Regulations).The standard is published by the Institution of Engineering and Technology (IET).

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.

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 (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.

Further information

• Who regulates health and social care

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
• who require augmented care (such as 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.

Further information

• Who regulates health and social care

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 them (such as discomfort or burns). 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 (such as 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 and 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.

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.

Further information

• Health and safety training: A brief guide (HSE leaflet INDG345)

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 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 the GDC website.

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 (for example 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.

Further information

• First aid at work

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

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 HSE’s advice on smoking at work. Look for sensible solutions and compromises that protect the wellbeing 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 (for example 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, for example 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 environmental tobacco smoke 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 Welsh Assembly guidance on second-hand smoke will be useful across the UK.

HSE's advice is consistent with the British government's ongoing commitment to reduce people's exposure to tobacco smoke, and recognition that introducing smokefree 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.

Further information

• HSE advice on smoking in the workplace
• HSE guidance on health and safety in care homes

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. HSE, with the support of NHS England and ACPO, have therefore withdrawn it. 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.