2. Managing the risks of moving and handling
If risks from moving and handling are to be managed successfully, there must be support from those at the top of the organisation, whatever its size. This can be expressed in a clear statement of policy – supported by organisational arrangements – to ensure the statement is implemented. Key elements include:
- recognition of the risks
- commitment to introducing precautions to reduce that risk
- a statement of clear roles and responsibilities
- an explanation of what is expected from individual employees
- arrangements for training and providing or maintaining equipment
- arrangements for monitoring compliance
- a commitment to supporting people who have been injured in connection with their work
Employers must reduce the risk of injury to staff and people using care services by:
- avoiding those manual handling tasks that could result in injury, where reasonably practicable
- assessing the risks from moving and handling that cannot be avoided
- putting measures in place to reduce the risk, where reasonably practicable
Employees must:
- follow appropriate systems of work and use the equipment provided
- co-operate with their employer and let them know of any problems
- take reasonable care to ensure their actions do not put themselves or others at risk
Do I need a manual handling policy?
Health and social care providers carrying out a wide variety of moving and handling activities may need to develop a moving and handling policy.
Key elements should include:
- a statement of the organisation's commitment to managing the risks associated with moving and handling people and loads
- details of who is responsible for doing what
- details of your risk assessment and action planning processes
- a commitment to introduce measures to reduce the risk
- arrangements for training
- arrangements for providing and maintaining handling equipment
- details of your systems for monitoring compliance with the policy and for regular review
- information for staff on reporting pain and injuries
Carrying out a risk assessment
Moving and handling risk assessments help identify where injuries could occur and what to do to prevent them. It should be possible to complete the majority of assessments in-house as no-one knows your business better. The person carrying out the assessments must be competent to identify and address the risks from the most complex handling activities you undertake. This usually requires specific training.
Identifying the risk
Activities that may increase the risk include, for example:
- assisting in person transfers
- aiding treatment
- assisting in carrying out daily activities (such as bathing) with individuals who will have specific needs
Assessments, care needs, competence and equipment provision are some of the factors that need to be addressed but handling people is not the only risk. Ancillary staff, porters, maintenance and support staff may also be expected to undertake handling activities which put them at risk and their activities will also need assessment and controls to manage the risk.
Some staff may have to adopt and hold awkward postures as part of their work, for example, nursing staff, sonographers and theatre staff. Stresses and strains arising from adopting awkward or static postures when caring for and treating people need to be addressed.
Two types of risk assessment are usually needed:
- Generic assessments to consider the overall needs of the setting, looking at:
- the type and frequency of moving and handling tasks
- overall equipment needs
- staffing
- the environment
- what moving and handling would be required in emergencies such as fire evacuations or residents' falls
- Individual assessments which consider the specific moving and handling needs of care service users and form part of the care planning process
Generic risk assessments
Care providers should balance the safety of employees with the needs, safety and rights of the people using care services. Manual handling policies and practice should not place unreasonable restrictions on residents' rights to autonomy, privacy or dignity.
Risk assessment should be part of a wider needs assessment process to achieve the best outcome. Health and safety issues will then be identified and built into the complete care package.
Individual risk assessments
The assessment should be person-centred and, where possible, involve the service user or their family in decisions about how their needs are met. This can reassure them about the safety and comfort of the equipment, and how it and the methods used will ensure their safety and the safety of staff.
Record the risk assessment and care plan. Include detail on the individual's moving and handling needs, day and night, specifying:
- what the user of the care service is able/unable to do independently
- the extent of the individual's ability to support their own weight and any other relevant factors, for example pain, disability, spasm, fatigue, tissue viability or tendency to fall
- the extent to which the individual can participate in/co-operate with transfers
- whether the individual needs assistance to reposition themselves/sit up when in their bed/chair and how this will be achieved, eg provision of an electric profiling bed
- the specific equipment needed – including bariatric where necessary – and, if applicable, type of bed, bath and chair, as well as specific handling equipment, type of hoist and sling; sling size and attachments
- the assistance needed for different types of transfer, including the number of staff needed – although hoists can be operated by one person, hoisting tasks often require two staff to ensure safe transfer
- the arrangements for reducing the risk and for dealing with falls, if the individual is at risk
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.
An example of a person-based manual handling risk assessment can be found in the All Wales NHS manual handling passport scheme and Scotland NHS manual handling passport scheme.
An individual's needs and abilities can change over the course of a day. Staff should understand the impact this may have on moving and handling practices.
Individuals may become upset or agitated when being moved. Others, though willing to assist at the start of a manoeuvre, may find themselves unable to continue.
Training may prevent injury arising in such circumstances. A natural reaction, while helping with walking, for example, is to try to prevent a fall. Injuries have occurred to both staff and the service user in such circumstances. Properly positioned, the helper may prevent a fall or allow a controlled slide. Having made the individual comfortable, they can determine how to move them safely – often with a mechanical aid.
Specialist advice on how to help some users with specific moving and handling needs will also be useful. Sources of advice include:
- occupational therapists
- physiotherapists
- manual handling advisers
- ergonomists with experience in health and social care
- professional bodies
- organisations such as the National Back Exchange or Chartered Society for Physiotherapists
It is a legal requirement to record the findings of your risk assessment if you have five or more staff. However, it is good practice to keep a record of risk assessments to help you manage the risks. You must communicate the findings of your assessment to all relevant staff.
Monitoring and review
Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current.
There should also be arrangements in place to ensure that moving and handling activities are monitored to ensure that correct procedures, techniques and equipment are being used.
Summary checklist: Carrying out a moving and handling risk assessment
- Ensure that your assessor is suitably trained and competent
- Carry out a moving and handling assessment:
- to include consideration of the person's needs and ability, task, load and environment
- Identify what is needed to reduce the risk for all the tasks identified:
- to include appropriate techniques and training, equipment and accessories required for each task, number of staff needed etc
- Record the assessment and controls necessary in the person's individual care plan:
- to include details of the task, techniques to be used, equipment type and size, number of staff and any other relevant information
- Review the handling assessment periodically, and when the person's needs change
- Ensure you have arrangements to monitor handling activities:
- to help make sure correct safe techniques and equipment are used
- Review your procedures to ensure that suitable arrangements are in place:
- to include competence of staff, equipment provision and management arrangements