The need for safer people handling

No matter whether in primary care, acute care, care of the elderly or any another sector, how people are moved and handled is vital in promoting recovery, maintaining independence and providing a feeling of wellbeing. To be treated with dignity and respect during the handling process is a basic human right, as well as being a legal requirement.

The vast majority of people employed in the care sector show more concern for those they care for than they do for themselves. They often put themselves at risk for the good of their service users.

Musculoskeletal strain or injury accounts for more days off work than all other causes put together. Across all sectors, at least 120 million such days – and many more hours – are lost every year because of it. The most up-to-date figures show that musculoskeletal disorders (MSDs) cost society around £5.7billion each year.

About one third of all accidents reported to the Health and Safety Executive involve manual handling. In the health services, manual handling injuries account for 40 per cent of sickness absence, and there are more than 5,000 manual handling injuries reported each year in this industry. Approximately half of these happen during the handling of patients.

New challenges
According to figures from the NHS, in 2008 nearly a quarter of all adults (those aged over 16 years) in England were obese (had a BMI of over 30). One in seven children (aged two to 15 years) were obese.

The obese population in the UK is growing, and this group is over-represented in the use of health and social care services. The Foresight report, used to guide government policy, has predicted that by 2025 nearly half of men and more than a third of women will be obese.

This situation has serious implications for those working in the health and social care sector whose job it is to help move and handle their patients and clients.

A study commissioned by the Health and Safety Executive (HSE) found that 40-70 per cent of NHS Trusts did not have a bariatric policy. The implementation of such a policy is a vital first step to identifying and managing the risks involved with moving and handling bariatric patients and was recommended by the report.

Operational policies enable workers to plan for, assess and manage the manual handling risks for the care of bariatric and disabled patients.

The report also recommended that buildings and vehicles must be designed to accommodate bariatric patients in safety, comfort and dignity. Coverage in the media recently shows that steps have already been taken, with ambulances being specially-made to accommodate these patients. Similarly, moving and handling equipment must be designed to fit a range of bariatric shapes and sizes.

Training in safer people handling now includes information supporting the assessment of bariatric patients, and also of disabled patients, incorporating the use of specialist manual handling and clinical equipment.

Safer people handling falls within the wider sphere of an organisation’s health and safety management system and the importance of maintaining good health and safety performance cannot be overstated, particularly during tough economic times. When businesses and organisations in all sectors are having to make tough spending choices, the last thing they can afford is an accident or incident of ill health.

Approaches to people handling
Adapting existing policies to include the moving and handling of bariatric patients should not entail too much extra work, as all patients should be attended to according to their individual needs. A risk assessment for each case should take into account a patient’s individual circumstances, for example their physical condition and/or the medication they are taking.

When it comes to handling people safely, many approaches or models exist, including biomechanical, neuromuscular, neuro-developmental and haptonomic. All have something positive to offer and can be appropriate in the right circumstances. Approaches can also be adapted for bariatric patients or those who are disabled.

Recent research carried out by the Institute of Occupational Medicine (IOM) reviewed the array of existing models and found that while they each had their own specific techniques, all were founded on the same principles.

The Manual Handling Operations Regulations (MHOR) 1992 (amended in 2002) recognise that lifting and handling loads can cause MSDs, and they set out steps for reducing the risk.

Until fairly recently, training staff in traditional manual handling practices was generally seen as the best way of preventing back injury. However, this has not been as successful as hoped; injury rates remain extremely high in the health and social care sectors.

Training remains extremely important, but practitioners and professionals have begun to realise that an holistic approach to people handling and effective risk management is key. Some ways of minimising risk are: avoid lifting patients manually; encourage patients to assist in their own transfers; and thoroughly evaluate equipment and furniture before it is purchased.

HUMAN BEHAVIOUR
Haptonomy is a relatively recent social science based on human behaviour and feelings. By applying these principles to the safe moving of people, carers will be adopting an holistic approach, developed to reduce the risk of physical injury to those assisting in the movement of others, and designed to afford the patient or client dignity and as much autonomy as possible.

The tasks in the field of health and social care (one handed lifts, kneeling, having to bend over etc) and the environmental constraints (people trapped in vehicles or in confined spaces with difficult access etc) plus the possible unwillingness or inability of the person concerned tends to conspire to make the lifter disregard manual handling training.

People tend to take the easier and most natural option; if manual handling guidance doesn’t suit the task in hand, people will not follow it. It is vital for staff to understand how to minimise the risk to their backs and advisable for residential homes and authorities to purchase appropriate handling aids.

Moreover, the assessment of care workers’ health and safety must be go hand in hand with patients’ needs, and there is now more of a focus on an holistic approach to people handling. There can be conflict between protecting staff and preserving the independence and dignity of patients, for instance, some residents find hoists dehumanising. This is particularly pertinent when it comes to bariatric or disabled patients.

There is a need for joined up thinking between the various caring agencies, not only in training and selection of equipment but in how the use of handling aids should be negotiated between agencies and clients.

Bariatric and disabled patients will often require bigger or more specialised equipment, so it is important to involve staff in the purchase of lifting and handling aids. Too often, equipment is acquired that is not fit for purpose. A proper risk assessment should be carried out to ensure that all equipment purchased is suitable for the task for which it will be used.

Managing the risks
At the Royal Society for the Prevention of Accidents (RoSPA) we have long argued that there are not just obvious legal and moral reasons for effectively managing health and safety, it also makes good business sense. Recent prosecutions, for example, have resulted in some sizeable financial penalties. We also know that court proceedings can severely damage the reputation of both public and private sector organisations.

During difficult economic times, tough judgement calls about where to direct resources have to be made. It makes good economic sense to ensure that staff receive the training they need most. Money spent now can save an awful lot of cost later on.

RoSPA offers a five-day people handling course which uses the Welsh Passport Scheme as the model for the techniques taught. The IOM’s model of the principles to be applied is taught in the course, and it references recognised literature such as ‘The Guide to the Handling of Patients’ by Back Care. This new sixth edition contains a section dedicated to bariatric patients and focuses on evidence-based practice.

These ‘train the trainer’ courses are exceptional value for money. Not only do delegates leave the course with the skills and knowledge necessary to do their jobs to a very high standard, they are also able to deliver awareness training back in the workplace, stretching training budgets and minimising staff down-time.

It is vital that suitable and sufficient risk assessments are carried out in health and social care settings wherever people handling activities take place. The implementation of suitable risk controls at ward, department or home level, for people and objects, will help to ensure that the safety and health of service-user and carer are safeguarded.

The effective management of risk is central to providing a safe work environment, wherever that may be, and a risk assessment course based on the specific requirements of the health and social care sectors is the ideal way to start managing those risks.

Other specialist courses can be taken, enabling those working in the health and social care sector to improve their skills in other areas, for example, in the use of hoists and other handling aids. The specialist equipment available is no use to anyone if staff are not trained to use it safely and comfortably.

Courses based on haptonomic principles are now easily available, ensuring that an holistic approach to care is sought and implemented.

RoSPA’s approach to people handling is principles led; a flexible approach suitable for all care sectors and one that is focused on the person, taking into account their individual needs and circumstances. A blend of the best of the different approaches mentioned above is used, enabling delegates to solve problems themselves and develop their abilities.

The benefits to both carer and service user can be almost immediate with this flexible, leading-edge approach.

FOR MORE INFORMATION
For more information on RoSPA’s safer people handling course, visit our website at www.rospa.com/occupationalsafety/training/saferpeoplehandling/ or call on 0121 248 2233.