Community equipment and housing adaptations: draft guidance

Health & safety

The Health and Safety at Work etc. Act 1974 requires employers to ensure the health safety and welfare of all their employees, so far as is reasonably practicable.

It is therefore important to clarify that the liability and responsibility for ensuring adherence with health & safety legislation sits with the employers of staff using equipment, and not with the Store service provider who procures and delivers the equipment. Store services will, as part of their wider service, provide repairs, maintenance, and health and safety testing as directed by the partners, who fund the Store service arrangements. The Store service is therefore responsible for carrying out testing arrangements as agreed with the partners. It is therefore incumbent upon the partners to ensure they have funded and resourced, and clearly directed their Store service provider on the requirements to be met.

The general provisions in the 1974 Act are reinforced by Regulations which define in more detail what duty holders must do in particular areas.

Since 1993 the Manual Handling Operations Regulation 1992 have provided a general framework for tackling handling activities at work. The regulations require the following approach:

• To avoid the manual handling activities where it is reasonably practicable to do so; and, where it is not,
• To assess the risk and take appropriate steps to reduce it so far as is reasonably practicable.

The above regulation is not restricted to the lifting and moving of objects, but also covers 'helping people' tasks such as helping a disabled child out of bed or helping an elderly person go upstairs.

Risk Assessment

As an employer, the service provider or the employing agency has primary responsibility for ensuring the health and safety of their care workers and managing the risks associated with their work duties.

Mobility assistance considerations will be a significant factor in determining the overall cost of delivering any care package to the service user. Health and safety risk management must, therefore, form an integral part of the care assessment, so that the hazards are identified and dealt with before the care worker and the service user are put at risk.

This should be considered, while ensuring an enablement, rehabilitative approach to the shared care and support plan. The Moving and handling section earlier in this document highlighted the need to avoid blanket approaches to the management of risk and our services need to avoid inadvertently disabling people and impacting on their well-being, by over-prescribing equipment and adaptation provision.

Training

Training is an essential part of a proper risk management, based on sound risk assessment. When providing mobility assistance to a service user it is not always possible to avoid manual handling tasks, even when support equipment is available.

• It is essential, therefore, that all care workers (including unpaid carers) are suitably trained in safer handling techniques.
• It is the responsibility of the employing agency to provide appropriate Moving and Handling training for their staff.
• When services are assessing and providing equipment to be used by an unpaid carer they should be referring the carer, for support with accessing moving & handling training – this may be via their local Carer's project team.

Using equipment safely

Service users and care workers can be injured if equipment is used inappropriately, or is not properly maintained. Service providers, or employing agencies must ensure that the equipment is in good working order, and that all care workers are aware of and understand the appropriate application and limitations of the different pieces of equipment they are expected to use.

• Good practice advises that a visual inspection of equipment should take place by the workers, before they use the equipment, to ensure all parts are in working order. This is considered vital in the overall maintenance and safe-use of equipment.

Responsibility for maintenance of equipment

Equipment provided for use by care workers:

If the health and social care service provider supplies equipment such as a stair lift, or hoist, intended for use by care workers while attending to the service user, then the equipment may be considered 'work equipment'. In these circumstances, the Provision and Use of Work Equipment Regulations 1998 (PUWER) will apply. Depending on the type of equipment, the Lifting Operation and Lifting Equipment Regulations 1998 (LOLER) may also apply, i.e. if the principle function of the equipment is lifting. For example, LOLER will not apply to electrical profiling beds but it will apply to hoists, as their principle function is lifting persons.

• These regulations require the employer of the staff using the equipment, to ensure that equipment and adaptations are maintained and inspected as part of a servicing programme.
• In addition to routine maintenance and servicing, LOLER requires lifting equipment to be inspected and thoroughly examined. Thorough examination by a 'competent person' is required either at six-monthly intervals or in accordance with a written scheme of examination drawn up by a 'competent person'. A competent person is someone with the relevant technical knowledge and practical experience of lifting equipment to enable them to detect defects or weaknesses and to assess their importance in relation to the safety and continued use of the specific equipment being examined.
• It is therefore the responsibility of the partners to work with their community equipment Store service and adaptation service providers to agree and ensure appropriate inspection and service maintenance arrangements are in place for all relevant products.
• In most cases, Store services sub-contract this work to ensure this is kept separate from routine maintenance and repairs. It is essential that Store service keep accurate records detailing the testing schedules, and review these to ensure adherence with the timescales recommended in the regulations.

Equipment provided for use by the family and unpaid carer:

If the equipment is not intended for use by people at work, then PUWER/LOLER regulations will not apply. However, the equipment provider has responsibility under the general provisions of the Health and Safety at Work etc. Act 1974, to ensure that it is safe for the service user and others to use. Although the PUWER/LOLER regulations may not apply, their provisions can be used as a guide to establish proper maintenance arrangements. It is important that all parties involved are clear at the outset who will carry out the necessary maintenance. Partners and their Store service provider should ensure they have clarified what arrangements they wish to have in place as standard maintenance arrangements for all relevant equipment.

Equipment provided by the service user:

Service users have no duties under health and safety legislation to maintain their own equipment. However, the position is complicated where a formal carer is employed directly, for instance where the service user funds their care through self-directed support arrangements. In these circumstances, service users may have duties under health and safety legislation. The Scottish Government fund a number of independent agencies across the country which are facilitated by Inspiring Scotland to assist people to access and manage their self-directed support.

Health and social care service providers have no powers under health and safety legislation to compel service users to have their own equipment maintained. However, as an employer, the service provider is still responsible for ensuring their care workers' safety. It is up to the service provider to assess whether any equipment provided by the service user is suitable for their care workers to use, to discuss with the service user any changes which may need to be considered, and if the equipment is to be used by people at work, to ensure that any applicable maintenance and inspection legal requirements of PUWER and LOLER are complied with.

In these circumstances the HSE would expect a competent person, trained in risk assessment, to make the initial risk assessment of the tasks associated with delivering the care, including the use of the equipment, and to record the significant findings. This is in addition to the day to day need for formal carers (who have had sufficient and appropriate training) to make an assessment of a task before undertaking it.

Assessing equipment owned by the service user:

In some cases, service users may have a service agreement with an equipment supplier, particularly for major items of equipment, such as stair lift or mobile hoists. Where these arrangements provide evidence that the equipment is properly maintained and the service provider is satisfied that it is safe for their care worker to use, then it can be incorporated into the care plan. However, it will be necessary to confirm periodically that the service contact continues to operate and the necessary checks have been carried out regularly.

In the absence of such service agreements, the service provider will need to take other measures to ensure the safety of their care workers. This may be by taking over, with the service user's agreement, the equipment maintenance arrangements or instructing the care worker not to use the equipment.

Reporting Adverse Incidents to IRIC

The Incident Reporting & Investigation Centre (IRIC), which is part of Health Facilities Scotland (HFS), receives adverse incident reports from NHS Boards and local authorities. It is responsible for coordinating, investigations so that, as far as possible, root causes can be established and remedial action taken to prevent or reduce any identified risks.

• Partnerships should have clear arrangements in place which identify the roles and responsibilities of all stakeholders, in the event of an incident. These arrangements should ensure a thorough investigation which confirms whether potential equipment failure, or user error has caused the incident. This should clarify the role of the person reporting the incident, the role of the member of staff who originally assessed the provision of the equipment, their line manager/service, the role of the Store service in investigating any suspected failure of the equipment, with the manufacturer, and for notifying IRIC.

Details on how to report an adverse incident is available on NHS Scotland's Incidents and Alerts site.

Member of the public can also report adverse incidents through the Yellow Card Scheme.

Medical Device Alerts

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for the regulation of medical devices throughout the UK and for issuing Medical Device Alerts (MDAs).

A new Electronic Medical Device Alerts (eMDA) format has been used by MHRA since April 2009 and applies throughout the whole of the UK. It is a web based system with various information sections which include sections for each devolved administration so that relevant information may be selected for cascading within each organisation

As soon as a new alert is published HFS will notify all Equipment Coordinators in Scotland by email, as detailed in the Safety Of Health, Social Care, Estates and Facilities Equipment: NHS Board and Local Authority Responsibilities guidance.

In the case of an eMDA the email will contain a summary page and a link to the MHRA website. It is the responsibility of each Equipment Coordinator to determine if each alert is relevant to their organisation and to download it for onward distribution and action. In most cases, the Store service manager will circulate relevant alerts and identify appropriate action for the service and communicate this to partners e.g. this may involve the removal of a stock product.

The latest MDAs can be found on the HFS site on the NHS Health Facilities Scotland website.

Key Actions

• Partnerships should follow the Manual Handling Operations Regulation 1992 which provides a general framework for tackling handling activities at work.
• Health and safety risk management must form an integral part of the care assessment.
• All care workers (including unpaid carers) must be suitably trained in safer handling techniques. It is the responsibility of the employing agency to provide appropriate training for their staff and the assessor/care manager should refer the unpaid carer to relevant support for moving and handling training.
• Care service providers, or employing agencies must ensure that the equipment is in good working order, and that all care workers are aware of and understand the appropriate application and limitations equipment.
• Partners and their Store service provider should ensure they have clarified what arrangements they wish to have in place as standard maintenance arrangements for all relevant equipment. It is then the store services responsibility to ensure robust servicing and maintenance arrangements are in place.
• Partnerships should have clear arrangements in place which identify the roles and responsibilities of all stakeholders, in the event of an incident, including reporting to IRIC.
• Store services should have arrangements in place for the circulation of relevant MHRA alerts, and appropriate responses to the alert.