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Tuesday 27 September 2016
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Lone working - perils and protection

Quality Matters

Jane Bonehill
TechSP RDN LicCIPD
DenMed Training and Consultancy
Shirley, Solihull, W Midlands
E jab@denmed-uk.com

Jane Bonehill is an IOSH Technician Safety Practitioner (TechSP). The Institution of Occupational Safety and Health (IOSH) is Europe's leading body for Health and Safety professionals. Jane holds office on a range of Health and Safety advisory committees, has produced a series of Health and Safety advice sheets and takes part in the European Week for Safety and Health at Work; and she is a Licentiate Member of the Chartered Institute of Personnel and Development (CIPD). Jane recognises that behaviours affect Health and Safety, and that training is one approach to changing behaviours. She works with PCTs and general practices around the UK, giving presentations, delivering certificated training courses and providing consultancy to assist PHCTs in managing Health and Safety

The NHS definition of "working alone" (see Resource) refers to people who work by themselves without close or direct supervision. Employers are required to manage the additional Health and Safety risks that lone workers may be exposed to, just as they manage risks for all other employees.

Who are "lone workers"?
Potentially anybody who is employed, self-employed or contracted by the practice, including:

  • GPs.
  • Health visitors.
  • Practice nurses.
  • Practice managers.
  • Receptionists.
  • Cleaners.
  • Administrative personnel.
  • People who work from home.
  • People working outside normal hours.

Often people work away from the practice, such as when carrying out home visits, or when members of staff sometimes work from home. In addition, staff may be in the practice alone at specific times of the day. When defining who are classed as lone workers, it is important to differentiate between people whose work activities are intended to be carried out without close supervision and those who may find themselves alone. However, it is good practice to consider the safety of all persons who are working alone, whether it is planned or not.

Legal requirements
The law does not prohibit working alone except where specific legislation states that the hazards are too great for people to work unaccompanied. The specific legislation does not relate to general practice. However, general duties for lone workers exist under the following:

  • Health and Safety at Work etc Act 1974.
  • Management of Health and Safety at Work Regulations 1999.
  • First Aid at Work Regulations 1981.

The responsibilities of employers to ensure the safety of lone workers are no different from those of employees who are closely supervised. Employers need to consider the specific hazards lone workers are exposed to and the risks involved.
 
Self-employed lone workers must identify the hazards and risks to themselves.

Risk assessment
There is a general duty to carry out risk assessment for lone workers. This involves identifying hazards associated with the work: considering the risk factors, assessing the level of risk and determining safety measures aimed at removing or controlling the risk.

Potential hazards to lone workers

  • Physical violence/assault.
  • Verbal or threatening behaviour.
  • Theft.
  • Criminal damage to equipment/vehicles.
  • Unintentional damage to equipment.
  • Working in domestic/home premises.
  • Environmental.
  • Ergonomic/workspace.
  • Manual handling.
  • Household pets.
  • Communication systems.
  • Road traffic.
  • Medical history of lone worker.
  • Remoteness of "work place".
  • Access and egress.
  • Emergency procedures.
  • Supervision.
  • Working time.

Factors to consider when assessing risks
A range of factors should be considered to determine how the lone worker might be at risk and to what extent:

  • Can one person working alone carry out the activity safely?
  • Does the work involve going into known "high-risk" locations
  • How often is work equipment transported, and how may damage occur?
  • Is equipment awkward to handle, or does it appear "heavy"?

Risks in working in patients' homes

  • Is the lone worker a frequent driver and familiar with a range of driving situations?
  • Is the vehicle well maintained and serviced regularly?
  • Do members of the patient's family pose a risk of violence or threatening behaviour?
  • Is lighting sufficient to work safely?
  • Is there sufficient space for the worker and any necessary equipment?
  • Are the premises structurally sound, and if using electrical equipment do installations appear safe?
  • Are there any household pets, and do they present a danger?
  • Is the home in a remote area to which access is difficult (ie, rural areas)?
  • How may the work/treatment endanger others in the patient's home?
  • In an emergency situation, is there safe evacuation from the building?

Some of these factors will also relate to staff working from their own home.

Risks in working from home

  • If the worker was ill or had an accident, how would the employer know?
  • Does the worker take regular breaks?
  • How does the employer maintain contact with the worker?
  • How is the worker supervised in order to monitor any safety issues?
  • Does the work activity affect members of the worker's family?

Risks in working alone in the practice

  • Is the practice open to the public?
  • Are valuables/money exchanged or held on the premises?
  • Does anyone know the person is alone?
  • What type of work is being undertaken, and does it pose a significant risk?
  • In the event of an emergency how will anyone know?
  • Does the lone worker have an emotional or physical medical condition that would make it unsafe to work alone?

The above factors provide a range of examples, but it is not an exhaustive list and you may want to consider others.

Safety measures
The aim of determining appropriate safety measures is to control the risks that the lone worker may be exposed to and ultimately protect that person from harm. There are a number of steps that can be taken, depending on the range of risk factors present. Risk controls may include:

  • Define what can and cannot be done by staff working alone.
  • Provide information to the lone worker on the risks to which they are being exposed; ensure they fully understand the risks and the safe procedures to follow.
  • Assess the lone worker's medical history and decide whether the person is fit to work alone.

Safety during home visits

  • Identify known "high-risk" areas and carry out home visits to those areas only within daylight hours.
  • Identify patients or their family members who are potentially violent and whether animals are present.
  • Write to patients asking that animals are kept under control.
  • Carry out manual handling assessments; provide information, instruction and training on safe handling techniques.
  • Separate "heavy" loads or provide mechanical assistance.
  • Substitute awkward/heavy equipment with items that are safer to handle.
  • Place equipment out of sight (eg, in boot of car).
  • Keep a "home visit recording log" in the practice for each staff member (eg, time left practice, name and address of patient, purpose of visit) and report any changes to the practice.
  • Have an effective (ie, working) communication system, such as:
  • Mobile phone.
  • Personal alarm.
  • Automatic tracking device (although individuals and unions may take issue with use of such devices).
  • Telephone or text the practice when arriving at and leaving the visit.
  • Telephone or text the lone worker periodically to monitor their safety.
  • Provide first-aid travel kits.
  • Inform staff that, if they are in any doubt about their safety, work must stop.

Safety alone in the practice

  • Identify significant hazards and risks to lone workers and prohibit manual
  • handling activities or restrict access to the public.
  • Ensure someone else knows the person is alone.
  • Ensure the worker telephones, texts or emails someone at arranged times and when leaving the premises.
  • Fit a panic alarm that is connected to a manned point.
  • Provide personal alarms.
  • Ensure external areas are well lit.
  • If leaving by car, park in well-lit areas.

Safety when working from home

  • Carry out a risk assessment on the equipment that is used.
  • Ensure work equipment is regularly serviced and maintained.
  • Monitor work activities by visiting to ensure breaks are being taken.
  • Communicate at arranged times by telephone, text or email.
  • Devise a "home working" policy that includes safe working limits and what to do in an emergency.
  • Provide first-aid kits.
  • Determine whether it is suitable for the person to work from home and consider how it may affect others in the home.

In summary
Employers have a duty to ensure the health, safety and welfare of employees while they are at work. This responsibility is the same for lone workers as for any other member of staff. In this article we have considered some of the additional hazards and risks involved in lone working. We have also looked at possible ways of reducing the risks by implementing appropriate safety measures.

What to do now …?

  • Carry out a "lone working" risk assessment.
  • Identify who are classed as lone workers.
  • Consider specific factors associated with lone working.
  • Control the activities by implementing safety measures.

If any doubt exists about the safety of lone workers after the risk assessment has been carried out, then the activity should be prohibited.

Resource
For the NHS downloadable guidelines on lone working see:
www.cfsms.nhs.uk