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Wednesday 28 September 2016
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Meeting Health and Safety requirements: how safe is your practice?

Quality Matters

Wendy Garcarz
MA DipEd DipTM
Train 4 Health Ltd
Birmingham
E wendy@train4health.co.uk

Wendy is Sales Director of Train 4 Health Ltd, a Statutory & Mandatory e-learning and testing system designed specifically for the NHS and social care. She is an organisational development specialist and architect of learning organisations and has authored several books and publications including:

  • Make Your Healthcare Organisation a Learning Organisation. Radcliffe Medical Press; 2003.
  • Statutory & Mandatory Training in Health & Social Care. Radcliffe Medical Press; 2005.

For further details visit: www.train4health.co.uk

The National Audit Office (NAO) gathered data on accidents in 30 NHS Trusts over an eight-week period and identified an average of greater than 1,000 accidents a week, including needlestick injuries, manual handling incidents, slips, trips, falls, and patient violence and aggression.(1)

No such study has been undertaken in general practice, and therefore it is more difficult to assess the scale of the problem. However, there are parallels to be drawn with other aspects of organisational maturity: for example, the comparison of standards of policies and procedures between NHS Trusts and general practices would suggest that large established Trusts have more robust measures in place. If that is the case then the true risk of accident in a general practice setting could be significant.

A key challenge for general practice, therefore, is to ensure that the workforce is legally compliant in Health & Safety training and that they can produce evidence of annual maintenance. The implications for not doing this are significant and could result in fines from the Health & Safety Executive.

It is significant that "when a successful prosecution was bought by the Health & Safety Executive against Swindon & Marlborough NHS Trust it was not the result of a negligence or accident claim but as a result of a routine visit by Health & Safety Inspectors".(2)
 
The Quality and Outcomes Framework (QOF) has gone some way to focusing on the issue of systematic approach and policies for Health & Safety, but practice managers are often left with the problem of maintaining the legal compliance of their staff with little or no ringfenced training monies.

Health & Safety in general practice
It is precisely this that makes general practices vulnerable, as they have limited resources and smaller staff numbers dealing with a high patient/public flow through their premises. It is vitally important that they provide a range of training, to ensure that their workforce has the correct level of knowledge and skills to operate safely, and also to make sure that a safe and healthy working environment is maintained. It is their legal responsibility, but injecting any creativity or flair into the process is challenging.
 
Many practices are turning their attention to e-learning packages to help them meet this challenge. E-learning can be a very cost-effective way of ensuring compliance, particularly if the system used includes competence testing.

Although there is legislation ensuring that statutory training is identified, practices should establish their own minimum standards for safe practice, tailored to their business demands and requirements.

By publishing their mandatory training requirements, they are establishing the standard that offers clarity for the workforce and ensures consistency and quality in their provision of statutory and mandatory training. This also acts as evidence of a robust system for the QOF process.

It may be useful to revisit the basic statutory training requirements for independent contractors that they are legally bound to deliver for their whole workforce:

  • Familiarisation with the Health & Safety regulations and measures taken by the practice to create and maintain a safe work environment (usually given when an employee first starts work at the practice; generally forms part of the induction programme).
  • Nominated first-aiders for practices employing more than five members of staff (ratio is one first-aider for 25 employees), requiring certification renewal every three years.
  • Annual fire safety training to ensure that prevention and evacuation procedures are understood and adhered to, with regular alarm tests and fire drills (with nominated fire marshals to conduct safe evacuation of premises).

In addition to the basic Health & Safety training, the following topics should be covered in an induction programme:

  • Confidentiality and patient consent.
  • The data security act.
  • Fraud and whistleblowing.
  • Practice policies and codes of practice.

It is issues related to the basic elements of Health & Safety that often cause confusion. Electrical safety can seem an onerous task, but the facts are simple:

  • Regular electrical equipment testing means every one to two years, although general inspections should be carried out monthly if the equipment is used or moved frequently.
  • The visual inspection can be done by a competent staff member with some basic training, although electrical testing may require more specialist knowledge/skills.
  • All equipment should be unplugged for general inspections.
  • Any equipment that has a plug must be included in the testing cycle (eg, kettles, heaters, fans, televisions, computers, photocopiers, fax machines, sterilising equipment/autoclaves).
  • The visual check should cover the condition of the plug, cable and outer covering of the appliance. Breakages, taped joints, cracks or scorch marks need to be responded to immediately.
  • No bare wires, loose cables or overloaded plug sockets or boards should go untreated.
  • Checking fuses are the correct amp for the appliance and are fitted securely.
  • Appliances that do not require testing include battery-operated or extra-low-voltage equipment (eg, telephones).

Manual equipment also requires regular checks and maintenance with weighing scales and sphygmometers calibrated for accuracy. The manufacturer can often
advise on the best methods for doing this.

Keeping track of the processes that practices have put in place to provide a healthy and safe working environment does not need to be complex. Practices should record what is done and how it is monitored (frequency, action taken, etc), and those records should be kept on a simple spreadsheet. This means that if the practice has a visit from the Health & Safety Executive, information is easy to retrieve. Occasionally, review your monitoring process and procedures to ensure that they are still fit for purpose.

It also makes sense to create a training budget in your annual business plan to ensure that reasonable resources are secured for this important area of governance for general practice.

References

  1. National Audit Office. Health & Safety in NHS Hospital Trusts in England. 1997.
  2. James P, Kyprinou A. Health & Safety in the NHS. Available from: http://www.mubs.mdx.ac.uk/research/discussionpapers