Health and Safety in the Health and Social Care Workplace

INTRODUCTION (300 words)

This essay will look at three different learning outcomes, each using a specific case study for illustration. The first part will focus on the issues relating to health and safety legislation and how these are implemented in the work place.
The Health and Safety can trace its origin back to the year 1833 when The Factories Act led to the creation of the first factory inspectors and whose role was initially tasked with only preventing injury amongst child workers (Jarvis, 2011). This has significantly developed, since then, into a ‘must-have’ policy at work places not just here in the UK but throughout the European Unions (EU). The case of North Staffordshire combined NHS Trust (NSC) which will be discussed in some detail is living proof that Health and Safety, if managed effectively, could lead to better outcomes for all stakeholders.
The second part of this essay will focus on the practicalities and the implementation mechanism of Health and Safety at work or lack thereof and the consequences that an organisation which transgresses may suffer for non-compliance as seen in the case of South Birmingham Primary Care Trust. To this end, issues such as lifting and handling heavy loads as well as other dilemma faced by organisations in relation to health and safety will be explored with a view to grasping the implications not only at individual levels but also at corporate level.
The final part of this essay will attempt to show how Health and Safety at work can be reviewed in light of risk assessment which should be taking place as per prescribed organisation policies and procedures. The discussion will revolve around three main areas including Monitoring and Review, Promotion of Positive Health and Social Care culture and my own contribution towards personal development

LO 1.1
Health and Safety is extremely important not only at work place but at home too. This is due to the risk of injury to health and at worst death that may occur if important steps and care are not followed for instance when it comes to handing heavy loads, lifting, scaffolding, etc.
In a health and social care setting, health and safety becomes even crucial due to the fact that service users being dealt with are vulnerable and susceptible to potentially life-threating injuries. According to lecture notes (HSJAN14), three approved methods of communicating in health and social care exist which include verbal, written and graphic. This has some relevance to the new director of NSC who will need to implement systems, policies and procedures in order to meet the new improvement targets set out by the board. In relations to systems, the new director ensure that there are effective communication mechanism within the organisation which must lead to full compliance with legislation at all times. For example, training should be provided to new recruits and this should come from automated communication streams directly onto the recruits’ line manager to prompt them to book a health and safety course for their trainees. On the issue of policies and procedures, the new director of NSC should ensure that health and safety are communicated using written and graphic methods. This owes to the fact that it can be referred to easily in case of disciplinary procedures against employees who do not follow company policies and procedures. However, this should not be seen as a mere tool to coerce employees as it could demotivate them. Instead, graphic design posted on the wall should steer employees towards following correct procedures. It can be seen that NSC has already had positive results evidenced by the reduction in incidents and premiums by 16% and 10% respectively over two years. Given that the board has adopted a culture whereby employees are encouraged to report incidents, this should lead to a greater number of health and safety investigations. The benefits of this being the chance of finding out problem areas as early as possible and also the ability to risk-assess, for example, ‘high probability’/’high impact’ incidents which could be catastrophic to the organisation and, hence, proactively respond by putting safeguards in place.

LO 1.2 The management of Health and Safety within an organisation should be given the utmost importance. This is due to the fact that Health and Safety at work is a statutory requirement and failure to follow may result in heavy penalties. In the case of NSC, It is therefore crucial to assess the implication of non-compliance in the context of patient safety and the law bearing in mind that whilst responsibility can be delegated, accountability cannot. Looking at the hierarchy at NSC, the board would be overall accountable to any health and safety breaches and the health and safety of all that are owed duty of care. The chief executive who is responsible for running NSC should ensure that the director responsible for health and safety implements the ‘Whole System’ approach which the board wishes to see. Progress should then be reported to the chief executive who will report to the board. Once everyone at the board and director level is clear on health and safety priorities, which in the case of NSC is to have an integrated health and safety system which will make easier for NSC employees to report issues, senior managers should appoint health and safety manager to oversee the dissemination of health and safety information, training, instruction, and supervision. The health and safety manager should then appoint a health and safety representative in each department. For example in maternity, orthopaedic, sexual health departments, etc. should all have a health and safety representative who be the first point of contact and who will be responsible for feeding the information into the new health and safety integrated system. Now the last group on the hierarchy is that of employees. Employees must take good care of themselves, not to put themselves or other employees or services users in danger. They are also supposed to take part in health and safety trainings. LO1.3 Having looked at the structure and the responsibilities within NSC, we now turn our attention to a service area of surgical where an analysis of priority will be conducted in terms of Health and Safety. As we know, surgical procedures entail the use of equipment including syringes, forceps, needles, scissors, retractors, scalpels, amputation saws, etc. It is important that staff in the operating theatres observe health and safety when handling these equipment. Additionally, anaesthetists play a vital role in ensuring that the patient is sedated during the procedure. To this end, the priority for NSC should be to ensure patient safety at all time and this should start at the pre-operating stage where a patient will be risk-assessed to ensure their fit for the operation. Amongst the patients safety would include ensuring elimination of risks such as wrong-site/wrong-procedure surgeries, mismatch of organs to be transplanted, ignored allergies, unchecked blood transfusions, and so on. In order to ensure that no such mistakes take place, communication should be improved at inter-professional/ multi-disciplinary team level who are normally involved from start to end of a procedure. What’s more, a system of checklist should be established to ensure that everything that needs to be done has been done and that policies in relations to COSHH and RIDDOR have been adhered to. Once NSC has ensured that service users are safe it is now important to ensure that staff follow strict health and safety procedures as set out by the Health and Social Care Act 1974. According to Stp.Online (Health and Safety, Week 2, P19), employees should take reasonable care for their own health and safety. What this entails is, unlike patients, whilst at work, workers are expected to have some responsibility for their own safety as well as people around them which extend to following health and safety instructions and policies and procedures. LO2.1 Moving on to the case of South Birmingham Primary Care Trust (SBPCT), the death of patient Alice Bell (AB) reveals a tragic instance of negligence and failure in duty of care by the Trust. If carried out properly, Information from risk assessment would have revealed an unsuitable sling within the hospital but this was not picked up. Before proceeding any further, it is important that we understand what a risk assessment is. According to Stp.Online (Health and Safety, Week 4, P4), a risk assessment ‘is simply a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm’. The same source (P13-27) identify five steps involved in carrying out a risk assessment which SBPCT should have been aware of including: Identifying the hazards, deciding who might be harmed and how, evaluating the risks and decide on precautions, recording findings and implementing them and, finally, reviewing assessment and updating if necessary. If these steps were followed, the two auxiliary nurses would have picked up the incorrect size of the sling used to transport the patient. It is also possible that there were no proper policies and procedures in place in relation to transportation of patient or if there were, it was simply a case of gross negligence which must be addressed by the management of SBPCT. LO2.2 The implication of not following the proper protocol on lifting and handling have had significant implications on SBPCT not only financially but also in terms of its overall reputation and confidence from patients. Service users could suffer bad injuries or death. Likewise, the hospital could be damaged in terms of its reputation and could be put under special measures or even closed down. Given the tragedy, the Health and Safety policy on manual handling and lifting would have to be revised in light of this unnecessary loss of life at SBPCT. This would require addressing three key components or players that are directly or indirectly implicated in the incident. * The organisation’s philosophy regarding health and safety should be re-enforced from senior management downwards to portray a statement of intent. * Staff should be held to account but only after completion of training on lifting and handling. * Policies and procedures should be communicated via an effective system to be agreed by the board which should ensure, for example, target are sets, and reporting of malpractice is encouraged to the extent that whistle blowing becomes embedded in the policies and procedures. LO2.3 Of course this will not easily be achieved due to the dilemma that care workers encounter when carrying out health and safety policies and procedures. A dilemma is defined by the Oxford dictionary as ‘a situation in which a difficult choice has to be made between two or more alternatives, especially ones that are equally undesirable’. When working in a care setting environment, staff are faced with difficult decisions usually culminating in some sort of restraints of patients which (Gallagher, 2011) has categorised in five different forms below: Physical restraint involve holding the patient and preventing them from leaving an area could pose a dilemma as it could result in holding them to the wrong side of their body and leading to complaints. Chemical restraint involves, for example, administering drugs to a Mental Health patient to calm them down. The ethical dilemma here in the fact that patients are not told what is being injected in their bodies. Mechanical restraint entails using things such as raised bedrails and tables and chairs positioned to restrict their movement. The dilemma here is that it could be seen as excessive use of force to suppress free movement. Technological restraint involves using things such as tagging and CCTV in their rooms which, once again, have ethical dilemma in that they could be interpreted as invasion of privacy under human right law. Finally, Psychological restraint may involve telling patients what they can or cannot do. Even though it is in their own benefits, patients may feel that they are being prevented from making the choice they feel is right for them. All of the above restraint are necessary for the health and safety of a patient in a care home setting but patients may not view it this way and therefore cause a degree of dissatisfaction not only from the patients but also for the care givers who would have to ‘battle with these dilemmas’. LO2.4 Health and safety is not a regular discussion topic we hear from an average person on the street. I would imagine the same can be said about stock market traders, bankers and members of parliament as this would be the last thing on their mind when embarking on their day to day tasks from their nice air-conditioned offices. For people working in the care industry, this is unfortunately, not the case since health and safety has to be on their mind for just about every task they undertake whether it is transporting a patient, accompanying a care service user to their GP appointment or cooking their meals. Non- compliance with the Health and Safety Act 74 could lead to catastrophic consequences for the organisation, and individual employees alike. For corporations, the damage could be on reputation, brand and financial losses in the form of penalties. For a hospital such as SBPCT, it could be put under ‘special measures’ and/or fined. According to Stp.Online (Health and Safety, Week 8, P11), ‘individuals convicted of gross negligence manslaughter can face up to life imprisonment’.

LO3.1 Understanding the monitoring and review of health and safety in the health and social care workplace is our next task in this final part of the essay. Day to day monitoring usually take place at middle and junior management level whilst the senior management mainly focus on the formulation of strategic direction, policies and procedures to be implemented across the organisation. With regards to monitoring, this is more or less a tick box or check list exercise to ensure that all activities that were supposed to be performed in a certain way were actually performed to the expected standard. Where this falls short, corrective action can be taken to ensure adherence to the Health and Safety Act 1974. In the scenario given, it is revealed that carpet posed an ‘important risk’ as far as moving the patient mobile hoist is concerned as its wheels sank into the carpet whilst attempting to operate it. An important element in the monitoring phase is a reporting structure that allow staff at all levels to raise concerns about health and safety issues such as this so that action can be taken. The most obvious action here is to replace the carpet with a hard floor to facilitate movement of patient whilst eradicating this risk. The management has, however, the opportunity to evaluate the cost benefit of such an action as replacement of this carpet could incur costs, cause disruption to service and time consuming to management. Nonetheless, given the risk of having a carpeted floor which could cause injuries to patients and reputational damages, it is better for management to be pre-emptive rather than reactive to such an important issue. With regards to reviewing, this stage involves an assessment of how well and effective the overall health and safety strategy is working. It offers the opportunity to amend non-workable practices or method with a view to implementing suggested improvements. With reference to the scenario given, this a newly built hospital which should not have any health and safety issues of the nature being reported so soon after completion of the project. Therefore a post-completion audit could be instrumental in helping the hospital’s senior management team or the board to claim compensation from the designers if this was part of the contract clauses. LO3.2 It may be worthwhile examining whether there is a correlation between effective health and safety policies and practices of a given organisation and its impact whether positive or negative on health and safety culture at that organisation. Indeed, according to Stp.Online (Health and Safety, Week 9, P8), ‘an organisation’s attitude and values regarding safe working are important factors that influence the approach to work, and ultimately to an organisation’s health and safety performance …’ On one hand, too much emphasis on health and safety to the point of ‘micro-managing’ compliance could lead to demotivation of staff. In other words, if for example, the aim of the organisation is to effectively get all staff to be 100% compliant and they manage to achieve that, it should not automatically be assumed that a culture of health and safety has been created. It is possible that staff had been coerced to deliver the required health and safety targets. On the other hand, there have been a number of high profile health and safety disasters which resulted in fatalities, two of which being the Ladbroke Grove and Clapham Junction train crashes. Since then, effectiveness in health and safety has improved due to massive investments in track inspection and maintenance as well as public pressure and thankfully we have not any such disaster since. Importantly, this is partly due to the health and safety culture that has since dominated the railway network. This claim can be evidenced by a number of tube strikes that have taken place on the premise of health and safety issues. The unions have taken this issue seriously and have managed to promote it to the point that they are now getting public sympathy and opinion on their side to drive the changes they wish for. LO3.3 Health and safety is matter not only for employers but employees too including contractors, agency workers and casual workers who my come to the organisation’s premises for work now and then. Below, is an evaluation of own contribution to health and safety as an employee. Employees need to take ownership of their development and this include ensuring that they are up to date with the necessary training requirements. My own contribution will be vital in the sense that if, for example I am reckless in handling, lifting, or dealing with hazardous material, it can cause damage to the organisation and other people including employees and service users alike. I was working for a particular Care home 3 years ago and I was actively involved in ensuring that service users are as safe as possible. I was required to keep records of incidents, however small so that these could be followed up if necessary at future dates. My contribution in adhering to the health and safety standards as per company practice was crucial and I undertook important trainings to keep abreast of development in health and safety. This with a view of making a positive impact in terms of preventing environmental hazards, people hazards and equipment hazards. In contrast, if at my practice I didn’t do the basic right such as ensuring risk assessment on equipment is carried out, hazards are reported promptly to management, ensuring that I attend the relevant health and safety training, it could have put myself and other at risk but importantly the organisation I work for could end up being sued. Conclusion We have seen how the design of new effective health and safety communication system could contribute to the improvement and attainment of organisational goals. It is down to the departmental managers how they enforce health and safety at work bearing in mind the stringent legal requirements and implications which could result in closure of NSC, as per the first scenario, if things go wrong. Surgical care is one area where, if things go wrong, a patients’ health condition could suffer irreversible consequence, hence the need to receive and follow health and safety guidance provided during training. Similarly, we can now understand how important health and safety is, particularly in a care home setting where lifting and handling must be performed as per prescribed health and safety guidance despite some ethical dilemma which may, for instance, emanate from religious believe regarding physical contact and restraint. Consequently, business choose to take health and safety extremely seriously despite the low probability of occurrences of breaches which is seen as a preventative and proactive approach to mitigate the risk of potential violation of the Health and Safety Act 1974. Essentially, I share the view of many ordinary people who feel that it is ‘better to be safe than sorry’ in most situations. When it comes to health and safety, this is the view held by many organisations, not least owing to the threat of the Health and Safety Act 1974, since any failure would be punished both at individual and corporate levels. Whilst any success is credited to the effectiveness of health and safety promotion, it ultimately comes down to individuals within the organisation to take responsibility for their actions and in the process saving their lives, their fellow employee’s, other stake holders including the employing organisation. Reference

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Reference
Jarvis, A. (2011). Take care: a history of Health and Safety in the workplace. Available: http://www.independent.co.uk/life-style/health-and-families/features/take-care-a-history-of-health-and-safety-in-the-workplace-2275437.html. Last accessed 12th Feb 2014.

Anon. (nd). Health and Safety at Work etc Act 1974. Available: http://www.hse.gov.uk/legislation/hswa.htm. Last accessed 15th Feb 2014.
Example of ebook reference
Fishman, R., 2005. The rise and fall of suburbia. [e-book] Chester: Castle Press. Available through: Anglia Ruskin University Library website <http://libweb.anglia.ac.uk> [Accessed 5 June 2005].

Surgical equipment handling: http://cal.vet.upenn.edu/projects/surgery/1700.htm
Gallagher A (2011) Ethical issues in patient restraint. Nursing Times; 107: 9, 18-20.
Online via http://www.nursingtimes.net/Journals/2013/01/18/a/e/p/019_NT_080311.pdf
Definition of dilemma: http://www.oxforddictionaries.com/definition/english/dilemma