The changing role of the health and safety practitioner within the NHS
By Judith McEwan
Everyone is probably aware of the change in the philosophy of delivering an effective health care service that is also sustainable.
The current system is not sustainable for various changes in our demographic world, for example, people are living longer and that alone comes with an increase in health problems and consequently an increase in demand for health care, putting an added strain on the limited resources that currently exist.
Similarly, lifestyle changes have noticeably affected the demand on health care, which may include obesity, drug and alcohol abuse, often leading to chronic illness or violence and aggression.
The future plan is set around the delivery of more patient-centered services within local communities wherever possible, to be effective, safe, accessible and timely. This will require greater integration of services with primary care, community and secondary care services and with social care and third sector organisations.
So how does this affect the role of the health and safety advisor? Has anybody thought about the effects of health and safety in the new world of community care? The demands are slowing becoming evident. Where do the boundaries lie? Whose responsibility is it? Do our job descriptions fit? Do we have the right training? Is the Health and Safety at Work (etc) Act 1974 fit for purpose anymore, or should we go beyond protecting just people at work?
A few examples will illustrate the challenges we face:
The patient is living at home. The carers are family members. Equipment is supplied by a third party sector, while NHS employees provide medical care. All parties have an interaction with the overall care of the patient. This seems straightforward, so let us analysis the challenges.
The carers, when family members, undertake no formal training in health and safety, manual handling, fire and so on. Home environments are sometimes not fit for purpose, they may have inadequate electrical supplies, heating arrangements, sufficient space for manoeuvres, uncontrollable pets and unwelcome visitors …the list can go on.
The lack of training in manual handling means that the carers often adopt poor posture and working methods, but they may ask for assistance from a healthcare worker. Equipment supplied by third party organisations is not always the recognised model that the healthcare worker is familiar with or has received training with. Maintenance contracts for equipment lie with the equipment provider, but do these get checked and shared with all agencies?
I guess all of these issues should be addressed by a ‘suitable and sufficient’ risk assessment and adequate ‘consultation and communication’. But who should take the lead and who has authority to take the lead? Who also has the power to enforce recommendations are put into place? Where do the resources come from?
A member of staff is a victim of domestic violence, with a threat to kill from an estranged spouse. They inform their manager of their concerns and request to be protected while at work.
One could argue that this is nothing to do with work but equally, one could argue, where does the duty of care actually end?
Once the organisation is made aware of the risk, you have to consider the potential risk to others, such as other staff members, visitors and patients. You also have to consider the consequences of the staff member feeling insecure – will it lead to long term sickness? The general wellbeing of the individual will be at risk and consequently this can lead to distraction and human error, which could be detrimental to patient care.
So again, we need to carry out a ‘suitable and sufficient’ risk assessment recognising that every case will be different.
A qualified health and safety practitioner will be able to adapt the theoretical skills to any situation by following the five steps to risk assessment. However, to reach the standard that achieves ‘suitable and sufficient’, in quite unique situations that haven’t been experienced before may be more challenging. It is therefore imperative that the right people are engaged and contribute to the risk assessment and this may include a multidisciplinary/multi-agency team.
Finally, it is imperative that we achieve a sensible balance that is sustainable, protects the workforce and allows healthcare to be developed, recognising the changing world we face and being ready to adapt and meet the challenge at every hurdle.
Judith McEwan CMIOSH, MIHM.
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