Key legislation - Health and safety legislation
Safe practice is very important to the promotion of dignity in care. There are a number of legislative measures and regulations to support health and safety at work. These are intended to protect people in work, those using services and the wider public. The Health and Safety Executive (HSE), local authority Trading Standards and the Care Quality Commission (CQC) can all bring prosecutions against care providers who breach health and safety standards.
- A care home in South Lanarkshire was fined for breach of Section 3 of the Health and Safety at Work etc. Act 1974, following the death of Mrs Elizabeth Stevenson, 88. Mrs Stevenson broke her neck in a fall. ‘BUPA Care Homes (Carrick) Ltd admitted to failing to review and update a risk assessment for Mrs Stevenson and failing to provide adequate instruction and supervision to their employees engaged in moving and handling residents’ (Health and Safety Executive 2012).
- Essex County Council was prosecuted after a child with severe learning and physical disabilities almost drowned in his school’s swimming pool. The council had failed to provide schools with adequate information and guidance on how to safely manage and run their swimming pools (Health and Safety Executive 2012a).
Health and safety legislation and regulations
Health and Safety at Work Act 1974
The Act covers a wide range of issues relating to workplace health, safety and welfare across different sectors. Statutory instruments have developed to support the implementation of the Act and provide an interface with European regulations. The HSE holds enforcement powers which can result in unlimited fines and prison sentences. Employees have a general obligation under the Act to take care of others and cooperate with employers’ health and safety requirements.
Manual Handling Operations Regulations 1992 (amended 2002)
Manual handling is a major issue for care providers as people with limited mobility need to be assisted safely to move and transfer. It is important this is done in a way that respects the dignity of the individual. While employers are required to ensure that they comply with the regulatory framework, this does not mean that an individual's human rights can be disregarded. What is required is a balanced approach that reduces risks for workers while at the same time maintaining the dignity, privacy and autonomy of those they are caring for. The problem of lifting an overweight person, for example, must be solved not ignored. For example, a county council, concerned for the health of its employees, imposed a blanket ban on manual lifting of people using services. Unfortunately this resulted in certain people not receiving the community care to which they were entitled. The court held that the guidelines on manual lifting did not prohibit manual handling of people, nor operate a cut-off above which they would be too heavy to lift manually. Failure to lift these people could leave them stuck in a bath or on a lavatory, or suffering from bedsores. This created a potential breach of Article 3 of the HRA (the right not to be subject to inhuman or degrading treatment). Care workers' rights to a safe working environment must be respected, but these require safe working practices to be devised, not blanket bans that restrict levels of service [R v East Sussex County Council (2003)].
Control of Substances Hazardous to Health 2002
In the care sector these regulations may apply to cleaning materials and medications that may be dangerous if not used properly. Care providers must protect staff and service users from harm by ensuring that potentially dangerous substances are safely stored and that staff that use them are properly trained to do so.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
Employers, the self-employed and ‘responsible persons’ (people in control of work premises) have an obligation to report death or serious workplace accidents, occupational diseases and specified dangerous occurrences (near misses) to the HSE.
Health and Safety (First Aid) Regulations 1981
Employers must ensure that first aid equipment and trained first-aiders are present in the workplace and that employees are aware of first aid arrangements.
Food Safety Act 1990, Food Safety (General Food Hygiene) Regulations 1995 and Food Safety (Temperature Control) Regulations 1995
The Food Safety Act covers the preparation, storage and service of food and requires the registration of food businesses whether they are run for profit or not. A 'food business' includes canteens, clubs and care homes. The CQC requires that care services ensure that the food and drink they provide is handled, stored, prepared and delivered in a way that meets the requirements of the Act. The local authority is responsible for enforcement through environmental health and Trading Standards. The Food Standards Agency (FSA) can intervene where local authorities fail to meet the requirements and in emergency situations.
Quality in care
Circumstances that influence dignity, such as living conditions in care homes, are governed by a whole host of regulations. The CQC is the health and social care regulator. It has published guidance for compliance with the Essential Standards of Quality and Safety. However, personal assistants paid for through direct payments and personalised budgets and day services are unregulated.