Health & Safety Report
By Daniel Dutton (12 January 2020)
Introduction
This report analyses, evaluates and offers recommendations for the improvement of the policies, procedures and practices in the areas of employee stress management and service user fire safety.
It is intended to be reviewed by the registered manager of REDACTED.
Legislative and Regulative Framework
The Health and Safety at Work Act (HASAW) 1974 puts the responsibility on employers to ensure that work-related activities do not adversely affect the health, safety and wellbeing of their employees, visitors, clients and the wider public. This is supported by further regulation, including The Management of Health and Safety at Work Regulations 1999, which provides more details of employer’s duties under the HASAW and the Control of Substances Hazardous to Health Regulations 2002, which details employer responsibilities related to the handling of hazardous materials in the workplace. A full list of legislation and regulations relating to health and safety can be found on the Health and Safety Executive (HSE) website (or H&S legislation that just relates to care and support settings can be found here).
The HSE regulates and enforces health and safety law. HSE inspectors have powers to enter work premises without warning to make observations and talk to employees. They can also investigate accidents and complaints and force employers to make changes to policy and practice if the law is not being adhered to. In more serious cases, they have further enforcement powers including halting a dangerous work activity and prosecuting employers.
The safety of service users in the health and social care sector is further regulated by the Care Quality Commission (CQC) as detailed in the Health and Social Care Act 2012 and the Care Act 2014.
To reduce duplication of work and “…help ensure that there is effective, co-ordinated and comprehensive regulation of health and safety for patients, service users, workers and members of the public” (HSE & CQC, 2017), the HSE and CQC (with support from the Local Government Association) worked together to outline their respective roles and responsibilities relating to health and safety in health and social care settings and how they would liaise, share information and work in partnership. CQC takes the lead inspection and enforcement role relating to patients and service users receiving services from providers that are registered with them. HSE and Local Authorities (LA) are the lead inspection and enforcement bodies for employees, visitors and contractors (irrespective of CQC registration) as well as patients and service users that are receiving services by providers not regulated by CQC. Therefore, for my organisation, CQC are the regulating body for health and safety related to our service users with HSE and Local Authorities being responsible for health and safety related to others, including employees.
Our compliance with health and safety legislation and regulation is documented in the policies, procedures and risk management that we have in place. To support compliance, we currently use Quality Compliance Systems (QCS), which is “the UK’s Leading Bespoke Policies, Procedures and Management Toolkits for the Care Sector” (QCS, 2020). Their care management system provides compliant policy templates and the means for staff to easily view policies and procedures online and for management to update them. However, it is important that these base templates are not used “as is” and are reviewed and updated to reflect the bespoke needs of our organisation.
It is the responsibility of managers (and, ultimately, the registered manager) to ensure that policies are complied with by employees. Employees have a responsibility to keep their knowledge updated, which includes attending health and safety training when required. Employers must provide health and safety training and any related equipment.
When employees do not follow policies and procedures correctly, it could result in harm to themselves or others, disciplinary action and/or legal action against themselves and/or their employer. Therefore, it is essential to ensure that robust and detailed policies and procedures are in place and that employees understand their role and adhere to them.
Risk Management in Health & Social Care
Part of good health and safety practice is managing risk. Although it is not always possible to eliminate risk entirely, there must be documentation to demonstrate that all foreseeable risks have been examined and assessed and that measures have been put in place to minimise risk as much as possible.
Risk management is performed using risk assessments, which are documents used to record the process of identifying potential risks and hazards and who may be harmed by them, evaluating the likelihood of them happening and taking practical steps to reduce their impact or eliminate the risk altogether. Risk assessments should be reviewed regularly to ensure that they are still suitable for their purpose.
Working in health and social care presents further complications to the risk assessment process because our duty of care towards our service users must be balanced with their rights to independence and positive risk-taking. This was echoed in a recent conversation with one member of my team where they expressed their unease with managing this type of dilemma. They explained that they felt that if they were too risk averse then they could “get into trouble” for not promoting person-centred values, however if they were more risk-tolerant and it resulted in a service user coming to harm, then they would also “get into trouble”. They felt they were in a ‘no-win’ situation. I helped the team-member to understand the balance between risk and rights by explaining how I manage it in my own practice. I explained that, in a worst-case scenario, as long as they could justify the decisions that they made when assessing risks then they will have done their job correctly. They must be able to demonstrate that they had identified and assessed the risks, that the service user had been involved in the process, that the service user had agreed to the risk assessment and that the process had been fully documented. If these criteria were fulfilled then they would have evidence of their person-centred practice and how they had minimised the risks as much as was practicably possible.
Stress Management
Having an effective stress management policy and procedure is essential because statistics reveal that stress, depression and anxiety account for 44% of work-related ill-health cases and 54% of working days lost (HSE, 2019). Health and social care workers are particularly vulnerable to stress, depression and anxiety with statistics showing a 2.1% prevalence rate within this sector compared to 1.4% (average) prevalence rate for other industries combined (HSE, 2019). The predominant cause of stress, depression and anxiety are pressures related to workload (42%) with interpersonal relationships (26%) and changes at work (11%) also being significant factors (HSE, 2019). Preventing and managing work-related stress will not only reduce absences but also increase the wellbeing of employees resulting in increased job satisfaction and improved practice.
We have an existing ‘Management of Stress Policy and Procedure’ which primarily aims to identify and manage workplace stress, with secondary goals of ensuring staff remain well, attendance is improved and safety and quality of service is assured.
It is a credit to our organisation that we recognise work-related stress as a health and safety issue and understand that it can lead to anxiety and depression in staff. Protection from intimidation and victimisation for employees that report stress on their own or another’s behalf is provided under the policy as well as how my organisation will address the causes of stress and seek to find a solution. The policy also highlights that risk assessments should be performed to identify and assess workplace stressors so that the risks of stress can be eliminated or controlled. A ‘Management of Stress Risk Assessment’ template is included as well as a blank ‘Welfare Review Meeting Form’ to be used when an employee has been absent due to sickness for an extended period. Managers are also provided with actions to identify and prevent work-related stress within the policy.
Although our current policy and procedure acknowledges that work-related stress does exist and commits to preventing and controlling it, we could be more proactive in our approach, so there are improvements that can be made.
The existing policy highlights the importance of undertaking risk assessments to identify workplace stressors and put an action plan in place to reduce or eliminate them, however it does not specify the situations in which these risk assessments should be performed. Do we have one stress-management risk assessment for the whole organisation or separate risk assessments for each team? Or each service? Or on an individual basis? Front-line employees may be more likely to state verbal/physical abuse towards them as a stressor, whereas for management it may be workload pressures. Clarification of the preliminary requirements for a stress management risk assessment to be performed would be useful. In addition, only the template for performing a management of stress risk assessment is available via the QCS system – there are no completed risk assessments. Any risk assessments that have been performed in this area should be made accessible to the affected employees.
Discussions with several employees indicates that there is a stigma attached to work-related stress. It is a subject that is rarely talked about and is considered by some as a sign of weakness. This can prevent employees from seeking help for work-related stress, make them feel embarrassed or ashamed and make it more difficult to cope. Unfortunately, this reluctance to report workplace stress can lead to us not having the full picture of the extent of work-related stress within our organisation. It also means that employees will ‘suffer-in-silence’ until they reach breaking point, which can lead to performance issues, unprofessional behaviours and extended periods of absence from work.
This stigma can be reduced if we extend our existing policy to raise awareness amongst employees about work-related stress and encourage them to discuss and report it. Managers may also benefit from additional training in identifying and managing work-related stress within their teams. Discussions with employees revealed that some individuals were not aware that we have a contract with a human resources agency that can provide counselling (as well as other services) financed by our organisation, so awareness of this facility may also need additional promotion.
To further measure the prevalence and impact of work-related stress within our organisation, assess the related risks and provide solutions, we could implement the strategies recommended in the ‘Tackling work-related stress using the Management Standards approach’ workbook (HSE, 2019). The Management Standards are; demands, control, support, relationships, role and change. These cover the six primary sources of workplace stress, so effective management in these areas will reduce stress amongst employees. The workbook suggests methods of assessing and implementing an effective stress management policy by forming a steering group, involving employees, establishing commitment by senior management and gathering information from new and existing sources. Sources can include records of sickness absence, exit interviews and anonymous surveys amongst employees.
To summarise, I put forward the following recommendations to improve our existing stress management policy and procedure:
- Increase awareness and reduce the stigma of work-related stress by encouraging discussion in team meetings and providing information in our monthly newsletter
- Set up a project management team to identify and reduce work-related stress across the organisation using HSE’s ‘Tackling work-related stress using the Management Standards approach’ workbook
- Involve a cross-section of employees in the discussions
- Get accurate and reliable data about workplace stress within our organisation by conducting a confidential survey amongst employees
- Ensure that the outcomes from the stress management project, including associated risk assessments, are made available to employees
Fire Safety for Service Users
Fire safety within our organisation is currently provided by three separate policies and procedures.
Our ‘Fire Safety Policy and Procedure’ is designed primarily for our organisation’s offices and office-based employees. I will not be examining this policy and procedure in my report.
Our ‘Fire Safety in Service Users’ Homes Policy and Procedure’ is designed to ensure that employees and service users are safeguarded from potential risks of fire as far as is practically possible. This document contains practical advice about reducing the risk of fire in a service users home and the importance of employees having sufficient training and the confidence to report any fire hazards that they encounter.
Our ‘Service User Fire Evacuation Policy and Procedure’ ensures that measures are in place for service users to evacuate a property safely in the event of a fire. This will usually be documented in a Personal Emergency Evacuation Plan (PEEP). Attached to this policy and procedure is a blank PEEP form.
With regards fire safety for service users, it is noteworthy that there are two separate policies and procedures covering this area. The ‘Fire Safety in Service Users’ Homes’ policy and procedure deals with risk assessments relating to a particular service and the ‘Service User Fire Evacuation’ Policy and Procedure’ relates to an individual’s evacuation plan. I would suggest that in the interests of clarity, these two policies and procedures could be consolidated into a single document managing all aspects of fire safety for a service user. However, it should be made clear that this would not negate the legal requirement of a risk assessment for the building in addition to a service user’s person-centred risk assessment, which would include the PEEP. As stated in the government document ‘Fire Safety Risk Assessment: Residential Care Premises’, “In evaluating the risk to people with disabilities you may need to discuss individual needs with each relevant person and record specific arrangements within the care plan for the individual.” (HM Government, 2006).
A further issue is that the PEEP form provided in the policy and procedure is different to the form that is provided by our digital risk assessment software. Following discussions with other managers, the digital form is the one that they use for their services. Therefore, either the form in the policy should be replaced with the digital form or vice versa so that policy and procedure reflect what is happening in practice. The PEEP form within the policy and procedure may also be confusing to use because it asks for “one” questionnaire to be filled in dependent on an individual’s disability, with options for ‘visually-impaired’ service users, ‘hearing-impaired’ service users, ‘mobility-impaired’ service users and ‘other’. It does not specify which form should be filled in for an individual with complex needs. For example, should a deafblind service user fill out the ‘visually-impaired’ form, the ‘hearing-impaired’ form, both or ‘other’?
As an alternative, the National Fire Chiefs Council (NFCC) have produced a guide for fire safety in specialised buildings (NFCC, 2017), containing a template for a person-centred risk assessment, which can be used to identify risks that can be used in the PEEP.
In summary, I would recommend:
- Consolidating the ‘Fire Safety in Service Users’ Homes’ and ‘Service User Fire Evacuation’ policies and procedures into a single entity
- Consideration of the use of the NFCC’s person-centred risk assessment
- Ensuring the PEEP form used in the policy is consistent with the form that is used in practice
- Providing additional clarity of of the need for both a building-based risk assessment and a person-centred risk assessment with regards to fire safety
References
- Health & Safety Executive and Care Quality Commission. (2017). Memorandum of Understanding (MoU) between the Care Quality Commission (CQC) and the Health and Safety Executive (HSE). [online] Available at: https://www.hse.gov.uk/aboutus/howwework/framework/mou/mou-cqc-hse-la.pdf [Accessed 14 Jan. 2020].
- Health & Safety Executive. (2019). Tackling work-related stress using the Management Standards approach. [online] Available at: https://www.hse.gov.uk/pubns/wbk01.pdf [Accessed 16 Jan. 2020].
- Health and Safety Executive. (2020). Work-related stress, anxiety or depression statistics in Great Britain, 2019. [online] Available at: https://www.hse.gov.uk/statistics/causdis/stress.pdf [Accessed 15 Jan. 2020].
- Health & Safety Executive. (2020). Statutory instruments (Regulations) owned and enforced by HSE/Local Authorities. [online] Available at: https://www.hse.gov.uk/legislation/statinstruments.htm [Accessed 14 Jan. 2020].
- HM Government (2006). Fire Safety Risk Assessment: residential care premises. [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/14885/fsra-residential-care.pdf [Accessed 25 Jan. 2020].
- National Fire Chiefs Council. (2020). [online] Available at: https://www.nationalfirechiefs.org.uk/write/MediaUploads/NFCC%20Guidance%20publications/NFCC_Specialised_Housing_Guidance_-_Copy.pdf [Accessed 16 Jan. 2020].
- Quality Compliance Systems. (2019). Quality Compliance Systems – The UK’s Leading Bespoke Care Policies & Procedures. [online] Available at: https://www.qcs.co.uk/ [Accessed 14 Jan. 2020].