Moving and handling

Overview

Employers have a legal duty to protect their staff from the risk of injury from hazardous manual handling in work. No-one should routinely manually lift patients. Hoists, sliding aids, electric profiling beds and other specialised equipment are available as substitutes for manual lifting.

Patient manual handling should only continue in cases which do not involve lifting most or all of a patient's weight. This rules out for example, the shoulder or Australian lift.

The Health and Safety Executive (HSE) and HSE Northern Ireland (HSENI) advise a balanced approach to managing the risks from patient handling. These include:

health care workers are not required to perform tasks that put them and their clients at unreasonable risk
client's personal wishes on mobility are respected wherever possible
client's independence and autonomy is supported as fully as possible.

Poor moving and handling practice can lead to:

back pain and musculoskeletal disorders, which can lead to inability to work
moving and handling accidents - which can injure both the person being moved and the employee
discomfort and a lack of dignity for the person being moved.

For more information, see the section on back pain on the HSE website. In Northern Ireland see the HSEI guidance on back pain.

Employer obligations for safer patient handling

Legally, employers are obliged to provide a safe working environment for their staff. Under the Manual Handling Operations Regulations 1992 (as amended)/The Manual Handling Operations Regulations (Northern Ireland) 1992, employers are required to:

avoid work activities that can cause back pain where reasonably practicable
where the activity can't be avoided, assess it to identify how to reduce the risk of back pain
apply the control measures identified and monitor and review them to make sure they are working
consult nursing staff, discuss and resolve any concerns raised.

Moving and handling risk assessments help identify where injuries may occur. Two types of risk assessment are usually needed - generic and individual.

A generic risk assessment considers the overall needs of the setting for example, type and frequency of the moving and handling tasks, the equipment needed, safe staffing levels, emergency procedures during fire evacuations or patients/service user falls and the physical environment.
Individual risk assessments consider the specific moving and handling needs (for example, help needed, specific equipment needs, and number of staff needed to support the patient) to ensure the safety of staff and the patient/service user.

Employers also need to assess the risks of back and musculoskeletal disorders from a wide range of activities, including:

those which could involve bending or stooping for periods of time such as leg ulcer dressings, or
handling part of a patient for example, a limb being prepared for surgery in a theatre environment.

There is a requirement for a ‘competent person’ to conduct risk assessments. Competency is a mixture of skills, knowledge and qualifications to carry out the role. For further information see the HSE website.

Monitoring the implementation of the risk assessment and working practice to ensure that the correct procedures, techniques and equipment are being used is extremely important. In addition, risk assessments must be reviewed periodically or when circumstances change to ensure they remain current.

A patient centred care plan should include information on immobility and refer to any handling risks and risk assessments.

Employee obligations

Employees have a role to play in ensuring the risks of manual handling are minimised and should:

follow appropriate systems of work for example, safe operating procedures, safe systems of work, and use the equipment provided
co-operate with their employer and let them know of any problems
take reasonable care to ensure that their actions do not put themselves or others at risk.

If you suffer an injury or accident whilst at work you may be able to make a civil claim for personal injury. You can see our guidance on accidents at work and also our advice guide on making a personal injury claim.

Training and updates

Guidance from the RCN, the All Wales Manual Handling Passport Scheme, the Chartered Society of Physiotherapy, the Care Standards Act 2002 and the HSE recommends that update training in client handling is required when starting a new role and before commencing tasks and duties that require manual handling activities. Refresher training should be provided at a set frequency set by the employer.

Training and updates should be undertaken taking into account the Manual Handling Operations Regulations 1992 including keeping records and data to manage ongoing training programmes.

Moving and handling equipment including hoists

A variety of equipment is available to support moving and handling patients/service users. The equipment used will vary according to the patient/ service users specific needs.

The Lifting Operations and Lifting Equipment Regulations (LOLER) require employers to ensure that moving and handling equipment is maintained and safe to use. All moving and handling equipment must be thoroughly examined at six-monthly intervals, or in accordance with the examination scheme. Other pre-use checks and inspections may also need to be undertaken to ensure safety.

Hoists

Hoists are in common use in the health and social care sector and can reduce the risk of injury to staff, however if not used safety they can present a serious risk to patients and the user. See the HSE website for more information on hoists.

Staff should be fully trained in the safe use of specific pieces of moving and handling equipment and safe moving and handling and receive regular refresher training.

Further information on the Manual Handling Operations Regulations 1992 is available on the HSE website where you can also search for 'moving and handling in health and social care'. For Northern Ireland, check the HSENI website.

Maximum weight limits

The Manual Handling Operations Regulations 1992 do not set specific maximum weight limits for lifting and moving. The HSE website contains further guidance on assessing manual handling risks including risk assessment tools to identify high-risk handling operations and prioritise action to control the risks. The HSENI website also contains similar information for Northern Ireland.

Moving and handling in the community

We believe that carers and nurses in the community should have access to equipment and training to ensure the safe moving and handling of service users and patients.

Community and health and social care staff may not always be able to use or have the same access to equipment as hospital staff. In each circumstance, an individual service user handling risk assessment and individual plan of care is required. Individual care plans should identify the specific equipment required to safely move and handle patients and service users. Carers and nurses in the community should be familiar with the plans, the individual's moving and handling risk assessment and trained in the correct use of all related moving and handling aids.

It may also be necessary to obtain the support and advice from other specialists, such as occupational therapists.

Depending on the outcome of the assessment, employers should provide any necessary equipment.

The HSE provides a list of the type of equipment that can be considered as part of their guidance on moving and handling in health and social care.

Children's care environments

For staff working with children, it may not be possible to eliminate all lifting. It is still important to avoid the risk of injury to carers and minimise lifting at all times.

By law, employers must ensure that risk assessments have been carried out using appropriate guidelines which assess all factors. The design of a cot, for example, may be more of a risk factor than the weight of the baby in it. Poor posture is a greater risk to carers of babies and children than actual lifting.

Another example is the neonate with complex care needs. This baby may have many pieces of equipment attached to them. Each of these require consideration when developing a safe plan for mobility.

In each situation a risk assessment must be carried out and an individual plan of care devised by all involved in the care, for example parents, health visitors, teachers. The day to day needs of children vary. Flexibility can ensure optimum independence of the baby/child whilst minimising carer risk.

If you are concerned

Organisations must have effective procedures in place to allow nursing staff and their representatives to raise any concerns in relation to staffing, equipment, policies and processes for managing unsustainable work pressures at the earliest opportunity. This includes consultation regarding risk assessments and new equipment.

In addition, staff must be encouraged to and provided with easy access to report any incidents related to moving and handling. Employers should ensure that incidents are investigated and appropriate measures put in place to prevent recurrence and that information from incidents and investigations is shared with staff and RCN representatives.

Nursing staff should feel able to raise concerns without detriment and should receive timely feedback on their concerns. Please see: