Examination of Witnesses (Questions 260-267)
5 MAY 2004
MS HOPE
DALEY, MS
JUNE CHANDLER,
MS SHEELAGH
BREWER AND
MS CYNTHIA
ATWELL
Q260 Miss Begg: I notice that three per
cent of trusts have adopted a no lift policy. How are they able
to do their job?
Ms Brewer: We try to avoid the
use of the word "lifting" and talk about "safer
patient handling" because it is clear that if somebody is
taking the physical weight in time they will cause themselves
some injury. The policies are about safer patient handling, coming
back to looking at the risk assessment and, from that, developing
safe systems of work that eliminate the need to physically bear
the weight of a very heavy load, very often. There are ways by
some innovative thinking and some systems and equipment that are
around whereby you can safely move patients and not lift them.
Q261 Miss Begg: I will tell you what
worries me. It comes from personal experience. Sometimes, health
and safety considerations are used as excuses for health care
workers not to do what is necessary for the comfort of the person
needing the care. I was wondering whether you find that perhaps
the pendulum has gone too far in one direction. The National Centre
for Independent Living says that there is a balance to be struck
between the needs of the workers who are doing the lifting and
the service users. I have had personal experience where young
nurses have been trained that they must not lift and they have
to watch what they are doing to the extent that they are risk
averse and frightened to do any kind of handling. They refuse
point blank. "We are not allowed to do that" is the
exact quote we get. Is there not a danger that the job they are
being paid to do they are unable to do because they are misinterpreting
much of the health and safety legislation and the training has
frightened them off doing what should be part of their job. That
is obviously to the detriment of patients in their care or the
service users.
Ms Brewer: There is certainly
a balance to be struck in relation to keeping the staff and nurses
safe and a balance between the needs of the patient in terms of
the nursing care they need to have. Nevertheless, the health and
safety legislation is statutory legislation and those members
of staff have a duty of care in relation to their own health and
safety. Given partnership and collaborative working, involving
the patient as well in terms of their own needs and their own
mobility and the need for their independence as much as possible,
we should be able with expert advice, to develop methods that
can suit both the carer and the patient.
Q262 Miss Begg: I am very impressed always
by ambulancemen and women and A&E staff who do manage the
manual handling extremely well. Because it is so much part of
their job, they are extremely well trained. Once you get away
from those special ties into either a hospital or a home situation,
that training is not there. As soon as some people hear the phrase,
"We have a no lift policy", they literally do not touch
or move the person at all. I wonder if UNISON has any comment
on whether that level of training could be necessary or should
be in place for those further away from the front line, who are
still bearing the brunt of a lot of the manual lifting?
Ms Chandler: UNISON would advocate
very strongly a shared responsibility around any care plan in
any situation so that whatever a patient or client requires is
looked at within a team environment. Then you have a joint approach
to looking at the implied risks, assessing what is necessary.
Staff need to feel confident in saying, "How do we get round
this? How can we do this safely? What needs to be done and how
can we avoid injury?" If you set it in that sort of environment
and promote that kind of culture, the necessary training needs
to follow on from that in any given situation.
Q263 Miss Begg: In that collaborative
approach, what is the role of the service user to have their input
and say, "I want it done in a particular way because my dignity
is affected if it is done in a different way"?
Ms Daley: I think that is a very
important aspect of the care and it would need to be taken into
consideration very carefully and taken forward. There is no one
answer to that question but dignity is extremely important.
Q264 Miss Begg: I do not get a sense
that the patient or service user gets consulted on how they would
like to be handled.
Ms Daley: I think practice differs.
As with so many other aspects of health and safety, there are
pockets of very good practice around and other areas where perhaps
it is less so. One of the things that UNISON is calling for is
a focus for sharing good practice in all aspects of health care.
Maybe you are speaking from your personal experience, but I have
experience where I have had home care with poorly parents and
they have been engaged in the process of their own care plan.
I think it varies across the service.
Q265 Mrs Humble: To pick up on this debate,
although there has been much discussion about care plans and plans
in hospitals, has the regime of health and safety at work kept
up with the changes in health and social care settings, where
people are receiving their care? 20 years ago the people who are
now in nursing homes would have been in a hospital setting. The
people who are now in care homes would have been in nursing homes.
People in their own homes would have been in some sort of residential
care. We are getting people now with quite profound health and
social care needs who are being looked after in their own homes,
in care homes or in nursing homes where all the resources that
are available in hospitals are not there to look after the health
and safety of staff. What can be done about it? You have mentioned
training and there are aids and adaptations that can be put into
people's homes to help with an outside agency coming in to perform
care tasks, but it does not seem to me that it is working in the
way that it should be working. What can be done?
Ms Brewer: It does feel as though
resources have been devoted more to the acute sector and that
a lot of the guidance that is available is looking more towards
the acute sector and the primary care sector is only beginning
to be a focus of attention. It is clear, for example, that for
staff in GP practices the awareness of health and safety issues
and the safe working environment for them is sometimes behind
the standards that exist in the acute sector. Yes, I think there
is the need to raise awareness of the issues in the primary care
sector to make sure that guidance and research is carried out
that incorporates and covers the primary care sector. Lone workers
are another problem. There are more people who are out in the
community working on their own. Keeping them safe at work from
violence and assault is a problem as well. I think it is about
reviewing the needs of that sector now and making sure that we
are beginning to improve the standards of health and safety management
that they deserve as well.
Ms Daley: We would agree with
that. Certainly for people who are being cared for in their own
homes, we have the added situation where some refuse to have particular
aids to help in their homes. Also, perhaps because of space considerations,
some cannot have particular things that are needed to help. In
our view, the risk assessment alongside the care plan would again
identify those issues and deal with them in the relevant way.
Of course, this is not always the case. That is not happening
and more does need to be done to examine changes that have occurred
over the last 20 years and how we can put identify forward appropriate
resource ideas to help with that.
Q266 Chairman: Is there anything finally
that you think you would like to say to us that we have not covered
this morning? The evidence session has been, alas, all too brief
but the written evidence was very comprehensive and we are grateful
to you for doing the additional bits of work that we are asking
you to do. Is there anything finally you would like to add?
Ms Daley: I think the issue around
consultation and worker involvement has not come up and that is
a very crucial area, particularly for workers who are out on their
own, who are working in the community alone. They are often not
consulted about what is happening, how it is happening and proper
systems are not necessarily in place for them to report and record
when things go wrong. More needs to be done around consulting,
workers and safety representatives and also getting them more
involved in whatever precautionary measures are considered and/or
introduced.
Q267 Chairman: That point is very well
taken.
Ms Atwell: Although we have talked
a lot about the public sector, a lot of what we have been discussing
does apply in the private sector. As a practising occupational
health nursing consultant who works in private industry, a lot
of the issues still apply there in relation to stress. To pick
up on a point that Anne Begg raised regarding the treatment of
MSDs, there is a lot of good practice within some of the private
sector on how physiotherapy has successfully helped to manage
things like lots of different musculoskeletal disorders, particularly
in the car industry which is very physical, which might be useful.
Chairman: That point is well taken too.
Thank you very much for your appearance this morning which was
commendably concise and clear.
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