Health and safety in the public sector

Good health and safety management needn’t be complicated and time consuming. The Health and Safety Executive analyse the importance and scale of health and safety in the public sector

Question - What links frilly socks, collapsing walls, back pain from poor manual handling practices in hospitals, soldiers suffering climatic illness during training exercises, asbestos in schools, and violence and aggression in prisons?

Answer - They are all health and safety issues arising in the public sector. (A school had banned pupils from wearing frilly socks on spurious health and safety grounds.)

The range of health and safety issues is unsurprising given the size and scope of the public sector. It currently employs nine million workers, including those under ‘contracted out’ arrangements, representing around 30 per cent of the British workforce. These people work in health and social care, education, local and central government, emergency services and the military.

The sector is still dominated by large employers but there are increasing numbers of small organisations, for instance in social care and education. Small providers often lack the resources or understanding of health and safety possessed by larger organisations – and they don’t have the same networks and engagement levels. This has consequences for both employees and the public, and there is a clear need for tailored health and safety information and advice for this audience.

There has been challenging change in the public sector. Tightened finances, and changes in policy and the regulatory landscape have resulted in a more fragmentary picture in places. New service delivery methods have emerged across every element of the public sector. Most public sector organisations now draw on private (and indeed voluntary) sector input. This may have an impact on health and safety provision, and there are fewer fully representative national stakeholders who can influence health and safety performance.

How dangerous is the public sector?
Annual accident figures for the whole sector - around 170,000 work-related non-fatal injuries - are in line with the ‘all industry average’. But the risk profile can be visualised as a low-lying plain of low-risk activities, such as office work, punctuated by peaks of varying heights representing higher risks, such as waste and recycling, army live-firing exercises. The emergency services have significantly higher than average rates of injury, and the whole sector has significantly higher rates of work-related ill health. 400,000 public sector workers per year suffer an illness they believe to be work-related, in particular mental health conditions and musculoskeletal disorders (MSDs).

On average, five workers are killed each year in this sector, significantly lower than the whole-industry rate. Main causes of death include falls from height and being struck by a vehicle. But 38 members of the public were also killed as a result of public sector work activities in 2015/16.

Regulatory framework
The Health and Safety at Work Act (HSWA) places overarching duties on employers to ensure the health and safety of their employees and of others who may be affected by their work activities – this is home-grown, ‘pre-EU’ law. The main regulator is the Health and Safety Executive (HSE).

The public protection aspect of HSWA is one key challenge in the public sector. Others include the proportionality principle, and operating in environments where other regulators are involved. This sometimes means another regulator is better placed to take on an issue.

The Mid-Staffs Inquiry into patient care exposed a regulatory gap between various agencies involved in health and social care. In England, the Care Quality Commission (CQC) is now the lead inspection and enforcement body for safety and quality of treatment and care involving patients and service users receiving a health or adult social care service from a CQC-registered provider. In Scotland and Wales, HSE works with Healthcare Improvement Scotland and Health Inspectorate Wales respectively, but retains responsibility for ensuring that providers’ systems of work do not put health or safety at risk. HSE continues to be the regulator for employee health and safety throughout Britain.

Policy and delivery responsibility for most public services is devolved to the Scottish and Welsh governments but health and safety is a non-devolved matter; HSE remains the regulator. Both administrations have the power to legislate in areas that overlap with HSE’s interests, so good liaison arrangements are essential to maintain clarity on respective roles and remits.

Proportionality
Good health and safety management involves identifying risks correctly, assessing them and working out how to control them where needed. In environments where the public, including children, are present, there can be a temptation to take disproportionate measures to avoid or control risks. A proportionate approach allows health and safety to be an enabler, ensuring that beneficial activity of all kinds can proceed safely; it needn’t stifle initiative or act as a barrier to innovation.

Proportionality is important for the work of local authorities (LAs) and schools. LAs have to balance public protection against promoting desirable social/community activities. Sometimes public events are prevented from going ahead through an excess of caution or through health and safety being used as a catch-all excuse to hide the real reason. In schools the key balance to be struck is between managing risk and opportunities for learning - outside the classroom as well as in it.

The Myth Busters Challenge Panel addresses over the top instances where health and safety was used as a reason not to do something. LAs and schools were fertile territory and many examples were collected. A set of principles was required for LAs and schools to refer to, so HSE published sensible risk web pages for local government and education. Leadership is a key concept – a clear and consistent vision of the balance to be achieved has to come from the top and be embedded in the organisation.

On the other hand, sadly, a failure to identify or understand real risks can lead to getting the balance wrong the other way. A district council was recently fined £250,000 after a worker was left with permanent injuries from hand arm vibration (HAV), resulting from working up to six hours a day using vibrating equipment such as mowers and hedge cutters. Despite the availability of information on HAV and how to control it, the council had not acted to control worker exposure, also failing to inform employees about the risk and how to control their exposure.

Sometimes the balance has to be struck between operational imperatives and health and safety responsibilities. An element of risk is woven into the work of the police and the Fire and Rescue Services (FRS). HSWA applies to their activities and HSE has worked with them to clarify how balance can be achieved. Officers should not behave recklessly or expose themselves to needless risk, but they may find themselves at risk in acts of heroism. In such cases HSE considers the public interest and takes a proportionate, common sense approach.

Even when all reasonably practicable precautions have been taken, in accordance with HSWA, harm may still occur – not all risk can be eliminated.

What direction for health and safety in the public sector?
Helping Great Britain Work Well is the refreshed strategy for health and safety in Great Britain. It includes strong commitments to working together and to tackling ill-health. Some public sector organisations have already made their own specific commitments as part of the strategy and there will be further opportunities for stakeholders and duty holders to register participation in the coming months.

Key priorities for the public services sector are set out in HSE’s Sector Plan, which will be finalised following further stakeholder consultation.

A key priority is tackling work related stress which representatives a significant problem. Reductions in budgets and staff can increase the pressure on employees resulting in work-related stress, anxiety or depression. An estimated 4.2 million days were lost to the economy over the last year due to these causes. HSE is carrying out stress pilots in three of the priority areas: education, healthcare and prisons, working with duty holders to implement its management standards approach and develop tailored solutions.

It also includes: a comprehensive review of why MSDs persist in healthcare, which may lead to HSE interventions; setting out HSE’s position on realistic training in the military, where it is necessary to expose individuals to risk in order to prepare for combat; management inspections of the prison service’s policies on violence and aggression and its arrangements for managing them.

And not forgetting our own backyard
While central government is generally considered a low-risk environment, health and safety issues do exist – many have front line services including enforcement roles. These organisations are large and many have sophisticated management systems, with detailed health and safety policies and arrangements. HSE belongs to a cross-government health and safety network, which promotes effective co-operation between departments, including working with Civil Service Learning on a new approach to mandatory health and safety training – you might want to look out for it soon.