Module 1 of 2 · 50 minutes
The law, the hierarchy and the decisions that matter
By the end of this module you will be able to
- State the duties under MHOR 1992 and HSWA 1974 section 7
- Apply the avoid, assess, reduce hierarchy
- Use the TILE or LITE factors in a handling assessment
- Handle a fallen person, a single handed situation and an unsafe instruction
Work through it
1 interactive for this module, built on the WAJD Teach engine. Nothing moves until you ask it to, and every one has a written version if you would rather read it.
Amara Moving and handling. Be honest with me, is this the most skipped training in care?
Nadia It is the most skipped and it is the one that ends careers. Musculoskeletal disorders are the largest single cause of sickness absence in this sector. People leave with backs that never come right.
Amara Start with the law. What is the actual duty?
Nadia The Manual Handling Operations Regulations 1992. Three steps, in order. Avoid hazardous manual handling so far as is reasonably practicable. Assess what you cannot avoid. Reduce the risk so far as is reasonably practicable.
Amara And most people go straight to lift carefully.
Nadia Which is the last resort dressed up as a technique. And there is something I want to clear up, because it is quoted at me constantly. There is no legal maximum weight you are allowed to lift.
Amara Really? Everybody says twenty five kilograms.
Nadia That is a filter value in HSE guidance for assessment purposes. It is not a permitted limit and it is not a legal threshold. Every task is assessed on its own facts, and a light person in a bad position is more dangerous than a heavy one in a good one.
Amara What do I assess?
Nadia Remember it as TILE. Task, how far, how often, twisting, stooping, holding. Individual, meaning you: your training, your health, whether you are pregnant, your own back history. Load, which is the person, their weight, condition, pain, cooperation and unpredictability. And Environment: space, floor, lighting, obstructions, bed height.
Amara You would add something to that.
Nadia The person's own abilities and wishes. A handling plan written without the person produces resistance, and resistance gets written down as challenging behaviour when it is actually a reasonable objection to being moved in a way nobody discussed.
Amara Equipment. What goes wrong?
Nadia Slings, mostly. They are person specific and size specific, and the wrong sling is the commonest reason somebody slides out of a hoist. Check for fraying. Check the loops. Check the LOLER date, which for a sling is at least every six months and for the hoist itself at least every twelve. And check the loop configuration matches the plan.
Amara Are there techniques that are simply banned now?
Nadia Several. The drag lift under the arms. The Australian or shoulder lift. Lifting somebody under the arms from the floor. And allowing a person to put their arms around your neck.
Amara That last one sounds harmless.
Nadia It is the single most common route to a permanent neck injury in care work. And it happens precisely because it feels affectionate, so nobody wants to be the person who says no. Say no.
Amara Right, the hard situations. Somebody has fallen. What do I do?
Nadia Not rush to lift, which is everybody's instinct. Assess for injury. Ask what happened and whether they hit their head. Check for pain and deformity. Do not move anyone with a suspected spinal injury or fracture. Keep them warm, keep them comfortable, and use the right equipment, usually a lifting cushion or a hoist.
Amara Even if they say they are fine and want to get up?
Nadia Especially then. And record every fall, including unwitnessed ones, because the pattern is the clinical information. One fall is an event. Three falls is a diagnosis waiting to be made.
Amara Second situation. It is a two person hoist and I am alone.
Nadia Then it does not happen. There is no version of this where you improvise safely. Escalate it, and record the staffing shortfall as an incident.
Amara And if my senior tells me to do it anyway?
Nadia You may decline, and you are lawfully entitled to. Say what you are willing to do, state the specific risk in one sentence, and put the exchange in writing afterwards.
Amara In writing. That feels confrontational.
Nadia It feels confrontational for about a day. It is decisive on the day somebody is injured and everyone is asked what was said. Write it down.
The written material
The legal frame
The Manual Handling Operations Regulations 1992 require employers to avoid hazardous manual handling so far as is reasonably practicable, to assess what cannot be avoided, and to reduce the risk of injury so far as is reasonably practicable. Section 7 of the Health and Safety at Work etc Act 1974 places duties on you as an employee.
Two further sets of regulations matter with equipment. PUWER 1998 governs the provision and use of work equipment. LOLER 1998 governs lifting equipment: hoists must be thoroughly examined at least every 12 months, and lifting accessories such as slings at least every 6 months. Check the date before you use it.
The hierarchy and the assessment
Avoid, assess, reduce, in that order. Most services skip to lift carefully, which is the last resort dressed up as a technique.
The assessment factors are usually remembered as TILE: the Task, the Individual doing it, the Load, meaning the person being moved and their condition and cooperation, and the Environment. Add the person's own abilities and wishes, because a handling plan written without them produces resistance that gets recorded as challenging behaviour.
- Task: how far, how often, twisting, stooping, sustained holding
- Individual: your training, your health, pregnancy, your own back history
- Load: the person's weight, condition, pain, cooperation, unpredictability
- Environment: space, floor surface, lighting, obstructions, bed height
Equipment, and the errors that hurt people
Use the equipment named in the handling plan and the number of staff named in the handling plan. Slings are person specific and size specific, and the wrong sling is the commonest cause of a person sliding out of a hoist. Check the sling for fraying, check the loops, check the LOLER date, and check that the loop configuration matches the plan.
Prohibited practices in modern UK care: the drag lift under the arms, the Australian or shoulder lift, lifting a person under the arms from the floor, and allowing a person to hold on to your neck. All of them cause injury, some of them cause shoulder dislocation in the person being moved.
The three hard situations
The fallen person. Do not rush to lift. Assess for injury, ask what happened and whether they hit their head, check for pain and deformity, and do not move anyone with a suspected spinal injury or fracture. Keep them warm and comfortable, and use the correct equipment, which in most services is a lifting cushion or a hoist. Report and record every fall, including an unwitnessed one, and consider whether an ambulance is needed.
The single handed situation. If the plan says two staff, it needs two staff. There is no version of this where you improvise safely. Escalate, and record the staffing shortfall as an incident so it is visible.
The unsafe instruction. If a senior tells you to carry out a handling task you believe is unsafe, you may decline. Say what you are willing to do, state the specific risk, and put the exchange in writing afterwards.
Knowledge check
The knowledge check and your certificate need a free account, so that your progress and results can be saved as evidence.
The learning itself stays free and open. You are reading all of it right now without an account.