# Moving and handling people safely

*The module that decides whether you still have a working back in fifteen years.*

## Production summary

- Modules to record: 2
- Total script: 1164 words, about 8 minutes of finished audio
- Voices: Amara (host) and Nadia (practice educator)
- Level: All health and social care staff

## Accreditation wording that must appear in the description

- **Skills for Health Core Skills Training Framework** (aligned): Content is mapped by us to the moving and handling outcomes described in the CSTF. This is our own mapping and implies no assurance, verification or endorsement by Skills for Health.
- **The CPD Certification Service** (planned): Application scheduled.

> Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved.


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## The law, the hierarchy and the decisions that matter

**Runtime** about 4 minutes. **Words** 647. **Starts at** 00:00 in the full course recording.

### Learning outcomes to state on camera

- 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

### Script


`[CUE 1]` *MHOR hierarchy as three descending blocks with avoid at the top.*

**AMARA**  [00:00]
Moving and handling. Be honest with me, is this the most skipped training in care?

**NADIA**  [00:06]
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**  [00:19]
Start with the law. What is the actual duty?

**NADIA**  [00:23]
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.


`[CUE 2]` *Filter value myth buster: 25kg crossed out with no legal maximum written beside it.*

**AMARA**  [00:36]
And most people go straight to lift carefully.

**NADIA**  [00:40]
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**  [00:54]
Really? Everybody says twenty five kilograms.

**NADIA**  [00:57]
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.


`[CUE 3]` *TILE assessment wheel with the person's wishes added as a fifth segment.*

**AMARA**  [01:17]
What do I assess?

**NADIA**  [01:19]
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**  [01:38]
You would add something to that.

**NADIA**  [01:40]
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.


`[CUE 4]` *Sling check sequence: fraying, loops, LOLER date, configuration.*

**AMARA**  [01:55]
Equipment. What goes wrong?

**NADIA**  [01:57]
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**  [02:21]
Are there techniques that are simply banned now?

**NADIA**  [02:24]
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.


`[CUE 5]` *Prohibited techniques montage, each crossed out, including arms around the neck.*

**AMARA**  [02:36]
That last one sounds harmless.

**NADIA**  [02:38]
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**  [02:52]
Right, the hard situations. Somebody has fallen. What do I do?

**NADIA**  [02:57]
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.


`[CUE 6]` *Fallen person decision tree ending at equipment rather than a manual lift.*

**AMARA**  [03:18]
Even if they say they are fine and want to get up?

**NADIA**  [03:23]
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**  [03:35]
Second situation. It is a two person hoist and I am alone.

**NADIA**  [03:40]
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**  [03:50]
And if my senior tells me to do it anyway?

**NADIA**  [03:54]
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**  [04:06]
In writing. That feels confrontational.

**NADIA**  [04:08]
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.

### Sources for the on screen credit

- Manual Handling Operations Regulations 1992, Health and Safety Executive
- LOLER 1998, Health and Safety Executive
- Manual handling at work, INDG143, Health and Safety Executive
- Moving and handling in health and social care, Health and Safety Executive

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## Equipment, slings and the person on the floor

**Runtime** about 3 minutes. **Words** 517. **Starts at** 04:18 in the full course recording.

### Learning outcomes to state on camera

- Select and check a sling correctly, and explain why size and type matter
- Carry out pre use checks on a hoist, including LOLER dates
- Manage a fallen person safely, including when not to move them
- Handle bariatric and unpredictable transfers within your competence

### Script


`[CUE 1]` *Correct sling beside one too large, with the person sliding through.*

**AMARA**  [04:18]
Hoists frighten me more than anything else in this job.

**NADIA**  [04:22]
Then here is something reassuring and something not. Hoists themselves very rarely fail. Slings fail constantly.

**AMARA**  [04:29]
Why slings?

**NADIA**  [04:30]
Because they are the part people improvise with. A sling is person specific and size specific, prescribed in that individual's handling plan. And the commonest failure in the country is somebody grabbing a different size because the right one is in the wash.

**AMARA**  [04:47]
What happens then?


`[CUE 2]` *Universal sling against an access sling, with the unsupported back highlighted.*

**NADIA**  [04:48]
Too large and they slide through it. Too small and it cuts in, restricts breathing and puts the load in completely the wrong place.

**AMARA**  [04:58]
And types? A sling is a sling.

**NADIA**  [05:00]
It really is not, and this is the dangerous one. A universal or hammock sling supports the whole body. An access or toileting sling leaves the back open and gives far less support.

**AMARA**  [05:14]
So the toileting one is only for?

**NADIA**  [05:16]
Somebody with genuine trunk control who can hold themselves upright. Fit one of those to a person who cannot, and you have suspended somebody with almost nothing supporting their back. It is one of the most dangerous single errors anybody makes with this equipment.


`[CUE 3]` *Illegible label with size, safe working load and inspection date all unknown.*

**AMARA**  [05:34]
What do I check before using one?

**NADIA**  [05:37]
Fraying, cuts, stretched stitching, and the label. And if the label is illegible, that sling is out of service.

**AMARA**  [05:44]
Out of service over a label?

**NADIA**  [05:47]
Over a label. Without it you cannot confirm the size, the safe working load or the last inspection. And a sling that fails does so with a human being suspended in mid air.

**AMARA**  [06:00]
And the hoist itself?


`[CUE 4]` *Ninety second hoist check as a six point sweep.*

**NADIA**  [06:02]
Ninety seconds. Battery charged. Emergency lowering understood and reachable, which people never check until they need it. Castors and brakes. Legs opening and closing. Spreader bar and hooks. LOLER dates on both.

**AMARA**  [06:14]
Anything about the room?

**NADIA**  [06:16]
Clear the route first. A hoist transfer over a rucked rug is how a hoist tips, and it takes four seconds to look.

**AMARA**  [06:25]
Right. Somebody is on the floor. What do I do?

**NADIA**  [06:29]
Not what your instinct says, which is to get them up. Assess before anybody touches them.


`[CUE 5]` *Shortened, externally rotated leg flagged as a suspected fractured neck of femur.*

**AMARA**  [06:36]
What am I looking for?

**NADIA**  [06:38]
Did they hit their head. Are they on anticoagulants, because a head injury on a blood thinner is a different situation entirely. Pain, deformity, and particularly a leg that looks shortened and rotated outwards.

**AMARA**  [06:51]
Which means?

**NADIA**  [06:52]
Classic fractured neck of femur. Move that person and you have made a bad injury much worse. Keep them warm, keep them comfortable, call for help.

**AMARA**  [07:02]
And if they are genuinely uninjured?


`[CUE 6]` *Three separately recorded falls assembling into a pattern.*

**NADIA**  [07:05]
If they can assist, a supervised assisted rise using furniture is fine. If they cannot, lifting cushion or hoist with a floor recovery sling.

**AMARA**  [07:14]
Never manually?

**NADIA**  [07:15]
Never. Lifting somebody off the floor by hand is precisely where carers destroy their backs, and it is a completely avoidable injury.

**AMARA**  [07:24]
Do I record a fall where nobody was hurt?

**NADIA**  [07:28]
Especially those, and this is the bit people skip because it feels like paperwork about nothing. One fall is an event. Three falls is a diagnosis waiting to be made, and the pattern only exists if somebody wrote down the two where nothing happened.

### Sources for the on screen credit

- Moving and handling in health and social care, Health and Safety Executive
- LOLER 1998 and thorough examination, Health and Safety Executive
- Falls in older people: assessing risk and prevention, CG161, NICE

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