16.09 Issue 10 PDF

Manual Handling and Back Care – 16.
09
SECTION: 16 - HEALTH AND SAFETY
POLICY /PROCEDURE: 16.09
NATURE AND SCOPE: POLICY AND PROCEDURE - TRUST WIDE
SUBJECT: MANUAL HANDLING AND BACK CARE
This policy has been produced in line with the Manual Handling Operations Regulations
1992, the Management of Health and Safety at Work Regulations 1999 and all other
nationally accepted standards, guidelines and Codes of Practice to implement all
reasonably practicable measures to reduce risks associated with manual handling.
DATE OF LATEST RATIFICATION: SEPTEMBER 2015
RATIFIED BY: TRUST HEALTH AND SAFETY COMMITTEE
IMPLEMENTATION DATE: NOVEMBER 2015 – (RE-ISSUED APRIL 2016)
REVIEW DATE: SEPTEMBER 2018
ASSOCIATED TRUST POLICIES

AND PROCEDURES: Health, Safety & Welfare – 16.01
Safe Working with Display Screen Equipment – 16.11
Risk Assessment in Health and Safety -16.20
Provision and Safe Use of Work Equipment – 16.18
Falls: The Assessment, Prevention and Management of
Patient Falls (Adult Services) – 1.34
Bariatric – 1.35
Medical Devices – 15.14
Reporting of Accidents, Untoward Incidents and Near Miss
Situations Including Serious Incidents – 15.01
ISSUE 10 – APRIL 2016 1

Manual Handling and Back Care – 16.09
U NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST
U MANUAL HANDLING AND BACK CARE POLICY
U CONTENTS
1.0 Introduction
2.0 Policy Principles
3.0 Definitions
3.1 Manual Handling
3.2 Back Care
3.3 Ergonomics
3.4 Hazard
3.5 Risk
3.6 Reasonably Practicable
4.0 Duties
5.0 Risk Assessment
6.0 Implementation
7.0 Training
8.0 Target Audience
9.0 Review Date
10.0 Consultation
11.0 Relevant Trust Policies / Procedures
12.0 Monitoring Compliance
12.2.1 Process of Monitoring Compliance and Effectiveness
13.0 Equality Impact Assessment
14.0 Legislation and Compliance
15.0 Champion & Expert Writer
16.0 References /Source Documents
Appendix 1 An Insight into Risk Assessment

Appendix 2 Employee Safe Working Check Sheet for Staff Needs and Limitations
Appendix 3 Movement and Handling Risk Assessment for All Loads
Appendix 4 Explanations of Consequence and Likelihood Tables
Appendix 5 Patient Handling Information Sheet To Be Completed For All Patients, Patient
Handling Risk Assessment Filter, PURPLE, GREEN, YELLOW And RED
Documentation
Appendix 6 Patient Handling Information Sheet
(exclusively for use at Lings Bar Hospital in-patient wards as part of the patients rehabilitation plan)
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Appendix 7 Optional Safe Working Check Sheet – Community / Home Care

Appendix 8 Record of Changes
Appendix 9 Record of Employee Having Read the Policy

U NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST
U MANUAL HANDLING AND BACK CARE POLICY
1.0 U INTRODUCTION
1.1 Lifting and handling tasks involve three kinds of risk; the risk of accidental injury by, for
example, a loss of footing or trapping fingers, over-exertion injury or over-use injury. In
terms of the latter two examples, injuries can occur from a mismatch between the demands
of the task and the capabilities of the person (Pheasant 1991). International statistics state
that healthcare workers are among those at highest risk of musculoskeletal disorders,
especially of the back and shoulder (Menoni et al. 2015). The purpose of this Policy is to
provide a framework around which safe manual handling and movement practices can be
maintained and promoted for the benefit of all Nottinghamshire Healthcare NHS Foundation
Trust (the Trust) employees and patients.
1.2 The Manual Handling Operations Regulations 1992 apply to the manual handling of loads by
human effort. The main aim of this Regulation is to “prevent injury not only to the back, but
to any part of the body” and requires the employer to take into account the whole handling
operation. This Regulation establishes a hierarchy of measures to avoid hazardous manual
handling, to assess that which cannot be avoided and reduce the risk of injury from manual
handling that cannot be avoided.
1.3 The Management of Health and Safety at Work Regulations 1999 requires that employers
make “suitable and sufficient” assessments of risks to the health and safety of its employees
while at work. Detailed guidance can be found in the Trust Risk Assessment in Health and
Safety Policy and Procedure 16.20.
1.4 The Trust recognises its obligations under nationally accepted standards, guidelines and
codes of practice in implementing reasonably practicable measures to reduce risks
associated with manual handling activities.
1.5 Policies help organisations to direct its resources and personnel to act in a positive way
towards safe practice and in the reduction of musculoskeletal injuries (Menoni et al. 2015).
2.0 U POLICY PRINCIPLES
2.1 The Trust recognises its duty of care to ensure so far as is reasonably practicable, that
employees undertaking manual handling activities do so with the minimum risk of injury to
themselves and others who may be affected by what they do.
2.2 The Trust will ensure compliance to the Regulations by removing or reducing the risk of
manual handling related musculoskeletal injuries by applying appropriate methods of
prevention. One such method will be an ergonomic approach giving consideration to the way
the task is carried out, the characteristics of the load, the working environment and individual
capability. This approach will be reflected in the formal risk assessment documentation.
2.3 The Trust acknowledges that better job and / or workplace design may not “eliminate”
handling injuries but there is evidence that it can greatly reduce them. This, along with the
appropriate use of equipment is also part of an ergonomic approach.
2.4 The Trust recognises that manual handling is integral to work activities and activities of daily
living. Education, training, information, instruction and supervision provided by the Trust for
the benefit of employees will take this into account.

2.5 The Trust will ensure that the Hierarchy of Measures for the manual handling of loads will be
followed in all instances to remove or reduce the risks from manual handling. These
measures are:
(a) avoid hazardous manual handling operations so far as is reasonably practicable
(b) assess any hazardous manual handling operations that cannot be avoided
(c) reduce the risk of injury so far as is reasonably practicable
2.6 Assessments may be best carried out by those who are familiar with the operation in
question providing they have the necessary competencies. In more complex cases
specialised knowledge might be required. The Trust will ensure that specialist advisers are
used in these situations.
3.0 U DEFINITIONS
3.1 U Manual Handling
Regulation 2 of the Manual Handling Operations Regulations 1992 interprets manual

handling as “… any transporting or supporting of a load (including the lifting, putting down,
pushing, pulling, carrying or moving thereof) by hand or bodily force. The load includes any
person and any animal (HSE 2004). The application of human effort for purposes other than
transporting or supporting a load such as turning a handle or lashing down a rope on a
vehicle is not a manual handling operation.
3.2 U Back Care
The concept of back care is wider than manual handling. It includes the application of
ergonomics, health promotion, occupational health and safety, injury support and
rehabilitation and lifestyle (National Back Exchange 2004).
3.3 U Ergonomics
Ergonomics is the science of work: of the people who do it and the way it is done, of the
tools and equipment they use, the places they work in and the psychosocial aspects of the
working situation (Pheasant and Haslegrave 2006). Ergonomics aims to achieve the best
possible match between the product and its users fitting the job to the worker (Pheasant
2001).
3.3.1 Examples of three ergonomics approaches to ensure that demands are less than the
individual’s capacity include:
o The Biomechanical Approach – how work activities stress the musculoskeletal

system
o The Physiological Approach – a person’s ‘endurance’ when undertaking a

repetitive lifting activity
o The Psychophysical Approach – human sensations, physical stimuli and

perceived levels of exertion
Because confusion can result from conflicting recommendations provided by different

models or even by the same model, it has been suggested that future models should
concentrate on providing insight into the musculoskeletal risks of jobs and careers
instead of tasks (Kumar 1999).

This can be interpreted as not restricting measures made to protect musculoskeletal
health to materials handling and patient handling activities but rather, promoting
musculoskeletal health whether work is principally sedentary or involves movement
and postures which might over time lead to either a predisposition to or actual injury.
This includes staff involved with Violence Reduction.
3.4 U Hazard
A hazard is something with the potential to cause harm and can include methods of work
and the working environment.
Identifying the presence of a hazard enables actions to be taken to reduce biomechanical

overload (Menoni et al. 2015).
3.5 U Risk
A risk is the likelihood of potential harm from that hazard being realised.
In the case of lifting and handling, to set an acceptable ‘loading’ limit is difficult. Having a
limit at the level of just noticeable risk would be the equivalent of calling for the abolition of all
useful manual work and guidelines that cannot be met in practice are likely to be ignored and
fall into disrepute. A reasonably practical compromise is therefore required which allows
working life to continue without incurring excessive risk. This position roughly approximates
the legal concept of a risk that is reasonably foreseeable or a level of risk which a
reasonable person would agree to accept in the course of his or her working life where they
are fully appraised of the facts of the matter (Pheasant and Haslegrave. 2006).
3.6 U Reasonably Practicable
The term reasonably practicable implies that a computation must be made in which the
quantum or risk is placed in one scale and the sacrifice involved in the measures necessary
for averting the risk (whether in money, time or trouble) is placed in the other (Selwyn 2002).
The employer must weigh up the risk against cost involved in the removal or reduction of
that risk. Unless the cost is grossly disproportionate to the risk, then it will be reasonably
practicable to do something about it (Mandelstam 2002).
4.0 U DUTIES
4.1 The Chief Executive shall be responsible for ensuring that this Policy is implemented and for
compliance with the above mentioned Regulations, nationally accepted standards,
guidelines and Codes of Practice. However, it is the duty of all employees to act responsibly
to alert their immediate Manager should any activity give rise for concern. It is the business
of everyone to be ‘alive’ to risk and to act appropriately.
4.2 Each Director / Head of Service / General Manager has responsibility for compliance with
the requirements of this Policy and ensuring its implementation within their own areas.
4.3 Each Director / Head of Service / General Manager will ensure that all hazardous manual
handling operations are avoided or where this is not possible reduce the risk of injury from
the manual handling operation, so far as is reasonably practicable, by ensuring suitable and
sufficient risk assessments and action plans are in place.
4.4 Each Director / Head of Service / General Manager must ensure that any design or change
of use of any building / room is done so with due consideration to ergonomics so that design
innovations and scientific knowledge can be drawn upon for the benefit of worker comfort,
safety and productivity. This includes patient safety. Where necessary the relevant experts
should be consulted i.e. The Trust Manual Handling Advisory Group.

4.5 Each Director / Head of Service / General Manager will monitor the results of manual
handling risk assessments and their action plans and will allocate appropriate resources and
training to manage the risks which cannot be managed locally.
4.6 Each Director / Head of Service / General Manager will report to the Trust Health and Safety
Committee the significant risks arising from their areas manual handling operations which
remain after the Hierarchy of Measures have been applied with an action plan on the
proposed measures to be taken to control the risk of injury.
4.7 Each Director / Head of Service / General Manager will ensure that where significant risk(s)
remain that these are placed in a timely manner on to the Trust Risk Register.
4.8 Where each Director / Head of Service / General Manager are unable to manage a manual
handling risk for whatever reason, then it shall be discussed at the Trust Risk Register
Monitoring Group and /or other Trust Group(s) with specialist knowledge to consider the risk
and action as appropriate.
4.9 Each individual Manager within the Trust is responsible for:
4.9.1 Ensuring all staff, including bank and agency staff are made aware of and have
access to this Policy and that staff understand their responsibilities for participating in
the process of identifying manual handling risks and risk assessments.
4.9.2 Ensuring that documented risk assessments including any action plans for all manual
handling activities involving moving patients and inanimate loads that present a risk
of injury are undertaken with resultant actions. Where managers have concerns
about the health, injury or training needs of the staff they manage, the Employee
Safe Working Check Sheet for Staff Needs and Limitations in Appendix 2 can be
used to help support them.
4.9.3 Ensuring that risk assessments are overseen by a person(s) with competence in the
risk assessment process and with appropriate knowledge of inanimate load handling
and / or patient handling for example; a Key Mover who will have received training in
the risk assessment process.
4.9.4 Making sure that the findings and subsequent actions resulting from a risk
assessment are communicated to all those connected with the task that has been
assessed.
4.9.5 Implementing the range of strategies and control measures identified from the
manual handling risk assessment before the activity and / or manual handling
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operation takes place.
4.9.6 Ensuring that all staff involved in patient handling including bank and agency staff,
are “appropriately” instructed and / or trained prior to the activity including the use of
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work equipment. Where this is not possible and while instruction and training is
being arranged suitable supervision must be given. The Medical Devices Policy
15.14 will apply to most patient handling equipment.
4.9.7 Keeping up to date training records for training that staff receive and ensuring that
the training is appropriate for any required handling equipment and its accessories
such as slings. This will be in accordance with the Provision and Safe Use of Work
Equipment Policy 16.18.
4.9.8 Ensuring that staff undertaking manual handling activities wear appropriate Personal
Protective Equipment (PPE); and that this does not impede movement and that
personal ‘effects’ which staff might be wearing do not pose a risk of injury to self,
patient or others.

4.9.9 Ensuring that all new equipment is only purchased via Trust Procurement in
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compliance with the Provision and Safe Use of Work Equipment Policy 16.18 and its
accompanying appendices prior to its purchase.
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4.9.10 Ensuring that equipment is installed, set up and used in accordance with the
manufacturer’s instructions with due regard to movements and postures and that
training in the safe use of the equipment has been undertaken by those who will be
operating the equipment.
4.9.11 Ensuring that equipment and any accessories such as lifting attachments are
maintained, inspected and serviced at regular intervals in accordance the relevant
Regulations as mentioned within Provision and Safe Use of Work Equipment Policy
16.18.
4.9.12 Ensuring that new or any existing handling equipment / medical device has been
registered with the Medical Devices Team and is recorded in the Trust Medical
Devices Inventory. Thereafter it will be the nominated ‘responsible person(s)’
responsibility to keep this information up to date; for example if there is a change of
location or service information.
4.9.13 Ensuring that where equipment is to be loaned to another or from another that the
relevant documentation from the Trust Provision and Safe Use of Work Equipment
Policy 16.18 is completed prior to its loan and before its use. In patient handling
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areas infection control issues must also be considered.
4.9.14 Liaising closely with those in control of the premises not belonging to the Trust where
Trust staff carry out manual handling operations to enable them to plan their work
safely for example Safe Systems of Work.
4.9.15 Directing staff who work with equipment in community or home care settings to
identify any concerns using the Optional Safe Working Check Sheet – Community /
Home Care in Appendix 7.
4.9.16 Where manual handling equipment becomes faulty remove from service with
immediate effect and follow the Trust Provision and Safe Use of Work Equipment
Policy 16.18 requirements.
4.9.17 Ensuring that all accidents, incidents and near misses arising from manual handling
activities are reported and investigated in line with the Reporting of Accidents,
Incidents and Near Miss Situations - Including Serious Incidents Policy 15.01
4.9.18 Monitoring the remedial action put in place to ensure that it is and continues to be
effective.
4.9.19 Ensuring that relevant patient handling equipment is purchased, maintained and pre-
use checked in compliance with the Medical Devices Policy 15.14 in patient handling
areas and furthermore, that staff are competent to use such equipment.
4.9.20 All employees within the Trust have responsibilities for managing risks. They should
therefore co-operate and participate at all times in carrying out manual handling risk
assessments when they are required. Each member of staff, including bank and
agency are responsible for:
• Being familiar with this policy and its contents and for complying with its
requirements.
• Participating in the manual handling risk assessment process and action plans.

• Using work equipment and Personal Protective Equipment provided in

accordance with any instruction and training given and following appropriate
systems of work.
• Ensuring that equipment is not used unless the person using it has received the
appropriate training.
• Being aware of what manual handling tasks they will be expected to do and what
tasks they are not expected to do.
• Participating in all training and refresher training as identified by their line

manager as essential or relevant to the inanimate load handling or patient
handling they undertake and to participate in training in readiness for new
activities and new equipment use.
 Immediately informing their line manager and others of identified manual handling
risks, faulty or dangerous equipment and to cease the activity and use of the work
equipment in these situations.
 Using the Employee Safe Working Check Sheet for Staff Needs and Limitations
in appendix 2 to make managers aware of any support they might need.
 Using the Optional Safe Working Check Sheet – Community / Home Care in
Appendix 7 if working in environments that are not Trust premises and needing to
alert managers to any shortfalls in equipment and training needs.
4.10 The Trust Back Care Manager and other appropriately qualified manual handling
practitioners will provide advice and guidance to managers and employees to support them
to undertake their duties as outlined in this Policy and other Health and Safety Policies.
4.11 Procurement must ensure that in all instances the appropriate documentation has been
received as per the requirements of the Trust Provision and Safe Use of Work Equipment
Policy 16.18 prior to arranging the purchase of any work equipment item. Where this
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documentation is not received and correctly signed off then this equipment must not be
purchased.
5.0 U RISK ASSESSMENT
5.1 If manual handling cannot be avoided, the hazards for a worker’s health and safety must be
assessed. At a very basic level where risks were negligible, the load light and all conditions
favourable, then the process should be quite straightforward (Columbini et al. 2013).
5.2 Favourable conditions include:
• A light easy to manage load (with low risk of biomechanical overload)
• Not repetitive
• No distances involved
• Good (healthy) postures can be maintained
• Worker uninjured
• Worker fully ‘alive’ to the risks and able to move and handle well

5.3 Risk assessments should be undertaken for:
• the handling of all loads – see:

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Appendix 1 - An Insight into Risk Assessment

Appendix 2 – Employee Safe Working Check Sheet for Staff Needs and Limitations
Appendix 3 - Movement and Handling Risk Assessment for All Loads
Appendix 4 - Explanations of Consequence and Likelihood Tables
• for the moving and handling of people/handling plans - see:

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Appendix 5 – Patient Handling Information Sheet To Be Completed For All Patients,

Patient Handling Risk Assessment Filter PURPLE, GREEN, YELLOW And RED
Documentation
Appendix 6 - Patient Handling Information Sheet – Lings Bar Hospital

(exclusively for use at Lings Bar Hospital in-patient wards as part of the patients rehabilitation plan)
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Lings Bar Hospital are the only inpatient general nursing area within Nottinghamshire
Healthcare NHS Foundation Trust. Because of this various patient specific
documentation has been developed for exclusive use in this area of nursing and
rehabilitation. Further to trialling a specific patient handling risk assessment tool for use
at Lings Bar Hospital it has been agreed that the risk assessment documentation in
Appendix 6 shall be used exclusively for inpatient wards at Lings Bar Hospital as part of
the patient’s rehabilitation plan.
Appendix 7 – Optional Safe Working Check Sheet – Community/Home Care
• U For Violence Reduction Methods Training
An assessment of the risks involved in undertaking violence reduction methods training

should be carried out using the Rapid Entire Body Assessment (REBA) tool and / or a
Borg Scale (Rating of Perceived Exertion) and documented using Appendix 4 of the Risk
Assessment in Health and Safety Policy 16.20. REBA and Borg Scale documentation is
available on the Trust Health and Safety Management System Guidance.
5.4 Improving the working conditions of the carer and improving the quality of patient care go
hand in hand. A Risk Management Approach to safer handling requires adequate numbers
of staff, the provision of suitable movement aids and equipment, enough space to carry out
tasks, effective training and ongoing monitoring (Menoni et al. 2015).
5.5 Unavoidable manual handling requires an assessment but fully assessing every manual
handling operation might involve wasted effort. Assessments need to be concentrated
where they are needed. In an inpatient area, the environment should be conducive to safe
patient care.
5.6 Managers should address staff capacity and competence to carry out any manual handling
activities at regular intervals and before those activities take place. The Safe Working Check
Sheet for Staff Needs and Limitations in Appendix 2 can be used for this purpose.
5.7 The level of detail in a patient handling risk assessment is determined by using the PATIENT
HANDLING RISK ASSESSMENT FILTER. In particularly complex scenarios, the person/s
carrying out a patient handling risk assessment might need to be familiar with the five key
principles of the Mental Capacity Act 2005 and articles 3 and 8 of the Human Rights Act
1998. Where load handling applies to patient care (YELLOW and RED Documentation) the
load handling documentation in Appendix 3 will need completing as appropriate.
5.8 The hierarchy of measures mentioned in 2.5 above must be followed in all instances. It may
not be necessary to assess risk in great detail if the operation can be avoided or where steps
to “reduce the risk to the lowest level reasonably practicable are obvious”.

5.9 The Manual Handling Operations Regulations set no specific requirements on weight limits.
An ergonomic assessment is used to determine a range of factors that may present a risk
and where remedial action can be made.
5.10 The ergonomic assessment for “Load Handling” is used to “design” the manual handling
operations as a whole and includes full consideration to the following:
• Task (postures and movements)

• Individual (capacity and needs of the handler)
• Load (all the various characteristics that affect its movement and handling)
• Environment (where the manual handling activity takes place)
Note: each of the above may influence the others and should not therefore be considered in
isolation.
5.11 The risk assessment process must follow the principles and requirements, duties,
responsibilities and competencies set out in the Trust Risk Assessment in Health and Safety
Policy and Procedure 16.20 for all “types” of risk assessment and include the following:
5.11.1 Where a “low risk” has been identified no further action may be required.
5.11.2 Where the Trust supply any equipment in Service Users homes then this operation
must be assessed and training provided to the Service User / informal carer.
5.11.3 Where “Generic” assessments are undertaken these must consider all of the manual
handling risks present in the operations and should only be used for broadly similar
operations.
5.12 Team handling may introduce additional problems and this must be considered in the risk
assessment process. It should be noted that “the load that a team can handle safely is less
than the sum of the loads that the individual team members could cope with when working
alone”.
5.13 Where there is a risk of injury then account must be taken of any other relevant risk
assessment “findings” such as:
• specific risk assessments for young people, new and expectant mothers
• workplace layout
• work organisation
• equipment use
5.14 Particular consideration must be given to staff who are “especially at risk”, for example:
• those who are pregnant as risk(s) may be to mother, child or both. In this instance you
must follow the duties set under the Management of Health and Safety at Work
Regulations. See Trust Risk Assessment in Health and Safety Policy and Procedure
16.20 - Appendix 7 Guidance and Risk Assessment for New and Expectant Mothers at
Work
• those who have recently given birth – see above
• young workers
• those who have a history of musculoskeletal disorder, back, knee or hip trouble, hernia
or any other health problem which may affect their movement and handling capability
• those returning to work after injury or time off due to a health change
• previous manual handling injury
• those with a disability which may affect their manual handling capability

5.15 The Employee Safe Working Check Sheet for Staff Needs and Limitations in Appendix 2 will
help managers to address important but more straightforward ‘staff at risk’ situations. For
more complicated or more long term musculoskeletal issues it might be more appropriate to
make a referral for an Individualised Ergonomic Workplace Assessment.
5.16 Risk Assessments must be kept up to date and relevant and reviewed if any changes arise
to the activity, a person’s needs, the environment or equipment.
6.0 U IMPLEMENTATION
6.1 All employees, including bank and agency staff will be made aware of this policy.
6.2 Responsible persons must ensure that they implement the requirements of this policy
specifically completing risk assessments, developing action plans and putting in place
remedial actions / control measures where relevant to avoid or reduce the risk of injury.
7.0 U TRAINING
7.1 All new employees will attend the Trust Back Care Induction Programme to introduce them
to the various resources available to them throughout the Trust and to give them an insight
into any specific training they may need in the future. Local inductions will be necessary but
these will not be a substitute for the Trust Programme.
7.2 All employees should receive timely and appropriate training prior to the work they are
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required to do and must attend training programmes that have been categorised as
mandatory or essential for their particular occupational group. Where this cannot be
achieved, as an interim measure, the employee must receive adequate supervision for any
manual handling tasks they have to carry out. A Training Needs Analysis is completed by
each Directorate to determine the nature and frequency of the training required. Completed
Training Needs Analysis Grids are returned to Learning and Development and the database
is updated accordingly. To help Managers with their Training Needs Analysis the Trust has
adopted some Standards in Manual Handling Training Provision. This document can be
found on the Learning and Development Trust Intranet site.
7.3 Information, instruction and training in the use of equipment will be necessary for employees
prior to its use and inexperienced, young and newly trained staff must be appropriately
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supervised.
7.4 The Management of Health and Safety at Work Regulations 1999 refers to the provision of
adequate training where for example, there are new or increased risks, where new work
equipment has been introduced, or where systems of work change, therefore, such training
may need to be repeated periodically where appropriate (HSC 2000).
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7.5 Training programmes that include moving patients and inanimate loads will be carried out
within the parameters of known and acceptable movement principles for pushing, pulling,
reaching, turning and lifting. Methods taught will represent current best practice. This also
applies to the use of equipment.
7.6 As a result of Training Needs Analysis or risk assessment update, refresher training must be
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arranged at timely and appropriate intervals depending upon the nature of the work
undertaken and the subsequent risk of injury.
7.7 Mandatory training will be centrally recorded and all other training must be recorded locally
with managers ensuring that records are kept up to date.
7.8 Managers of non-attendees will receive a ‘not attended’ letter informing them to book their
staff member onto the next available course. In the event of persistent non-attendance /

non-completion, General Managers / Heads of Service will be informed by Learning and
Development in order to take this through local management performance routes.
7.9 The Trust will enable “nominated” persons, managers, trainers, advisers and others involved
with promoting safer manual handling to attend any relevant programmes of training and
professional development in order to support, promote and encourage back care and good
practice in manual handling in their work areas.
7.10 Managers must ensure that the staff they are responsible for have attended relevant and
essential training programmes and / or inductions. This includes taking into account an
individual staff members needs and limitations.
7.11 The Trust Manual Handling Advisory Group whose membership includes lead practitioners
involved with the organisation and delivery of manual handling training for the Trust will
provide specialist advice on all aspects of manual handling.
This advice can include policy making, risk assessment, workplace design, the purchasing of
equipment and furniture and standards for training.
7.12 Over the longer term, it has been proven that only broadly based strategies adequately
manage worker risk, reduce injury and sickness absence and ultimately lead to higher
quality patient care. Risk assessment has a key role to play as part of this strategy along
with appropriate training and the use of mechanical aids (Menoni et al. 2015). The Trust
recognises that training alone will not be a substitute for other higher order measures such
as job design, environmental considerations and actions influenced by risk assessments.
Further to these controls, employees experiencing back pain or other musculoskeletal
discomfort or injury will be offered support from a range of Trust resources. This will include
Occupational Health, Individualised Ergonomic Workplace Assessments and access to
advice from the Trust Back Care Manager and other appropriate health practitioners and
advisers.
8.0 U TARGET AUDIENCE
8.1 This policy applies to all employees, including bank and agency staff working on Trust
premises or on ‘shared’ sites or within the community.
8.2 Occupational groups will include managers, health practitioners such as nursing staff, care
assistants and those providing therapeutic or advisory services. Administrative workers,
Estates and Hotel Services personnel will also be part of this number.
9.0 U REVIEW DATE
9.1 This policy will be reviewed in 3 years or in light of organisational or legislative changes.
10.0 U CONSULTATION
• Manual Handling Advisory Group

• Trust Health, Safety and Security Committee
• Executive Leadership Council
• Learning and Development
11.0 U RELEVANT TRUST POLICIES/PROCEDCURES
• Health, Safety & Welfare 16.01

• Risk Assessment in Health and Safety 16.20
• Provision and Safe Use of Work Equipment 16.18
• Safe Working with Display Screen Equipment 16.11
• Medical Devices 15.14

• Reporting of Accidents, Untoward Incidents and Near Miss Situations Including Serious
Incidents 15.01
12.0 U MONITORING COMPLIANCE
12.1 Each Executive Director will monitor the implementation of this Policy in all areas within their
control and ensure that risk assessments and action plans are completed within a timely
manner and reviewed in line with any changes.
12.2 The Trust Health, Safety and Security Committee will monitor the effectiveness of this Policy
and its associated documentation on a regular basis.
12.2.1 Process of Monitoring Compliance and Effectiveness

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• The monitoring arrangements for compliance and effectiveness will be to

undertake scheduled audits across the Trust, reporting findings to relevant
managers and the Trust Health, Safety and Security Committee on a regular
basis.
• For audit purposes all areas will be asked to produce “outcome” evidence of their
documented risk assessments, action plans and training records for non-
mandatory training for manual handling activities and mechanical aids for meeting
the Trusts legal and other requirements.
• Audits will take place in line with the Trust Health and Safety Management
System Audit Programme.
• The Trust Health, Safety and Security Committee will monitor appropriate access
to Back Care Specialists and other appropriately qualified manual handling
practitioners and make any relevant recommendations.
• The Trust Manual Handling Advisory Group will monitor standards for manual
handling training provision and other strategies involving Back Care, Ergonomics
and the Manual Handling of Inanimate Loads and People and advise or escalate
concerns to the Trust Health, Safety and Security Committee.
• The Trust Manual Handling Advisory Group will monitor incidents related data for
manual handling activities and feedback any concerns or recommendations to the
Trust Health, Safety and Security Committee.
13.0 U EQUALITY IMPACT ASSESSMENT
13.1 This policy has been assessed using the Equality Impact Assessment Screening (EIA). The
outcome of the EIA was that the Policy could not adversely affect different groups on the
grounds of disability, BME, gender, age or sexual orientation.
14.0 U LEGISLATION AND COMPLIANCE
14.1 This policy has been developed with due consideration to:
• The Health and Safety at Work Act 1974

• Manual Handling Operations Regulations 1992 (as amended)
• Management of Health and Safety at Work Regulations 1999
• Provision and Use of Work Equipment Regulations 1998
• Lifting Operations and Lifting Equipment Regulations 1998
• Workplace (Health, Safety and Welfare) Regulations 1992
• Mental Capacity Act 2005

• Human Rights Act 1998
15.0 U CHAMPION AND EXPERT WRITER
15.1 The Champion for this document is the Executive Director of Forensic Services and the
expert Writer is Bill Varnam, Back Care Manager.
16.0 U REFERENCES /SOURCE DOCUMENTS
o Alexander, P. and Johnson, C. 2011. Manual Handling of Children: National Back

Exchange: p 19
o All Wales. 2003. All Wales NHS Manual Handling Training Passport and Information
Scheme: All Wales Trust Manual Handling Advisers Group
o Colombini, D. Occhipinti, E. Alvarez-Cascado, E. and Waters, T. 2013. Manual Lifting –
A Guide to the Study of Simple and Complex Lifting Tasks. CRC Press: p 26
o DIAG. 2011. Care Handling for People in Hospital Community and Educational Settings
– A Code of Practice. UK. Derbyshire Interagency Group: p 72
o Health and Safety Commission. 1998. Lifting Operations and Lifting Equipment
Regulations 1998 Approved Code of Practice and Guidance. HSE Books.
o Health and Safety Commission. 1998. Provision and Use of Work Equipment
Regulations 1998 Approved Code of Practice and Guidance. HSE Books.
o Health and Safety Commission. 2000. Management of Health and Safety at Work
Regulations 1999 Approved Code of Practice and Guidance. 2 nd Edition. HSE Books.
P P
o Health and Safety Executive. 2001. Handling Home Care – Achieving Safe, Efficient and
Positive Outcomes for Care Workers and Clients. HSE Books: pp 3, 66
o Health and Safety Executive. 2004. Manual Handling Operations Regulations 1992 (as
amended) Guidance on Regulations. 3 rd Edition. HSE Books.
P P
o Kroemer, K.H.E. 2006. Extra-ordinary Ergonomics – How to Accommodate Small and

Big Persons, The Disabled and Elderly, Expectant Mothers and Children. CRC Press:
Forward
o Kumar, S. (Ed). 1999. Biomechanics in Ergonomics. Taylor and Francis: pp 267, 273,
283
o Mandelstam, M. 2002. Manual Handling in Health and Social Care – An A-Z of Law and
Practice. Jessica Kingsley Publishers: pp 27-28, 41
o Menoni, O. Battevi, N. and Cairoli, S. 2015. Patient Handling in the Healthcare Sector –
A Guide for Risk Management with MAPO Methodology (Movement and Assistance of
Hospital Patients). CRC press: p 2, 15, 18, 22-23, 26-28, 46, 145
o National Back Exchange. 2002. Essential Back-Up an Employers Guide for Setting up
and Maintaining an Effective Back Care Advisory Service. National Back Exchange.
o National Back Exchange. 2004. Manual Handling Standard 2004 – Interim Document for
Healthcare Providers. National Back Exchange: p vi
o Nelson, A.L. Motacki, K. and Menzel, N. 2009. The Illustrated Guide to Safe Patient
Handling and Movement. Springer Publishing Company: p3
o Pheasant, S. 1991. Ergonomics, Work and Health. Palgrave Macmillan: pp 278-279, 286
o Pheasant, S. 2001. Bodyspace – Anthropometry, Ergonomics and the Design of Work.
Taylor and Francis: pp 4-5
o Pheasant, S. and Haselgrave, C.M. 2006. Bodyspace – Anthropometry, Ergonomics and
the Design of Work. Third Edition. Taylor and Francis: pp 218-219
o Ruszala, S. (Ed). 2010. Moving and Handling People – An Illustrated Guide. Clinical
Skills Ltd: p x
o Selwyn, N. 2002. The Law of Health and Safety at Work. Croner. CCN Group Limited: p
38
o Smith, J. (Ed). 2005. The Guide to the Handling of People. 5 th Edition. Back Care in
P P
Collaboration with the Royal College of Nursing and National Back Exchange.
o Smith, J. (Ed). 2011. The Guide to the Handling of People – A Systems Approach. 6 th
P P
Edition. Backcare:
o The Scottish Manual Handling Passport Scheme 2014.
http://www.hse.gov.uk/scotland/pdf/manual-passport.pdf [accessed 16.01.2014
16TU U16T

U APPENDIX 1
AN INSIGHT INTO RISK ASSESSMENT
Risk Assessment enables employers to identify the measures necessary to comply with health and
safety law. A Risk Assessment should identify how the risks arise and how they impact on those
affected. From this information, decisions on how to manage those risks can be taken in order to
then take proportionate action.
If the level of detail in a risk assessment is proportionate to the risk, it aims to be a suitable and
sufficient risk assessment. Risks arising from routine activities associated with life in general can
usually be ignored unless the work activity compounds or significantly alters those risks. No
complicated process or skills will be required where the hazards and risks are obvious. These can
be addressed directly. Employers would not be expected to anticipate risks that were not
foreseeable.
Specialist advice, knowledge and analytical methods might be required for more sophisticated risk
assessments.
In situations where the nature of the work changes fairly frequently or where the worker moves to
different sites, the risk assessment might have to concentrate on the broad range of foreseeable
risks. There are no fixed rules about how a risk assessment should be carried out. General
principles should be followed.
In some cases, a first stage will be to eliminate from further consideration risks for which no further
action is required. General principles involve:
• Firstly identify the activities and any associated hazards from your activities
• Then identify who might be harmed and how
• Evaluate the risks arising from the identified hazards – are risks sufficiently controlled or does
more need to be done
• Regard the significant findings; the preventive and protective measures that need to be in
place; any further action required
• Review the risk assessment if changes arise; to the work, in the event of an adverse event, if
the assessment is no longer valid
The information provided in risk assessment documentation should be pitched appropriately in a

form that can be understood by everyone (HSC 2000).
‘Generic’ assessments based on risks which are common to a number of broadly similar operations
are acceptable but care should be taken not to miss any of the associated manual handling risks.
Assessments should identify in broad terms the foreseeable problems likely to arise during a
manual handling operation along with the measures needed to deal with them (HSE 2004).
Policy 16.20 Risk Assessment in Health and Safety includes a Health and Safety Self-Monitoring
Form in Appendix 1. It includes manual handling. Within this policy there are some helpful
definitions which further clarify the risk assessment process.
Pages 3 – 6 are recommended reading.

GUIDANCE FOR THE ASSESSOR
Working life should not involve unnecessary risk. Where risks are negligible, the risk assessment
process should be quite straightforward. Fully assessing every manual handling activity might
involve wasted effort so focus on where the assessment is needed.
The more risks = the more detail.
Ask yourself whether carrying out any of your work activities involves the movement and handling of
loads (and this means people as well as materials). Do any of these activities put people at risk of
injury?
With no or few risks, just check that enough has been done to make people as safe as possible.
If there are risks present, think things through in more detail and decide what more needs to be
U U
done if you cannot avoid the activity altogether.
When assessing load or materials handling Part A will need completing. If more needs to be done,
continue to complete Parts B, C and D.
When assessing patient handling activities start with the documentation in Appendix 5 (or if for
Therapeutic Services, Appendix 6). Use the documentation in Part A (and through to B, C and D if
needed) to ensure care staff have been taken into account.
GUIDANCE FOR THE MANAGER
Managers have a responsibility to ensure that their staff have been sufficiently trained for the
activities they carry out. If this is not the case then adequate supervision is necessary.
Managers and staff can use the Employee Safe Working Check Sheet for Staff Needs and
Limitations if they have any concerns about whether any particular support for the staff member is
required. Staff can complete this form independently if this wish and escalate any concerns or
needs to their Manager.
RISK ASSESSMENT FOR PATIENT HANDLING
A balanced approach to patient handling ensures that carers are not performing tasks that
put them and the patients they assist unreasonably at risk. Furthermore this approach
ensures that the patient’s wishes are respected wherever possible and their independence
and autonomy supported as fully as possible (HSE 2001).
The information gathered from a risk assessment is essential in helping to plan the safest
way to accomplish the required task (Nelson et al. 2009).
Risks are always present but risk assessment strives to reduce those risks. Key factors to
consider are the patient’s abilities, space requirements, equipment use, staff training and
existing health risks / injuries. The T.I.L.E approach will still apply (see Appendix 3) with
any load handling activity except in this case the load is a patient. The carer’s postures
must not be overlooked.
The presence of a patient indicates the presence of a HAZARD (Menoni et al. 2015). If that
patient requires any assistance with movement then the next step is to carry out a risk
assessment.
If in doubt, assume that risk is present. The PATIENT HANDLING RISK ASSESSMENT
FILTER will help those carrying out a risk assessment to avoid unnecessary detail where

risks are negligible and ensure enough detail when the patient’s needs are greater which
will include the T.I.L.E approach. As the table below shows, conditions are favourable and
risks are negligible when the patient is independent, when there is enough space to work,
when there is less equipment involved, when the worker is properly trained and when they
are free from injury. These parameters should always be considered during the risk
assessment process.
Independent Dependent Enough Space Space

Patient Patient Constraints
Risk Risk Risk Risk
Minor Equipment Major Equipment Trained Worker Untrained

Worker
Risk Risk Risk Risk
Uninjured Injured Indicates – Favourable conditions

Worker Worker
Indicates – Some risk is present
Indicates – Caution is required

Risk Risk
Indicates – Higher risks are present

PARAMETERS OF CARE HANDLING RISK ASSESSMENT (a colour coded guide)
The Patient Handling Information documentation has been colour coded for ease of use
helping the person/s carrying out the assessment to select the most appropriate
documentation for the patient’s movement and handling needs; but not forgetting the
postures of the carers.
As illustrated below, when a patient handling scenario moves from purple towards red, so
increases the risk to the carer of biomechanical overload. The YELLOW and RED
Documentation will trigger the need to include the documentation in Appendix 3.
PARAMETERS OF CARE HANDLING RISK ASSESSMENT
Purple Ideal conditions
Green Acceptable conditions
Yellow Improvements required
Red Only acceptable in exceptional circumstances
An alternative way of looking at these parameters uses the following classification of risk:
RISK CLASSIFICATION
Purple Risk absent
Green Risk negligible
Yellow Risk medium
Risk high
Red
The PATIENT HANDLING RISK ASSESSMENT FILTER uses the colours PURPLE, GREEN,
YELLOW and RED to guide the person/s carrying out the risk assessment towards the most
appropriate documentation. Using the FILTER ensures that ample consideration is given to all the
parameters of the care handling scenario. After completion of some basic details on the Patient
Handling Information Sheet, stage one of the documentation and decision making process begins
by consulting the PATIENT HANDLING RISK ASSESSMENT FILTER.
Remember: actual manual / patient handling triggers the use of Appendix 3

A QUICK GUIDE TO USING THIS DOCUMENTATION
Identify which category you fit into and follow the relevant stages
DO YOU LIFT, MOVE OR CARRY ANY OF THE FOLLOWING
NEED TO CHECK Objects/Loads/Materials NEED TO CHECK Patients/Clients
1. Complete the documentation in 1. Go to Appendix 5 and complete the Patient

Appendix 3 Handling Information Sheet as far as
weight and height
2. Consult the Patient Handling Risk

WHEN MORE NEEDS TO BE DONE Assessment Filter
3. If no patient handling is involved complete

the small PURPLE DOCUMENTATION to
complete this task
2. Continue to complete Parts B, C
and D 4. Complete the GREEN DOCUMENTATION
for any minimal patient handling
OR
5. Complete the YELLOW

PERSONAL SAFETY AND DOCUMENTATION for more complex
WELLBEING patient handling
The Employee Safe Working OR

Check Sheet for Staff Needs and
Limitations can be completed by 6. Complete the RED DOCUMENTATION for
anyone who has concerns about patient handling that is unconventional and
their musculoskeletal health therefore more hazardous
ALSO
REMEMBER TO ASSESS THE

ACTIVITES OF THE STAFF WHO
PERFORM THE HANDLING
TASKS

APPENDIX 2
U
EMPLOYEE SAFE WORKING CHECK SHEET FOR STAFF NEEDS AND LIMITATIONS
Workers can complete this sheet if they have any personal concerns about safe moving & handling
All manual handling risk assessments must take into account the Task (postures), Individual
Capabilities, Load Characteristics and the Environment; sometimes referred to as T.I.L.E. Being
aware of what postures might be involved, the characteristics of the load and of the handling
environment are critical to safe handling.
As for our abilities to carry out manual handling activities, these can change within the normal
course of a lifetime. In addition, certain unplanned events may occur that moderate our abilities on
a short-term basis due to an accident, injury, illness or pregnancy (Kroemer 2006). It is important
therefore, that managers are aware of a given individual’s needs and limitations in order to offer
them appropriate support.
Staff Member Check List NO YES

Have you attended ‘Healthy If yes state when this was:
Postures’ training or similar
If working with patients have you If yes state when this was:
attended any relevant patient
handling training
Have you received training to use List any equipment training needs:
any required equipment
Have you sufficient experience to State any concerns:

carry out the tasks required
Do you have any musculoskeletal If this affects your work give details:
injury
Do you have any health concerns If this affects your work give details:
Are you or have you recently been If yes has the risk assessment in
pregnant Appendix 7 of Policy 16.20 Risk
Assessment in Health and Safety been
completed:
Are you satisfied that you can work reasonably safely Y N
If NO, to whom will you escalate these concerns?
State what action is required
Staff member’s name (Printed) Signature
Manager’s name (Printed) Signature
Check Date: Review Date:
NB: Copy to be placed in Staff Personal File.

APPENDIX 3
U
Must be completed to identify movement and handling activity and to determine whether a more detailed assessment is required
MOVEMENT AND HANDLING RISK ASSESSMENT FOR ALL LOADS
Hospital / Premises: Person/s Completing :
Ward / Department: Date:
The ‘Person(s) Completing’ (above) will be stating that controls ticked YES are satisfactory. This person or persons must ensure that all parties involved
or affected by each assessed activity are aware of the control measures in place.
All YES = Assessment Complete , If NO = Complete B, C and D for each activity
What movement and handling activities are What control measures are already in place
Who might be harmed and how
you in involved with in your work (things done already to make it safe) YES NO

MOVEMENT AND HANDLING RISK ASSESSMENT TOOL FOR ALL LOADS
Complete this documentation if you have said NO to any activities identified in PART A. Make use of
the T I L E Picture Sheet on the next page to help you think about and identify all factors that
influence safe handling.
Person(s)
Hospital/Premises: Completing:
Ward/Department: Designation:
Precise Location: Date:
Describe each activity. Give each an activity name. Against the letters T I L E enter all the
numbers that apply. The more numbers the higher the risk.
1: Activity Name T
Total Risk Score
Description:
I
L
E
2: Activity Name T
Total Risk Score
Description:
I
L
E
3: Activity Name T
Total Risk Score
Description:
I
L
E
4: Activity Name T
Total Risk Score
Description:
I
L
Now go to PART C to work out the Total Risk Score to enter in the appropriate box. If more
control measures are required enter these in PART D.

Part B Continued TILE PICTURE SHEET

U Click/Tick all boxes that actually or potentially apply to the activity you are assessing
1 Stooping 2 Lifting to or 3 Lifting from a 4 Handling 5 Repetitive 6 Reaching High 7 Reaching 8 Carrying for a
from a height low position while seated Work Low distance
13 Handling
9 Twisting 10 Bending whilst kneeling 14 Difficult to
11 Pushing 12 Pulling
sideways get close
4 Insufficient 8 Risk to
1 Effort/ 2 Training 3 PPE required 5 Time spent in 6 Age related 7 Medical pregnant
time to recover
strength required required static postures risks condition/injury women
1 Awkward/ 2 Difficult to 3 Hot 4 Cold 5 Heavy 6 Light 7 Sharp/abrasive 8 Unstable

unwieldy grip / slippery
2 Outdoors 3 Hot 4 Cold 5 Damp / Wet 6 Windy 7 Dusty 8 Noisy

1 Indoors
10 Uneven 13 Confined 15 Inadequate

9 Vibration surfaces 11 Obstructions 12 Slopes 14 Steps
spaces lighting
16 Doors to 17 Slip/trip 18 Is route clear

negotiate hazards
How often is the activity done: Rarely Fairly frequently Very frequently Constantly
From the information you have now gathered in Parts A and B consider the Consequence
and Likelihood Table in PART C to determine the Total Risk Score for the activity you are
assessing.
PART C - CONSEQUENCE AND LIKELIHOOD TABLE TO FIND THE TOTAL RISK

SCORE
With either low (green) or medium (yellow) outcomes, you may be satisfied that the current control
measures are adequate and that they appropriately address the risks. If so refer to the information
in Part A that you previously completed and confirm this by writing them into Part D.
If you are NOT SATISFIED with the control measures already in place, record any new or further
U U
control measures in Part D. Use the table below, then, record the Revised Total Risk Score in the
appropriate box.
NOTE: Depending upon the nature of the activity being assessed a Medium Total Risk Score might
result. Further control measures therefore might or might not be required. Conversely a High Total Risk
Score might result for an activity that cannot be eliminated or improved. These circumstances will be
rare and involve suitably qualified practitioners in order to make this judgement.
Remember, your Total Risk Score will simply be a letter L for Low, M for Medium, H for High or E for
Extreme.
Example below shows a Total Risk Score of
M [Medium Risk]
1 L L M H H
1 L L M H H
2 L M M H E 2 L M M H E
3 L M H E E 3 L M H E E
Likelihood
Likelihood
4 M M H E E 4 M M H E E
5 M H E E E 5 M H E E E
1 2 3 4 5 1 2 3 4 5
Consequence Consequence
Likelihood Rating Guide Consequence Rating Guide
1 = Rare / Almost Impossible 1 = Minor Consequences
2 = Possible 2 = Moderate Consequences
3 = Likely 3 = Serious Consequences
4 = Very Likely 4 = Major Consequences
5 = Almost Certain 5 = Catastrophic Consequences
NB: Refer to Appendix 3 for a detailed explanation of the Consequence and Likelihood Tables
Low Green No Major Concern
Possible Total
Medium Yellow Action and Needs Regular Monitoring
Risk Score
High Orange Needs Actions and Periodic Management
Extreme Red Needs Immediate Active Management Outcomes
YOUR TOTAL RISK SCORE WILL BE : L or M or H or E

ACTIONS REQUIRED TO REDUCE RISK

Person(s)
Hospital/Premises: Completing:
Ward/Department: Designation:
Precise Location: Date:
ACTIONS
1: Activity Name Revised Total Risk Score:
Named Person: Target Date:
Ensure that all appropriate staff are aware of the revised control measures for these
activities. This risk assessment will need reviewing if any of the above circumstances
change.

U APPENDIX 4
EXPLANATIONS OF CONSEQUENCE AND LIKELIHOOD TABLES
Using the consequence and likelihood tables helps you to work out a Risk Rating; that is to say whether
a risk is of low, medium or high concern. Scores of between 1 and 5 for consequence and likelihood
have to be determined to achieve a Total Risk Score.
CONSEQUENCE TABLE
&
Service Delivery
No. of Persons
Consequence
Description
Enforcement
Reputation
Human
Impact on
Impact
Financial
at Risk
Score
Action
Image
Fatality Total loss of
Full National inquiry,
Select Committee, Prosecution / HSE Very High Costs
critical 50+
5 Catastrophic Public Accounts Prohibition Notice Trust impact
service
RIDDOR reportable Committee
Some critical Healthcare

Permanent or long- service loss, Ongoing national Commission Action,
High Costs
term injury RIDDOR major publicity, regional Threat by Royal
Trust impact 26 - 50
4 Major reduction in inquiry, Ombudsman College/Postgraduat
reportable service e Dean
Semi-permanent HSE Improvement

Medium
injury requiring time General Notice,
National news, Costs
service loss, Concerns raised by
3 Serious off work/ hospital Independent review 10 – 25
minor delays Royal College /
Divisional impact
RIDDOR Postgraduate Dean
Temporary Local only. Low Costs

st Local adverse
injury/effect 1 Aid/
P P
Some delays
publicity, Internal
Written
2 Moderate Occ Health/GP in service enforcement Departmental 3–9
inquiry
provision Impact
No injury or adverse Little impact,

Local interest, None or Verbal Low Costs
no loss of 1-2
1 Minor outcome, near miss informal complaint recommendation Local area Impact
service
Column Score
LIKELIHOOD TABLE
Score Description Guidance
The hazard is expected to occur in most circumstances (daily, weekly or many times a
5 Almost Certain
month) (9 in 10 chance)
The hazard will occur in most circumstances (say once a month) (between 5 in 10 and
4 Very Likely
8 in 10 chance)
3 Likely The hazard is likely to occur at some time (say once a year) (50 /50 chance)
The hazard may occur at some time (say once every 3 - 5 years) (between 2 in 10
2 Possible
and 5 in 10 chance)
1 Rare/Almost Impossible The hazard may occur in exceptional circumstances (1 in 10 or less chance)
With a consequence score and likelihood score a Total Risk Score can be achieved using the vertical
and horizontal boxes of the Risk Matrix.

APPENDIX 5
U
Patient Handling Information Sheet To Be Completed For All Patients
Hospital/Premises:
Specific Ward/Unit: Date:
NB: All care handlers have a responsibility not to put themselves or others at risk. They
therefore have a responsibility to locate, read and follow a documented handling
plan which is unique to the named patient.
Where will copies of this information be kept:
Patient’s Name: Date of Birth:
NHS Number: Male: Female:
Reason for Patient Receiving Care:
Actual weight Actual height
Estimated weight Estimated height
BEFORE YOU CONTINUE, CONSULT THE PATIENT HANDLING RISK ASSESSMENT FILTER (see
next page) AND COMPLETE THE RELEVANT PURPLE, GREEN, YELLOW OR RED
DOCUMENTATION. If there are no moving and handling requirements for your patient simply tick the
No Handling Requirements box below.
PATIENT FULLY INDEPENDENT
The patient can perform self-care tasks and mobilise safely without assistance. At most, only
verbal prompting will be required.
Take into account all reasonable factors for physical and mental capacity and for any
unpredictable behaviour. If you have any doubts at this stage, complete the GREEN
DOCUMENTATION. If PURPLE will suffice review regularly or if any conditions change.
Responsible Person/s Name (PRINTED):
Responsible Person/s Signature/s:
No Handling Requirements Date of Decision:

PATIENT HANDLING RISK ASSESSMENT FILTER

U STAGE ONE OF ASSESSMENT PATIENT ABILITIES AND CARE NEEDS
PURPLE GREEN YELLOW RED
FULLY INDEPENDENT PARTIALLY DEPENDENT DEPENDENT REQUIRES UNCONVENTIONAL

HANDLING
This means the patient can This means the patient needs This means the patient’s handling
perform tasks safely without minimal assistance such as needs are difficult to predict or This means that assisting or
assistance prompting, reassuring touch, they depend on help with the use moving the patient in conventional
guidance or the positioning of aids of equipment. The use of ways is not possible and violence
Appendix 3 will be required. In reduction methods may be
more complex cases input from involved. The use of Appendix 3
☐ Sufficient comprehension ☐ Sufficient comprehension other health practitioners such as will be required
Physiotherapist or Occupational
☐ Can sit-stand-sit ☐ Can offer some assistance
Therapist will be required
☐ Can balance with all the activities listed on
☐ All conventional options
☐ Can walk the left
have been explored
☐ Can dress ☐ Can use aids independently ☐ Comprehension difficulties ☐ The handling methods
☐ Can eat or with minimal help ☐ Cannot assist with all or most required are unavoidable
☐ Can bathe of the activities listed on the ☐ Physical lifting cannot be
☐ Can toilet left avoided
☐ Safe environment ☐ Requires assistance with
☐ At most may need verbal transfer devices or with a
prompting stand-aid or hoist or is cared
for in bed
Complete details on the Complete details on the Complete details on the

Complete details on the
but be ‘alive’
to any risks from postures, and ensure the proper and safe sheet. This will require a multi-
sign it off and review if
equipment use, the environment use of equipment and check disciplinary approach and
circumstances change
and training requirements whether further training is specific training
required
Are you confident that your use of this filter reflects the abilities or needs of the patient YES ☐ NO ☐
If YES complete the appropriate PURPLE, GREEN, YELLOW or RED documentation otherwise seek further help

PARTIALLY DEPENDENT PATIENT
Have you consulted the PATIENT HANDLING RISK ASSESSMENT FILTER to

STOP
select the appropriate documentation?
READ
If you continue, you are satisfied that the patient needs only minimal assistance
such as prompting, reassuring touch, guidance or the positioning of aids.
Falls
Despite the patient being partially dependent they might still be at risk of a fall or for behavioural reasons put
themselves on the floor. If these are factors to consider consult Policy 1.34 Falls: The Assessment,
Prevention and Management of Patient Falls (Adult Services) and use the appropriate version of the Guide
to Action for Falls Prevention Tool.
Patient’s NHS
Name: Number:
Aide Memoire:
Examples of minimal assistance that helps to promote safe movement and handling.
Verbal and / or visual prompting / cues, reassuring touch, touch to guide or direct movement, ensuring
any vision or hearing aids are being used, allowing enough time, placement of aids such as a transfer
board, walking frame or wheelchair, transporting in a shower chair or wheelchair.
Patient Handling Plan (use the aide memoire above as a guide)
How Many
Minimal Assistance Required For Method of Assistance / Equipment Used Handlers
Date Completed: Date of Review:

DEPENDENT PATIENT
Have you consulted the PATIENT HANDLING RISK ASSESSMENT FILTER to select
the appropriate documentation? Yellow documentation triggers the use of the
STOP
READ documentation in Appendix 3
If you continue, you are aware that the patient’s handling needs are difficult to predict or they
depend on help with the use of equipment. In particular, you might need to consider the
physical capacity of carers to provide any assistance, training requirements and whether the
environment is conducive to safe handling activities. In more complex cases input from other
health practitioners such as a Physiotherapist or Occupational Therapist will be required.
If you have any concerns with regard to the working environment, consult the OPTIONAL
SAFE WORKING CHECK SHEET – COMMUNITY / HOME CARE in Appendix 8
Falls
If you think the patient might be at risk of a fall consult Policy 1.34 Falls: The Assessment, Prevention and
Management of Patient Falls (Adult Services) and use the appropriate version of the Guide to Action for Falls
Prevention Tool.
Patient’s Name: NHS Number:
Familiarise yourself with the patient’s abilities/needs. Determine the safest way to assist.
Patient’s Abilities – Physical No Fluctuates Yes

Weight bearing through both legs / stand
Weight bearing through right leg
Weight bearing through left leg
Sit unsupported
Patient’s Abilities – Communications No Fluctuates Yes

Can understand instructions
Can communicate verbally
Communicates using gestures / hand movements
Communicates with head movements
Communicates with eye movements
Communicates by signing
Do cultural and / or religious needs impact on communication
Patient’s Needs – Behaviour No Fluctuates Yes

Likely to be co-operative
Likely to become agitated or aggressive
Is confused
Patient’s Needs – Physical No Yes Comments / Impact

Any pain
Limited range of motion
Loss of strength
Any paralysis
Poor control / co-ordination
Do any of the following factors impact on the patient’s handling needs
Factor No Yes Comments / Impact
Skin condition / sensibility to
pressure / touch
Height (particularly small or
tall – please state which)
Hearing
Sight
Size / weight / shape –

bariatric
Stiffness / jerky movement /
high-low tone (state which)
Epilepsy
Likely to fall
Likely to lower or put self on

floor
Medication
Specific clothing requirements
Specific footwear
requirements
Prosthesis
Limb supports
Attachments (drips / tubes)
Unpredictable movement
Unpredictable behavior
Day / night variations

Patient Handling Plan
With a fuller picture of the patient’s abilities and needs complete the handling plan below.
Use the aide memoire to make sure you cover all handling requirements.
WHEN HOISTING it is essential to record the equipment required, the sling type and
size and the installation method. Clearly and precisely name ALL equipment and U U
accessories.
Aide Memoire:
Sit-to-stand Walking Movement on-in-out of bed Flat surface-to-surface transfer

Bathing Toileting Sit-to-sit transfer Pressure relief/adjusting skin loading
Showering Dressing To/from floor Limb support
Lifting legs In-out of vehicles Steps/stairs Changing pads
Assistance required for Method of Assistance / Equipment use How many

handlers
Use the documentation in Appendix 3 to assess the movement and handling activities of the
handlers.

VARIANCE RISK ASSESSMENT
Have you consulted the PATIENT HANDLING RISK ASSESSMENT FILTER to select
STOP the appropriate documentation? Red documentation triggers the use of the
READ
documentation in Appendix 3.
If you continue, you are aware that assisting or moving the patient in conventional ways is not
possible and that all conventional options have been explored. The handling methods
required are unavoidable and physical lifting might be necessary. Violence reduction
methods might be involved. This assessment therefore requires a multi-disciplinary
approach. Specific training might be required.
NOTE: A VARIANCE RISK ASSESSMENT IS NOT DESIGNED TO ALLOW DANGEROUS

PRACTICE
Patient’s Name: NHS Number:
Give details of all practitioners and specialists who have been consulted
Name Designation
Describe the activity stating why it is necessary:
Details of handling method required including number of handlers:
What equipment will be used:
Training / instruction given by: Date:

Competency Statement
These people have been suitably trained or instructed in the methods required to move and
assist the above named patient by:
Name: Designation:
Completion Statement
The unconventional handling method detailed above is deemed to be an unavoidable and

acceptable risk for those trained or instructed to carry it out. Only those who have been
specifically trained or instructed will be expected to take part in this activity.

Patient Handling Information Sheet
U U APPENDIX 6 U
Exclusively for use at LINGS BAR HOSPITAL in-patient wards as part of the patients rehabilitation
U U
plan assess staff activity using documentation from Appendix 3.
Hospital: __________________________________ Date of Assessment: ______________________
Ward: ________________________ Name of Assessor: _____________________ Role: __________
NB: All Care handlers have a responsibility not to put themselves or other at risk. They therefore
have a responsibility to locate, read and follow a documented handling plan which is unique to
the named patient.
Height:
Patients Name: ___________________________ DOB: _________________
NHS Number: ___________________________ Male / Female Weight:
IN CASE OF THE NEED TO USE A HOIST IN AN EMERGENCY:

Hoist Make: Sling Size: Application method:
(Clip / Loop / Cross over / Amputee, etc)
Initial Assessment
If the patient is independent in all aspects of Movement and Personal Care the risk assessment
can stop here and be reviewed weekly or at any change in condition.
YES – Sign _______________________________ NO –→ Continue with assessment

Details Action required
Does the patient have any
difficulties with
communication or
understanding?
difficulties with perception or
remembering instructions?
pain or discomfort?
movement, sensory or
strength issues (Parkinson’s
Disease, disability from a
Stroke etc)
problems with their feet or
footwear?
Does the patient have a Refer to the patients Falls Management Plan
history of Falls?
Are there any other safety factors present particular to the patient? (Non or Partial Weight
bearing only, Plaster in situ, leans backwards, weak knee etc)
Patient discussion & explanation given: Signature: _____________________ Role: _____

Equipment Aide Memoire: Hoist. Standing Hoist. Rotunda. ‘Cricket’. Bath Seat. Shower Chair. Wheelchair. Own Wheelchair Frame. Walking Stick.
U IMPORTANT NOTE: FOR ANY PATIENT HANDLING METHOD THAT DOES NOT FOLLOW RECOGNISED MANUAL HANDLING PRINCIPLES
U
For Hoist use, see details on Page 1

Initial Moving & Handling Plan Progress Reviews
Assistance Moving & Handling Sign, Moving & Sign, Moving & Sign, Moving & Sign,
required method – (State Role & Handling method Role & Handling method Role & Handling method Role &
for: equipment ) Date (State equipment) Date (State equipment ) Date (State equipment) Date
Bed to
Chair/
Wheelchair
Transfers Number of staff Number of staff Number of staff Number of staff
Chair/
Wheelchair
to Bed
Toileting
Mobilising
Distances:
(State how Number of staff Number of staff Number of staff Number of staff
far)
Steps /
Stairs: Number of staff Number of staff Number of staff Number of staff
Bathing or
Showering: Number of staff Number of staff Number of staff Number of staff
– COMPLETE A VARIANCE SHEET FROM THE POLICY APPENDIX FOR LINGS BAR HOSPITAL
Equipment Aide Memoire: Hoist. Standing Hoist. Rotunda. ‘Cricket’. Bath Seat. Shower Chair. Wheelchair. Own Wheelchair Frame. Walking Stick.

Progress Reviews Name: ________________________ NHS No: __________________________

Ward: ________________________ LINGS BAR HOSPITAL
For Hoist use, see details on Page 1
Assistance Moving & Handling Sign, Moving & Sign, Moving & Sign, Moving & Sign,
required for: method – (State Role & Handling method Role & Handling method Role & Handling method Role &
equipment ) Date (State equipment ) Date (State equipment) Date (State equipment) Date
Bed to Chair/
Wheelchair
Chair/ Wheelchair
to Bed Transfers
Number of staff Number of staff Number of staff Number of staff
Toileting
Mobilising
Distances:
(State how far) Number of staff Number of staff Number of staff Number of staff
Steps / Stairs:
Number of staff Number of staff Number of staff Number of staff
Bathing or
Showering: Number of staff Number of staff Number of staff Number of staff
U IMPORTANT NOTE: FOR ANY PATIENT HANDLING TECHNIQUE THAT DOES NOT FOLLOW RECOGNISED MANUAL HANDLING
U
PRINCIPLES COMPLETE A VARIANCE SHEET FROM THE POLICY APPENDIX FOR LINGS BAR HOSPITAL

U APPENDIX 7
OPTIONAL SAFE WORKING CHECK SHEET – COMMUNITY / HOME CARE
The inability to be able to use equipment or adopt ‘healthy’ postures can be defined as
‘ergonomic inadequacy’. Equipment use and movement should not be hampered (Menoni
et al. 2015). Whereas an inpatient area should be conducive to safe patient care,
community settings such as a patient’s own home can hamper movement and equipment
use.
Use this check list to help you identify shortfalls and make improvements.
Which documentation have you completed: PURPLE GREEN YELLOW RED
NHS Number:
Indicate what can or needs to be

Check list NO YES
done
Enough space
Enough light
Noise problems
Good floor / ground surfaces
Steps or stairs to negotiate
Doorways to negotiate
Ramps / slopes to negotiate
Enough headroom
Is the route clear
Any slip hazards
Any trip hazards
Temperature problems
Are you satisfied that you can work reasonably safely Y N
If NO, to whom will you escalate these concerns?
Concerns escalated to

APPENDIX 8
U
Policy/Procedure for: Manual Handling and Back Care
Issue: 10
Status: APPROVED
Author Name and Title: Bill Varnam, Back Care Manager
Issue Date: NOVEMBER 2015 – (RE-ISSUED APRIL 2016)
Review Date: SEPTEMBER 2018
Approved by: TRUST HEALTH AND SAFETY COMMITTEE
Distribution/Access: Normal
RECORD OF CHANGES
POLICY/
DATE AUTHOR DETAILS OF CHANGE
PROCEDURE
Section 4.4 amended, change to review date
06/06 B Varnam HS/GS/13
and house style
09/07 B Varnam HS/GS/13 Reviewed in order to meet NHSLA standards.
06/08 B Varnam HS/GS/13 Reviewed in order to meet NHSLA standards.

To harmonise with County Health Partnerships,
08/11 B Varnam 16.09
minor changes throughout
16.09
08/12 B Varnam Changes to Appendix 5 only
(Issue 6)
5.0 new paragraph inserted also a new
Appendix 6: Patient Handling Information Sheet
16.09
09/13 B Varnam (exclusively for use at Lings Bar Hospital in-
(Issue 7)
U U
patient wards as part of the patients

rehabilitation plan).
Updates to Policy and Risk Assessment
16.09 documentation in compliance with agreed
02/15 B Varnam
(Issue 8) review date and to reflect highly regarded
sources of manual handling guidance.
16.09 Minor amendments to appendices references
11/15 B Varnam
(Issue 9) on page 9 and page 17.

APPENDIX 9
U
EMPLOYEE RECORD OF HAVING READ THE POLICY/PROCEDURE
U Title of Policy/Procedure : MANUAL HANDLING AND BACK CARE POLICY

U
I have read and understand the principles contained in the named Policy/procedure.
PRINT FULL NAME

0B SIGNATURE DATE

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Manual Handling and Back Care – 16.

SECTION: 16 - HEALTH AND SAFETY

POLICY /PROCEDURE: 16.09

NATURE AND SCOPE: POLICY AND PROCEDURE - TRUST WIDE

SUBJECT: MANUAL HANDLING AND BACK CARE

DATE OF LATEST RATIFICATION: SEPTEMBER 2015

RATIFIED BY: TRUST HEALTH AND SAFETY COMMITTEE

IMPLEMENTATION DATE: NOVEMBER 2015 – (RE-ISSUED APRIL 2016)

REVIEW DATE: SEPTEMBER 2018

ASSOCIATED TRUST POLICIES

ISSUE 10 – APRIL 2016 1

U NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST

U MANUAL HANDLING AND BACK CARE POLICY

Appendix 1 An Insight into Risk Assessment

Appendix 7 Optional Safe Working Check Sheet – Community / Home Care

ISSUE 10 – APRIL 2016 2

U NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST

U MANUAL HANDLING AND BACK CARE POLICY

2.0 U POLICY PRINCIPLES

ISSUE 10 – APRIL 2016 3

(a) avoid hazardous manual handling operations so far as is reasonably practicable

(c) reduce the risk of injury so far as is reasonably practicable

3.1 U Manual Handling

Regulation 2 of the Manual Handling Operations Regulations 1992 interprets manual

3.2 U Back Care

o The Biomechanical Approach – how work activities stress the musculoskeletal

o The Physiological Approach – a person’s ‘endurance’ when undertaking a

o The Psychophysical Approach – human sensations, physical stimuli and

Because confusion can result from conflicting recommendations provided by different

ISSUE 10 – APRIL 2016 4

Identifying the presence of a hazard enables actions to be taken to reduce biomechanical

3.6 U Reasonably Practicable

ISSUE 10 – APRIL 2016 5

4.9 Each individual Manager within the Trust is responsible for:

operation takes place.

ISSUE 10 – APRIL 2016 6

areas infection control issues must also be considered.

ISSUE 10 – APRIL 2016 7

• Using work equipment and Personal Protective Equipment provided in

• Participating in all training and refresher training as identified by their line

5.0 U RISK ASSESSMENT

5.2 Favourable conditions include:

• A light easy to manage load (with low risk of biomechanical overload)

• Good (healthy) postures can be maintained

ISSUE 10 – APRIL 2016 8

• the handling of all loads – see:

Appendix 1 - An Insight into Risk Assessment

• for the moving and handling of people/handling plans - see:

Appendix 5 – Patient Handling Information Sheet To Be Completed For All Patients,

Appendix 6 - Patient Handling Information Sheet – Lings Bar Hospital

Appendix 7 – Optional Safe Working Check Sheet – Community/Home Care

• U For Violence Reduction Methods Training

An assessment of the risks involved in undertaking violence reduction methods training

ISSUE 10 – APRIL 2016 9

• Task (postures and movements)

ISSUE 10 – APRIL 2016 10

ISSUE 10 – APRIL 2016 11

8.0 U TARGET AUDIENCE

9.0 U REVIEW DATE

• Manual Handling Advisory Group

11.0 U RELEVANT TRUST POLICIES/PROCEDCURES

• Health, Safety & Welfare 16.01

ISSUE 10 – APRIL 2016 12