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Legal: Don’t slip up

25 November 2013

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Implementing your health and safety policy effectively can help prevent unwanted personal injury claims against your practice

More than three million people are injured in accidents each year – at home, in their cars, at work, or outdoors. In many cases, someone else or something else is at fault and the accident victims have a right to compensation. The trend for making personal injury claims has soared in the last decade and there has been little to stem the financial drain this has, particularly on small businesses through increased premiums and lost workforce-hours investigating complaints and claims.

This ‘compensation culture’ leaves general practices vulnerable from slips trips and falls claims, particularly in the recent winters when there have been prolonged icy conditions. In 2003 the ‘compensation culture’ was defined as:  “The desire of individuals to sue somebody, having suffered as a result of something which could have been avoided if the sued body had done their job properly.”

Although personal injury law is complicated, with the help of a solicitor the process of making a claim can be quite straightforward. We are subjected to nightly adverts on TV and radio from personal injury lawyers offering a free consultation, and often people see it as a quick win with no-one really suffering as a result.

Practice managers and GPs see it differently; they have the responsible role of protecting the safety of their colleagues and patients using the surgery. No matter what you do, accidents can never be 100%, prevented but simple measures can be taken to drastically reduce risks and put controls in place, but this requires a team effort.

Take precautions now to ensure you protect yourself from ever having to go through a major liability case, and crippling insurance premiums.

Section 2 of the Health and Safety at Work Act requires employers with five or more employees to prepare and write a health and safety policy, but this is not meant to be a policy in isolation; it must form part of an overall safety management system, a culture that means people are aware of hazards and risks and take responsibility to report, repair or control them. 

The message is very clear. Your health and safety policy should be a living document within the practice – it is an essential part of managing health and safety. Those who see it as any less than this, or those paying lip service to it, may find themselves on the receiving end of the courts, and may also be putting their staff and their patients at risk of injury. 

All practices should have a safety management system in place that focuses on creating a safe environment to work and visit.

Trips, slips and falls are one of the most common areas of personal injury and are so preventable with a little planning and some teamwork.

Measures to ensure employees and staff do not trip or fall 

Work related trips, slips and falls can be costly to a small team due to:

 – Absenteeism.

 – Lost productivity.

 – Compensation claims.

 – Higher insurance premiums.

Top 10 trips, slips and falls hazards should be covered in your policy with associated prevention strategies and processes. These should include:

 – Contaminants on the floor (soap, hand gel, bodily fluids, water etc).

– Keep floors in all areas of the practice clean using designated tools and cleaning agents (stored in accordance with regulations).

– Use ‘wet floor’ warning signs sited to warn but not become a tripping hazard in their own right.

– Specify when and how often public areas should be cleaned.

– Encourage all users (staff, visitors and patients) to report hazards when they see them, place notices in patients’ view to ask for their co-operation.

 – Ensure staff wear appropriate footwear to reduce the risk of trips, slips and falls.

– Cordon areas off while they are being cleaned and inform people to avoid these areas until they are dry.

– Always remove signage when floors are clean and dry to prevent people becoming overfamiliar with the sight of them.

Poor drainage; pipes and drains. Inside – sinks, toilets, drains, and outside – drainpipes, guttering, drains and manholes

– Ensure pipes are aligned properly with drains so that water is taken away efficiently.

– Keep drains clean and unclogged from debris (paper, leaves, etc).

– Ensure downpipes are directed away from pedestrian areas and walkways.

Damaged or uneven floor covering

– Pay careful attention to heavy traffic areas such as entrances, consulting/treatment rooms, hallways, play areas, around drains, in doorways, etc.

– Regularly do a visual assessment of the condition of internal flooring, replace loose or worn carpet, buckled or stretched vinyl or cracked/splintered laminate flooring.

– Reduce or eliminate any trip hazard larger than a quarter of an inch (6mm) in all pedestrian areas and ensure there are visual cues for steps, changes in level or sloped areas. Any cracks larger than this should be filled and repaired.

External access hazards

– Regularly inspect foyers and entrances, lawns, pathways, parking areas, drains and metal covers.

– Repair paving that is loose or cracked, avoid heavy cobbles or decorative paving in areas of heavy pedestrian use (tripping hazard).

– Ensure there are visual cues for steps, changes in level or slopes/ramps.

– Keep external pedestrian areas free of stones, gravel and debris (slipping hazard).

– Ensure external drain covers fit flush where possible or are clearly marked/cordoned off where they stand proud of the walking surface.

Weather conditions (ice and snow): entrances, pedestrian walkways, outside steps and ramps, car parks, tiled foyer or entrances

– Have an aggressive programme to promptly remove snow and ice from access routes belonging to the practice.

– Use visual cues and signage to inform people of the continuing hazard.

 – Ensure labeled grit bins are kept stocked.

– Sweep ice-melting grit up after walkways have dried.

– Provide additional moisture absorbing matting with non-slip backing in all entrances during winter months or heavy rain.

Inadequate lighting: car parks, storage rooms, hallways, stairwells, external pedestrian areas (internal and external)

 – Install more lighting in poorly-lit areas.

– Ensure light bulbs have an appropriate brightness. With modern light bulbs, wattage is not an accurate way of determining brightness – instead, check for lumens.

 – Use light fittings that emit light from all sides.

 – Replace light bulbs as soon as possible after they fail.

Stairs and handrails: internal and external stairs and steps, elevated or sloping area/ramps

– Create visual cues to show steps or elevation/slope is present.

– Ensure step tread is non-slip surface (particularly in areas exposed to rain, snow and ice).

– Keep steps clear of snow and ice and other slippery substances (clean up any spills immediately).

– Check the condition of handrails to ensure they are firmly fixed.

Steps and ladders: external areas, pharmacy, records storage, office, treatment/consulting rooms, etc

 – Train employees on the proper use of steps and ladders.

– Ensure proper footwear for climbing is worn when steps are in use.

– Ensure steps are properly deployed before use (fully open/extended).

– Corden areas off where steps/ladders are in use to prevent pedestrian traffic in the same area.

Physical tripping hazards; trailing cables, rubbish and clutter: all areas of the practice – public and staff-only areas

 – Organise storage to prevent clutter.

 – Keep walkways clear at all times.

– Ensure rubbish is disposed of using the right receptacle and is stored away from pedestrian areas.

 – Use cable tidies and organisers to prevent tangles.

– Temporary trailing cable should be secured with tape or a rubber cable cover.

Improper use of mats and runners: practice entrances, treatment rooms, play areas

 – Mats and runners should be in good condition with rubber/non-slip backing and flush edges, sufficient in size for several footfalls (to clean moisture and snow from footwear before they contact with the floor).

– Place additional mats in entrances during snow and heavy rain and replace as they become heavily soiled.

– Replace any damaged or worn mats and runners immediately.

 – Secure mats so they do not move around the floor.

Appropriate signs and safety notices

The Health and Safety (Safety Signs and Signals) Regulations 1996 requires employers to use a safety sign where there is a significant risk to health and safety that has not been avoided or controlled by the methods required under other relevant law, provided the use of a sign can help reduce the risk. Safety signs are not a substitute for those other methods of controlling risks but are there to support and safeguard those using the area.

Common signage that is used in practice includes:

 – Fire safety signs.

 – Wet floor warnings.

 – Emergency exit signs.

 – First aid safety signs.

 – Emergency evacuation signs.

 – Car parking safety signs.

 – General patient safety signs.

 – No smoking signs.


Considerations for children and the elderly or disabled

Access to the building and all public areas of the practice is an important part of reducing trips, slips and falls. A risk assessment may be carried out, but whose perspective is it done from? If you use able-bodied staff members to do this important task, what measures do they take to consider the entrance from a wheelchair user’s perspective, or a three-year-old toddler’s perspective. What is a normal and easy-to-navigate step to one patient may be a negotiation hazard to someone on crutches or with visual impairment.

Preventing potential compensation claims

Every staff member is responsible for the enactment of your health and safety policy. You must make sure that the policy is integrated into your organisation so that it becomes part of the culture of your business. It must be seen as a policy implemented and followed by those at the top of the organisation and, in this respect, senior staff (GPs, practice manager, nurses, etc) must take the lead. You must actively communicate the policy, for example through training, team meetings and notices, etc, and it must be regularly updated. Ensure all practice staff are up-to-date with the relevant statutory and mandatory training to be competent in health and safety at work. You should audit health and safety systems, eg. risk assessments regularly documenting any changes, controls and improvements you make. Record incidents and breeches formally and deal with non-compliance positively, and ensure any complaint linked to health and safety issues is dealt with systematically using the practice procedure.