Accidents, Injury and Incidents

Clear risk assessments should be in place for any activities or environments that are identified as particularly risky. These must be understood and followed by everyone.

Everyone has a responsibility to be aware of potential health and safety risks in any given situation or environment, and to take appropriate and proportionate steps to reduce the risk of accident or injury. For example, removing slip and trip hazards or reporting a problem with the functioning of a hoist.

For further guidance see: Assessing and Monitoring Health and Safety Risks

Occupational diseases are physical conditions that occur in staff as a direct result of the work they do. They include things like severe cramps of the hand or forearm, occupational dermatitis and occupational asthma.

If you have been diagnosed with any occupational disease you must let the registered person know, even if it occurred before you started working for the service.

If you feel that any of the work activities you do will make your condition worse, speak to the registered person. They will be able to work with you to assess risks and agree measures to reduce the risk of a deterioration in health.

The Health and Safety (First Aid) Regulations 1981 require all employers to provide adequate equipment, facilities and personnel to ensure staff receive immediate attention if they are injured or taken ill at work.

Regulation 12: Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires all staff to have the qualifications, competence, skills and experience to keep people safe.

In order to meet these legal requirements, it is necessary for all staff to have first aid training.

Training should be carried out by a reputable trainer and cover:

• CPR;
• Using the recovery position;
• Choking;
• Medication or drug overdose;
• Reducing the risk of infection during first aid;
• Using bandages;
• First aid kit contents.

Additional training may be necessary if there is a defibrillator on site, or if a person being supported has a specific medical emergency risk. For example, oxygen users, Dysphagia, epilepsy, PEG feeds, tracheotomy.

The need for first aid training, specialist training or refresher training should be discussed as part of supervision activity.

First aid should only be carried out by those with the competence and skills to do so safely.

Staff should only carry out first aid in line with the training provided to them.

Staff should not put themselves or other people being supported at any risk of harm by carrying out first aid activity when they do not possess the necessary competence and skills.

In a medical emergency, call 999 and take the advice of medical professionals - they are there to provide support and guidance.

All services should have a fully stocked first aid box. If anyone notices that stock is not sufficient, a manager or the registered person should be informed as a matter of urgency.

It is important that all known potential health and safety risks are assessed and monitored. This is part of good governance.

Risk assessments should be developed in collaboration with staff, and their views on the best way to manage potential risks should be considered.

Risk assessments should be readily accessible and clearly communicated to everyone, and again when they are updated.

Understanding of risk and risk assessment measures should be tested as part of supervision activity.

The working environment should encourage staff to raise concerns about potential risks to themselves and the people being supported.

Issues with equipment, PPE supplies or any other health and safety factors should be swiftly addressed.

The following are all effective steps to reduce the risk of occupational disease:

• Only allocate physical tasks to staff members that are strong and fit enough to do them;
• Make sure manual handling activity is only carried out once training has been provided;
• Provide appropriate PPE and instructions on how to use gloves, masks etc.
• Make sure staff have breaks and don't spend too long on activities that could pose a risk;
• Carry out DSE assessments where applicable (see: Personal Safety and Wellbeing).

If a new member of staff has already been diagnosed with a condition, the focus should be on preventing deterioration.

In order to meet CQC regulations, staff must be and remain competent and skilled to keep people safe.

There should be systems in place to make sure that:

• People have opportunities to undertake appropriate first aid training;
• Qualifications do not expire, and refresher training is arranged in a timely way;
• Any need for specialist first aid training is identified and accessed.

Any requests for first aid supplies should be managed in a timely way to ensure that those providing first aid have access to the supplies they need.

All accidents and incidents, however minor, should be fully investigated.

Key questions:

1. What happened?
2. How did it happen?
3. Could anything have been done to prevent it?
4. Was there a risk assessment in place?
5. Was the risk assessment accessible, up-to-date and followed?
6. What was the impact on the person/staff member/visitor
7. Has anyone else been affected?
8. Has appropriate medical intervention been sought and followed?
9. What do the staff team think needs to change to reduce future risk?
10. What immediate actions need to happen and who is responsible for them?
11. Would it be beneficial to seek advice from e.g., the CQC, a health provider?

Following investigation, it may be necessary to update risk assessments or prepare a new risk assessment. It may also be necessary to update an individual care or support plan.

Any changes should be effectively communicated to the whole staff team.

Opportunities to reflect on the incident and implement any learning or new risk strategies should be provided for the whole staff team.

See: Learning from Safeguarding Enquiries, Safety Incidents and Complaints

For examples of how CQC registered services have learned from safety incidents, see: Learning from safety incidents.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) set out the legal requirements for reporting injuries to the Health and Safety Executive (HSE).

Recording under RIDDOR

The service must keep a record of all injuries, near misses and occupational diseases that are reportable to RIDDOR.

Records must be made available to anyone who asks to see them as part of any inspection process, including a CQC inspector or commissioner.

Reporting injuries to staff

Injuries to staff must be reported when all the following apply:

1. The injury was caused by an accident at work;
2. The accident was work-related;
3. The injury sustained is reportable under RIDDOR.

The following injuries are all reportable:

• Death;
• A fracture (other than to fingers, thumbs or toes);
• Amputation;
• Permanent loss or reduction of sight;
• Crush injuries leading to internal organ damage;
• Serious burns;
• Scalpings that require hospital treatment;
• Unconsciousness caused by head injury or asphyxia (being starved of oxygen);
• Any other injury that leads to hypothermia, heat induced illness, requires resuscitation; or admission to hospital for more than 24 hours;
• Any injury that means the staff member is away from work or unable to perform their normal duties for more than 7 consecutive days.

Reporting injuries to people being supported and visitors

Work-related accidents involving people being supported or visitors must be reported if a person is injured and is taken from the scene of the accident to hospital for treatment.

Note: There is no need to report incidents where people are taken to hospital purely as a precaution when no injury is apparent.

Reporting occupational diseases

The following occupational diseases are reportable, if the disease is likely to have been caused by, or made worse by, work-related activity.

• Carpal tunnel syndrome;
• Severe cramp of the hand or forearm;
• Occupational dermatitis;
• Hand-arm vibration syndrome;
• Occupational asthma;
• Tendonitis or tenosynovitis of the hand or forearm;
• Any occupational cancer;
• Any disease attributed to an occupational exposure to a biological agent.

Note: Occupational diseases are only reportable at the time of diagnosis. This means that if a new staff member already has an occupational disease, it does not need to be reported. If, over time a health professional believes current work-related activity is making the disease worse it may need to be reported.

Reporting near misses

Most near miss incidents in social care will not need to be reported as ‘Dangerous Occurrences’ under RIDDOR.

The following are the only exceptions:

1. The collapse, overturning or failure of load-bearing parts of lifting equipment;
2. Explosions or fires causing work to be stopped for more than 24 hours.

How to report under RIDDOR 

Most RIDDOR reporting should be done online.

See: How to make a RIDDOR report

When making a report, it is important to make sure that the report is properly coded. RIDDOR estimates that around one third of health and social care reports are not properly coded.

For guidance see: How to code health and social care RIDDOR reports.

CQC notification

A notification must be made to the CQC if any of the following applies:

1. A person using the service has died;
2. A person using the service has been seriously injured;
3. An incident has stopped the service running smoothly and safely.

Notifications should be made without delay.

See: Notifications

Notifying commissioners

The commissioning organisation should be notified whenever a CQC notification is made, a report is made under RIDDOR and in any other circumstances set out in the contract between the service and the commissioning organisation.

If the incident or injury occurred or could have occurred as a result of abuse or neglect a safeguarding concern should be raised to the local authority.

See: Disclosure and Raising a Concern

If serious physical or psychological harm has occurred, the duty of candour may apply.

For further guidance see: Duty of Candour.