Last reviewed 21 October 2014

Kathy Daniels reports on the updated edition of HSG220 Health and Safety in Care Homes, published in the summer of 2014.

HSG220 from the Health and Safety Executive (HSE) contains much that is new. It is designed to give service providers a better understanding of the health and safety risks in the residential care sector and how to manage them effectively, incorporating the latest changes in health and safety legislation and taking into account the Government’s “red tape challenge”, which has sought to simplify and streamline legislation over recent years.

HSG220 provides more than 70 pages of health and safety guidance, divided up into the following key areas.

Managing health and safety

The first section looks at the legal duty on residential care providers to manage risks in a sector that comprises a large, diverse workforce looking after a predominantly vulnerable population of service users. This, the guidance warns, presents “unique and complex” situations that can, if not managed well, result in serious harm to employees or residents.

Good management of health and safety does not happen on its own, and requires:

  • leadership and management

  • a trained and skilled workforce

  • an environment where people are consulted and feel involved.

The HSE recommends that homes set out their arrangements for managing health and safety in a policy that is communicated to all staff, and clearly states who is responsible for what. Homes should consult with staff and control risks by conducting appropriate risk assessments, which should be recorded and regularly reviewed. Significant hazards should be identified and suitable control measures put in place.

Providers are advised to be clear about the employment status of any temporary agency workers and, with regard to migrant workers, to consider:

  • language, communication and cultural differences

  • literacy and numeracy

  • general health and relevant work experience

  • whether qualifications are compatible with those in Great Britain.

Change of regulation

Care homes face a number of changes in regulation, with new Fundamental Standards being introduced in April 2015 and new Care Quality Commission (CQC) inspection regimes implemented in autumn 2014. HSG220 also announces changes in health and safety arrangements, with the CQC in England becoming the lead investigator of incidents where residents have been harmed because of unsafe or poor-quality care.

Care needs

The paper not only concentrates on more traditional areas of health and safety, but also looks at the everyday activities and decisions of residents. This reflects the “balanced decision making” guidance developed by the HSE in 2013, arguing that a reasonable balance should be maintained between the freedom of the individual to make his or her own decisions about risks and safety — the aim being to enable residents to live fulfilled lives rather than being unnecessarily restricted.

HSG220 advocates close liaison with residents, carers and family/representatives when carrying out risk assessments, concentrating on “real risks” that could actually cause harm, rather than being overprotective. Clear instructions, information and adequate training should be provided for staff, including:

  • induction of new staff

  • additional training for those given specific responsibilities under health and safety arrangements, where tasks or equipment changes, or where staff change jobs.


The latest changes to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) are set out in the guidance. Care home providers are urged to record all incidents at work — including “near misses” — to provide an indication of how well health and safety is being managed.

Moving and handling

The moving and handling advice in HSG220 has been updated. The paper acknowledges that work in care homes can involve many handling tasks, including moving and handling residents who need assistance to move around safely. Poor moving and handling practices, the guidance notes, can lead to:

  • back pain and musculoskeletal disorders in staff, resulting in disability and people being unable to work

  • accidents, which can injure both staff and residents

  • discomfort and a lack of dignity for residents.

Again, the paper calls for a balanced approach and states that risk assessments and care plans should be person-centred for individual residents, adequately covering their moving and handling needs both day and night.

Specific guidance is provided on the use of hoists and slings. Such equipment should only be introduced following an assessment, and should be used in conjunction with the care plan and the manufacturer’s instructions.

Where there is a significant risk of injury because a resident requires regular moving and handling in bed, the HSE recommends that providing an electric profiling bed would be a “reasonably practicable” control measure. Specific guidance is provided on the use of these beds, which can reduce the risk of musculoskeletal disorders in staff and enhance comfort for the service user.

Equipment safety

The more general use of equipment is covered by the guidance, which stresses the need for regular maintenance and inspection. The paper clarifies the role of the Medicines and Healthcare Products Regulatory Agency (MHRA) in the safety of medical devices, and includes useful guidance on electrical safety — both fixed electrical installations and portable electrical equipment — and the safe use of stair lifts and lift platforms.

Bed rails

Poorly fitted bed rails or cot sides have caused numerous accidents in care homes in the past, including entrapment causing asphyxia, and falls. The updated guidance covers detailed advice in their safe use, including the need to consider the compatibility of the resident, bed, mattress, bed rail and any associated equipment.

H3 Slips, trips and falls on the level

This section includes not only a focus on slips and trips to staff and users of buildings, but also the need to identify residents who are at particular risk. Key points identified in the guidance include:

  • the need to assess risks adequately

  • the need for flooring to be suitable (eg non-slip flooring in potential wet areas)

  • a requirement for appropriate floor-cleaning methods.

Falls from height

Falls from height are considered separately and include the risks of residents falling from windows, balconies or stairs. This can result in serious or fatal injuries and the HSE states that they continue to be a serious issue.

The paper advocates the use of window restrictors to reduce openings to 100mm or less wherever vulnerable residents have access to window openings large enough to fall through.

Hazardous substances

This section includes substances such as drugs and medicines, cleaning materials, disinfectants and maintenance products containing chemicals (eg pesticides). It also includes the dangers of diseases spread by poor infection-control methods. The guidance includes:

  • up-to-date information on changes to the Control of Substances Hazardous to Health Regulations 2002 (COSHH)

  • advice on compliance with the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 and on requirements for the safe disposal of hazardous waste

  • the latest information on the safe use of protective gloves and the avoidance of latex allergies

  • the latest advice on the control of infection, including reducing the risk from infections carried in blood and body fluids, such as hepatitis B, C and HIV.


The guidance contains up-to-date information from the updated Approved Code of Practice (ACOP) on Legionnaires’ disease, which requires care homes to adequately manage the risks of this potentially fatal form of pneumonia.

Legionella prevention is achieved by the proper management and maintenance of water systems within a home and is usually achieved by storing water at a temperature high enough to kill the bacteria. HSG220 contains a suggested management checklist and notes on risk assessment.

Hot water and surfaces

Keeping water at high temperature raises the risk of scalds and burns, particularly for vulnerable service users such as the elderly, who may not be able to react quickly enough to avoid injury. HSG220 summarises actions required by care home managers, including:

  • assessing the risks of water temperatures, hot surfaces and the vulnerability of individuals

  • installing and maintaining suitable engineering controls, such as thermostatic mixer valves and guards for radiators and pipework.

Work-related violence

The guidance states that providers should not expect staff to accept incidents of violent or aggressive behaviour as a normal part of the job. Managers should therefore work with staff and residents to reduce the risks. Considerable detail is included in the guidance, which requires managers to assess risks, train staff and ensure that incidents are reported.

Work-related stress

The HSE publishes a set of Management Standards, which are designed to identify and control the incidence of work-related stress among staff. The paper refers managers to these and makes a number of suggestions to address stress issues.

General work environment

This section of the guidance draws in information about a variety of other premises hazards, including asbestos, gas safety, fire safety, working with contractors, outside areas and vehicle movements, doors and gates, ventilation and heating, and display screen equipment.

Staff welfare

The final section of the guidance covers the need for care home managers to address issues such as staff welfare facilities (eg suitable rest facilities and toilets) and smoking.

The guidance reflects the most recent changes in first aid and work environment legislation, and also covers arrangements for new and expectant mothers.