Standardising Health & Safety

Since its introduction in 1948, the National Health Service (NHS) has grown to become the world’s largest publicly funded health service.  Responsibility for healthcare in Northern Ireland, Scotland and Wales is devolved to the Northern Ireland Assembly, the Scottish Government and the Welsh Assembly Government respectively.
The NHS in England is the biggest part of the system by far, catering to a population of 53 million and employing more than 1.35 million people.
There are different strands to the NHS. As a result of the Health and Social Care Act 2012, all Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) were abolished on 31 March 2013 and replaced by Clinical Commissioning Groups (CCG). Even more recently, NHS Property Services was set up. This is a company formed by the Department of Health (DH) to take over the ownership of around 3,600 NHS facilities.
When it comes to training in the NHS in England, things can get even more intricate. There has been for a significant period of time no standard approach on what is classed as mandatory and what is graded as statutory training; some of which depends on the commitment and the Trusts’ approach to risk.
There has been work to identify core training requirements and to formalise the Statutory and Mandatory (S&M) approach to it. This was originally started in the London region, and is now expanding across England, in the form of the national UK Core Skills and Training Framework. The overarching principle is to standardise the training approach across the NHS and develop a ‘passport’ scheme to streamline training and avoid any duplication.

The UK Core Skills and Training Framework sets out a structure for each identified area which offers: Identified core subjects; Proposed learning outcomes; Suggested standards for delivery; Proposed  refresher training periods.
The aim is to encourage a quality driven and consistent approach. The guidelines set out the minimum standards expected. Many healthcare organisations will already meet, if not exceed these, but the guidelines offered will be helpful in establishing a healthcare-wide minimum standard. This will enable the mechanisms and quality assurance processes to be put in place, which will then support efficiency and also enable potential recognition of training.
The core subjects are: Equality, diversity and human rights; Health and safety; Conflict resolution; Fire safety; Infection prevention and control; Moving and handling; Safeguarding adults; Safeguarding children; Resuscitation; and Information governance.
The passport initiative is something that has been discussed in different forums for over 10 years now. The idea is that training is the same no matter which Trust you go to.

Only familiarisation  with Trust  equipment would therefore be required, potentially saving time and money.
The core skills take into consideration the requirements of the NHS Litigation Authority (NHSLA), which manages negligence and other claims against the NHS in England. The body aims to share learning about risks and standards in the NHS and improve safety for patients and staff.

The NHSLA has tried, and succeeded to some extent, to introduce standards targeted around safety at different levels. With each level achieved comes savings for the Trust. Part of these standards are based specifically around training and ensuring a suitable needs analysis is carried out, covering each staff group. This would include, for example: Admin and support staff; Doctors; Healthcare assistants; Qualified nursing and midwifery; Consultants and career grade doctors; Clinical support staff; Qualified allied health professionals.
For each of these staff groups the Trust would need to identify: requirements for each group; length of training; frequency; updates;
who provides training; and method of delivery.
So there are many demands for Trusts to meet. The disadvantage with no standard approach is that each one has its own view on what statutory and mandatory training is. The main benefit of introducing the UK Core Skills and Training Framework is that there would be a structure to work from. Of course, it is vital to adapt training material to different staff groups – for example, clinical and non clinical, consultants, and estates staff.  Aside from the generic content to be covered each group will have different requirements, so keeping the material relevant is a must.

Sometimes the mere mention of health and safety is seen by many as not the most dynamic of subjects, so fixed ideas of the session content can be a hurdle for the trainer. Delivering a memorable training session is about knowing the subject, and being able to relate it to practical examples and true-life scenarios. It is about making it interesting and relevant.
Naturally, delivery of content will vary. For example, an executive and a board of directors need to know what their roles and responsibilities are, but it is also an opportunity to win their attention by making them aware of the importance of health and safety within their organisation. It is also a chance to remind them of all the good work that has gone on.
For the majority of the health and safety training required, the question has to be how much law and how much actual awareness of the hazards and risks are delivered. Effectiveness can be measured by means of a staff survey; from evaluations and feedback of the training and through incident data and audits of wards and departments. This enables measurement of the content and also the approach.
Needless to say, we must not forget there are other necessary forms of health and safety training requirements within an acute setting. These can include display screen equipment; control of substances hazardous to health; risk assessment training; the management of stress; conflict resolution; inoculation injuries – the list goes on.  
Despite all of this, two key factors remain: the ability and time of the trainer, and the availability of staff to attend. Getting the two to match up is always going to be the challenge.
And with demands on the NHS growing, the dichotomy of nurses delivering patient care or being away from the wards receiving training is an ongoing debate.