Health, Safety and Wellbeing

Health and safety at work as COVID restrictions change

On 19 July 2021, further Government guidance will come into effect in England as the country moves to Step 4 of the roadmap, this step sees the removal of many of the legal requirements that have been in place since the start of the pandemic. Although the legal requirement to wear a face mask will be removed the Westminster Government has recommended that people continue to wear masks in public places such as on public transport. You can access the guidance here.

In Scotland Government guidance confirms that on 19 July Scotland will move to level 0, which reduces restrictions but not the requirement to wear face masks. That guidance can be found here. In Wales it has been confirmed that the alert level will move from 2 to 1 on 19 July but face masks will still have to be worn on public transport and in most indoor public places. Guidance can be accessed here. In Northern Ireland restrictions remain in place with an indicative date of 26 July set to review the restrictions. Guidance can be found here.

The RCM alongside other NHS trade unions have been pushing to ensure current safety measures including use of face masks remain in place in the NHS for service users, staff and visitors, NHS England have now confirmed that current PHE infection prevention control guidelines will remain in place. See media release here.

NHS Confederation published a poll showing that almost 90 per cent of its members want the public to continue wearing masks in all health care settings and many individual NHS trusts have stated that all safety measures will remain in place. The RCM continues to lobby for national guidance to NHS trusts to ensure that this is the case across the NHS.

Employers are under a duty to ensure “so far as is reasonably practicable” the health, safety and welfare at work of all their employees. This includes providing a safe system of work and the provision of information and training and supervision as is necessary to ensure the health and safety at work of employees. Employers are required to carry out a “suitable and sufficient” risk assessment to identify the risks to the health and safety and take “reasonably practicable” steps to eliminate or reduce that risk. Changes to guidance from the Government does not negate employers responsibility under health and safety law. Employers should continue to work in partnership with trade unions around health and safety issues particularly ensuring that risk assessments are up to date and based on evidence.

Health and Safety of individual midwives and MSWs during COVID-19

On 1 April 2021 the Westminster Government - with remit for health in England only - ended the formal shielding measures for those who are clinically extremely vulnerable, if you are in that category you should have received a communication from the NHS sent to clinically vulnerable people, which highlights the need to take cautious approach. Employers should ensure that all clinically extremely vulnerable staff are able to stringently following any active government guidance.

In Wales formal shielding measures also ended on 1 April, Welsh Government guidance is available here. In Northern Ireland formal shielding ended on 11 April, you can find the relevant Government guidance here. In Scotland, shielding advice is covered on the Scottish Government website here and is based on local protection levels, you can also access guidance on individual risk assessment here. Return to workplaces should only happen when it is safe to do so following an individual risk assessment and an assessment of the proposed working environment.  

The NHS Chief People Officer, and Medical Director for Primary Care have written to NHS Trust HR Directors in England, highlighting the need to undertake comprehensive, individual, workplace risk assessments that reflect the current working context and that discussions with staff should be sensitive and understanding, focussing on both individual and workplace risk. The NHS Staff Council have also produced guidance covering workplace adjustments and additional protective measures.

As well as those identified as clinically extremely vulnerable, further groups have been identified as at risk from COVID-19, this includes pregnant and Black and Asian staff. For vulnerable staff in these categories, the NHS should support staff to stay well and at work. NHS organisations should make adjustments to enable this wherever possible. Risk assessment is absolutely key to keeping staff safe and NHS staff must feel able to raise concerns without fear of detriment and those concerns should be listened to. NHS trade unions have developed principles on health and safety risk assessments and vulnerable workers. NHS Employers guidance can also be found here. The Scottish government has published occupational health risk assessment guidance.

Advice for pregnant healthcare workers

All employers have a responsibility to protect the health and safety of pregnant women who are working. These are enshrined in the Management of Health and Safety at Work Regulations 1999 (MHSW), Government coronavirus (COVID-19) advice for pregnant employees can be found here. NHS trade unions have also developed joint principles on pregnancy and COVID-19 The latest clinical evidence on coronavirus and pregnancy can be found here 

Risk assessment is an important tool, however it is important to take into account wider organisational decisions which may impact on staff. An equality impact assessment (EqIA) is  vital to ensure new policies and practices are fair and don’t have unintended consequences for some groups. An EqIA must be carried out ahead of the introduction of any new COVID-19-related practices and policies, with the results shared with local trade unions and continuous monitoring and evaluation done in partnership. Practical support to reduce stress and infection risk should be communicated to staff, for example employee assistance programmes, childcare and transport.

The development of local policies for carrying out risk assessments should be done in consultation with trade unions and Health and Safety representatives must be consulted on any workplace and workforce risk assessments. If you have concerns you should be able to ask for an individual risk assessment or risk assessment review if your circumstances change. Where there is a disagreement between line managers and occupational health or the person’s GP/consultant/midwife, clinical advice must always be followed. 

Supporters attending maternity services (England)

The latest coronavirus regulations (England) include specific mention of maternity services, stating that a person who is self-isolating (due to having close contact with someone with coronavirus not because they themselves tested positive) can accompany an expectant mother to a medical appointment at their request. These changes do not negate an employer’s responsibilities under health and safety legislation, so risk assessment (both individual and workplace), infection control, cleaning, ventilation and social distancing are key.

The most recent NHS England guidance ‘Supporting pregnant women using maternity services during the coronavirus pandemic: actions for NHS providers’ was published 15 April 2021. It includes some really helpful information such as the need to undertake risk assessments, make changes to the configuration of spaces addressing any issues highlighted in the risk assessment, provision of appropriate infection prevention and control measures, including training and PPE and the testing of women and support people. The guidance emphasises the need to overcome the practical challenges faced in maternity units such as the size and layout of rooms whilst also ensuring the safety of staff.  Involving those with relevant expertise in the risk assessment process e.g. the lead for infection prevention and control, the director/head of midwifery, safety champions and local staff representatives is also covered.

The RCM as part of the One Voice coalition and with the Society of Radiographers have written to Health Minister Nadine Dorries calling for upgrades to England’s NHS maternity service buildings to improve care for women and conditions for staff. We highlighted the fact that old, poorly designed buildings, meant that many women were unable to have their partners with them because the layout of facilities prevented social distancing, and would have put women, their partners and other service users at risk of catching the virus. You can read more about the letter here.

In Northern Ireland, Scotland and Wales existing guidance around supporting pregnant women using maternity services and wider attendance at hospitals has been successfully implemented with the full and ongoing engagement of trade unions and stakeholder groups.

Working in partnership on health and safety

Working in partnership on health and safety benefits everyone, regular meetings between managers and Health and Safety Representatives can help to nip potential issues in the bud and promote positive engagement. The recommendations from the Health and Safety Executive (HSE) following its COVID-19 hospital inspections included the importance of consulting trade union reps and of worker engagement in the risk assessment process to the success of establishing workable control measures. Managers tasked with carrying out risk assessments should have the support of the trust’s health and safety team and appropriate training, this is covered as good practice in the HSE report referenced above. You can access a copy of that report as part of the NHS trade unions guidance here though aimed primarily at trade union reps the information may also be useful for managers. You can access NHS Staff Council guidance about the benefits of partnership working.

Suggested actions for RCM Health and Safety Reps

• Speak to RCM members and find out if they have any specific health and safety concerns – you could organise a virtual branch meeting.

• If you have not carried out a workplace inspection, this is a good place to start. You have a legal right to arrange and carry out your own site inspections around your maternity unit – to do this you will need to arrange with the relevant managers. You should write in advance to arrange a time for the inspection, it may be a good idea to carry out a joint inspection but remember that staff should also have the opportunity to speak with you privately.

• You can access the Safety Representatives and Safety Committees Regulations 1997 and Health and Safety (consultation with Employees) Regulations 1996 Approved Codes of Practice and Guidance via the HSE website. In Northern Ireland the relevant Regulations are The Safety Representatives and Safety Committees Regulations (Northern Ireland) 1979

• Regulations also cover your right to time off with pay during working hours to carry out your duties.

• Ask for support from other H&S reps to carry out inspection. It helps if you are new to the role or helps to have a fresh pair of eyes.

• Your NHS trust may have a standard form to complete on workplace inspections but if not the Health and Safety Executive provide information and report forms for representatives and inspections. Here is a list of considerations when conducting a workplace inspection.

If you have any questions or concerns do not hesitate to contact your Regional Officer. We know how busy you are but please do continue to feedback any health and safety concerns in your trust. It is valuable information that enables us to represent our members and you effectively.  

Useful resources

• Current NHS England guidance can be found here.

• The RCM supports a woman having a birth partner present (who is not COVID positive). We developed 10 common sense principles to support safe visiting.
• Ventilation and air conditioning during the coronavirus (COVID-19) pandemic, HSE guidance here
• Making your workplace COVID-secure during the coronavirus pandemic, HSE guidance here
• Workplace health, safety and welfare. Workplace (Health, Safety and Welfare) Regulations 1992. Approved Code of Practice and guidance

• NHSEI updated guidance 15 April 2021: COVID-19 infection prevention and control guidance: aerosol generating procedures