On this page we discuss current issues around health and safety in care work. From here, you can navigate to tables in which we identify relevant laws in England, Scotland and Wales.
Social care workers face health and safety risks which are particular to their work in care-settings, whether private homes or institutions. In this section we explore how the regulation that governs social care provision is shaping the management of occupational health and safety risks for care workers. In a general sense, regulations and legal rules about health and safety at work can only be made by the UK-wide parliament in Westminster. Yet the devolution of social care matters to governments and legislatures in Wales and Scotland means that sector-specific laws, regulations and rules about health and safety in social care are distinct to England, Scotland and Wales.
Which issues arise in care settings?
The corona virus pandemic has brought sharply into focus that care workers are at a high risk of acquiring or spreading infectious disease. Personal protective equipment is therefore essential but also needs to be used sensitively so that service-users do not feel unnecessarily objectified or pathologized.
On 14th April we published our first report: Care workers’ perceptions of health and safety issues in social care during the COVID-19 pandemic. L. Hayes, A. Tarrant, H.Walters, University of Kent (2020).
In that report we make two recommendations. Firstly, we call on national and local governments to appoint care workers to problem-solving roles in respect of the use and distribution of PPE and the allocation of resources, including staffing resources. Secondly, we call on the UK government to take action to ensure care workers are paid their normal wages when they are self-isolating.
In addition to risk of infectious disease, care workers are exposed to a range of occupationally specific health and safety risks. Care work is a physically demanding job and workers perform tasks which lead to a high number of work-related back disorders, including those occurring because of lifting, carrying, and frequent bending and twisting (Burdorf and Sorock 1997). Research has demonstrated that the physical nature of the role means home care work sees high rates of musculoskeletal issues, including neck, back, knee and shoulder injuries (Wipfli et al 2012; Faucett et al 2013; Markkanen et al 2013; Quinn et al 2016). One study found a third of care workers surveyed experienced backpain in the last 12 months (Quinn et al 2016). Others have noted that some care workers are expected to lift individuals multiple times during their shift, some performing over twenty transfers (e.g. from bed to chair) per day; in spite of this, the study found that 85% of those performing multiple transfers did so without any help from lift equipment or aids (Faucett et al 2013). It is also known that zero-hour contracts and insecure terms and conditions of work can have a negative impact on the mental health of workers in the care sector (Revalier et al 2018)
In addition to health issues arising from physical and mental stress, there are a number of hazardous substances to which care workers may be routinely exposed. These include:
- Biological hazards and medicines, such as: urine, faeces, soiled clothing and bed linen, and clinical waste etc.; certain medicines which can be dangerous; infectious pathogens requiring infection control to prevent spread.
- Cleaning products including those which irritate skin and eyes or release harmful fumes or vapours; some cleaning products can cause chemical burns, contact dermatitis and prolonged or excessive exposure can raise risk of cancer.
- Items used for maintenance work, such as: glues, paints and solvents which can act as irritants or be hazardous, especially in poorly ventilated spaces; water treatment chemicals and dust.
Is the health and safety risk profile of care settings distinctive?
Yes, care settings are distinctive workplaces. The vast majority of workers are women. In homecare settings they are moving from one private home to another and in residential care they provide intimate care and support to a community of residents. In either context health and safety risks arise because their tasks are physically tough, emotionally demanding, and involve close physical contact with others. In addition to the manual handling matters discussed above – which may arise from assisting individuals with daily tasks such as bathing and dressing – there can be issues of abusive behaviours towards workers. This can include experiences of verbal and physical aggression, violence, sexual harassment, and sexual aggression (Hanson et al 2015). The incidence of violence in care settings is seemingly on the rise and UK trade unions report that a large number of care workers have experienced sexual or physical assault at work. A survey of union members in social care found more than half had experienced verbal abuse in the past year, 25% had experienced verbal abuse on a daily or weekly basis, and a quarter had experienced a physical assault. While the majority of this violence and abuse came from individuals receiving care, family members were also responsible. A 2013 investigation for the Department of Health found hands-on care workers were at an elevated risk of physical assault, violent intimidation and verbal abuse because of a particular ‘lack of respect’ for them and their work. Low level, yet routine, violence is typical of care workers’ experiences.
Matters that relate to staffing levels also have an impact on the health, safety and wellbeing of both staff and those for whom they care. Running a service with inadequate or low levels of staffing creates a higher risk that legal provisions relating to health and safety will not be in place, and/or that incidents will occur that put people at risk. In particular, it should be noted that inadequate care is likely to cause distress and frustration among those using services, and increase the risk of behaviours that challenge staff or put them at risk. The same is true of inappropriate care, which is more likely when staff levels are low and individual care workers are stretched, or are supporting people who do not know them. Similarly, matters that relate to staff training and supervision have a direct impact on the health and safety of workers. When workers are properly trained and supervised to perform their roles and to use equipment correctly, there are fewer risks of accident or injury in the workplace.
Atkinson, C. and Crozier, S. (2020). Fragmented time and domiciliary care quality. Employee Relations, 42(1), 35-51
Baines, D., and Cunningham, I. (2011). ‘White knuckle care work’: violence, gender and new public management in the voluntary sector. Work, Employment and Society, 25(4), 760–776.
Burdorf, A. & Sorock, G. (1997) Positive and negative evi- dence of risk factors for back disorders. Scandinavian Journal of Work, Environment & Health 23(4), 243–256.
Faucett J, Kang T, Newcomer R. 2013. Personal service assistance: Musculoskeletal disorders and injuries in consumer‐directed home care. Am J Ind Med 56:454–468.
Hanson, G. C., Perrin N. A., Moss, H., Laharnar, N., and Glass, N. (2015) Workplace violence against homecare workers and its relationship with workers health outcomes: a cross-sectional study. BMC Public Health. 15(11) 1-13
Hussein, S. (2018) Job demand, control and unresolved stress within the emotional work of long-term care in England, International Journal of Care and Caring, 2(1): 89-107.
Markkanen, P., Galligan C.J., Quinn M.M., Sama, S., Brouillette, N. and Okyere, D. (2013). Characterizing the nature of home care work and occupational hazards: A Developmental intervention study. American Journal of Industrial Medicine. 57(4), 445-457
Quinn M.M, Markkanen P.K. and Galligan C.J. (2016) Occupational health of home care aides: results of the safe home care survey Occupational and Environmental Medicine (73), 237-245.
Revalier, J., Morton, R., Russell, L. and Fidalgo, A. R. (2018) Zero‐hour contracts and stress in UK domiciliary care workers, Health and Social Care in the Community. 27(2), 348-355
Wipfli B, Olson R, Wright R, Garrigues L, Lees J. (2012). Characterizing hazards and injuries among home care workers. Home Healthc Nurse 30,387–393.
If you use any material from these web pages, we suggest this is cited as follows:
Hayes, L., Tarrant, A. and Walters, H. (2020) Social Care Regulation at Work: Health & Safety. University of Kent. [Viewed date]. Available at: <https://research.kent.ac.uk/social-care-regulation-at-work/health-safety/>
