Archive for July, 2011

29 July, 2011

Sensible safety and a review of legislation

RoSPA has now submitted evidence to the Löfstedt Review team, in which I urged the members to take a broad and evidence-based approach to its task. I believe that they need to look for practical solutions which could help all businesses, including small firms, to meet their health and safety duties.

We have cautioned against reducing the number of regulations by merger purely for cosmetic reasons and political expediency – which will, in any case, be easily seen through. By focusing on how to help businesses – particularly smaller ones – meet their health and safety duties easily, cheaply and with a minimum of bureaucracy, the review team will do far more for the UK’s economy.

I have advised the team of the danger of making ad hoc and possibly haphazard changes without full consideration of the consequences.

Our submission made a number of proposals for practical measures that could be taken, including:

  • Giving lower-risk small and medium-sized enterprises (SMEs) the option of producing simple health and safety action plans based on the combined safety policy and risk assessment template already offered by the HSE
  • Encouraging third party “semi-regulators” (such as clients, insurers, investors, and training funders) to implement mediation procedures enabling firms to appeal against what they see as over-the-top requirements
  • Looking at lessons that can be learned from what has worked well in other industrialised countries and link this to wider efforts to promote effective health and safety regulation worldwide.

While accepting that there may be a case for removing repetitious duties in certain regulations (such as on risk assessment, information and training), we have urged the team to also look at where there may still be significant gaps in health and safety law (e.g. accident investigation and work-related road risk).

There may be a case for better regulatory housekeeping, but owners and managers in small firms do not read raw, undigested health and safety law. What they need is good guidance and above all competent advisers to point them in the right direction. The Löfstedt team needs to take a wider view of current challenges in health and safety and suggest imaginative solutions.

RoSPA has also urged that the review should encompass analysis of the health and safety aspect of the Government’s Red Tape Challenge and the HSE’s major programme for revising its inventory of more than 1,300 pieces of key guidance.

Health and safety law and standards are important and are essential to safeguard people’s lives and health. The existing legal structure and the underpinning guidance has been based on literally hundreds of thousands of hours of detailed research, development and consultation.

What worries us most about this review, though, is that it is being conducted at a time when the previous consensus of “good health and safety management is good for business” seems to be breaking down in favour of a view that it is a red tape burden on business.

Hopefully, as with previous reviews of regulation, Professor Löfstedt and his colleagues will confirm that it is balanced, well-structured and helps not only to save lives and safeguard health but also boost UK competitiveness.

Information about the review is available at www.dwp.gov.uk and RoSPA’s full submission will be uploaded to the RoSPA website in due course. Since 2007, RoSPA’s National Occupational Safety and Health Committee has been conducting an inquiry into health and safety help available to small firms. Full details are at www.rospa.com/occupationalsafety/adviceandinformation/smallfirmshealthandsafety/inquiry/.

Roger Bibbings, RoSPA’s occupational safety adviser

27 July, 2011

An Olympic effort for health and safety at work

The Big Build is the first Olympic project of its kind in the world to have been completed without an accident-related fatality.

With one year to go until London 2012, we at RoSPA are delighted to congratulate all those who have worked on the Olympic Park and Village “Big Build” construction project for their outstanding health and safety performance.

With 12,500 workers on the Olympic Park and Athletes’ Village, and more than 60million hours worked, their safety record is particularly impressive.

Of those working hours, 24million of them have been “RIDDOR reportable accident-free”, meaning that no serious accidents, incidents or near-misses occurred.

The accident frequency rate achieved has been 0.17 accidents per million hours worked, which is lower than for the construction sector as a whole and more in line with the average across all UK employment sectors. Near-miss reporting has been equivalent to 100 reports for every RIDDOR event, giving confidence that reporting levels are very good.

RoSPA was particularly impressed with how the ODA, from its inception, declared that its aim was to be a leader in safety and health, integrating these objectives into planning, design and construction operations and enhancing workforce wellbeing. Among the features of the safety and health programme, there have been detailed inductions and further training for workers, plus leadership and communication training for supervisors.

The challenge now will be to maintain this excellent record during the next phases of the Olympics project, running up to and through “Games Time” and beyond. However, what has been achieved thus far is a highly commendable British achievement that is well worth celebrating, particularly in an international context.

Given the prestige and profile of the Big Build and the level of performance achieved, the lessons the project has generated for health and safety form an important part of the overall Olympic legacy – with enormous potential to influence health and safety in the UK as well as globally and to demonstrate further the contribution which high standards in this area make to overall business success.

The ODA and CLM have achieved an internationally-recognised certification of their health and safety management systems (OHSAS 18001) and the Olympic construction project’s occupational health function has won two awards, including the RoSPA Astor Trophy.

RoSPA is delighted that the Big Build project will be submitting an entry to the RoSPA Occupational Health and Safety Awards in 2012, through which its health and safety management systems and performance will be considered by an independent judging panel.

Tom Mullarkey, RoSPA’s chief executive

22 July, 2011

Use your head

It’s just over a year since James Cracknell, the double gold medal-winning Olympic rowing champion, was seriously injured in a cycling accident in America.

He was filming a documentary series when he was hit by a truck during a 2,500-mile cycle ride across America. His skull was fractured in several places and the frontal lobe of his brain – the part of the brain that governs the personality – was damaged. It wiped out his memory for five weeks.

Doctors are amazed that James survived the accident – and he credits his helmet with saving his life.

A year on, he made a short film imploring people to wear their helmets when they’re out cycling.

It is, quite rightly, a personal choice – but we at RoSPA recommend you do so too.

20 July, 2011

Babysitting: a hazardous occupation!

Babysitters can be absolutely invaluable to busy parents: like angels they swoop in, sometimes at short notice, to care for your children and relieve you of chocolate biscuits.

However, it’s not always possible to hire a babysitter from outside the family, especially if the requirement is urgent! So the oldest child is often drafted in to take care of the younger ones.

With media coverage earlier this year of the mother investigated for leaving her 14-year-old son in charge of his three-year-old brother, this is an issue likely to be at the forefront of many parents’ minds.

So, what does the law say? Well, not a great deal. While children who choose to work on newspaper delivery rounds, on farms or in retail jobs are covered and hopefully protected by general and specific health and safety law – notably the Health and Safety (Young Persons) Regulations 1997 – those who choose babysitting as a means of earning money fall outside these laws.

With this in mind, RoSPA and the NSPCC recommend that no one under the age of 16 should be left to care for a baby or toddler. The British Red Cross, which runs babysitting courses, states that participants must have reached their 14th birthday by the time of their final assessment.

However, parents usually know their children best, and will make their own judgements as to whether or not their eldest is mature and responsible enough to look after the young ones. We all know younger children who are wise beyond their years; and equally, we know those in their twenties who shouldn’t be left to care for a pot plant!

Will your babysitter spot the hazards?

So how can parents minimise the risks involved in leaving their older children to care for younger siblings? There’s a good deal of useful information on our freshly updated webpages, so head over there and take a look.

What’s particularly interesting, though, is a relatively new piece of research undertaken at the University of Guelph, Canada, and published in 2010. The original article appeared in the BMJ’s Injury Prevention journal, and the abstract can be viewed online.

The research, entitled “Please keep an eye on your younger sister”: sibling supervision and young children’s risk of unintentional injury took a look at how and why young children were more likely to suffer an injury while being cared for by older siblings than by their parents.

What did the research find?

The study explains why children are more likely to be injured when being supervised by a sibling or young sitter rather than a parent. The research shows how parents identify and remove hazards (such as small objects which could cause choking), while siblings left in charge of their younger brothers and sisters are more likely to play with the objects. This behaviour is then imitated by the younger child, with potentially harmful consequences.

Research objectives: Parental supervision reduces young children’s risk of unintentional injuries, but supervision by older siblings has been shown to increase risk. This study explored how and why this may be the case.

Methods: The supervision behaviours of mothers were compared to those of their older children when each was supervising a young relation in a setting having “contrived hazards”.

The researchers found that mothers were more proactive in supervising their children by actually removing hazards from the vicinity. Older siblings, however, tended to interact with the hazards in front of the children – effectively teaching them to do likewise.

It’s fairly well known that young children copy – particularly their older siblings. It’s how they learn, and the little ones tend to want to be “just like my big sister/brother”.

Indeed, the study found that this took place – children under the supervision of their older siblings were more likely to interact with the hazards in a similar way to their older supervisors.

Compounding this tendency of young children to behave in a more risky manner when supervised by a sibling, their older siblings were less alert to this behaviour than their mothers.

Everyone with younger brothers or sisters will be aware of the “you’re not my mom!” phenomenon; and again, the research bore this out. It showed how younger children have less respect for the authority of older siblings and are actually likely to behave in more risky ways when a parent is not present.

Could you keep your charges occupied?

The study concluded that the behaviour of both the young child and the supervisor contributed to increase the risk of injury when older children babysit for younger ones.

So it’s not necessarily a simple matter of raising awareness of risks among older children; it’s important for parents to also sit down with the younger child and explain that, in your absence, the older sibling is in charge.

It’s very common for older children to care for younger children within families, and this practice will not stop any time soon – particularly in such difficult economic times, when families can ill-afford to pay a babysitter.

However, research such as this is invaluable in helping parents to understand not only what the risks are when leaving older children to babysit younger ones – but why this should be the case.

Of course, the ideal solution is to employ a professional. But this just isn’t an option for many, so making information and guidance available to as many people as possible is vital. Parents should ensure that they know what they’re asking of their eldest – it’s a big responsibility, and providing them with as much information as possible will help to reduce the likelihood of injury occurring.

So parents: don’t be afraid of taking some time out, whether for work or for leisure – everyone needs time away from primary colours and Justin Bieber – but make sure you talk through what babysitting entails with all your children first.

RoSPA would love to hear from young babysitters about their experiences, especially examples where the intervention of a babysitter has prevented a serious injury to a child in their care. Please email Cassius Francis at cfrancis@rospa.com if you think you can help.

Jenny McWhirter, RoSPA’s risk education adviser

15 July, 2011

A childhood scald can be a life sentence

We were recently made aware of a good video by North Bristol NHS Trust called “Hot Drinks Harm”, produced to highlight the scalding risk to children posed by hot tea and coffee.

Every 90 seconds someone in the UK is burned or scalded in an accident. That’s quite a shocking statistic, particularly when you realise just how serious it can be.

Most people are well aware that a scald or burn is extremely painful when it happens. However, not many know that a serious scald in childhood is a life sentence for the individual – and one that can be easily avoided.

It’s relatively well known that hot bath water is the number one cause of serious scalding injuries among young children. Every day, at least one child under five is admitted to hospital with serious scalds caused by bath water. Thankfully, the fitting of thermostatic mixing valves (TMVs) is reducing the incidence of bath-time scalds.

Less well known, though, is the fact that many children go to hospital each day with scalds caused by hot drinks.

Under-fives make up six per cent of the population but receive a much larger proportion of scald injuries. Given children’s smaller size, they are more damaged, proportionally, than adults by the same amount of hot water. Children’s skin – and particularly babies’ skin – can be up to 15 times thinner than adults’, making it far more delicate and susceptible to damage. Did you know that a hot drink can still scald a child up to 15 minutes after being made?

So what are the costs?

Scalds make up around 70 per cent of all burns injuries to children. From a purely financial point of view, the cost to the NHS is an average of £1,850 per child scalded – in really severe cases, up to £250,000.

However, the implications of a childhood scald go far beyond monetary costs: a burn injury takes seconds, but stays for life. A child who receives a burn or scald can look forward to years of painful treatment; and in the most serious cases, they face hundreds of operations to release the scar tissue as they grow.

With serious burns, it’s not just a case of patching up a child with protective bandages and antiseptic – skin grafts are required, and a toddler may need further grafts until they stop growing 15 or 20 years later.

The psychological impact of a burn injury is also immense, particularly when children reach their teenage years and have to cope with their scarring alongside the usual teenage image and self-confidence issues. Some children are disfigured for life, with their parents experiencing a prolonged sense of guilt.

Support is available for families who have experienced scald injuries; but it’s far better to prevent them occurring in the first place.

What can be done?

A few simple precautions can prevent a lifetime of pain:

  • Don’t hold a hot drink and a child at the same time
  • Never leave young children alone in the bathroom
  • Put hot drinks out of reach and away from the edges of tables and worktops – and beware of tablecloths! A drink in the middle of the table can quickly be a danger to a toddler grabbing at the edge of a tablecloth
  • Encourage the use of a coiled flex or a cordless kettle
  • Keep small children out of the kitchen whenever possible
  • Run the domestic hot water system at 46°C or fit a thermostatic mixing valve to taps
  • When running a bath turn the cold water on first and always test the water temperature with your elbow before letting a child get into the bath or shower
  • Always use rear hotplates and turn the panhandles away from the front of the cooker
  • Keep hot irons, curling tongs and hair straighteners out of reach even when cooling down – or use a heat-proof bag.

We need to make people understand that these are largely preventable injuries, emphasising that the cost of treatment is far greater than the cost of prevention. Nobody wants their child to come to harm, so in most cases, a little education goes a very long way.

Jane Trobridge, home safety officer for RoSPA

12 July, 2011

Scramble your way to a coastal adventure

As promised in the last blog on tombstoning, we’d like to introduce coasteering: a popular and developing activity that involves traversing the intertidal zone – or, in everyday language, scrambling around the coastline having fun.

Those taking part in the activity use a combination of scrambling, walking, swimming and jumping to complete the

The idea is NOT to stay dry...

journey – if you set out with the intention of staying dry, you’re not coasteering!

In its early days, coasteering was a niche activity which began in Pembrokeshire, south Wales, where there are miles of wild, rocky coastline to explore. It was run by a small number of well-managed outdoor centres; but since then the activity has spread around the UK. This growth in the sport’s popularity has brought new activity providers onto the scene.

In the summer of 2007, primarily as a result of several incidents and near misses, members of the National Water Safety Forum (NWSF) began to think about the management and development of coasteering – and, in parallel, approaches to managing “tombstoning” incidents.

In response to these incidents, a joint project was launched with the Royal National Lifeboat Institution (RNLI), the Maritime and Coastguard Agency (MCA) and the Royal Life Saving Society (RLSS). Under the direction of the NWSF beach advisory group, an industry working group was established involving some 120 organisations and individuals providing commercial coasteering services to the public. The project aimed to reduce the number of accidents, and implement an industry standard for organisations offering coasteering activities.

How did we address the issue?

  1. Developing an industry group. Bringing the providers, regulators and rescue organisations together has been the key activity over the last few years.

New and emerging sports often have local pockets of knowledge and excellent practice; sharing this and embedding good practice was the objective, along with helping the industry to formalise the knowledge that was sometimes locked away.

One of the early achievements was the development of a workable definition of coasteering:

Coasteering involves traversing along a stretch of intertidal zone, often as part of an organised group activity. Participants travel across rocks and through water, using a variety of techniques including climbing, swimming and jumping into water. Coasteering guides and participants wear appropriate clothing and equipment while undertaking coasteering activities.

  1. Agreeing industry standards and common practice. This was no mean feat. Many of the providers had to sacrifice some of their hard-earned commercial experience and compromise.

The maxim of “not allowing excellence to be the enemy of good” proved true; many providers had first rate standards and operations, which were beyond the capability of smaller companies. The working group addressed this by developing a “safe as necessary” standard that was achievable by everyone in the industry. The group put together two documents outlining the agreed practice and information.

The guidance has proved to be influential and both documents have been adopted by the outdoor industry regulator, the Adventure Activities Licensing Authority (AALA).

  1. Developing capacity. One of the issues identified early in the project was the number of organisations involved in developing the sport, who were doing a good job in terms of promoting good practice, but had little resource to scale this nationally.

The original industry group has now progressed from being a NWSF working group into the National Coasteering Charter (NCC), which now includes the majority of providers and training bodies. This group will take forward the sharing and embedding of good practice across the sport.

Adventure is beautiful

Did the project deliver everything we wanted?

No. Not all the training providers are currently involved, nor are some of the other wider industry groups. But, and this is an important “but”, the key providers are involved and they have a common vision of improving the safety and quality of the sector.

However, the wider impact of the project shouldn’t be underestimated.

The process itself and the fact that an industry group overcame its difficulties to work together through what were contentious issues and achieve a good number of excellent outcomes have been noted both in the UK and internationally.

The coasteering project was presented at the World Conference on Drowning Prevention in Vietnam (look out for a blog on this event soon!).

So, what next?

The NCC will take over governance of the key documents with RoSPA, the RNLI, the MCA and other members of the NWSF taking more of a watching brief. The NCC, if it grows as promised, looks to be the best forum for managing the issues associated with coasteering and as such it will have a formal reporting route through the NWSF and, we hope, through other groups.

For more information about coasteering:

Coasteering is great fun, and a unique way of experiencing our country’s beautiful coastline. Get out there and have a go!

David Walker, RoSPA’s information manager and NWSF member

This blog was based on an article in RoSPA’s Staying Alive journal. Take a look at RoSPA’s Flickr account for more coasteering photographs (all owned by John Paul Eatock and Keirron Tastagh).

8 July, 2011

Don’t jump into the unknown!

It’s that time of year again – the weather is (sometimes!) beautifully warm, people are on holidays, and perhaps a touch too much alcohol may have been consumed. Inhibitions are lowered, and somebody decides to jump off a pier or a bridge.

I can see the attraction of tombstoning, being a bit of an adrenaline junkie.

However, there is a really simple message for people to keep in their minds: don’t jump into the unknown!

Look before you leap

Last week’s newspapers wrote about a man in his 20s who jumped 30 feet off Brighton Pier into just three feet of water. Unsurprisingly, he suffered serious head and spinal injuries – hopefully he will make a full recovery, but others have not been so lucky.

Sadly, it’s not difficult to find many stories of deaths and serious injuries caused by tombstoning in recent years.

Tombstoning offers a high-risk, high-impact experience but it can have severe and life-threatening consequences. Some of these reasons may seem obvious, but they’re worth emphasising – as the accident stats show!

Injuries and deaths as a result of tombstoning are a growing problem. Over the five year period 2004-2008 – 139 incidents required a rescue or emergency response and 12 of them ended in a fatality.

We looked at 41 of the most serious cases in more detail, and the stats may surprise you.

  • Most of those involved in the most serious cases were male (85%)
  • Teenagers were involved in just over half the cases (55%), followed by those in their 20s (25% with the remainder of incidents involving people aged over 30 years
  • All of the known alcohol-related incidents involved males aged over 40 (which accounted for three of the fatal incidents)
  • Of the non-fatal incidents, spinal and limb injuries (both at 20%) were most commonly reported.

So, perhaps counter intuitively, it’s not just teenage boys who are the problem. And it’s not the teenagers who are putting their lives in danger after drinking – that is reserved for those who are old enough to know better.

Many of the non-fatal incidents have resulted in life-changing injuries and they required significant resources from the rescue services. As well as the costs to the authorities, these people are now going to require lifelong care from family and friends – it’s not just their own quality of life that has been reduced.

Young and older fathers were among the fatalities, along with at least three teenagers. The coastguard has produced a video clip highlighting the consequences.

So what’s RoSPA’s advice? You may be expecting me to wave my arms and say, “Don’t do it!” But this is the real world. People are going to do what they feel like doing – and most of the time, that’s fine. So all we are saying is that people should arm themselves with information, and know what they’re getting themselves into.

Taking a moment to think through what you’re about to do may save a lifetime of pain and regret – or it may simply save your life.

Don’t jump into the unknown. Consider the dangers before you take the plunge:

  • Check for hazards in the water. Rocks or other objects may be submerged and difficult to see
  • Check the depth of the water. Remember tides can rise and fall very quickly – as a rule of thumb, a jump of ten metres requires a water depth of at least five metres
  • Never jump while under the influence of alcohol or drugs
  • Check for access. Can you get out of the water once you’re in?
  • Consider the risks to yourself and others. Conditions can change rapidly – young people could be watching and may attempt to mimic the activity. And, if you jump when you feel unsafe or pressured, you probably won’t enjoy the experience.

Jumping in is the easy part; getting out of the water is often more difficult than people realise, and don’t forget that strong currents can rapidly sweep people away – even strong swimmers cannot swim against the tide.

The best way to learn about the risks involved and have a good experience is to try coasteering – a mix of scrambling, climbing, traversing and cliff jumping around the coast with a professional guide.

Stay tuned to the blog next week for an article on coasteering!

Vicky Fraser, RoSPA’s press officer/web editor

5 July, 2011

Goldilocks had the right idea about health and safety

Among the questions posed in his call for evidence which ends on July 29, Professor Löfstedt asked: “To what extent does the concept of ‘reasonably practicable’ help manage the burden of health and safety regulation?”

“Reasonable practicability” as a concept causes much confusion, particularly when it comes to its practical application. However, it is a cornerstone of the UK’s approach to regulation of work-related risk, which has proportionality at its heart.

As is widely recognised, the principle was originally established in the now famous common law judgement of Edwards versus the National Coal Board in 1949. Lord Justice Asquith said at the time:

“Reasonably practicable is a narrower term than ‘physically possible’ and implies that a computation must be made… in which the quantum of risk is placed in one scale and the sacrifice involved in the measures necessary for averting the risk (whether in time, trouble or money) is placed in the other and that, if it be shown that there is a great disproportion between them – the risk being insignificant in relation to the sacrifice – the person upon whom the obligation is imposed discharges the onus which is upon him.”

In other words, for things to be considered safe so far as is reasonably practicable you have to go on trying to make them safer until you reach a point where it is not worth doing more (a point of diminishing safety returns) – AND the risks which still remain must not be too great.

Making such safety judgements with confidence is often quite difficult. If the efficacy of safety measures is uncertain in reducing the likelihood of failure, particularly when the consequences of failure are serious, the result is more likely to be a precautionary “belt and braces” approach.

Critics say the concept of reasonable practicability allows too much flexibility and leads to weak or inadequate precautions being taken. Evidence suggests that, properly applied, reasonable practicability guarantees a high standard of safety. Investigations tend to confirm that few accidents occur where reasonably practicable safety measures have been taken.

The real importance of the concept is that it allows proportionality of response to risk, taking account of different variables. The alternative to this might be a rising scale of specific solutions laid down in law, but this would be cumbersome and might lead to both “under-hitting” and “over-hitting”. Reasonable practicability allows for fine tuning.

Making sound judgements about such risk/cost optimisation can pose real challenges for those firms lacking the necessary skills or access to professional expertise, particularly where options must be chosen from a range of solutions. For example, to take a case related to public safety, reasonably practicable water edge treatments to prevent drowning can vary from little or no action, to shelving and/or planting edges and erecting signage, through to extensive physical barriers at the extreme.

Factors such as population density and foreseeable behaviours can influence the scale of control measures. Those not in the know sometimes find it difficult to understand why maximum measures have been taken in one setting but not in another.

What is useful about reasonable practicability is that it provides a constant reminder to risk creators, risk takers and regulators that safety is not an absolute but always a matter of judgement. At RoSPA we try to express this simply by saying that things need to be as safe as necessary, not necessarily as safe as possible.

On the other hand the concept can give rise to conflicting responses. Firms tend to welcome the flexibility it provides; but when faced with lack of clarity they can then demand official advice about exactly what would constitute a minimal standard of compliance.

There is also confusion about costs. The affordability of specific measures does not relate to the financial circumstances of the individual duty holder. You cannot plead poverty and get away with a lower standard of safety but you can factor in opportunity costs, for example, the longer-term costs of restricting a particular activity or of unintended consequences such as risk transfer.

The fundamental ideas in our health and safety law about risk/cost optimisation originated in the philosophy and practice of radiological protection developed from the 1940s onwards. Here, the core doctrine was “justification, optimisation, risk limits”. In other words:

  1. If an exposure is tolerable, is it justified by sufficient benefits?
  2. Has exposure been optimised? (I.e. has a point of diminishing returns been reached in terms of further dose reduction?)
  3. Have upper bounds been set? (I.e. have suitable dose limits been established?)

This approach can be applied to all kinds of risk decision-making in health and safety.

In practice the workability of a reasonably practicable approach to safety depends on skill in undertaking suitable and sufficient risk assessments. Initially this means establishing if risks are trivial, moderate or high and, if they fall into the last two categories, deciding if control measures are adequate or if more needs to be done. Assessments also enable duty holders to prioritise risks for attention and they can be generic, specific and/or dynamic.

In many cases, those managing risk may carry out very little actual assessment. Much of what is called “risk assessment” is really little more than hazard identification and involves minimal exercise of judgement as to the probability or consequences of failure. If this simple approach enables standard but quite satisfactory solutions to be selected from the overall health and safety guidance lexicon then this does not necessarily matter, particularly if it leads to people adopting sufficiently safe systems of work. On the other hand, there is always a danger of “over-hitting” if the level of risk actually presented by the hazard is trivial and the standard solution selected is substantially more than is really required.

A simple approach to finding the right balance is what I have called “iterative triage” or “the Goldilocks Principle”. (In her search for beds and porridge Goldilocks found beds that were too hard or too soft, and porridge that was too cold or too hot – and this enabled her to find the ones that were “just right”.)

What all this demonstrates are two awkward truths:

  1. There is probably no practical regulatory alternative to a goal-setting approach supported by reasonable practicability, especially in the complex risk environment of our contemporary world of work
  2. If this approach is to be successful in practice, duty holders need to be suitably informed and competent or have access to suitably competent advice.

Those daunted by the challenges posed by this approach to work-related safety and health often demand regulatory simplification or a return to common sense. The reality is, though, that the risk profile of even apparently benign settings such as shops, office and schools can often be quite varied and complex; the devil is always in the detail and the right solutions are sometimes counter-intuitive.

An approach to regulating and managing risks based on what is reasonably practicable is undoubtedly a more mature approach than one based on prescription, but it only works in practice if the challenges are matched by necessary competence.

Getting health and safety judgements right is not always easy, but if they help to save lives, reduce injuries and safeguard health without wasting scarce resources, then the effort involved is surely worthwhile.

As ever, readers’ comments are invited below.

Roger Bibbings, RoSPA’s occupational safety adviser

1 July, 2011

Falling for accident prevention

“The NHS treats elderly patients with broken hips as a ‘low priority’ by failing to give them prompt and high-quality treatment that could extend their lives,” reported the Daily Telegraph on June 22.

This may be true – indeed, this information was provided by NICE (the National Institute for Health and Clinical Excellence) – and it’s worrying that the older population is growing, so the problem is not going to go away.

However, on this issue, the media appears to have missed the obvious – in that scant, if any, mention is made of preventing these injuries in the first place.

According to NICE, up to 75,000 people suffer hip fractures each year. This figure is expected to rise to 100,000 by the end of the decade – a consequence of an ageing population.

To put the issue into perspective: broken hips affect more women than breast cancer does.

People’s quality of life is vastly reduced following a fall-related fracture, and older people’s independence is often curtailed. Health problem follows health problem, and about 10 per cent of people with a fractured hip die within one month – and around a third will die within 12 months. Add to this the stress and worry to family and friends, and the increased burden of care, and we have human tragedy on a massive – and increasing – scale.

If the human costs of fall-related injuries aren’t enough to convince you that things need to change: in terms of financial costs – at the forefront of everybody’s minds at the moment – hip fractures are estimated to cost £2 billion a year in medical treatment and social care.

What about preventing the fall in the first place? Accident prevention can and should play a starring role in the UK’s public health plan.

At the moment, accident prevention advice and information is being delivered by numerous smaller, extremely dedicated and hard-working organisations around the country.

There have been some great examples of successful working between local NHS organisations and local authorities. In Dudley in the West Midlands, for example, a falls prevention initiative, the £158k a year costs of which were funded by the Primary Care Trust and the council, saved £3 million over five years due to the corresponding reduction in hip fractures.

The problem of falls among older people was highlighted during Northern Ireland’s recent Home Accident Prevention Week (June 6-10).

Accidental falls claimed the lives of 155 people across Northern Ireland in 2009, of whom two thirds (103 people) were aged 65 or over. The most serious accidents usually happen on the stairs and injuries can have long lasting and life limiting effects – as we have seen.

We know that the risk of falling in the home and of suffering a serious injury as a result increases with age. We hope the simple prevention tips shared below will be shared among communities and families and reach as many people as possible.

  • Keep landings, stairs and hallways well lit
  • Insert a dual handrail on stairs where possible
  • Replace worn carpets and remove loose rugs and mats (or use non-slip backings)
  • Wear suitable footwear
  • Remove clutter from floors and stairs
  • Use stepladders for household jobs instead of climbing on chairs
  • Store everyday items in easy-to-reach places
  • Review medication with your GP/pharmacist
  • Wipe up spills straight away, and use bath/shower mats
  • Ensure you get your eyes tested
  • Keep active!

These last two points deserve to be expanded upon a little.

The Daily Express reported last week that two million over-60s have not taken advantage of free eye tests, even though 270,000 older people have had falls as a result of poor vision in the past two years. These figures came from a study to mark Age UK’s Falls Awareness Week.

Age UK is rightly concerned that many older people are not aware that they are entitled to free eye tests. Their study found a range of reasons were given for not going to the optician: 42 per cent felt there was nothing wrong with their eyes, nine per cent were concerned about the cost of buying glasses, and six per cent simply said they forgot to go and have a sight test.

Raising awareness of the connection between poor eyesight and falls may encourage more older people to take advantage of this free service.

As far as keeping active goes: this is extremely important in improving mobility and balance among the older population. However, it goes deeper than that. Keeping fit and active from a young age and throughout life will help to ensure that you stay fit and healthy into old age.

These issues highlight the fact that accident prevention is intimately linked to many other areas of healthcare – and could save a lot of pain in the long run.

So why is it underreported? Why is the media missing the obvious when reporting on falls, and ill health relating to accidents? I guess it’s not “sexy”, not headline grabbing enough. Perhaps. Then it’s down to accident prevention charities and organisations to make the subject newsworthy – spread the word.

Everyone has parents and grandparents or elderly friends and neighbours – not to mention the fact that we are all (hopefully!) going to live to a ripe old age, and reap the benefits of this type of accident prevention advice ourselves.

Ita McErlean, RoSPA’s home safety manager for Northern Ireland

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