Manual handling and people handling in healthcare

The HSE National Manual Handling and People Handling Policy describes how to safeguard employees against injuries caused by hazardous manual handling activities.

'Manual handling involves any transporting or supporting of any load by one or more employees. It includes lifting, putting down, pushing, pulling, carrying or moving a load, which because of its characteristics or unfavourable ergonomic conditions, involves risk, particularly of back injury, to employees'.

In the HSE, manual handling refers to handling of inanimate objects and loads. People handling refers to the manual handling of people.

Inanimate manual handling examples include:

lifting or carrying documents, files, charts, and stationery
pushing or pulling: heavy fire doors or lead-lined doors, wheeled equipment trolleys, rehabilitation aids and devices, furniture, beds, hoists (patient and non-patient such as lab hoists) or medical equipment
waste handling such as emptying bins, removing clinical and non-clinical waste
handling and storage of fluid boxes

People handling examples include:

assisting service users to get up in the morning in a short timeframe
regular bathroom or bedtime routines
supporting a service user while walking
manoeuvering a fallen service user in a restricted workspace
transferring a service user from bed to chair, chair to bed, sit to stand, stand to sit, bed to floor, floor to bed or chair

Manual handling in healthcare

The number of manual handling injuries in the workplace is significant. The HSA reported that manual handling injuries accounted for 43% of the top 3 non-fatal accident categories in 2022.

It is the managers and employees responsibility to:

avoid hazardous manual handling, so far as reasonably practicable
assess the risk of injury from any hazardous manual handling operations and implement controls. Managers must provide relevant information, instruction, training and supervision

Roles and responsibilities are described in the HSE National Manual Handling and People Handling Policy.

Manual handling risk assessments

The Manual Handling and People Handling risk assessment process requires:

Identifying manual handling and people handling tasks:

For inanimate loads

Identify inanimate manual handling activities and tasks that because of their characteristics or unfavourable ergonomic conditions pose a risk to employees, particularly of back injury.

Consider the following to determine if a task requires risk assessment:

does the load exceed the guideline weights (refer to Manual Handling (Inanimate Loads) Task Identification Record)
is the load within guideline weights but the tasks involve awkward postures imposed by a work activity or the environment, or is repetitive
is the manual handling task associated with any previous reported incidents or ill health
have staff reported any issues associated with the manual handling task

If you answer yes to any of the above, use the Manual Handling (Inanimate Loads) Task Identification Record to list the activities that require task specific risk assessment.

For people handling

Identify people handling tasks that because of their characteristics or unfavourable ergonomic conditions pose a risk to employees, particularly of back injury. These tasks must be listed on the People Handling Task Identification Record.

Complete the appropriate risk assessments

Workplace manual handling risk assessment

In all cases you must complete a workplace manual handling risk assessment. This is an assessment of inanimate manual handling and people handling activities within, for example, an ambulance service, home environment or department. It details the general control measures to manage the risks from manual handling. List these on the Generic Risk Assessment Form.

The Workplace Manual Handling Risk Assessment Prompt Sheet will help you complete your risk assessment.

Worked examples:

Prompt sheet (worked examples)

These worked examples must be read alongside the workplace risk assessments for the catering and surgical departments

Workplace manual handling prompt sheet for catering department

Workplace manual handling prompt sheet for surgical department

Task specific manual handling and people handling risk assessment

When a manual handling task or activity poses a risk of injury, or where there is people handling tasks or activities, these must be assessed in greater detail to reduce the risk of injury to employees. These activities require a task specific handling risk assessment.

Further assessment is required for activities listed on:

Use the Task Specific Manual Handling and People Handling Risk Assessment Form to record your assessment.

Risk factors associated with manual handling and people handling activities are considered under Task, Individual, Load, Environment and Other (TILEO).

The risk assessment form includes TILEO, which considers:

the Task - does it involve twisting, bending or reaching upwards for example
the Individual - for example, consider individual risk factors and who is doing the task? Is task specific manual handling training required?
the Load - for example, what is being moved? Is it heavy, stable or difficult to grip?
the Environment - for example, is the floor slippery, are surfaces uneven?
Other risk factors such as Personal Protective Equipment, mechanical aids

Once you have considered the task or activity using TILEO, you can assess whether the existing control measures are adequate. If not, you must identify additional control measures needed to reduce the risk.

It may be necessary to develop local Safe Operating Procedures (SOPs). The SOPs should outline the steps needed to ensure safe manual handling tasks or activities. The SOPs can be referenced or hyperlinked in your risk assessment, as shown in the worked example provided below. The SOPs must be communicated to relevant employees and documented.

Templates for SOP and employee signature sheet:

If you are unable to identify additional control measures during the risk assessment, use supplementary tools to identify risk factors for inanimate manual handling tasks or activities.

The Health and Safety Executive (UK) has developed supplementary tools.

These include:

manual handling assessment charts - MAC Tool to be used if the task involves carrying, lifting
risk assessment of pushing and pulling - RAPP Tool to be used if the task is specific to pull and push risks
assessment of repetitive tasks of the upper limbs - ART Tool to be used if the task involves repeated awkward postures and involves upper limbs and upper body primarily

Your local Health and Safety Officer or the NHSF helpdesk can provide advice in using these supplementary tools. You can access the supplementary tools in the NHSF Manual Handling Risk Assessment Workbook

MAC worked example

Task Specific Manual Handling Risk Assessment for transfer of 10kg boxes of intravenous fluids from various levels of shelving in the pharmacy stores (worked example including MAC supplementary tool)

Worked examples of Task Specific Risk Assessments for manual handling of inanimate loads

Worked examples of Safe Operating Procedure (SOP)

Worked examples of task specific risk assessments for people handling tasks and activities

Task Specific People Handling Risk Assessment for assisting a patient sitting forward in bed (worked example)

Service user specific clinical risk assessment and moving and handling plan

In addition to completing the risk assessments, where a service user cannot move independently, a Service User Specific Clinical Risk Assessment and Moving and Handling Plan must be completed. This should be completed with the clinician to help inform the care plan. Completing this moving and handling plan will ensure the service user's safety by identifying the safest way to carry out people handling tasks. It also promotes service user independence.

Worked example of a service user specific clinical risk assessment and moving and handling plan

Service User Specific Clinical RA and Moving Plan Sample

Dynamic risk assessment

A dynamic risk assessment is an undocumented risk assessment completed by trained employees. This is an essential, undocumented step, but it plays a critical role in injury prevention. By reassessing each situation before acting, you ensure that risks are constantly evaluated and managed effectively. It is carried out before undertaking any manual handling or people handling activity or task.

As per your training, ensure that every manual handling activity is assessed using TILEO.

Safe moving and handling of service users with bariatric needs

Handling service users with bariatric needs presents a specific challenge. Local guidelines and safe operating procedures (SOPs) are required.

HSE National Guideline for the Safe Moving and Handling of Service Users with Bariatric needs

Resources

Manual handling training for managers

The NHSF has developed 2 manager training modules that describe the risk assessment process (available on HSeLanD):

Managing Manual Handling Risk (Inanimate Loads)
Managing Manual Handling (Inanimate Loads) and People Handling Risk

Manual handling techniques booklet

The Manual Handling and People Handling techniques booklet contains standardised techniques, a step-by-step guide and images. Use the techniques to develop a SOP specific to your workplace, detailing the equipment and controls needed.

Manual Handling Risk Assessment Repository Workbook

To help conduct thorough manual handling risk assessments, the NHSF has designed an interactive Manual Handling Risk Assessment Repository Workbook.

Key features of the workbook:

Comprehensive content - covers all aspects of manual and people handling risk assessment process
Templates - ready-to-use templates that can be completed and managed in one location
Supplementary tools - HSE (UK) MACC, RAPP and ART tools with guidance and calculations to support risk identification are built into the workbook
Step-by-step guidance - provides clear, step-by-step instructions to simplify the assessment process
Compliance - helps to meet legal and regulatory requirements and enables tracking of risk assessments for review and completion

The benefits of using the workbook to manage risk assessments include:

efficiency - streamlines the risk assessment process, saving time and effort
compliance - helps ensure compliance with legal and regulatory requirements
safety - enhances workplace safety by identifying and mitigating manual handling risks

Manual Handling Risk Assessment Respository Workbook

Manual Handling Risk Assessment Repository Workbook (worked example)

Watch this short instructional video on how to use the workbook

Support and advice

If you have any manual handling health problems related to your work, you must first discuss them with your manager. Your manager may review the risk assessment and identify further controls.

You may be referred to your local occupational health department.

NHSF has secured a contract for complex ergonomic assessments and consultancy services. For more information contact the NHSF helpdesk on 1800 420 420.

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