Lesley Riddoch - Health and safety the twin gods that put nonsense before care

Published on Sunday 14 September 2008 22:07

I WAS waiting in the accident and emergency department of Ninewells Hospital in Dundee last week, staring idly at the feet crossing and re-crossing the room.

Suddenly, I realised all the A&E staff – men and women, young and old, local and foreign – were wearing Crocs, the foam, clog-like sandals that supposedly mould to your feet. I'd been "converted" on holiday and was still wearing the pink flowery items bought then. I started wondering – aloud – if long-term wearers found them more comfortable than trainers.

"Lady," said one doctor pointing downwards, "we stand for ten hours a shift so we vote with our feet."

But Crocs in Ninewells are about to be banned because a Swedish hospital fears they might cause static interference with some types of machinery. Never mind that the claim is unproven, the Crocs company is investigating and backache, absenteeism and sore feet are the biggest problems in the NHS. We are now in the land of health and safety, so the Crocs must go.

Somehow, health and safety have become twin Old Testament gods – unreasonable, unassailable and inflexible, their commandments understood only by health board high priests.

Their rules cannot be adapted on grounds of common sense; their ways cannot be polluted by slack thinking about human comfort.

In their name, absolute compliance is demanded – and no-one in the NHS seems prepared to challenge their authority.

So maybe carers will have to do it instead.

The Scottish Motor Neurone Disease Association held its annual meeting in Stirling this weekend. MND attacks the neurones that carry messages from the brain to the muscles, inhibiting speech, posture and mobility. The diagnosis means husbands, wives, mums, dads, partners and kids rapidly become carers and discover the hard way that patient-centred care comes a poor second to health and safety compliance.

Moving and handling is the big problem – and the H&S incantation goes something like this: "Our staff cannot lift your spouse out of bed because that is a manual handling operation that requires two people and we aren't covered. They might get injured and we could be sued. Or, worse, your spouse might get injured and then where would we be?"

It doesn't matter that the carer might be frail, alone or injured doing the job themselves, because the relevant legislation is the Health and Safety at Work 1974 Act and the unpaid carer isn't at work. They are simply at the end of their collective tether.

At the meeting, I heard from a very softly spoken man in his seventies who lost his wife recently to motor neurone disease. Two paid carers were meant to be present to wash her hair when she became severely ill – because of under-staffing, only one generally arrived. His own help didn't count because he wasn't a professional. As a result, her hair was unwashed for a year.

The "health and safety" approved method of moving his wife was a hoist – which she hated because the straps cut into her and the procedure made her feel like a crate of tatties on a forklift truck. But even with two members of staff present, health and safety didn't allow paid staff to lift her without using the hoist. So her husband had to guess when the professionals were about to arrive and rock his practically paralysed wife in three movements from the bed to the wheelchair to the commode – himself.

The care staff knew. But turning a blind eye to this "compromise" was the best they could do. What might have happened to his back or her safety? Irrelevant.

In hospital, his wife fell and was left on the floor of the ward for 20 minutes while staff went in search of a hoist. Did he complain? "I didn't want to jeopardise the help we were getting. I just didn't want to annoy them."

Soon after, she was taken home by ambulance, but staff refused to stretcher her into their bungalow because there were four steps to climb. Four steps. The ambulance staff discussed taking her back to the hospice until someone (else) could find a more appropriate form of transport – her husband pleaded with them to make an exception. Thankfully, they did. For the two days before her death, a nurse was sent round the clock. The nurse said the doctor would have assigned her earlier if his wife had a terminal condition. MND is presently a terminal condition.

This is of course anecdote. Anecdote reinforced by the carers present at that meeting from every part of Scotland.

And anecdote which suggests the government was right to bring in a system of direct payments so carers, not councils, can opt to spend the cash allocated in their social work assessment. Of course, there's a snag. To receive direct payments, the carer must become an employer, with all the worries and responsibilities that status brings.

And, ironically, with the same health and safety compliance requirements that may have driven carers toward direct payments in the first place.

No-one wants paid health or care workers to hurt themselves. But no-one seems worried about the wellbeing of the husbands, wives, mums, dads and children who step in when the professionals walk away.

There may be just one way to challenge the mindless monster health and safety has become. Unpaid carers will have to sue councils after hurting themselves completing tasks social work staff have refused to perform. Although legislation doesn't back them, there is a common law duty of care that might.

It's the only way to get common sense back into the care system and to persuade one in eight Scots who deliver free labour worth 6 billion that their love, loyalty and grief are not being exploited by managers unable to make the judgment calls for which they are paid.