Moving and Handling

Moving and handling injuries have ended more care careers than almost anything else, and poor technique bruises, tears and frightens the people being moved. The law's logic is refreshingly practical: don't do dangerous lifting if you can avoid it; where you can't avoid it, assess it; then use equipment, technique and teamwork to make it as safe as possible.

In care, the "load" is a person — which changes everything. People startle, grab, stiffen, help unexpectedly or tire suddenly. That's why individual assessments matter more than generic technique: how does this person transfer, what can they do themselves, what frightens them, which sling fits them, how many staff, what happens on a bad day versus a good one?

There is also a dignity dimension. Being hoisted is strange and vulnerable; being talked across, hurried, or left mid-air while staff chat is degrading. Narrate, involve, go at the person's pace. The best handlers make a hoist transfer feel like assistance; the worst make a steady arm feel like luggage handling.

• Health and Safety at Work etc. Act 1974: the umbrella duties on employers and employees.
• Manual Handling Operations Regulations 1992 (as amended): avoid–assess–reduce for hazardous manual handling, with the TILE factors (Task, Individual, Load, Environment).
• Lifting Operations and Lifting Equipment Regulations 1998 (LOLER): lifting equipment for people — hoists, slings, bath lifts — must be strong, stable, marked, and thoroughly examined at least every 6 months by a competent person.
• Provision and Use of Work Equipment Regulations 1998 (PUWER): equipment maintained, suitable, and used by trained people.
• Regulation 12 (2014 Regulations): unsafe moving and handling is unsafe care.
• RIDDOR: handling injuries to staff, and equipment failures (e.g. hoist collapse) as dangerous occurrences, are reportable.

Assessors check individual handling assessments against what they see on the floor: right equipment actually used, right number of staff, slings matched to the person (not the "house sling" for everyone — shared slings also raise infection control questions), LOLER certificates in date, staff trained practically and confident to describe each person's transfers. Care plans saying "full hoist transfer" delivered by one worker because "she's light" is exactly the mismatch that ends in enforcement after an injury.

• Assess per person, per transfer type: bed to chair, toileting, bathing, floor recovery, in-bed moves. Review after any change — weight, pain, stroke, new equipment.
• Before every hoist use: check the LOLER date, battery, sling label (type, size, condition — fraying or broken stitching fails it), and attachments; explain to the person; check clearance.
• Plan falling and fallen-person scenarios: you do not catch a falling person — you control the environment, ease where trained to, and use proper floor recovery (assess for injury first, equipment such as inflatable lifting cushions or hoist, never a two-person underarm haul).
• Banned by every credible standard: drag lifts, underarm/axilla lifts, bear hugs, lifting by clothing or limbs. If a plan seems to need them, the plan is wrong — escalate.
• Look after backs like the tools they are: warm up on cold morning starts, adjust bed heights, report the first twinge, rotate heavy runs across the team.
• In home care, escalate environmental problems — beds against walls, broken profiling beds, cluttered rooms — rather than improvising around them visit after visit. Single-handed care packages need proper assessment, not just budget hope.

Example 1. A domiciliary worker arrives to find her client on the bathroom floor, uninjured but stuck. The old habit — get him up under the arms — flashes past. Instead she makes him comfortable, checks him over per training, phones the office, and uses the agreed plan: he shuffles onto a towel, onto all fours, and up via a stable chair with her guiding, not lifting. Twenty minutes, zero injuries, and his dignity led the operation.

Example 2. A night senior notices a sling starting to fray at one loop. It would probably last weeks — but "probably" and "hoist" don't belong in one sentence. She withdraws it, tags it, records it, and orders a replacement; the resident's plan notes the temporary alternative sling with size and loop settings. The LOLER examiner later confirms the call. Boring, five minutes, possibly spine-saving.