Blue Book Conference: Keeping up to date

Occupational health and safety has come a long way in the last few years. On the resource side, we have seen a doubling in the number of consultants in NHS OH units, the launch of the Association of NHS Occupational Health Nurses, the development of NHS Plus to provide services to small and medium-sized enterprises (SMEs), and a substantial rise in the numbers of qualified health and safety managers, particularly in the developing primary care sector.

On the work side, there has been a rise in expectations of what the service can and does provide. The roll out of occupational health and safety services to GPs, their staff, and to dentists, has seen NHS providers developing new ways of delivering their services to meet the needs of a dispersed and fragmented client base.

An increasing awareness of the need for multi-function working, to deal with issues such as stress, has seen health and safety professionals and OH professionals working more closely than ever before, and the development of truly multi-professional teams.

The Department of Health’s role has changed, with it passing control to front-line staff. Responsibility for workplace health and safety issues now sits with NHS Employers, the new employers’ organisation for the NHS in England. Part of the NHS Confederation, NHS Employers represents employers in the NHS and supports them, giving advice, guidance and information on a range of employment issues, including health and safety.

With such a fast-moving environment, and following requests from colleagues in the field, it was time to produce updated guidance on OH and safety that also reflected the findings in the National Audit Office’s (NAO) 2003 report.

In January 2005, NHS Employers launched an updated version of The Management of Health, Safety and Welfare Issues for NHS Staff, more commonly known as the Blue Book, which was first issued in 1998. The guidance was launched at the second National Occupational Health and Safety Conference, hosted by NHS Employers in Manchester.

The new version is a complete revision. It provides information on what the NAO expects the NHS to do to improve occupational health and safety management, and also includes summaries of existing guidance on the major issues facing the service. There is also new guidance on issues that have risen to prominence over the last couple of years, and useful pointers to further information from organisations such as the Health & Safety Executive (HSE) and the NHS trade unions.

The Blue Book has chapters on perennial favourites such as latex and needlestick injuries, as well as blood-borne viruses and drug and alcohol abuse. It also includes other issues recognised by NHS managers and the HSE as being top priority because of the strain they put on the provision of patient services. These include musculoskeletal problems and back pain, slips and trips, working with contractors and sub contractors, and work-related stress, which now accounts for more sickness absence than any other single cause.

New chapters include managing risk and the process of risk assessment, a smoke-free NHS, and rehabilitation and redeployment. Further details on some of the chapters are set out below.

Managing Risk

In its report A Safer Place to Work: Improving the management of health and safety risks to staff in NHS trusts,1 the NAO identified major failings in the identification and management of risk by NHS organisations. Its authors believed that effective risk assessment and improved risk management would drastically reduce the number of accidents in the NHS each year.

The new guidance sets out the legal background to managing risk and the responsibilities, timing and process for managing risk. It also provides a useful organisational framework for taking the process forward. The NAO’s finding that all staff should be trained to assess risks and to maintain a robust and up-to-date reporting and logging system for their workplace is highlighted in this chapter.

Slips, Trips and Falls

Accidents are not an inevitable part of the healthcare industry – they should be prevented wherever possible. Where this is not achievable, the risk should be reduced to the minimum acceptable level.

Slips and trips resulting in falls are the most common causes of major injuries in all workplaces in the UK and the second biggest cause of injuries that last more than three days. Each year, more than 200 reported injuries to employees in healthcare are attributed to slips and trips.
The new guidance sets out the legal background to the issue, provides evidence of how and why the accidents occur, the costs of doing nothing, and sets out plainly what action NHS trusts need to take. It also provides five steps to managing slips and trips.


Stress is the issue at the top of most people’s agendas in the NHS and across the whole of the public and private sectors at the moment. In the NHS, stress accounts for 30% of sickness absence.

The cost of stress includes high levels of sickness absence, accidents, errors, low morale and poor performance. Stress is conditioned by, and contributes to, major environmental, economic and health problems, and has a significant impact on the well-being of staff, their productivity and effectiveness. Much of it is preventable.

The chapter on stress management introduces the management standards of good practice issued by the HSE, which employers will be able to use to measure their performance in identifying and tackling a range of key stressors. It also sets out the legal position and the benefits of tackling stress.

The links between managing stress, which is not a problem that can be solved overnight, and policies such as Improving Working Lives, are set out, as well as suggestions on to develop a strategy and different ways of working. Once again, we raise the importance of training managers to recognise symptoms of stress in their colleagues and the actions they can take on an individual basis to relieve it.

Finally, we offer brief details of two or three prominent cases that have come to litigation and the financial costs to the organisations involved.
Of all the issues covered in the Blue Book, stress is probably the one that has achieved the highest profile, both in the media and the workplace, and it is an issue – costly in both human and business terms – that the NHS, along with other employers, will have to battle for some time to come.

Other issues

Other new chapters include guidance on handling infected cadavers – a piece of work prepared in association with the National Association of Funeral Directors. While this is not a subject that is likely to leap to mind when discussing occupational health and safety, it is an area that has concerned mortuary and funeral director staff.

NHS Employers has now published a model code of practice based on that developed by Dr Surinder Bakhshi, and re-issued earlier guidance from the DoH on handling bodies with infections, which will hopefully address the concerns of all involved.

NHS Employers has also been able to issue new guidance on needlesticks and needlestick management, thanks to the Safer Needles Network and Dr Paul Grime. This problem is a continuing one in the NHS and pulls together a number of other issues mentioned in this article.

There is the need for better training and retraining in needle management, for better risk assessment and risk management in relation to the use of needles and sharps, and for much better record keeping than we have managed to achieve so far. It is not acceptable that the NHS still cannot say precisely how many staff are injured by needles every year. Hopefully, with the publication of this guidance, the new emphasis on risk management and training, and with more work to be carried out by NHS Employers, the HSE and the Safer Needles Network, this is one problem we are now on the road to solving.

Health and safety is an area that is constantly developing. NHS Employers is already looking at better and more effective ways of providing a service across the NHS that is consistent in its standards and delivery. For the first time, the Blue Book is now available online as well as in hard copy. This will allow NHS Employers to update chapters and add new ones to the website as occupational health and safety issues develop.

Julian Topping is NHS Employers occupational health and safety lead

For an online version of the Blue Book go to


1. A Safer Place to Work: Improving the management of health and safety risks to staff in NHS trusts, The Stationery Office 28 April 2003

 NHS Occupational Health Nurses Annual Conference

Julian Topping will be among speakers at next month’s Association of NHS Occupational Health Nurses annual conference. Readers of Occupational Health are offered a discount of 10; 90 for ANHONS members and 100 for non-members.

Date: Thursday 21 April
Venue: National Motorcycle Museum, West Midlands
Tel: 0121 424 3609
E-mail: mary.brassington@heartsol.
Address: Mary Brassington, OH department, Stratford House, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5 SS.

Programme topics and speakers

Dr Ian Blair – Update on TB and healthcare workers from overseas
Speaker to be announced – The Shipman Report, OH issues
RCN – Update on current OH issues
Martin Davies, Talking Life – Occupational stress and burnout workshop

Breakout sessions

OH physician TBC and Jane Aston, Health Protection Agency – Bloodborne Virus and Inoculation Injuries Update
Julian Topping, NHS Employers Organisation – Back In Work
Ergonomist TBC – Ergonomic Aspects of Workstation Assessment
Simon Oakley, Aventis Pasteur – Vaccination Update

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