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Safe Moving and Handling of Bariatric Service Users Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and dignified moving and handling procedures for bariatric service users while protecting the health and safety of both service users and staff. This policy outlines the best practices, training requirements, risk assessments, and specialist equipment needed to manage the care of bariatric service users safely and in compliance with Care Inspectorate Wales (CIW) regulations.

This policy supports compliance with the following legislation, regulations and statutory guidance:

• The Regulation and Inspection of Social Care (Wales) Act 2016.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.
• Welsh Government statutory guidance for service providers and responsible individuals on meeting service standard regulations, Version 3, March 2024.
• The Social Services and Well-being (Wales) Act 2014.
• The Health and Safety at Work etc. Act 1974.
• The Management of Health and Safety at Work Regulations 1999.
• The Manual Handling Operations Regulations 1992, as amended.
• The Provision and Use of Work Equipment Regulations 1998.
• The Lifting Operations and Lifting Equipment Regulations 1998.
• The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, where applicable.
• The Equality Act 2010.
• The Human Rights Act 1998.
• The Mental Capacity Act 2005 and associated Code of Practice.
• Social Care Wales Codes of Professional Practice and employer requirements.
• CIW notification and reporting requirements, including the requirement to notify CIW through CIW Online where a notifiable event occurs.

2. Scope

This policy applies to:

• All employees, including care workers, supervisors, and managers.
• Service users who require specialist moving and handling due to their weight or mobility needs.
• External healthcare professionals, occupational therapists, and family members involved in care planning.

It covers:

• Risk assessments and care planning for bariatric service users.
• Training and competency requirements for staff.
• Specialist equipment and assistive devices.
• Safe handling techniques and emergency procedures.
• Workplace adaptations and staff well-being.

3. Definitions

• Bariatric service user – A person whose weight, body size, body shape, weight distribution, mobility, health condition, equipment needs or environmental circumstances require specialist assessment, equipment, staffing arrangements or moving-and-handling procedures to ensure that care is provided safely, lawfully, respectfully and with dignity. A bariatric moving-and-handling assessment must not be based solely on a fixed weight threshold.
• Safe Working Load (SWL) – The maximum load that equipment is designed, tested and approved to support. Staff must never use any hoist, sling, bed, chair, wheelchair, commode, transfer aid or other equipment beyond its stated safe working load.
• Personal plan – The plan required under the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, setting out how the individual’s care and support needs will be met on a day-to-day basis and how they will be supported to achieve their personal outcomes.
• Provider assessment – The assessment undertaken by the service provider within 7 days of commencement of care and support, or earlier where required, to confirm how the individual’s care and support needs will be met and how risks will be managed.
• Moving-and-handling risk assessment – A task-specific assessment identifying the risks associated with assisting a person to move, transfer, reposition or mobilise, and the control measures required to reduce risk so far as reasonably practicable.
• Manual handling – Any activity requiring the lifting, pushing, pulling, or supporting of a service user.
• Specialist equipment – Includes bariatric hoists, beds, slings, wheelchairs, and chairs designed for safe support and mobility.

4. Risk Assessments and Care Planning

4.1 Initial Assessment

• A comprehensive moving and handling risk assessment must be conducted for all bariatric service users upon referral.

Before agreeing to provide care and support, {{org_field_name}} must determine whether the service is suitable to meet the individual’s care and support needs and to support the individual to achieve their personal outcomes. This decision must take account of the individual’s care and support plan, any provider assessment where applicable, health or other professional assessments, the individual’s views, wishes and feelings, risks to the individual’s well-being, risks to staff or others, and any reasonable adjustments that may be required.

Where {{org_field_name}} cannot safely meet the individual’s moving-and-handling needs, including because suitable equipment, staffing, training, travel time, environmental access or specialist professional input is not available, the service must not commence until safe arrangements are in place. The Registered Manager must record the decision, rationale, actions required and communication with the individual, representative, commissioner and relevant professionals.

• Involvement of occupational therapists, physiotherapists, and moving and handling advisors is required.
• Factors assessed include:
  • Weight and mobility level of the service user.
  • Home environment suitability (doorway widths, flooring, accessibility).
  • Specialist equipment needs (bariatric bed, hoists, chairs).
  • Number of staff required for safe transfers.
  • Potential risks to service users and care staff.

• The person’s preferred method of communication, language needs, including Welsh language needs, cognition, anxiety, pain, skin integrity and any known trauma or distress associated with moving and handling.
• The individual’s consent and capacity to consent to the proposed moving-and-handling arrangements.
• Whether a Mental Capacity Act assessment or best-interests decision is required for a specific moving-and-handling decision.
• The person’s ability to participate in movement, follow instructions, weight bear, sit unsupported, roll, stand, transfer or reposition.
• Any history of falls, collapse, breathlessness, fatigue, pressure damage, continence needs, pain, tissue viability concerns or medical instability.
• The safe working load, size, compatibility and availability of all equipment required.
• Sling type, sling size, attachment loops or clips, compatibility with the hoist, and any contraindications.
• The availability of sufficient trained and competent staff for the specific task.
• Access into and within the home, including external steps, door widths, internal turning space, flooring, lighting, bathroom/toilet access, emergency exits and space for equipment.
• Whether care workers can carry out the task without unsafe twisting, stooping, reaching, pushing, pulling or lifting.
• Arrangements for emergency access by ambulance, fire and rescue services or specialist lifting services where required.
• Any impact of the moving-and-handling plan on visit length, scheduling, travel time and continuity of care.

4.2 Personal Plan and Moving-and-Handling Plan

Each bariatric service user must have a tailored moving and handling plan based on their assessment.

Plans must include:

• Preferred handling techniques that promote dignity and comfort.
• Step-by-step guidance for transfers and repositioning.
• Required staff-to-service user ratio for safe handling.
• Equipment specifications (e.g., correct hoist and sling type).
• Emergency evacuation procedures in case of fire or medical emergency.

The moving-and-handling plan must be sufficiently detailed to guide staff safely and consistently. It must include:

• the specific task being undertaken, for example repositioning in bed, bed-to-chair transfer, toileting transfer, assisted standing, use of slide sheets, or emergency response;
• the equipment required for each task, including make/model where relevant, safe working load, sling type and sling size;
• the minimum number of staff required and the role of each staff member;
• the step-by-step technique to be used and techniques that must not be used;
• communication prompts and how the individual will be involved before, during and after the manoeuvre;
• the individual’s preferences, privacy, dignity and cultural or religious needs;
• warning signs requiring the manoeuvre to stop, such as pain, breathlessness, distress, equipment instability, loss of balance or staff concern;
• contingency arrangements if equipment is unavailable, faulty, unsuitable or refused;
• when staff must contact the Registered Manager, health professional, commissioner, emergency services or safeguarding team;
• confirmation that staff must not improvise unsafe techniques or manually lift the person from the floor.

The Registered Manager will ensure that the personal plan and moving-and-handling plan are reviewed at least every three months, or sooner if the individual’s needs, weight, mobility, health, skin integrity, cognition, home environment, equipment, staffing arrangements or risks change. The plan must also be reviewed following any fall, incident, near miss, equipment fault, hospital admission, safeguarding concern, complaint, refusal of care, or professional recommendation.

4.3 Consent, Mental Capacity and Refusal

Staff must explain each moving-and-handling procedure to the individual before it begins and must seek the individual’s consent wherever the individual has capacity to make the specific decision. Consent, refusal, distress or withdrawal of cooperation must be recorded where it affects the safety or delivery of care.

Where there is reason to believe the individual may lack capacity to make a specific moving-and-handling decision, staff must follow the Mental Capacity Act 2005. Any act of care or support must be necessary, proportionate, the least restrictive option available, and in the person’s best interests. A best-interests decision must involve the individual as far as possible, and where appropriate their representative, family, commissioner, occupational therapist, physiotherapist, GP, nurse or other relevant professional.

Staff must not force, threaten, restrain or move a person against their will unless there is lawful authority and the action is necessary and proportionate to prevent harm. Any use of restraint or restrictive practice must be reported, recorded and reviewed in accordance with the provider’s restraint, safeguarding, incident reporting and Mental Capacity Act procedures.

5. Staff Training and Competency Requirements

5.1 Mandatory Moving and Handling Training

All staff providing care to bariatric service users must complete:

• Bariatric Moving and Handling Training.
• Safe use of specialist equipment training.
• Risk assessment and problem-solving workshops.

Training must be appropriate to the worker’s role and the assessed needs of the individuals they support. Staff must not undertake bariatric moving-and-handling tasks until they have completed relevant training, have been assessed as competent in practice, and have read and understood the individual’s moving-and-handling plan.

Training must include:

• the legal duty to avoid hazardous manual handling so far as reasonably practicable;
• person-centred moving and handling, dignity, privacy, consent and communication;
• Welsh language and communication needs where relevant;
• use of bariatric hoists, slings, slide sheets, transfer boards, standing aids, profiling beds and other assessed equipment;
• safe working load, equipment compatibility and sling selection;
• pre-use checks and action to take if equipment is faulty, unsuitable or unavailable;
• risks associated with pushing, pulling, twisting, stooping, reaching, confined spaces and working in people’s homes;
• responding to falls and emergencies without unsafe manual lifting;
• recording, reporting and escalation requirements;
• infection prevention and control when using shared or reusable equipment.

Training covers:

• Minimising injury risks for both staff and service users.
• Correct use of bariatric hoists, slings, beds, and wheelchairs.
• Safe positioning and repositioning techniques.
• Dignity and communication strategies for service user comfort.

5.2 Competency Assessments

• Staff must pass a practical competency test before assisting bariatric service users.
• Annual refresher training is required to maintain skills.
• Supervisors conduct spot checks and direct observations to ensure compliance.

Competency assessments must be recorded and must identify the specific equipment, techniques and tasks the staff member is competent to undertake. Competence must be reassessed following any incident, near miss, equipment change, change in the individual’s needs, prolonged absence from work, poor practice concern, or where the Registered Manager has reason to doubt the staff member’s competence.

The provider must maintain a written record of moving-and-handling training, supervision, competency checks, direct observations and refresher training. These records must be available for audit, inspection and review.

6. Specialist Equipment and Assistive Devices

6.1 Required Equipment for Bariatric Service Users

• Bariatric hoists, whether mobile, gantry or ceiling track, must be suitable for the individual, the task, the environment and the person’s current weight and body dimensions. The safe working load must exceed the load being lifted and must be checked before use.
• Specialist bariatric beds – Reinforced frames with adjustable positioning.
• Bariatric slings – Correctly fitted and weight-rated.
• Bariatric wheelchairs and commodes – Safe seating and toileting support.
• Slide sheets and air-assisted transfer mats – Reduce friction and manual lifting strain.

Equipment must be selected following assessment and, where required, advice from an occupational therapist, physiotherapist, moving-and-handling adviser, tissue viability nurse, equipment provider or other competent professional. Staff must not use equipment unless it is suitable for the individual, compatible with other equipment being used, within safe working load, available in the correct size, clean, maintained and safe.

6.2 Equipment Maintenance and Safety Checks

• All equipment must be maintained, inspected, serviced and, where applicable, thoroughly examined in accordance with manufacturer’s instructions, LOLER, PUWER, organisational procedures and any contractual arrangements with the equipment owner or provider. Hoists and lifting accessories must have evidence of current inspection/thorough examination where required, and staff must check this before use.
• Pre-use safety checks must be carried out before each transfer.
• Pre-use checks must include visual inspection of the hoist, sling, clips or loops, spreader bar, brakes where applicable, batteries, emergency lowering function, safe working load, signs of wear, contamination, damage, missing labels, service dates and compatibility of sling and hoist. If staff are unsure whether equipment is safe or compatible, the transfer must not proceed until advice is obtained.
• Where equipment is supplied by the local authority, NHS, community equipment provider, private supplier, landlord, individual or family, the Registered Manager must clarify and record who is responsible for maintenance, servicing, LOLER examination, repair, replacement and urgent breakdown response.
• Faulty equipment must be reported immediately to the Registered Manager and taken out of use.

6.3 Equipment Failure or Unavailability

Staff must not use any equipment that is damaged, faulty, overdue for required inspection, outside safe working load, visibly worn, contaminated, incompatible, unstable, missing essential parts or otherwise unsafe. The equipment must be taken out of use immediately where possible, clearly labelled as not to be used, and reported to the Registered Manager without delay.

If essential moving-and-handling equipment is unavailable or unsafe, staff must not improvise or manually lift the individual. The Registered Manager must complete an urgent risk assessment and arrange safe alternatives, which may include replacement equipment, additional trained staff, professional advice, emergency services, commissioner involvement or temporary suspension of the unsafe task until safe arrangements are in place.

7. Safe Moving and Handling Techniques

7.1 Two-Person or Multi-Person Transfers

Bariatric moving-and-handling tasks must only be undertaken by the number of staff identified in the individual’s moving-and-handling risk assessment and personal plan. Staff must not carry out any task alone where the assessment requires two or more staff, specialist equipment, or professional support. Single-handed care may only take place where it has been risk assessed as safe, the required equipment is available, the staff member is trained and competent, and the task can be completed without hazardous manual handling.

The minimum staffing level for each moving-and-handling task must be determined by risk assessment. The assessment must consider the person’s needs, the task, the equipment, the environment, staff competence, emergency arrangements and whether the person can safely participate in the movement.

7.2 Step-by-Step Safe Transfers

Using a Bariatric Hoist

1. Ensure the service user is aware of the procedure before commencing.
2. Position the hoist correctly and attach the correct sling securely.
3. Lift slowly and smoothly while monitoring comfort and safety.
4. Guide the service user gently to the new position and check stability.

Bed to Chair Transfer Where a Hoist Is Not Required by Assessment

• A non-hoist transfer must only be used where the moving-and-handling assessment confirms that it is safe and appropriate.
• Staff must confirm that the individual can participate safely, that the correct transfer aid is available, and that the environment is suitable.
• Staff must not lift the individual manually.
• Slide sheets, transfer boards, turners, standing aids or other equipment must only be used where they are specified in the moving-and-handling plan and staff are trained and competent to use them.
• The transfer must stop if the individual becomes distressed, breathless, fatigued, unstable, in pain, unable to follow the agreed technique, or if staff identify any risk.

8. Emergency Procedures and Incident Reporting

8.1 Managing a Fall or Medical Emergency

• If a bariatric service user falls, staff must:
  1. Call for assistance immediately – do not attempt to lift alone.
  2. Assess for injuries and reassure the service user.
  3. Use a specialist inflatable lifting aid or emergency hoist if available.
  4. Call 999 if urgent medical support is required.

Staff must not manually lift a fallen bariatric service user from the floor. Staff must make the area safe, reassure the individual, assess for immediate danger, call emergency services where required, and follow the individual’s falls plan and moving-and-handling plan. Specialist lifting equipment, ambulance assistance or other emergency support must be used where required.

Following a fall, the Registered Manager must ensure the incident is reviewed, the moving-and-handling risk assessment and personal plan are updated, and appropriate referrals are made to the GP, falls service, occupational therapist, physiotherapist, tissue viability nurse, commissioner, safeguarding team or emergency services as required.

8.2 Incident Reporting

• All moving and handling incidents must be reported immediately to the Registered Manager.
• A Moving and Handling Incident Report Form must be completed for:
  • Equipment failure or malfunction.
  • Staff injury or near-miss incidents.
  • Service user distress or discomfort during transfers.

The Registered Manager or Responsible Individual must ensure that CIW is notified of notifiable events in accordance with Regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended. Notifications must be made without delay, usually within 24 hours, in writing and in the manner required by CIW, including through CIW Online where applicable.

Not all moving-and-handling incidents are automatically CIW-notifiable. The Registered Manager must decide whether the incident meets the notification threshold. CIW must be notified where required, including but not limited to serious accident or injury to an individual, any allegation of abuse involving the provider, staff or volunteer, any incident reported to the police, any occurrence of category 3 or 4 pressure damage or unstageable pressure damage, or any event that prevents or could prevent the provider from continuing to provide the service safely.

Where an accident or injury requires treatment by a healthcare professional and has or may have resulted in serious or lasting harm, CIW notification must be considered and completed where required. RIDDOR reporting must also be considered where the incident meets RIDDOR reporting criteria.

8.3 Safeguarding

Unsafe moving and handling, inappropriate manual lifting, failure to provide assessed equipment, failure to follow the moving-and-handling plan, neglect of mobility needs, avoidable injury, pressure damage, humiliating practice, discriminatory treatment or failure to respond to pain or distress may constitute a safeguarding concern.

Staff must report any safeguarding concern immediately in accordance with the Safeguarding Policy and the Wales Safeguarding Procedures. The Registered Manager must ensure immediate action is taken to protect the individual, preserve evidence where relevant, notify the local authority safeguarding team, commissioner, CIW, police or other agencies where required, and record all actions taken.

9. Staff Well-being and Workplace Adaptations

• Regular manual handling assessments to prevent staff injury.
• Access to physiotherapy or occupational health support for staff experiencing strain.
• Rotation of duties to prevent overexertion for care workers supporting bariatric service users.

Staff must not continue with a moving-and-handling task where they believe it is unsafe. Staff must stop, make the situation safe, reassure the individual and contact the office or on-call manager for advice. No staff member will be required or pressured to manually lift, improvise unsafe techniques, use unsuitable equipment, or work outside the agreed moving-and-handling plan.

Lone working risk assessments must consider bariatric moving-and-handling needs, the home environment, emergency communication, staff safety, parking, access, visit timing, availability of assistance and escalation arrangements.

10. Monitoring and Compliance

• The Registered Manager ensures compliance with CIW regulations and health and safety laws.
• Quarterly moving and handling audits to assess safe practices.
• Audits must include review of risk assessments, personal plans, provider assessments, equipment records, LOLER/PUWER documentation, staff training and competency records, incident reports, near misses, complaints, safeguarding referrals, CIW notifications, staff feedback and service user feedback.
• The Responsible Individual must ensure there are effective systems for recording incidents, complaints and notifications, and for ensuring policies and procedures remain up to date. Learning from audits, incidents, safeguarding concerns, complaints, professional feedback and CIW inspection findings must be included in the provider’s quality assurance and improvement arrangements.
• Service user and staff feedback to improve handling techniques.
• Care Inspectorate Wales (CIW) inspections will review moving and handling policies during audits.

11. Related Policies

This policy should be read in conjunction with:

• Health and Safety at Work Policy (DCW16).
• Moving and Handling Policy (DCW18).
• Risk Management and Assessment Policy (DCW19).
• Infection Prevention and Control Policy (DCW17).
• Staff Safety and Abuse Prevention Policy (DCW42).

• Safeguarding Adults and Children Policy.
• Mental Capacity and Best Interests Policy.
• Falls Prevention and Management Policy.
• Incident Reporting and CIW Notifications Policy.
• Equipment Safety and Maintenance Policy.
• Lone Working Policy.
• Equality, Diversity and Human Rights Policy.
• Welsh Language and Communication Policy.
• Duty of Candour Policy.
• Complaints Policy.
• Staff Training, Supervision and Competency Policy.
• RIDDOR / Accident Reporting Procedure, where held separately.

12. Dignity, Equality and Welsh Language

Bariatric service users must be treated with dignity, respect and sensitivity at all times. Staff must not use stigmatising, judgemental, humiliating or discriminatory language. Care must be provided in a way that protects privacy, promotes independence, respects personal preferences and supports the individual’s physical, emotional and psychological well-being.

The service will make reasonable adjustments where required under the Equality Act 2010. This may include adjustments to equipment, staffing, visit duration, communication, care planning, access arrangements, training or the way care is delivered.

The service will take reasonable steps to meet the individual’s language and communication needs, including Welsh language needs. Where an individual’s first language is Welsh or they prefer to receive care through the medium of Welsh, this must be recorded in the personal plan and considered when allocating staff and communicating about moving-and-handling procedures.

13. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, Welsh Government statutory guidance, CIW requirements, HSE guidance, Social Care Wales requirements, equipment guidance, organisational practice, incident learning, safeguarding findings, audit outcomes or the needs of people using the service.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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