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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Safe Moving and Handling of Bariatric Service Users Policy

1. Purpose

This policy sets out the arrangements {{org_field_name}} will follow to ensure that people whose body size, weight, shape, weight distribution, mobility, health condition or other individual characteristics create additional moving and handling requirements are supported safely, effectively and with dignity.

For the purposes of this policy, the term “bariatric service user” is used to describe a person who requires additional assessment, equipment, environmental adaptations, staffing or moving and handling arrangements because of their individual size, weight, body shape, mobility or related needs. No single body weight or body mass index threshold will determine whether this policy applies. Moving and handling requirements will be determined through an individual, suitable and sufficient risk assessment.

{{org_field_name}} will:

• Avoid hazardous manual handling operations so far as is reasonably practicable.
• Where hazardous manual handling cannot reasonably be avoided, carry out a suitable and sufficient assessment of the risks.
• Reduce identified risks so far as is reasonably practicable through appropriate care planning, staffing, equipment, environmental controls and safe systems of work.
• Ensure that care and treatment is planned and delivered in a safe and person-centred manner.
• Obtain and respect valid consent to moving and handling interventions and act in accordance with the Mental Capacity Act 2005 where a person lacks capacity to make the relevant decision.
• Protect each service user’s privacy, dignity, autonomy and rights throughout moving and handling activities.
• Provide suitable equipment that meets the assessed needs of the individual and ensure that it is properly selected, used, maintained, inspected and, where applicable, thoroughly examined.
• Ensure that staff undertaking moving and handling activities have the competence, skills, training, knowledge and experience necessary for the tasks they perform.
• Maintain accurate and contemporaneous records of assessments, care plans, equipment requirements, incidents and relevant reviews.
• Review moving and handling arrangements whenever there is reason to believe that an assessment or care plan is no longer valid or there has been a significant change in the person, task, equipment, environment or circumstances.

2. Scope

This policy applies to:

• All staff involved in moving and handling, including carers, nurses, physiotherapists, and support staff.
• Bariatric individuals requiring assistance with mobility, transfers, repositioning, and personal care.
• Management teams, responsible for ensuring compliance with training, risk assessment, and equipment availability.
• External professionals, including occupational therapists and manual handling specialists.

3. Legal and Regulatory Compliance

{{org_field_name}} will comply with all legislation and regulatory requirements applicable to moving and handling within the service. Relevant requirements include:

• Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as amended, including:
  • Regulation 9 – Person-centred care: care and treatment must be appropriate, meet the person’s needs and reflect their preferences.
  • Regulation 10 – Dignity and respect: service users must be treated with dignity and respect, including respect for their privacy, autonomy and independence during moving and handling.
  • Regulation 11 – Need for consent: care and treatment, including moving and handling interventions, must only be provided with the consent of the relevant person. Where a person aged 16 or over lacks capacity to give the relevant consent, the requirements of the Mental Capacity Act 2005 must be followed.
  • Regulation 12 – Safe care and treatment: risks to the health and safety of service users must be assessed and all reasonably practicable measures taken to mitigate identified risks. Staff carrying out moving and handling activities must have the qualifications, competence, skills and experience necessary to do so safely, and equipment must be used safely and appropriately.
  • Regulation 13 – Safeguarding service users from abuse and improper treatment: service users must be protected from abuse, degrading treatment and unnecessary or disproportionate restraint. Any physical intervention used during moving and handling must be lawful, necessary and proportionate.
  • Regulation 15 – Premises and equipment: premises and equipment used for moving and handling must be clean, secure, suitable for their intended purpose, properly used, properly maintained and appropriately located.
  • Regulation 17 – Good governance: effective systems and processes must be maintained to assess, monitor and improve the quality and safety of care, mitigate risks and maintain accurate, complete and contemporaneous records.
  • Regulation 18 – Staffing: sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed. Staff must receive the support, training, professional development, supervision and appraisal necessary to enable them to carry out moving and handling duties safely.
• Health and Safety at Work etc. Act 1974: {{org_field_name}} must, so far as is reasonably practicable, protect the health, safety and welfare of employees and must conduct its undertaking so that people who are not employees are not exposed to health and safety risks.
• Management of Health and Safety at Work Regulations 1999: suitable and sufficient assessments must be undertaken of risks to employees and other people arising from the service’s activities, and appropriate preventive and protective arrangements must be implemented.
• Manual Handling Operations Regulations 1992, as amended: hazardous manual handling must be avoided so far as is reasonably practicable. Where it cannot be avoided, a suitable and sufficient assessment must be undertaken and the risk of injury reduced so far as is reasonably practicable.
• Lifting Operations and Lifting Equipment Regulations 1998 (LOLER): lifting equipment used at work must be suitable and lifting operations must be properly planned by a competent person, appropriately supervised and carried out safely. Equipment and accessories used for lifting people must be subject to statutory thorough examination in accordance with LOLER.
• Provision and Use of Work Equipment Regulations 1998 (PUWER): work equipment must be suitable for its intended use, maintained in an efficient state and good repair and, where required, inspected. Staff using equipment must receive adequate information, instruction and training.
• Mental Capacity Act 2005: where there is reason to doubt a person’s capacity to make a specific moving and handling decision, capacity must be assessed in relation to that particular decision. Where the person lacks capacity, any decision or act must be made in accordance with the Mental Capacity Act 2005, including its best-interests requirements and the requirement to choose the least restrictive option.
• Equality Act 2010: {{org_field_name}} will not unlawfully discriminate against any person because of a protected characteristic. Where a person meets the statutory definition of disability, reasonable adjustments will be made where required by the Equality Act 2010. Decisions about equipment, staffing, access or care must be based on an assessment of the individual’s needs and risks and not on assumptions or stereotypes associated with body size or weight.
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR): work-related deaths, specified injuries, over-seven-day incapacitation of workers, specified occupational diseases and reportable injuries to non-workers must be reported to the relevant enforcing authority where the statutory reporting criteria are met.
• Care Quality Commission (Registration) Regulations 2009: notifications must be made to CQC where an incident arising from moving and handling falls within a category that the registered person is legally required to notify.

4. Managing Safe Moving and Handling of Bariatric Individuals

4.1. Risk Assessment and Care Planning

A suitable and sufficient, person-specific moving and handling risk assessment must be completed before staff undertake moving and handling activities where a foreseeable risk exists. Where immediate action is required in an emergency, staff must take reasonably practicable steps to minimise risk and a formal assessment must be completed or reviewed as soon as practicable afterwards.

The assessment must be undertaken by a person who is competent to assess the moving and handling risks involved and must consider, where relevant:

• The moving and handling task to be undertaken, including transfers, repositioning, mobility assistance, personal care, emergency evacuation and recovery from the floor.
• The person’s weight, body dimensions, shape and distribution of weight where these affect the task, equipment or environment.
• The person’s mobility, balance, strength, ability to weight-bear and ability to understand and participate in the manoeuvre.
• Any pain, wounds, fractures, joint problems, contractures, neurological conditions or other clinical factors that may affect safe movement.
• Skin integrity, pressure-area risks and the risk of shear or friction.
• Respiratory or cardiovascular conditions and the effect that positioning or exertion may have on the person.
• Falls risk and any history relevant to the proposed handling activity.
• The person’s communication needs, cognition and ability to understand instructions.
• The person’s preferences, dignity, privacy and cultural needs.
• The person’s consent to the proposed moving and handling intervention.
• Where there is reason to doubt capacity, the person’s capacity to make the specific decision and, where capacity is lacking, the Mental Capacity Act 2005 requirements applicable to the proposed intervention.
• The environment, including available floor space, doorway widths, access routes, room layout, floor surfaces, bathroom facilities and emergency evacuation routes.
• The equipment required, including its compatibility with other equipment and its safe working load.
• Sling type, size and compatibility where a hoist is required.
• The number of staff and the level of competence required to undertake each manoeuvre safely.
• Foreseeable emergencies, equipment failure and contingency arrangements.

The resulting care plan and moving and handling plan must clearly state:

• What assistance the person requires.
• What the person is able and encouraged to do independently.
• The agreed method for each relevant transfer, repositioning or mobility activity.
• The equipment to be used, including sufficient information to identify the correct equipment, accessory and sling where applicable.
• The number of staff required and any particular competence required for the task.
• Any positioning requirements or precautions.
• Any actions necessary to maintain privacy and dignity.
• What staff must do if the planned method cannot be followed safely.
• Relevant emergency or contingency arrangements.

Staff must follow the current assessed moving and handling plan. They must not improvise a manoeuvre or use different equipment where doing so would expose the person or staff to an unassessed risk.

The assessment and care plan must be reviewed:

• Whenever there is reason to suspect that the assessment is no longer valid.
• Following a significant change in the person’s mobility, weight, body dimensions, health, cognition, skin integrity or ability to participate.
• Following a fall, moving and handling incident, near miss, injury or equipment-related event where the existing arrangements may have contributed to the event or may no longer be appropriate.
• When equipment, staffing arrangements or the physical environment change in a way that may affect the assessment.
• Before introducing a materially different moving and handling technique.
• At other planned intervals determined by the person’s needs and level of risk.

Any changes identified through review must be incorporated promptly into the assessment, care plan and staff instructions.

4.2. Specialist Bariatric Equipment

{{org_field_name}} will provide, obtain or arrange access to equipment that is suitable for the assessed needs of each service user and the intended moving and handling task.

Depending on individual assessment, equipment may include:

• Appropriately rated profiling beds.
• Mobile or overhead hoists designed and rated for the intended use.
• Compatible slings of the correct type and size.
• Slide sheets, transfer aids or repositioning systems.
• Appropriately sized wheelchairs and mobility equipment.
• Appropriately sized commodes and shower or toileting equipment.
• Suitable seating and pressure-relieving equipment.
• Appropriate evacuation equipment where required by the person’s emergency evacuation assessment.

Equipment must not be selected solely because it is described as “bariatric”. Its dimensions, safe working load, compatibility, intended use and suitability for the particular person and task must be confirmed.

Before use, staff must ensure that:

• The equipment is appropriate for the planned task.
• The service user’s assessed weight does not exceed the equipment’s stated safe working load.
• Relevant equipment and accessories are compatible with each other.
• The correct sling type and size is used where applicable.
• Any required pre-use checks have been completed.
• There are no visible defects or other reasons why the equipment should not be used.
• The equipment remains within any required examination, inspection or maintenance period.

Equipment must be used in accordance with the manufacturer’s instructions and the person’s moving and handling plan.

Lifting equipment must be properly maintained and, where LOLER applies:

• Lifting operations must be properly planned by a competent person, appropriately supervised and carried out safely.
• Equipment used to lift people and lifting accessories must be thoroughly examined by a competent person at the statutory interval, normally at least every six months, unless examination is undertaken in accordance with a written examination scheme specifying a different interval.
• Thorough examination must also take place where required following installation or assembly, exceptional circumstances or other circumstances specified by LOLER.
• Records of thorough examinations must be retained in accordance with statutory requirements.
• Equipment with a defect that presents, or could present, a danger to people must not continue to be used contrary to the competent person’s report or applicable legal requirements.

Equipment subject to PUWER must be suitable for its intended use, maintained in an efficient state, in efficient working order and in good repair and inspected where required.

Where equipment needed to provide safe care is unavailable, defective or unsuitable, the planned moving and handling activity must not proceed unless an alternative method has been assessed as safe. The matter must be escalated immediately to the person in charge and appropriate contingency arrangements implemented.

4.3. Safe Moving and Handling Techniques

Hazardous manual handling must be avoided so far as is reasonably practicable. Where it cannot reasonably be avoided, staff must follow the person-specific moving and handling assessment and care plan and use the control measures identified within it.

Staff must:

• Use appropriate mechanical or other handling aids where these have been identified as necessary by the assessment.
• Follow the agreed moving and handling method and manufacturer’s instructions for equipment.
• Use the number of staff specified in the person’s current moving and handling assessment and care plan. There is no automatic minimum or maximum number of staff; staffing must be sufficient and appropriate for the assessed task.
• Confirm that all staff involved understand the planned manoeuvre and their roles before commencing.
• Encourage and enable the service user to participate and maintain independence to the extent that it is safe and consistent with their wishes and abilities.
• Obtain the person’s consent before commencing and continue to monitor consent throughout the intervention.
• Stop and reassess the situation if the person withdraws consent, becomes distressed or unwell, or if the planned procedure cannot be completed safely.
• Maintain the person’s privacy and dignity throughout the activity.
• Use controlled movements and avoid sudden, jerking or otherwise unsafe manoeuvres.
• Observe any prescribed positioning, respiratory, skin-integrity or clinical precautions.
• Never exceed the safe working load of equipment.
• Never use equipment, including a hoist, sling or transfer aid, that is defective, incompatible, inappropriate for the person or outside applicable inspection or examination requirements.
• Report any change in the person’s abilities or needs, any difficulty encountered during the manoeuvre, equipment concern, incident or near miss so that the risk assessment and care plan can be reviewed where necessary.

Staff must not manually lift the full weight of a service user except where an exceptional and unforeseen emergency makes this necessary and the action taken represents the safest reasonably practicable response to the immediate risk. Such an event must be reported and reviewed.

4.4. Consent, Mental Capacity and Restrictive Practice

Moving and handling support is part of the person’s care and treatment and must only be provided with lawful authority.

Staff must seek the service user’s consent before carrying out a moving and handling intervention and must recognise that consent is an ongoing process. A person with capacity may refuse assistance or withdraw consent even where staff consider the proposed intervention beneficial.

Information about the proposed moving and handling method, its purpose, significant risks and reasonable alternatives must be communicated in a way that the person can understand and which meets their communication needs.

Where there is reason to doubt whether a person has capacity to make a particular moving and handling decision, capacity must be assessed in accordance with the Mental Capacity Act 2005. Capacity must not be presumed absent because of a person’s age, diagnosis, disability, appearance, behaviour or communication difficulty.

Where a person lacks capacity to make the specific decision:

• Any decision or action must be taken in accordance with the Mental Capacity Act 2005.
• The person must be involved in the decision as far as reasonably practicable.
• Relevant wishes, feelings, beliefs and values must be considered.
• Relevant people must be consulted where required and appropriate.
• Any valid and applicable decision made by an attorney, deputy or other person with lawful decision-making authority must be respected within the scope of that authority.
• The option chosen must be in the person’s best interests and must achieve the required purpose in a way that is less restrictive of the person’s rights and freedom of action where this can reasonably be achieved.

Moving and handling techniques must not be used for the purpose of coercion, punishment or staff convenience.

Where a moving and handling intervention amounts to restraint, it must have a lawful basis and must be necessary and proportionate to the risk of harm. Any restriction forming part of an ongoing care arrangement must also be considered within the service’s Mental Capacity Act and deprivation of liberty procedures.

Consent, capacity assessments, best-interests decisions and any restrictive interventions relevant to moving and handling must be recorded appropriately.

4.5. Infection Prevention and Skin Integrity Care

• Regular skin assessments must be conducted to identify pressure ulcers.
• Pressure-relieving mattresses and repositioning schedules must be in place.
• Infection control measures must be followed, including cleaning of bariatric equipment after each use.
• Adequate hygiene support must be provided to prevent skin infections.

4.6. Staff Training, Competence and Supervision

{{org_field_name}} must ensure that staff who undertake, assist with, assess, supervise or manage moving and handling activities have the competence, skills, knowledge and experience necessary for the responsibilities allocated to them.

Before undertaking moving and handling tasks without appropriate supervision, staff must receive training and practical instruction appropriate to:

• Their role and responsibilities.
• The moving and handling tasks they are expected to undertake.
• The needs of the people they support.
• The equipment they are expected to use.
• The organisation’s moving and handling procedures.
• Relevant emergency arrangements.

Where staff are expected to support service users with bariatric or otherwise complex moving and handling needs, their training and competency assessment must address those needs and the relevant specialist equipment and techniques.

Competence must be assessed in practice where appropriate. Staff who have not demonstrated the required competence must not undertake the relevant activity unsupervised.

Training and competence must be reviewed at appropriate intervals and additionally where:

• A member of staff is required to use unfamiliar equipment or undertake a materially different moving and handling technique.
• The needs of people using the service change and require additional knowledge or skills.
• A moving and handling incident or near miss indicates that knowledge, competence or practice requires review.
• Observation, supervision or audit identifies unsafe practice or a training need.
• There has been a significant period during which the member of staff has not performed the relevant task.
• Relevant legislation, guidance, equipment or organisational procedures change.

Staff must receive appropriate ongoing supervision and support to maintain competence.

Training, competency assessments, supervision and identified learning or remedial actions must be documented.

Staff involved in emergency evacuation must also receive instruction and training appropriate to the service’s fire and emergency procedures and the assessed evacuation needs of the people they support.

4.7. Emergency and Contingency Planning

The emergency and contingency arrangements for each service user with complex moving and handling needs must reflect their individual assessed requirements.

Where relevant, the person’s care and emergency plans must address:

• Fire and emergency evacuation.
• The equipment and number of staff necessary for evacuation.
• Recovery from the floor following a fall where this can be safely planned.
• Medical emergencies.
• Failure, breakdown or unavailability of essential moving and handling equipment.
• Loss of power affecting electrically operated equipment.
• Circumstances in which external emergency assistance may be required.

Personal emergency evacuation arrangements must be compatible with the service’s fire risk assessment and emergency plan. Any specialist evacuation equipment identified as necessary must be available, suitable, maintained and accessible, and staff expected to use it must be trained and competent to do so.

In a medical emergency, staff must provide emergency responders with relevant and available information necessary to support safe care, including information about the person’s mobility, moving and handling requirements, equipment needs, access restrictions and, where relevant to the emergency response, known weight or body dimensions.

Where essential moving and handling equipment becomes unavailable or unsafe, staff must not substitute an unassessed method that exposes the person or staff to unacceptable risk. The matter must be escalated immediately and an appropriately assessed alternative or emergency arrangement implemented.

Emergency arrangements must be reviewed where the person’s needs, staffing, equipment or environment change.

4.8. Emotional and Psychological Well-being

• Staff must provide reassurance and respect when assisting bariatric individuals.
• Language must be non-judgmental to prevent emotional distress.
• Staff should be aware of the mental health impact of obesity and offer psychological support referrals if needed.

5. Monitoring, Incident Reporting and Compliance

{{org_field_name}} will maintain effective systems to monitor compliance with this policy and the safety of moving and handling arrangements.

Monitoring must include, as appropriate:

• Reviewing individual moving and handling risk assessments and care plans at planned intervals and whenever a statutory or clinical review trigger occurs.
• Checking that staff follow person-specific moving and handling plans in practice.
• Monitoring staff training, competence and supervision.
• Monitoring the availability, suitability, maintenance, inspection and statutory thorough examination of moving and handling equipment.
• Maintaining records of LOLER thorough examinations and acting promptly on defects or recommendations identified by the competent person.
• Reviewing moving and handling accidents, incidents, near misses, equipment failures and unsafe practices.
• Identifying trends, contributory factors and actions needed to prevent recurrence.
• Recording required actions, allocating responsibility for those actions and checking that actions have been completed and are effective.
• Ensuring relevant assessments and care plans are updated following incidents or significant changes.
• Seeking and acting upon relevant feedback from service users and staff.
• Maintaining accurate, complete and contemporaneous records relating to moving and handling.

All moving and handling incidents and near misses must be reported through {{org_field_name}}’s incident-reporting procedure.

The registered manager or other authorised person must determine whether an incident also requires external notification or reporting, including:

• Notification to the Care Quality Commission under the Care Quality Commission (Registration) Regulations 2009 where the statutory notification criteria are met.
• Reporting under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 where the incident is reportable under RIDDOR.
• Notification to the local safeguarding authority where the incident raises a safeguarding concern.
• Notification to other relevant statutory bodies where required by law.

Where an incident constitutes a notifiable safety incident for the purposes of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the statutory duty of candour procedure must be followed.

Findings from audits, incidents, complaints, safeguarding concerns, staff feedback and regulatory activity must be used to improve practice and reduce identified risks.

6. Related Policies

This policy should be read alongside:

• CH11 – Safe Care and Treatment Policy​.
• CH15 – Premises and Equipment Policy​.
• CH17 – Infection Prevention and Control Policy​.
• CH16 – Health and Safety at Work Policy​.
• CH27 – Staff Supervision, Training, and Development Policy​.

• Consent to Care and Treatment Policy.
• Mental Capacity Act and Deprivation of Liberty Policy.
• Accident and Incident Reporting Policy.
• Safeguarding Adults Policy.
• Fire Safety and Emergency Evacuation Policy.
• Duty of Candour Policy.

7. Policy Review

This policy will be reviewed annually or sooner if necessary due to changes in legislation, CQC guidelines, or risk assessments.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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